Open Letter to UnitedHealth Group CEO Andrew Witty from Dr. Linda Peeno | June 9, 2024
“I am deeply, deeply sorry."
- Testimony of Andrew Witty, Chief Executive Officer, UnitedHealth Group before the United States Senate Finance Committee, May 1, 2024.
Open Letter to Mr. Andrew Witty
CEO, UnitedHealth Group
9900 Bren Road East
Minnetonka, Minnesota 55343
CC: Stephen J. Hemsley, Chair of the Board, UnitedHealth Group
John Rex, President and Chief Financial Officer, UnitedHealth Group
June 9, 2024
Mr. Witty,
You do not know me, but I have known the likes of you for almost four decades. Nothing about you surprises me.
You see, in the mid-1980’s, as a young, naïve physician, I got a job with Humana, Inc, one of your competitors, based in Louisville, Kentucky. I thought I was hired to make good medical decisions for patients, but after a rocky start, a senior executive corrected my course: “You are here,’ he instructed, “to use your medical degree to justify our economic decisions. You approve something, we lose money. Clear?”
At that moment I grasped that the commercial health insurance industry model is shockingly simple: companies take in money as premiums and then figure out as many ways as possible to keep it. It’s brilliant when you think about it. The commercial health insurance lobby has created a business that makes money by depriving customers (patients in need of medical care) of a product for which they have prepaid. UnitedHealth Group / UnitedHealthcare and all of your industry allies, take the money upfront, and then implement the schemes you have concocted to deliver piecemeal medical care, or, preferably, never deliver medical care at all. The big bugaboo is that it takes extensive human and technological resources to develop systems to do that. That’s why you and your industry need compassionless, high-paid executives like you, coupled with callow, compliant doctors—like they tried to train me to be—willing to forfeit professional oaths to accomplish the dirty work.
After nearly a half-century, corporatized healthcare has shown that it is an insidious system that works stunningly—as long as no one thinks too much about what is going on to American citizens who are not capable of tracking your practices and the ways in which those practices harm them. And it’s all made easier by the reduction of human beings to numbers and dollars, moving them through the Rube Goldberg schemes that easily transform patients and doctors into currency.
Why should persons, like you, who are not licensed medical professionals, be making decisions about the health outcomes of American citizens while earning millions of dollars a year for manipulating, substituting, delaying, and denying medical care to premium-paying consumers? (Yes, as of this writing, this Denial of Care business model remains legal in the United States of America.)
You certainly weren’t using this exorbitant pay to ensure that one of your prize companies, Change Healthcare (Optum), which is responsible for $1.5 trillion in claims processing a year, had protection from a cyberattack. Protecting patients and medical records is not a priority for UnitedHealth Group. In fact, you had four other excessively compensated executives to help you, with the five of you taking in more than $74 million in 2022.
What were you doing with all that money? We know it was not used to protect patients and the professionals responsible for their care. While they reel from the damage caused by your negligence, none of your compensations will suffer.
I am sure, Mr. Witty, you would claim that it is difficult running a multi-billion-dollar global company, one that is also the largest U.S. commercial health insurer and largest employer of physicians in our country. However, let readers be clear: UnitedHealth Group is not a “healthcare” company. UnitedHealth Group is an investment banking firm and private equity fund. Patients are not the priority, Return on Investment (ROI) for shareholders is. And how do investors benefit? They are rewarded financially every quarter from the denial and sabotage of medical care to human beings. They profit from untreated illness, injury, disability and death.
It takes dogged ingenuity and an extremely manipulative mind to manage a “Harm-for-Profit” enterprise that impacts the lives of millions of people. It takes brazen genius to mine and extract profits from spin-offs and vampire ventures.
Just two years ago, you raved in an interview about your grand plans to “transform consumer experience” with the creation of a comprehensive “healthcare marketplace.” You sweet sell this expansive “consumerization” of medicine with syrupy references to the “individual,” the “patient,” and the “whole person orientation.” You continued these kinds of honeyed claims in your testimony with phrases like “value-based care” and “personalized, high-quality care,” as if patients are shopping for vacation spots.
Thing is? These are all terms architected and invented by the commercial health insurance industry. None of these terms are medical terms. No ethical physician or ethical healthcare administrator would use these terms in the context of Do No Harm medical practice. Your industry has created a ruse and has effectively hoodwinked unsuspecting Americans who don’t understand your shell game.
I doubt that you have ever encountered a single patient for whom your company may have caused harm or death. In fact, I know that if we talked to medical providers and patients who have suffered from the tactics your companies impose, their testimonies would belie your hollow, bumper-sticker mission to “help people live healthier lives and help make the health system work better.”
The practices of UnitedHealth Group, UnitedHealthcare and Optum do a lot of things. Helping Americans to live healthier lives is not one of them.
Let me tell you, Mr. Witty, despite your representations that you are “fixing” problems, what is really harmful is that ethical medical providers across our country are now struggling to pay staff payrolls; sacrificing to take care of patients amidst billing chaos; and witnessing patients suffer for lack of medicines and treatments. Ethical medical providers and healthcare professionals are digging into their own personal savings to keep their clinic doors open; physicians and behavioral health therapists are still processing claims manually in many instances, all while managing the overall emotional, financial and physical distress of what you and your C-Suite and executive board have set in motion.
Could you, your board and your C-Suite survive on zero cash flow?
I don’t know if you have ever been a patient or not, but facing a medical condition with all its potential fear, pain, and suffering, is not a “consumer experience.” Maybe you do not realize that patients lying in emergency rooms, surgical suites, or ICU beds are not on a shopping spree at a mall. Do you ever wake in the middle of the night and think about the power you wield over life and death for your millions of patients and thousands of ethical medical providers—those special individuals with values and ethical commitments to care, regardless of the cost or consequences? Do you ever consider that you get by with so much preventable harm and death because so many unethical Yes Men serve as moral buffers for your industry’s destructive actions?
Now, Mr. Witty, over the years I have heard all the prideful mantras about how the industry claims to ensure unprovable “high-quality,” “better outcomes at lower costs,” and “value-based care.” Behind all of this, it is about quantity and profits—not real quality and genuine care. Without you and your ilk, your argument goes, there would be no stopgaps for those runaway patients and doctors demanding “too much.” Business gurus, like you, who make obscene amounts of money from Denial of Care, are very quick to remind American people that “everyone can’t get everything.” And, you insist, limitations (“rationing”) and controls are necessary and we just have to accept it. (Funny, I never hear that argument with regard to executive compensation.) Of course, the hidden reality behind such rhetoric is that some patients are liabilities, just Profit/Loss calculations that will always be expendable for the good of the bottom line. No one is honest with the public about the possibility that any of us could become a “cost” to be callously eliminated.
As a most egregious result of your schemes, we’ve seen the rise of Medicare Advantage plans, as companies like yours figured out how to profit from unsuspecting seniors (our parents, grandparents and beloved friends), who are at most risk of medical needs), luring them to hand over their Medicare benefits to Managed Care organizations, with bait-and-switch offers, like “Silver Sneakers” memberships, when necessary medical care, like home health and skilled nursing, would be taken away later.
Now, we are in the midst of the Private Equity tsunami, as Wall Street wizards buy, ruin, and sell healthcare entities faster than they can be tracked.
So, this is where we are.
Over the years, UnitedHealth Group and its subsidiaries have committed multiple crimes. Last fall, UnitedHealth Group Chairman Stephen Hemsley and three of your senior executives netted a combined $101.5 million from stock sales made over four months leading up to when the public became aware of a federal antitrust investigation. You have lied to investors; lied to shareholders; lied to Senators; lied to providers and patients. Your company is ever-mired in legal battles for methodical overbilling; breaking Mental Health Parity laws across the country; intimidation practices related to Mergers and Acquisitions, and now, you are running a hustle with Private Equity companies to reimburse providers at a higher rate if they join your Private Equity network.
My colleagues and I, in the Do No Harm movement, have voicemails and emails demonstrating intimidation, coercion and harassment of providers by your companies. And yet, nobody is indicted, nobody is convicted, and nobody is incarcerated for these crimes.
The saddest aspect of your machinery? Victims of your crimes—meaning The Patients—have no rights.
You, and others like you, churn the healthcare industry to skim off precious dollars that we need to provide medicine, treatments, facilities, and providers. Your targets multiply faster than we can dissect them and counter their consequences. As a result, “Managed Care” has never died, as so many assert, but has been retooled into ever more insidious, deceptive tactics. For example, old-fashioned, injurious “Precertification” is now called “Prior Authorization,” a seemingly benign technical nuisance, right? But now we know your companies use cold PxDx and nH Predict algorithms and heartless AI (Artificial Intelligence) to get your dirty work done.
Who could have envisioned that we would have black boxes and machine learning dictating the health of our fellow citizens by removing licensed medical professionals, nuanced listening and human compassion entirely from the process?
Mr. Witty, you are the black box. And you have created a nesting doll of boxes inside boxes, all designed to confound and obstruct the public, professionals, policy makers, and regulators from any interference with your rapacious profiteering.
In all of this activity, citizens—all of us—are at risk. The harm and death are incalculable because it picks us off quietly, singly, at times when we are least able to fend for ourselves against corporate, insatiable behemoths. As a result, we have what amounts to a solitary, silent apocalypse of suffering, financial stress and ruin, emotional and physical tolls, disruption of work, families, and communities.
And on top of it all, the debt. Billions of dollars in medical debt being carried by Americans. Is that Public Health?
Meanwhile, healthcare CEOs, like you, have hit the jackpot. Michael DeLong, research and advocacy associate with Consumer Federation of America, warns that “the system is really broken…Theoretically, CEO pay is supposed to be tied to their performance, but in practice CEOs live high on the hog while increasing (commercial health) insurance premiums, which especially hurt people who are living paycheck to paycheck.”
Let me be more direct, because I am older than you, Mr. Witty, and I have much more experience with patients and ethical medical providers. I’ve looked directly into their eyes for nearly 40 years, have listened to thousands of stories of pain and suffering, and have been a witness to harm and death in a couple hundred legal cases.
You are a husband, a father, and, no doubt, family and friend to many. We have a healthcare nonsystem in which no amount of money or power—not even your millions—can buy empathetic, ethical care from weary professionals. I have held physician colleagues as they cried, their lives sucked away by the breaking of medicine they so loved. I regularly hear stories from patients, some with wealth and prestige, who have endured the horrific consequences of our failed, cruel, and barbaric privatized approach to, and model of, healthcare. As a doctor, who has admitted the harm and death I have caused, and as a mother, grandmother, sister, friend to many, I often have middle-of-the-night panic attacks. I fear, not only for the unpredictable medical needs we all face at some point, but more for the fact that we find ourselves in a mercenary maze that will entangle and harm as much as any surprise cancer.
What about you, Mr. Witty? Do you have any sleepless nights?
If I had been at your Congressional hearing in May, I would ask only this: Do you even know or care about the lives you have damaged and destroyed? Can you see their faces? Do you know their names? Have you heard their stories? Do you understand that our broken, morally bankrupt system could cause harm even to someone you love?
Until you—indeed all of us—confront that question, none of us are safe. Abraham Joshua Heschel once wrote: Some are guilty, but all are responsible. And, Mr. Witty, your multi-million-dollar compensation and power signal both great guilt—and responsibility.
You see, Mr. Witty, when the United States Congress held one of the first Managed Care hearings on May 30, 1996, I was there to tell the stories of patients and to admit my responsibility for an unknown man’s death. I had only a small voice to speak about the raging storm of Damaged Care. I predicted to the American people that none of us would be safe if we did not heed its effects.
On May, 1, 2024, almost three decades after my first testimony, you too had a chance to sit before members of Congress. By this point, many legislators have been complicit in the consolidation of wealth and power, enabling you, your executive board, your C-Suite and employees to harm patients and ethical providers with the cavalier nonchalance of a sociopath spinning a barrel in a game of roulette.
In addition to imposing unrelenting Moral Injury on ethical medical residents, doctors, and other healthcare professionals across the country, the business practices and tactics of UnitedHealth Group, United Healthcare and Optum have become a bureaucratic bulldozer of disregard that has pushed countless Americans into graves for decades—actions for which you have had no pangs of conscience.
You’ve also broken the hearts and wills of millions of ethical physicians, nurses and healthcare professionals.
The difference between me and you is that rather than defend Harm-for-Profit and Denial of Care, I warned the United States Congress and the American people.
Congressional Hearing, May 30, 1996: “What kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients? I became a physician to care for, not bring harm to my patients, and I am haunted by the thousands of pieces of paper on which I have written that deadly word, “denied.”
Sincerely,
Dr. Linda Peeno
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