In the immediate aftermath of the shooting death of UnitedHealthcare CEO Brian Thompson, “nothing justifies violence but …” became the first four words in nearly every social media takedown of America’s private health insurance system.
But the public’s anger with our balkanized and profit-centric health care system didn’t start with alleged shooter Luigi Mangione or when Medicare or Obamacare were under threat. It’s haunted me for decades.
In 2000, in response to the frustration of 23 million California HMO consumers, I was appointed by then-California Gov. Gray Davis to be the nation’s first “HMO czar.” The new agency I was running was the largest health reform project in the country since the Great Society of the late 1960s and remained so until Obamacare came along.
The clunkily named “Department of Managed Health Care” was unusual: The reforms we worked on didn’t extend coverage to new populations or unfurl a host of new medical benefits. It was about addressing patients’ anger and holding HMOs — health maintenance organizations, as they were known — accountable to patients. In time, our mission grew more expansive: We didn’t just keep an eye on the HMOs — we took on anyone who got between patients and the care to which they were entitled, including big doctor groups and even members of our own legal team who often regulated for the sake of it.
We opened a call center where patients could call for help when their treatment had been denied or delayed. We could then turn those complaints over to a new independent medical review board of doctors.
From there, we had the authority to order the HMOs to reverse their denial and change their protocols. We succeeded over and over — and in the most egregious cases, they paid a substantial fine.
Perhaps the most notable case was of Margaret Utterbach, who died in 1996 because of delayed treatment. Her death from a treatable aortic abdominal aneurysm triggered an unprecedented $1 million fine against her HMO, Kaiser Permanente, for the delay of lifesaving care, and more importantly, an order to change their practices.
Kaiser resisted, bringing contempt of court charges against me for overreach in representing the case of a Medicare patient. Their case failed, and industry was on notice. As a result, things got better for many California HMO patients, and public anger simmered down.
But in retrospect, we didn’t go far enough.
For one thing, we should have taken on price gouging in hospital systems and doctors’ groups. Patients understand that health care involves teams of highly trained professionals using some of the most expensive and cutting-edge technology. But too often, executives exploited reverence for the miracles of health care and overcharged patients. Today, states should step in and do more to ensure fairness in health care costs.
Attacking price gouging also means ending surprise out-of-network ambulance bills and instituting private-sector caps on co-pays for insulin to align with the newly instituted cap in Medicare.
My colleagues and I also should have done more on mergers and other anti-competitive practices that boxed out nonprofit health care providers. The new regime at the FTC might not take that sort of action but more states should step up to the plate.
More than anything, I wish we found a way to export what we did in California to more states. Over time, California expanded coverage to millions while creating a pragmatic and successful model of HMO oversight that all the players in the health care industry learned to live with.
But far too many states aren’t taking any action at all. While California governors of both parties acted swiftly to expand Medicaid via the Affordable Care Act, 10 states still have not expanded that access to coverage. Despite California’s high percentage of immigrants who face unique obstacles to care, our rate of uninsured is 6.4%, compared with 8% nationally and a dismal 16.6% in Texas. So that familiar frustration has been rising, with the drip, drip, drip of every patient delayed or denied care.
Now the rage is back, this time punctuated by the killing of one of the industry’s titans. Here’s the thing: We’re not getting Medicare for All anytime soon, and while Obamacare expanded coverage for millions, it was built on the same broken private insurance system that fuels the public’s rage.
So we need a more profound regulatory overhaul that takes on any entity that puts profits before people’s health, whether it’s dollar-obsessed health care CEOs, oversized doctor groups, or even well-intentioned but misguided government officials. That’s what we did in California and what other states and even Congress should pursue.
Neither Thompson nor Utterbach should have died as they did. It’s time to stop the madness on health care with some common sense on government oversight.
Daniel Zingale retired from state service in 2020 and is currently a part-time strategic adviser to Sacramento Advocates. He served as founding director of California’s Department of Managed Health Care from 2000 to 2003.