Tune in Saturday December 7th to Faction Talk, channel 103, at 4 PM East, 1 PM West.

If you miss the episode, you can hear it on demand on the SiriusXM app. Search: Lefsetz

https://www.aspenlive.com/speakers

We just had an hilarious discussion about the ability of AI to break acts.

What we had was an outsider, who’d started a label, trying to break his bands.

How many times have we seen this?

How come no one ever believes music is a professional business. How come everybody believes that we’re all wankers and we can be taught a lesson.

Remember that news guy who came into Sony to make the trains run on time? He came up with the rootkit, and he’s long gone, you don’t even remember his name.

AI is a tool.

But if algorithms are so damn good, how come the hit to sh*t ratio of my Spotify Discover Weekly is so damn bad?

This has been the dilemma for eons. How to predict that the AC/DC fan will like Joni Mitchell?

And the true breakthroughs…sound so foreign upon initial listen.

As for Vince’s statement re his kids discovering Led Zeppelin and the rest of the classic rockers… Do you know how much marketing went into those projects? Do you know how high the barrier to entry was just to be able to record and distribute music back then? There was a ubiquity to that music that will probably never be repeated.

The skiing has been fabulous. But most interesting was the agent at WME who represents Tyler the Creator, Snoop and…HUGH JACKMAN?

And the guy who manages the Roots.

Two Black guys, Kevin and Shawn respectively. They don’t lament racism in the music business, but the lack of opportunity for Black people.

And the guy who runs music for MGM Resorts International… Gambling only represents 25% of Vegas hotel revenues today.

But what is most astounding is how vast this business is, how much opportunity there is, it’s almost overwhelming. Used to be you could know everything, be comprehensive, but no longer.

Back to AI… I hosted a panel last year during Grammy week and the business people were all flipped out about AI. But Don Was wasn’t. He remembered the Linn drum machine. Once he saw what Prince did with it on “When Doves Cry”…he saw the opportunity. Once again, AI is a tool.

Music connects on an emotional level. That’s what so great about it. It’s unpredictable. And there is a business in me-too, but that’s not the essence of the business, it’s innovation.

And all we keep hearing about is bands as brands, merch, money. That’s what business people think about. Artists? True artists are about connecting, getting their message heard.

And there aren’t that many true artists out there.

But we’re hungry for them.

But the channel is overloaded with wanker wannabes because the barrier to entry is so low.

And income inequality is making some potential greats give up for more lucrative jobs.

I’ve got to rush out for dinner at Matsuhisa.

But I was so inspired by the argument just now.

The CTO of Cisco is telling us how it’s going to be.

But we’ve got decades of experience telling us how it really is.

Don’t be afraid of innovation. That’s the story of Napster. Don’t circle the wagons, you’re just going to be disrupted.

But the Blockchain, NFTs, AI in music…they’re the hot thing and then they’re not.

The hardest thing is creating great music, not selling it.

Don’t forget, the success of Napster was based on all the great music of the past, and exposure of a limited number of new acts.

I’ve got to jump into the shower, it’s late.

But the truth is this is a business about passion. That’s what you need to be successful on both sides of the fence, as artist or business person.

I hope you have it.

Of course, you’re right. Their business plan is deny and delay. It certainly isn’t about finding the best outcome for the patient.

Our son was diagnosed with a rare abdominal cancer in 2016. It grew to the size of a melon and impinged on his organs. To remove it required brutal chemotherapy to shrink it, and radiation, which threatened to damage the surrounding liver, kidneys, intestines, etc. The doctors said he needed proton radiation, which can be focused so well that it could kill the tumor at the margins of his organs without significant collateral damage. Massachusetts General, where Michael was being treated, has one of the few proton radiation devices on the East Coast.

United Health Care refused to pay for it. The small print of their contract with Michael’s employer specified that they would only pay for proton radiation if the cancer were in his neck or head. We got Sen. Warren involved, we begged and pleaded with United Health, the doctors made their case that Michael’s organs would be damaged irreparably without it. Nothing doing. We would have to pay the $200,000 ourselves.

At the last minute, Michael’s employer decided to pay for the procedure out of their own pocket. They probably had no idea until Michael’s illness that their contract with United Health even had this loophole. You can probably imagine our relief and gratitude! But my hatred for United Health will never fade.

Michael survived with his organs 98% intact, thanks to Dr. William Delaney’s skill with the proton radiation, and 8 years later he seems to be cancer-free.

I wouldn’t kill the CEO, but I would eliminate the entire “health” insurance industry if I could and replace it with a single-payer, government-run system. That would be a revolution. United Health and its counterparts are parasites that are enriching their execs and investors at the expense of everybody else.

Ross Eisenbrey

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My mom paid into her long-term care policy for 35 years. She got really sick roundabout April of last year.   It’s taken four separate people to continue to answer the questions from BrightHouse financial… (Met Life) who keep losing her information or getting the timeline wrong or asking for the same information again.  Our family is down about $70,000 and we’re still fighting to get the first dollar of the $386,000. she has vested in her policy. She passed away two weeks ago, Nov 14th.   We got a note today saying that they closed her policy out… No further explanation of benefits..  So I feel you Brian….

With Gratitude,

Matt Peyton

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Bob – your take on this important topic is excellent and quite instructive for those like myself who work in the healthcare, insurance, and employee benefits industry.

I’m a leading benefits consultant who founded one of the first fee-based benefits consulting, procurement, and management firms in 2018 so that we can help employers stop overpaying for healthcare by $300 billion each year (those are the most conservative estimates).

I’ve also been a working drummer, bassist, and audio engineer since 1995, and I have credits with U2, Freddie Jackson, and others.

Although my firm sits on the opposite side of the table from insurers (UHC and all the rest), I really do feel for Mr. Thompson’s wife, his sons, and his colleagues.

164 million Americans get care via their employer, and 81% of employers rely on benefits brokers to help them understand which products to buy so that they can maximize the return on their benefits investments and fulfill their fiduciary responsibilities.

The problem is that brokers work for insurance companies, and that’s why they make more money when costs go up — not down.

When the fox guards the henhouse healthcare far outpaces core inflation and, consequently, became most company’s second largest expense behind payroll.

It’s essentially like expecting a CPA who gets paid by the IRS to lower your taxes…not gonna happen.

As bad as the economic carnage has been, the human loss has been greater.

By the most conservative estimates, over 250,000 Americans die each year from “medical error”. It’s like having a pandemic every year…only no one talks about it.

To help colleagues in the benefits industry understand the plight of our customers, I shared your article with a popular listserv, and your analysis has been very well received.

Thanks for writing — let’s hope solutions get scaled, and patients get what they need before this kind of violence spreads.

With peace, love, and understanding,

Donovan Pyle in Orlando, FL

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Thank you for this. I’ve been struggling to organize the conflicting thoughts I’ve had all day thinking about this story. Empathy for the man and his family. Indignation at the healthcare industry in this country. I keep thinking about my personal (decades-long) struggles with UnitedHealthcare. I hope the discussion surrounding this isn’t just about guns either…but I’m not optimistic.

Sarah Martin

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After my wife suffered a bad fall at 3AM (collapsed lung three broken ribs concussion trouble breathing) I called an ambulance, that promptly took her to an ER that put her back together over a couple days.   It took us months of arguing with the insurance company that our policy…which specifically includes emergency care…covered us.  No we had not called the hospital first to see if the ER staff all took our insurance, my wife was in serious trouble and I called 911.   In the end they paid because we argued and fought like hell, but afterwards we thought about the people who they successfully beat back, who give up and are stuck with tens of thousands of dollars of bills…who had insurance!     But we all must contribute to the CEOs ten million dollar salaries.  Ten million this year, ten million the next year, ten million the year after that.   Because insurance companies don’t exist to provide insurance, they exist to create shareholder value.

Michael Alex

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F*cking amen bob f*cking AMEN. I’m a musician in NYC who can’t afford health insurance and my day job doesn’t offer it to me, because they legally don’t have to. So what do i do? I don’t have it. Pray I stay healthy and save some scratch in case I need to go to urgent care or something. It’s terrible. I’m a second class citizen because I can’t convince my boss to help pay for some of my monthly premium. I can’t shell out $627 dollars a month for insurance that requires me to pay when I use it. It’s incredibly f*cked. I and many others offer so much value to our community and city through our art and day jobs, but the system doesn’t care. I work just as long and hard as my friends in finance / office jobs, and I deserve the same benefits. I deserve health insurance, PTO, etc. We all do.

This is only a sign of things to come. Huge sympathy to the victims family, that can’t be overlooked.

But when you play stupid games, you win stupid prizes.

ok, tyler

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And then there’s this:

“Insurance company halts plan to put time limits on coverage for anesthesia during surgery”

https://t.ly/uFhcB

Helaine Krysik

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My doctor of 30 years, we’ll call him Dr. Mitch,  went off Medicare a long time ago  (“I didn’t go to medical school to fill out forms.”) and I didn’t think twice about staying with him, even though it’s not been cheap.

BUT, you call him, he calls you back the same day.  You have an appointment, you never wait more than 5 minutes to see him.  He takes his time with you, he’s incredibly thorough and he has a wicked sense of humor.  I have to travel across the dreaded 405 from the Hollywood Hills to Santa Monica to see him but I’d follow him anywhere and I count myself lucky to be his patient, especially when I hear what so many friends go through just to get a call returned or make an appointment that’s often three months away.  Major health reform must be a major priority.

Judie Gregg Rosenman

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It’s like John Q but the gun was loaded.  The man leaves a family, including young kids, behind. That’s tragic.

Hopefully this event can be a turning point. My wife and brother are in healthcare.  They see the BS firsthand. The system is so f*cked up.  Maybe DOGE can look into how to remove the layers of waste and bloat from health insurance or even better, as you indicate, let’s make it a right for everyone.  Basic healthcare for all, and if you want more of a premium service, you pay that on your own.  Seems reasonable.

Anyway, a guy got killed today and a family is without a dad and husband. That’s horrible no matter what.

Rich Stumpf

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Basically, the United States doesn’t have universal health care because of pure, unadulterated greed since greed is the American Way.

Lee Kelley

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Bob,

Could not agree more.  I am surprised that this is not a daily occurrence.

Ken Deans

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Twenty years ago I could count on one hand the people in my life who died for lack of healthcare.The first was the wife of my best friend. She left behind such crushing medical debt that he took a bunch of pills and followed.Today, I’m out of fingers and toes and the bodies keep piling up. My first ex-wife had a little tummy trouble and decided to tough it out; her income was just a little too high for Obamacare. Turns out it’s metastasized as cancer and she’ll likely be in hospice or the ground, by Christmas. She’s 57. I’d never celebrate anyone’s death, but there are people in my online peer group that cheered.

How could anyone criticize you for having sympathy for those screwed by insurance companies?  When  I first saw that story in the news, I assumed it was someone who had simply gone thru the hell of trying to make an appointment and get approval from their insurance company.  The medical system here in the US is so broken, so backwards, so corrupt and greedy, it  simply defies belief.  It’s not hard to see how someone could simply lose it for the lack of compassion, common sense and decency.

Geronimo Son

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I’m sorry someone was killed.

Now let’s use this time to wake up and understand how oligarchs, not doctors, are dictating our health outcomes == for-profit health insurance system. For-profit hospitals. Mega-health and mega-pharma donating billions to politicians.

We’re the only industrialized nation without uniform health care. We’re the only industrialized nation where mega-corporations and oligarchs can legally fund political campaigns.

We consistently rank near last in medical outcomes among industrialized nations, despite spending far more per capita.

https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

And, chillingly, around half of the country seems to think this is all OK.

John La Grou

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Bob- I am a long-time reader of your newsletter and have enjoyed and agreed with the majority of your thoughts over the years. Especially when it comes to your excellent columns and opinions regarding music and the entertainment industry.

That being said, you should be ashamed of this statement in today’s letter: “..when I saw the headline this morning, the first thing I thought about was our broken health care system and the overcompensation of the people who run it. They’re getting rich on our illnesses. They take our money and don’t pay.” Are you f*cking kidding me? A business executive is murdered in cold blood on the streets of Manhattan, and that is your “first thought?” Your twisted thought process and rationale is most likely the exact thing that led to this innocent man’s assassination in New York. Shame on you, Bob. The first thought that I (and most reasonable, caring people undoubtedly had on hearing this news), was that an innocent man was murdered on his way to a big business meeting in what used to be our nation’s greatest city. And that a wife, kids and family back in Minnesota were now left without a husband, father and friend. For a guy who usually comes across as a compassionate, decent person, you missed the boat horribly here, man… Bob E

Bob Ellis – Senior Vice President and General Counsel

Alter Trading Corporation

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There you go, speaking truth again. Better get it in while you’re still allowed.

The one thing that defines “America” and makes it distinct from the rest of the free world, is income disparity.  This translates through to most every facet of life but is most apparent in health care. The WHO keeps track of countries’ infant mortality rate.  Last I checked Cuba does better that the mighty USA at getting newborns through their first year.
Cubans, a people that the USA has essentially subjected to economic torture for years, look after their babies better than Americans.

And if you weren’t relatively rich, it sounds like you’d probably be dead now.

Pinhey

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There’s a comparison to be made between UnitedHealthcare (and their ilk) and Ticketmaster. Even though it’s the artists who sets the Ticketmaster, it’s Ticketmaster that gets portrayed as the villain. Meanwhile UnitedHealthcare gets portrayed as villain while they’re simply administering health plans on behalf of their client companies. I’ve had UnitedHealthcare coverage through three prior employers  (a German international conglomerate, a U.S. semiconductor chemical company, and a well-known U.S. organic grocer). My coworkers would complain about this or that being denied and this or that not being covered, and they would direct their ire at UnitedHealthcare. Meanwhile, behind the curtain, it’s the conglomerate, the chemical company, and the grocer paying the bills, through UnitedHealthcare, per an agreed-upon plan. If those companies want to cover any specific condition or procedure, they can, but it would cost them to do so, so they don’t. So UnitedHealthcare takes on the role of the the bad guy.   It’s nuts. Our healthcare system is beyond broken, but we won’t be able to fix it until people understand what’s really going on.

Thanks for the great newsletter and podcast.

David Dietrich

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I agree overall with your piece however I do think it was in poor taste to use the horrible death of United Healthcare executive Brian Johnson as a launching pad.  He was gunned down like an old farm animal yet you add a token sentence near the end of your piece expressing sympathy for Brian’s family.  I don’t know the man but I think the timing was in poor taste.

Regards,
Mark O’Neill
Peabody, Ma

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I live in the SF Bay Area. Income inequality is tearing the city/country/world apart. The media always focuses on some side issue (housing crisis, etc.) and I keep telling people that it’s income inequality. I say it again and again. It ate our town and it’s coming for yours (Seattle, Austin, etc.). The media should stop writing about money and putting the word “billionaire” in front of someone’s name. None of that matters. When you have food money and a roof over your head, you’ve made it. That’s success. Treating others with respect and thinking about society as a whole is what matters.

Thanks for your thoughts,

Jason Hall

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Amazing, I read your blog right after leaving the barbershop, where all I heard from the customers there was how that CEO got what he deserved! As always, your finger is on the pulse – no pun intended.

-John Presnell

singer/songwriter

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Hi Bob
Truly, a great letter you wrote today.. it definitely rings the truth.. when I was in the United States, the doctor gave me 15 minutes.. even with Medicare we had to have a supplement that also had to pay for medication as well.. here in Portugal we have private health insurance and it’s about 1/3 the cost of the United States…. We have a small co-pay when we go to the doctor… I had surgery to remove a kidney stone.. the co-pay was very modest.. I had an MRI.. it cost me €60.. my implants that I’m getting in my teeth are about 1/4 of the price in the US.. but the bottom line is the doctor spends with you as much time as is needed.. usually about a half an hour, and you don’t leave until everything is settled with what needs to be done… it is definitely not perfect by any means and the public health insurance is definitely stressed as well that’s why we got private as to not distress the system anymore for the Portuguese

They actually do care about you over here… but it’s changing.. American and foreigners are coming here and squeezing the Portuguese who don’t make that much money.. we support as many as we can here with our business and I know they appreciate it for how we are treated and we get what’s going on.. the rich are coming and pushing others out and it’s not just here in Portugal.. what is the answer and what is the result that’s going to happen.? . I have no idea… but people realize that there is a toxicity in the US and they don’t want to spread.. but it may be too late… I think about the struggles of my friends in the US.. and I wish there was something I could do about it… but it’s taken decades to happen and will take decades to fix.. how about starting with guns?

Peace,Jason Miles

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Yay Bob!
Please keep telling it like it really is. You totally nailed it.

The first thing I said this AM when I learned of this news was I wonder what UHC didn’t pay for…

My husband looked up the stats on  the average of denied health insurance  claims  – 16 percent among all health insurance companies.
UHC turns down 32 percent.

And then all I could think of was Bernie and how right he is.
Health care.
Income inequality.
Percentage of taxes paid by the ultra rich vs percentage paid by the not even rich.
America oligarchy vs the days when a corporate CEO made was it seven times what the lowest paid employee made?

Even Ray Dalio, one of the gazillionaires,  knows and has written about how destructive US capitalism and income inequality  is to the US.

Thank you Bob!!!

Regards

Amy Krakow

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This is maybe the most significant article you have ever written, and it has nothing to do with music except that up-and-coming musicians may be the most affected since a large majority have no health insurance.

Thank you for writing this.

Jeff Coggins

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… The cost of health care keeps going up, the children of Baby Boomers learn that their parents didn’t save enough to live on, the government isn’t going to pay for their long term care unless they go bankrupt first, and in any case the play seems to be to suck all the money out of the Boomers’ accounts before they can pass any on. I’m sure you’re aware of how much these new retirement communities offering progressive care cost. (Of course, in the meantime there will be a growing industry of lawyers helping the well-off keep their inheritances safe.)

Tom Moore

Fairfax, VA

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UnitedHealth’s Witty was highest-paid US health insurer CEO in 2023

https://t.ly/pU3Qj

WAM

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Andrew Witty

CEO UnitedHealth Group

2023 total compensation: $23,534,936

CEO pay ratio: 352:1

Peter Shurkin

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Totally agree

Scott Heiman

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Never have I been so distressed to completely agree with you.

You mightn’t like the reference but it was Bush the Senior that first spoke of the income divide and the critical need to address it.  Decades later that call is still falling on deaf ears.

Change is coming, let’s pray it’s positive and non-violent.

Thank you for a great, if disquieting letter.

Stu Le

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It is so exhausting having to pay thousands for insurance and they won’t pay for sh*t. I pay close to $500 per paycheck and still have relatively high deductibles and copays. I went for a colonoscopy and an endoscopy and of course the endo isn’t covered because it’s not “preventative” because there’s no real reason to look down in there. And I had bariatric surgery 7 years ago so you’d think they’d want me to be checking in there right? So me trying to be proactive about my health cost me $1500! Sometimes I think I’d be better off not paying 12k+ into health insurance and rolling the dice and just paying out of pocket. But I have a family so of course I can’t. I can totally see how someone can go postal over this sh*t.

I used to be a very optimistic person and as I’m now into my late-ish 40’s I look at life as just an endless loop of owing some f*cking asshole money and it’s never going to end. I’m perpetually at the base of Everest and can’t get past a few feet. It sucks, and it makes it worse watching the rich getting richer by the second.

Rob DiFondi

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Bob( jump to the wrong conclusion) Lesfetz

Jimmy Murphy

Nashville

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Thank you, Bob…  This all needed to be said!

XOXO

Mardi Silva

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Your last paragraph…same for me. Can not understate the tragic nature of our initial thoughts when it come to matters that are so important. Greed, lack of empathy, an overall distrust of institutions. We are at war on multiple fronts. One front being the war we are fighting with ourselves and the responsibility we should feel to and for each other.

Marty Winsch

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We’re too busy fighting each other to realize it’s the ultra rich vs. everyone else. The 2% vs. the 98. Yet we wanna sit here and act like Trump is our savior — the very guy who hangs with billionaires and cuts taxes for corporations. Stop drinking the FOOL aid.

Danny Jay

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You are not by yourself. I saw this coming exactly for the reasons you cited. People are tired of getting screwed over. It’s so blatant. When you see companies refuse to pay wages that would enable their workers to work one job and be able to live a basic life. Then you see CEOs make insane amounts of money. The internet has made it easy to get information and what people thought has been verified…this crap ain’t even close to being fair and it’s coming to a head.

Kenneth Williams

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I’m beyond words with this because there is so much more to the story. This man was targeting & whoever shot him, used a silencer which is illegally in our state.
Pissed off claimant that didn’t get what he/she needed?
One needs to remember that United healthcare is one of the bigger insurance companies hacked to the point where they were fined by the government and had to re-issue God knows how many Medicare supplement policies. If you’re an AARP member and you use their insurance, you know.
Is that reason enough to attack him and shoot him down in cold blood?

Not sure what happened to the world I used to live in. But in that world, this was unacceptable. No matter how much you hate the insurance companies and since I do insurance, believe me I do. I still don’t feel this justifies what happened.

CoulterCo

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I’m not one to sound the hoo-rah over blog posts, but you’ve hit a nerve with this one.

I’m a true blue man and, like you say, mad as hell and don’t want to take it anymore. Income inequality IS the root of the problem. I grew up in the 60’s-70’s in a family of 5 kids, single income. My dad was able to give us a nice, safe, middle-class suburban life on a salary of around $50K. This is IMPOSSIBLE today.

Real wages have NOT kept pace since then and when I hear of these wankers making high 7 figures to run companies it makes me want to puke. NO ONE should make that.

Whenever I voice this viewpoint, my Republican buddies call me a commie.

Larry Allen

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good one

Grant Peeples

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Bob- it’s about the money and people are pissed but that was a hit, not a normal citizen.

No way around it. Heinous video and the calculated-ness of it is unbelievable.

So sad. It is rich vs poor but this was a hit man

David Doan

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Amen, Bob, amen. And people think Trump is the guy to fix it? I’m disgusted. Some of these ordinary people in Liberty, NC will have new well-paying manufacturing jobs in a Toyota battery plant thanks to Joe Biden and the Democrat’s climate change bill. Stellantis just announced new battery plants in Indiana and Georgia. All three in red areas. 85 percent of the climate change money is going to red areas! But Trump calls it the “green scam.” Well, maybe these will all fail. We already are far behind China. But I bet Trump won’t do anything to derail them. Instead, he’ll be at the openings in Indiana and Georgia and take credit for them! And the suckers will lap it up.

Tom Moore

Fairfax, VA

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Amen to that Bob

Jonathan Miller

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I thought the same thing, as I’m sure did most of us.  Thanks for articulating it so well.

Michael Barker

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And to get this point across, Brian Thompson, who by all accounts was a genuinely good guy, needed to be murdered.

You could have saved a lot of time by keeping this to yourself.

Dan Hendricks

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Amen Bob. No one should have to kill someone to survive in 2024. BTW, read the book Caste. It’s great.

T.J.

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100% – these same health care companies that nickel and dime you to death (if they even decide to reimburse you) throw these insanely extravagant shareholder events. I remember one Oxford Health Plans had and the talent budget alone was north of a million. And this was 20 years ago..!!!

I had an appointment with a surgeon this am about finally taking out my gall bladder (over 3 years delayed). He was originally at Weil Cornell and left to head up a new division at Holy Name in Teaneck. I FOLLOWED him there … because is was such a kind doctor, took his time, etc.  Who has ever heard of Holy Name ..! Who cares – I bet he left for quality of life. Not part of any huge monster health care conglomerate.

Sad for Brian Thompson’s family … but not a surprise. I’m just surprised it took so long!

Simma Levine

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Well said, Bob. Thank you for drawing the right conclusions from this incident.

John Pitt

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So well said, Bob.  I hope people read it. All of it.
Thanks for doing what you do.

John Grigas

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well said. Nationalized health insurance and some breakup of these big healthcare companies can’t come quickly enough.

in case you missed this, here’s a compelling article from the WSJ on health insurers gaming the system while claiming to serve US veterans:

https://www.wsj.com/health/healthcare/veterans-medicare-insurers-collect-billions-bfd47d27?st=BzkZbc&reflink=desktopwebshare_permalink

keep on writing!

John Abrams

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Well said .

David Zucker

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Hey Bob are you on Reddit? I find it to be consistently the most accurate gauge of the Zeitgeist, and because all the forums are HIGHLY moderated, the communities are incentivized to only leave intelligent comments. . . so all over Reddit, the comments are pretty much your sentiments below.

Here’s a great example:

To stay alive as a PoS who made millions off the suffering of others.
byu/Last_Future3837 intherewasanattempt

If you’re not on Reddit, I’m warning you, you may get addicted.

Best,
Kia

Kia Kamran P.C.

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Just last night I was sitting in my NYC one-bed apartment with my wife, each of us in our mid-30s, railing against the health care system and joking about going postal. I’d been thinking, what has Obama’s supposed crowning achievement gotten me? My premium payments are stress-inducing and my coverage is trash. Doesn’t help that I don’t have employer-sponsored. It wouldn’t surprise me if Obamacare’s covering more people with preexisting conditions and expanding Medicare made it so I have to pay more for less — and only because I’m in the 75th percentile in terms of income and higher in terms of health, I was only joking about going postal. Obviously this guy had an urge and he acted. Can’t help but wonder, what if Obama had instead gone after the bankers after the GFC, which according to Rahm Emanuel he didn’t do in order to pass Obamacare; gotta believe we’d all be way better off — except, of course, the rich…

Sam Blake

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As a publicly traded company, the primary responsibility of the company leadership is to its shareholders. Not its customers or clients or policyholders. The insurance premiums paid by consumers are supposed to be used first & foremost to enlrich companyshareholders. Of course, every dollar spent paying insurance claims or paying doctors, nurses or hospitals comes out of the pockets of  shareholders
What a great country……

bkatchinson

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I love, and look forward to, reading your emails. However, what bothers me about your response is that it mirrored the rhetoric of pro-Palestinians who justify 10/7 because of all the “unjust” and “awful” things Israel does (we both know this is a false narrative of course).

In like manner, you glazed over the tragedy and said “but!!” this guy was pissed and the system is unfair, etc.

If we don’t like the pro-Palestinians saying “yes 10/7, but….” then we shouldn’t say it in this context either. Killing anyone for any reason is never justified, no matter how wronged you feel you are.

Saying the “real story” is about the health care system is like saying the real story about 10/7 is about Israel’s oppression. Killing is killing and it’s wrong.

I get that you’re highlighting the ills of the industry, and if we didn’t live in a world that justifies Jihadists I wouldn’t have take issue. But we do, and we can’t let the goyim think if there is a perceived ill anywhere, then violence is justified.

Anyway, love your stuff!!

Moshe Sinar, Esq.

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Go read Twitter. Zero sympathy. And it’s exactly what you’re talking about.

Rich vs poor.

American minimum wage is $7.25 an hour.

Since 2009.

There are 801 billionaires based in the USA in 2024 who have a total 6.1 trillion dollars.

That’s $6,100,000,000,000.

But can’t give them anymore than $7.25!

And it gets worse.

Some types of labor are exempt from the federal minimum wage, including:

Tipped employees

Employers can pay tipped employees a minimum of $2.13 per hour, as long as the total of their hourly wage and tips is at least the minimum wage.

Employees under 20

Employers can pay employees under 20 $4.25 per hour for the first 90 days of employment. This is sometimes called a youth, teen, or training wage.

No wonder people are pissed. Is everyone doing this? No. But the fact that it exists tells a lot about the poor vs rich in the USA.

$7.25 is paid in Mississippi, Alabama, Georgia,Texas… see a pattern here? Sure some f*cking moron will read this and say Florida pays $13!! Yes, true. And you might get a beach front property on that but guess what you won’t be able to afford? The insurance.

Top paying states? Washington $16.42  California $16.00. Mass $15.00. Surprised? But is that a liveable wage? Doubt it. And this is what the Democrats number one issue is. And yet we hear’” the economy is cruising, performing…” but for who? $7.25 for nine years? I can tell you who it’s not benefiting and how they voted in the last election.

Even in Saskatchewan we are $15 an hour, but liveable is deemed about $18.  Each province sets their own but we are basically dead last. But healthcare here is under a Conservative attack who want to go to an American based model.  Saskatchewan is the birthplace of State Run Medicare thanks to Tommy Douglas. In the 1960s (His grandson is actor Keifer Sutherland who has a good band if you wanna check them out) The battle is on.

Again,go read Twitter. Yes,it’s a cesspool. But there is a lot of truth there. I’m not surprised this happened today, only that it took this long. Was he gonna testify? Was he a victim of someone pissed off at United? Like you, I feel for him and his family but ultimately he is like many of those who got denied and then died. Thompson is a victim of health insurance companies no matter how it gets spun. And so is his family.

I’ll end with Bernie Sanders tweet. When Trudeau and Trump met last week, Trump joked that if you don’t like the tariffs coming to Canada, maybe you should just become  the 51 st state of the USA. What did Sanders say?

“Does that mean that we can adopt the Canadian health care system and guarantee health care to all, lower the cost of prescription drugs, and spend 50% less per capita on health care?

I’m all for it.”

Todd Devonshire

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I’m sure you’ll be getting responses about how understanding why this shooter may have done what he(she?) did, as reprehensible as it is, is akin to justifying it. That seems to be another failure of our current culture; the inability to hold to opposing thoughts in one’s mind.

The ends do not always justify the means, but anyone with any sense of history has to understand, things going on as they are with political and cultural division being constantly stoked for the benefit they very rich, thus furthering wealth inequality in the U.S., chickens will come home to roost, and they may very well peck your eyes out, since they’ve been denied so long.

As a Canadian, healthcare isn’t a top of mind concern or stressor in my daily life. My taxes means if my health takes a turn for the worst or some serious diagnosis, I can be seen by a doctor in a relatively short time.(Don’t listen to the wait-list-whiners who get the most media oxygen. If your condition is serious enough and time sensitive, regardless of income, or class, you are triaged as a priority. The whiners are the ones who are having quality of life issues, while aggravating, like a knee replacement, etc, isn’t more important than a time sensitive cancer diagnosis or cardiac condition!)  Or if the worst happens and I’m in a serious accident or work injury, an ambulance, be it road or air if needed, will take me to the nearest trauma hospital, with a small co-pay for said ambulance(currently $45 in Ontario, road or air) billed after. Your first thoughts in moments like those aren’t “Can I afford this?”. What’s that worth to (royal)you? I know based on the taxes I pay, it’s still a hell of a bargain!!!

My sister was diagnosed with 2 types of simultaneous breast cancer 9 months into the pandemic. A month later, they had her starting her treatment. 18 months later, she was in remission and considered cancer free. While my brother in law’s work prescription healthcare benefits covered all outside hospital drug costs, her biggest expense was parking for treatments, which by her most conservative estimates would’ve probably be in the mid 6 figures, after all was said and done. Her cancers, left untreated were a death sentence, but luckily she caught it soon.

Now imagine if she were in the U.S.. The time alone waiting for insurance company approvals could have cost her life, since treatment as soon as possible is what gave her the above average chance of beating it. Imagine being in a similar situation, and possibly losing a loved one because, like you said, an insurance company makes money by NOT paying out wherever they can. Imagine having that happen, and you learn the president of that company makes and obscene about of money annually and apparently this year, on top of that, he recently exercised $20 million in stock options! While I myself could not see myself ever having that kind of rage to kill, I can see myself having that rage up to that point without crossing it.

No one knows if that was the motive here, and it the end it could have nothing to do with denying anyone a health claim, but let’s face it, the fact nearly everyone is speculating that it could be the motivating factor, tells you how many Americans can see the forest for the trees, and have had those murderous thoughts after watching a loved one die due to corporate medical bureaucracy than enriches those who deny others life saving treatments or drag their feet in doing so all in the name of the next quarterly report.

Michael Moniz

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I thought the same thing about the shooter – pissed because the health insurance co wouldn’t pay. Or someone was pissed enough to hire a professional shooter.

Your opinion about health care is spot on. I received a couple of negative comments on Amazon because my last book, The Take Charge Patient: How You Can Get The Best Medical Care, explained why doctors have so little time ( health insurance companies have become dictators), among many other issues, and that patients need to meet them part of the way by becoming their own advocates.  Patients were mad that I didn’t attack the doctors. My goal was practical— how to get what you want- good healthcare.

I interviewed over 200 physicians, nurses and more for that book, my second.  I didn’t make this stuff up.  Plus my healthcare experiences and many others’ backed up what most said.  Now, I’m writing my third and healthcare is as you said.  Sad. So much worse than it was.
I was turned down 5 times by my healthcare insurance company for very expensive treatment that is documented ( published medical studies in credible journals) as mostly successful treatment for the disabling medical condition I have. My neurologist went as far as she could with appeals,  including requesting an outside physician to evaluate.  Still, treatment was denied.

I’m not giving up.  My health insurance company might want me to be on nerve pain medications for the rest of my life ( cheaper for them) but I certainly don’t.

Yes I’m pissed but my way is to interview at least 200+ more healthcare professionals and speak the truth and offer tips to help.
Thanks for shining a light on this topic.

Martine Ehrenclou

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It’s insane that insurance companies are for profit institutions to begin with. But our overly capitalist country can’t help itself. We have to have a free market and competition.

But why then am I punished for working for a small business when it comes to my health insurance? I get no real choice or options. I’m given what the company can afford to provide me. Now if I worked for Viacom, I would be presented 5 different options to choose from. Could choose to pay in more for a better plan, etc. What I don’t understand is why does my employer determine those options? Why do they pay the insurance company directly in the first place?  Put that money in a fund that i can only use to buy healthcare. Do this with everyone and have the insurance companies compete for our business. Like a free market!! And then I can choose what plan I want. If I want to pay extra for more coverage, then I can choose to do that. But it’s my choice.

But no, we get asinine and unrealistic suggestions of small businesses teaming together to negotiate better deals. Why is the onus on the small businesses? I thought republicans support small businesses. They sure like to tout that line in their campaigns. What a fallacy. They do whatever the health care lobbyists want, to help them profit more.

I met a new employee at Belleayre Mountain in the Catskills this weekend. She told me she came over from Hunter (Vail owns) because they would only give her 34 hours a week. Just enough to not have to give her health benefits. And this is for a Director level position. It’s out of control that our employers determine our healthcare. If we’re going to keep this insane system of you only get healthcare if you work enough hours, then at least let us consumers negotiate for our plans directly.

Best

Vin Hartong

Artist Manager

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I hope you are doing well.  You may or may not recall my name but I am a long-time music publicist, now an artist manager, in the biz. I am best friends with Fiona Bloom.

Your column really hit home touching on almost everything I thought yesterday morning when Thompson was gunned down in NYC.

One comment really hit home. “In the rest of the western world, health care is a right. Everybody gets it. We should have that in the U.S. too, but everybody is fearful of losing something they’ve already got and paying for the indigent so there can be no change. But Obamacare? People love it, it’s never going away, just like Social Security. Neither is going to be clawed back.”

I’ve been self-employed since 2002 and have been utilizing the “market place” ever since its inception.  Prior to “Obamacare” I had been rejected for coverage a few times.  Since then, I have been able to have coverage but at what price to the Federal Govt and taxpayers?  I KNOW how it works and it stinks.  All Obama had to do was open Medicare to all and allow folks to get coverage and pay based on their income.  Instead, he created a big bureaucracy that primarily benefits the private insurance companies that are raking in billions in profits every year.

I currently have Cigna.  The monthly premium is over $1500 a month.  I pay close to $300 a month while the rest is subsidized by the Federal Govt. I hardly use it but keep it in case of a catastrophe or serious illness.  Who is profiting?  The insurance company.  In June, I had a severe allergic reaction on my face.  I went to the ER and was there for about 2 hours.  I was copied on the bill sent to Cigna and it was over $8200.  They billed over $3000 for an IV….a saline solution with 1 Pepcid, ½ a valium and some steroids.  Of course, that it not what Cigna paid but what they did was still substantial.  Then the hospital writes the “the loses” off.  It is all a big shell game.  A scam.

I find it interesting that it has been all over the news these past few days that the Feds have been all up in the airline industry’s as*holes for making big bucks off of customers with their junk fees charging extra for baggage, seat selection, etc.  Why?  People can choose not to fly but they can’t choose to not have health insurance. One accident or illness, then one is covered in medical debt.  While I applaud your choice to self-pay, it is not an option for many of us.

The bottom line is that we need to go to a single payer system and quit adding to the coffers of these private companies who routinely deny care or offer plans with HUGE deductibles.

From Yahoo Finance, “UnitedHealth Group kicked off another round of earnings calls for major health insurance companies Tuesday morning, when it reported $6.06 billion in profit for the third quarter of 2024. That’s up slightly from the $5.8 billion the company posted in the third quarter of 2023.”

Trump promised in 2016 to repeal and replace Obamacare.  He’s not dumb.  He knows what is happening but will he and his new department of government efficiency…which is not even a sanctioned department…do anything about it, or keep letting their rich buddies and shareholders continue to rake in billions while some people die?

Eliminating these middle-men in the health insurance biz would be probably the biggest way to trim the budget…period.  That and dealing with all the Medicare fraud.  Forbes says, ”  Medicare fraud in the US is a huge and costly problem. Taxpayers are losing more than $100 billion a year to Medicare and Medicaid fraud.”

Oh, and do you know anyone in pharmaceutical sales that isn’t rich?  Nope.  And why do we still allow ads for pharmaceuticals?  Only country to do so.  $$$$$

You are right in that Social Security cannot be clawed back and it shouldn’t be.  People are forced to pay into it.  It’s not an entitlement.

Why are we the only country in Western civilization not offering healthcare to everyone?  $$$$$

Yesterday as I was glued to the TV, I kept thinking someone is sending a strong message here.  Like you, I don’t condone violence in any shape or form.  But there’s a lot of folks out there “mad as hell” and not going to take it anymore.

Interesting the BCBS reversed a major decision today trying to put a limit on time for anesthesia.

https://apnews.com/article/anthem-blue-cross-anesthesia-insurance-coverage-c8233db68f76342c4e794320f151a926

Sure, while they are getting screwed up the butt with bills, let’s make sure they feel the pain.

Best.

Michelle Roche

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Last December, I visited Norway with my family. We stayed in Oslo, but there was more snow and ice than I have seen in a lifetime living in San Francisco. I have never been a cold-weather guy or skier like you. After a day of walking around Oslo, I slipped on an icy sidewalk, landed on my head, and sprung my neck. I thought I had damaged something; the family concurred, and we went to the urgent care section of the local hospital. I had travel health insurance and credit cards.
They saw me promptly, diagnosed me, and gave me blood tests, X-rays, and an MRI. The attending physician admitted me for observation for the next 24 hours. They assigned me a private isolation room, which they routinely do for newly arriving non-residents. Every hour for the next twenty-four hours, a nurse did an exam, and a physician finally saw me before release for a complete Neuro exam.
I offered them my insurance information and credit cards, but the staff expressed little interest. I never received a bill of any kind, one that would have cost several tens of thousands of dollars here. It was great care offered even to a visitor in their country.

I usually get all my health care from the VA. I live in Marin County, California, with abundant and excellent private healthcare and doctors. Contrary to News reports about the care, I have never received better civilian care than at the VA. The MAGA Mob is alarmed as they race to eliminate so many public programs. And they want to attack the VA system as they are attempting to do with Medicare, Medicaid, and Social Security. They want to tear down an excellent public healthcare system and come up with a private system for the VA that puts us in the same mess as all others struggling with the tepid system of insurance.

Steve Greene

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Word.

Even though I practiced as a physician in CA, I learned this lesson from the patient’s perspective “the hard way” after a colleague committed medical malpractice on me, leaving me blind in one eye (I’m in a career that requires good depth perception to diagnose and treat patients, so had to pull myself out of the game or risk harming my future patients by failing to diagnose a problem that one of my colleagues could easily see).

I tried to locate a med-malpractice lawyer willing to take on my case, only to learn about MICRA, the medical malpractice “reform” act passed in 1975 (when I was 12) which conveniently “forgot” to account for effects of inflation by capping non-economic damages at $250k (if adjusted for inflation, it’d have to be North of $1.1M in 2024).

When a harmed patient calls, med mal attorneys do a quick back-of-the-envelope calculation, asking what direct damages a patient suffered are, and what expected future damages will be.

They also know that 9 times out of 10, juries will side with doctors (EVEN IF there’s clear-cut evidence of wrong-doing), as juries tend to side with doctors thinking finding them liable is bad juju (just like they’re more likely to acquit cops accused of wrongdoing: it’s a job they wouldn’t want to do, so they tend to give them a free pass).

Med-mal lawyers also know that working up a case easily exceeds six-figures, or they in turn face risk of clients suing them for legal malpractice!

Bottom line is it’s virtually impossible to find a med-mal lawyer willing to take on case (it’s why most med-mal attys limit their practices to suing docs where potential awards are large, eg OB/GYN docs, where forceps injury means a lifetime of actual damages that outweighs non-economic damages. But if you’re a middle-aged doctor, you’re SOL, as if just doesn’t pencil out).

That oversight in MICRA is the gift that keeps giving to med-mal insurers (eg SCPIE, a company most citizens don’t even know exists, or what it does). MICRA is also why although you see plenty of ads on TV for personal injury attorneys in CA, you won’t see any for med-mal claims.

When patients are placed in a tight squeeze after experiencing loss of career/income/health and they discover the legal system bars legal recourse, they begin to consider options they wouldn’t ordinarily think about, as they often feel they have nothing left to lose.

(I’m thinking of the patient who entered the Newport Beach clinic of the physician he felt wrongly harmed him about 10 yrs ago, killing him & himself in an act of murder/suicide.)

Physicians are obvious vulnerable targets (the patient knows exactly where to find them!), when the real benefactor of MICRA is some anonymous CEO of SCPIE, sitting safely ensconced in their high-rise executive suite in Beverly Hills (I’m thinking of that album cover for Steely Dan’s “Royal Scam”).

(I won’t bore with the details, but problems with MICRA were addressed about a year ago, boiling down to special-interest group of CA trial lawyers negotiating with med-mal insurers/CMA/AMA, rewriting MICRA to address its defects, but those harmed in the past are SOL.)

I ran across an article posted on BlueSky recently, a warning issued a decade ago by Nick Hanauer to his fellow plutocrats (the author is a bit wordy, falling for the temptation of loving his own words, as most of us do, but it’s worth a read nonetheless):

It’s amazing to me “the richest man in the World” Elon ignores his advice, his ego forcing him to step out from behind the curtain to prance about on stage with DT.

Call me old-fashioned, but I vastly prefer the good ol’ days, when members of the kleptocratic elite oligarch class had the common sense to pull the strings from off-stage (or stay in the proverbial smoke-filled room with other power brokers) in order to avoid becoming high-profile targets in the next French Revolution. ?

Christopher Press

Woodland Hills, CA

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Good column but the response isn’t going to be that more healthcare claims are approved and premiums go down… The response is going to be that more CEOs will start travelling with private security and they will put even more of a military presence around them.

Hope Dlugozima

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Wow. Wow wow.

You are such a fu*king asshole.

Richard Carlson

Ryan Mac covers Elon Musk for “The New York Times.” He and his colleague Kate Conger wrote the definitive book on Musk’s purchase of Twitter, “Character Limit.” This is the real inside story.

https://podcasts.apple.com/us/podcast/ryan-mac/id1316200737?i=1000679331400

 

 

 

https://music.amazon.com/podcasts/9ff4fb19-54d4-41ae-ae7a-8a6f8d3dafa8/episodes/fc9de18d-0960-4567-85dc-73d00fbf9c7c/the-bob-lefsetz-podcast-ryan-mac