THE FINE PRINT Exclusive: Commercial Health Insurance industry whistleblower Dr. Linda Peeno breaks her silence to directly address UnitedHealth Group CEO Andrew Witty before May 1st
Our bodies and health should not be for sale or traded on Wall Street | By Dr. Linda Peeno April 28, 2024
(UnitedHealth Group CEO Andrew Witty.)
Here we are again.
Another opportunity for a corporate CEO to gaslight us about the wonders of American healthcare. On May 1, 2024, Andrew Witty, will testify before Congress about his company’s recent corporate debacle, set off by a cyberattack of Change Healthcare, one of his companies, which is responsible for the payment of $1.5 trillion in claims per year.
It is no surprise to me that we have come to this point. For nearly four decades, healthcare has been a gold vault for corporate raiders, as they turned medicine into a marketplace free-for-all.
As a young physician, I experienced nearly four decades of this first hand—beginning as a naïve moonlighting doctor hired to deny care for profits and finally as an early outspoken critic of new systems called “Managed Care.”
My crash course began at Humana, Inc., a hospital and commercial health insurance company birthed in Louisville, Kentucky at the rise of corporate medicine. Early healthcare entrepreneurs recognized that there was money to be made by interceding into the physician-patient relationship to gain control over what physicians could and could not do and what patients could and could not get. First, though, they had to overcome that tenacious bond that is based at its core on trust, integrity, empathy, compassion, and commitment. The key, companies like Humana learned quickly, was to hire healthcare professionals—particularly doctors and nurses—who would provide the cover of medical legitimacy for their covert economic ends. It is a system that works brilliantly as long as the fundamental moral mandates of medicine are suppressed.
But then something happens. One of those healthcare professionals—a doctor, nurse or someone with a nagging compassion for fellow human beings—comes along and finds they can’t play the deadly game.
Of course, the system tries to do everything it can to quash these rogues with a conscience. Executives, like Mr. Andrew Witty and my former senior managers in the C-Suite, don’t want medical professionals trained with empathy and responsibility. So, patients are turned into faceless numbers subjected to heartless algorithms. They can’t have employees seeing beyond the computer screen to imagine actual faces or the look in someone’s eyes. They don’t want us to see a real person—someone with a life, work, family, friends, hobbies, maybe a pet.
If executives and employees looked into the eyes of persons the way physicians and nurses do, that someone might remind us of our mother, best friend, or a neighbor’s child. They don’t want us to think that these individual strings of numbers and letters love someone and are loved by others. That would be sensitizing, empathizing, humanizing, which would lead to thoughtful, individualized responses to human needs. Companies, like Mr. Witty’s UnitedHealth Group, spend millions to eliminate such transgressions.
But then one day, on the 23rd floor of Humana’s pink marble temple, I, Dr. Linda Peeno, screwed up the numbing, blinding system when a nurse handed me a request for a heart transplant. The patient was in the OR (Operating Room) with his new heart in a cooler, matched and ready. Who does an unnecessary heart transplant? You can’t even get to that point without months to years of progressive disease, followed by approved treatments, evaluations, and clearance for the list. It should have been a simple, immediate approval. Except, transplants are costly. Even worse, this patient was at an “out-of-network” hospital, which meant that the company would have to pay full charges.
While precious time passed for this young man and his doctor, a gaggle of cost-cutting functionaries gathered in my office, frantic to prevent the loss of a half-million dollars. Powerless to enforce an approval, I was the doctor charged with stamping “DENIED” on the form and conveying the death sentence to a stupefied doctor and patient 2000 miles away.
Afterwards, Humana executives celebrated the bounty.
Let’s be clear: that young man in Nevada, whose life, we at the commercial health insurance company, held in our hands, who needed a heart because he was unfortunate enough to get a virus that destroyed his heart muscle, wasn’t a disposable source of savings or profits. He was a real human being, a young man working hard, living life as he could, until he got seriously sick with something he neither caused nor could have predicted. He needed a specific, medically necessary, contractually justified treatment that would have given him continued life. Instead, our company reduced him to only a line item on some spread sheet. He was killed by a few key strokes on a computer by a system designed to achieve exactly that result. It was no accident. Some at the company received bonuses for this. This is what Mr. Witty and fellow healthcare titans are paid outlandish money for: to design, implement and perpetrate systems to limit, substitute, delay and deny care. That real people suffer as a result is of no consequence. So, what if someone suffers and dies. It is just the cost of doing business. They keep clean hands. Unlike ethical physicians, they feel no pain. They shed no tears. Their hearts never ache. Their nights are never sleepless.
But what Mr. Witty may never understand is that that young, naïve doctor in 1987 could not shake the thought that she had caused a man’s death. When I later discovered that the corporation had bought a piece of sculpture for their marbled rotunda for $3.8 million dollars (nearly eight heart transplants worth), a moment of moral epiphany struck deep. I vowed then to do what I could to expose the machinations of people like Mr. Witty and their destruction of medicine.
When 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 came before the committee with no training in health policy, business, law, or politics. I only had my voice to speak about the raging storm of Damaged Care. None of us would be safe if we did not heed its effects.
Warning One: 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.”
It was like standing alone in a hurricane with a tattered umbrella.
I went to that hearing with no support, at my own expense, tucked in toward the end of the day when nearly everyone had left. Few of the legislators seemed moved by my account of life and death. It could have defeated me then, but I am a plain, practical woman reared in rural Kentucky, where people work very hard, care for each other, and don’t give up. So, I persisted, vowing to continue to work every way possible to educate and challenge the corporatization of medicine and the Denial of Care business model.
With no surprise, things got worse. One year later, I was back at Congress, with even more evidence of harm and death. By this time, I had hundreds of patient stories—painful, horrific assaults on individuals and families that should have been outrageous and unfathomable in a country that touts “the best healthcare in the world.”
Warning Two: Congressional Hearing, October 28, 1997: “We are in the midst of an unprecedented system of market-based rationing of medical care which is resulting in patient harm. Unless we understand it systemically, we cannot begin to assess its impact or attempt to make appropriate corrections. Meanwhile the suffering, and even death, of some patients continues.”
I do not know where Mr. Witty was on those two days in 1996 and 1997, but I do know that he was in his late 30’s considered a rising star in the pharmaceutical industry. While Mr. Witty was the CEO of GlaxoSmithKline (GSK), he was responsible for cash and sexual bribery crimes that led to the arrest of four of his senior executives. Mr. Witty was also at the helm of GSK when the company was charged with cheating the National Health System (NHS in the United Kingdom) for overcharging for anti-depressant medication. Mr. Witty was pushed out of the country by citizen, patient and physician push back.
UnitedHealth Group then recruited him as the perfect hire.
No doubt he was like so many other young executives I had begun to meet, ravenous with the pursuit of new power and its multiplication of money from a lucrative healthcare sector. I witnessed the early giddiness back in the 1980’s, as MBAs, and even many of my physician colleagues, began to covet seven-figure salaries, stock options and other corporate perks.
During this time, I too was young, and could have been a rising star in healthcare in a new career for doctors called “physician executives.” As a woman, it could have been a way to break through glass ceilings and to make a mark on healthcare. I wrote about this in a piece about the use of a lone voice:
“Compared to the fatiguing practice of medicine I had a coveted six-figure income and a corner office with floor-to-ceiling windows. For the first time in my life, I had beautiful clothes, weekly manicures and facials, expensive salon appointments. It was lucrative, easy work. By all standards around me, I was successful. What in the world possessed me to sacrifice these accomplishments for a David-and-Goliath struggle doomed to fail?” (Voice Lessons)
Years later, as a guest in a university ethics class, a young woman challenged me: “You’ve gambled your career for nothing. Why? You could have had it all.”
Why? That’s a question that lives with me daily. I have wrestled with our fundamental ethical responses to that question for over three decades now. Healthcare is a microcosm of so much around us. I have agonized about this repeatedly, writing more:
“We live in a world of life-destroying complexities from which few of us have protection. Yet so much of this misery could be avoided or corrected. Webs of power and profit are spun from individuals who could choose different values and goals. The connection, though, between our actions and their effects can be negated by distance, disavowal, and disregard. William Butler Yeats, in his poem, ‘The Choice,’ probes us with the question: ‘When (our) story’s finished, what’s the news?’ What is the sum of our life? Yeats asks further: Did a day’s vanity ever lead to a night’s remorse? Did we cause or relieve suffering?” (Voice Lessons)
What passes for “ethics” today is a compendium of theories, systems, policies, and rules. No one seems to notice that at a time when there has never been so much produced about ethics—articles, books, classes, degrees, consultants, training, codes, and all manner of commercialized products—that we have obvious breakdowns nearly everywhere we look. When I issued a death sentence to the patient in 1987, the ethical arguments for its justification could fill a book. Now they could fill a library. At the time I could not find anyone around me to justify my deep, deep sense of wrong, guilt, and remorse. Today, there are podcasts, investigative newsroom teams, debt consolidation charities, GoFundMe campaigns and entire sectors dedicated to navigating and exposing Denial of Care Harm-for-Profit.
I continue to struggle with this paradox.
Over the years, I have come to understand that we have to try to establish some fundamental understanding of our relationship with others. In medicine, we face individuals’ times of greatest, most life-altering and life-taking needs. Michael Ignatieff, in his profound book, The Needs of Strangers, writes about how “it is the manner of the giving that counts and the moral basis on which it is given, whether strangers at my door get their stories listened to by the social worker, whether the ambulance man takes care not to jostle them when they are taken down the steep stairs of their apartments building, whether a nurse sits with them in the hospital when they are frightened and alone. Respect and dignity are conferred by gestures such as these. They are gestures too much a matter of human art to be made a consistent matter of administrative routine.”
I have come to understand my place in this world and my relationship with all who share it with me—that, as I have written often, “we are called to answer for the suffering of others, to make amends in whatever ways we can.” Abraham Joshua Heschel reminds us that “everything we do…leaves its imprint upon the world through our breath, thought, speech.” That understanding guides my life, and I believe we are each:
“…called to open our lives to others. Once we’re attentive to their need, we can offer ourselves as solace; we can use our voices, however small, and sometimes weak and ineffective, to understand and change the sources of suffering. This is the essence of being human, Heschel writes, and ‘our being human is always on trial, full of risk and precarious.’ But the needs of others make demands of us, they interrupt our lives, upend our plans, can often make a mess of things. It’s why we have so many ways to justify our self-centeredness, causing us, as Heschel says, to ‘always be in danger of forfeiting our humanity.’” (Voice Lessons)
But it is the living of this that is hard.
“The demands of life and work will grind away at ideals and values. Few of us knowingly sell our souls, but we do. Our spirits can be leached away by fatigue, escape, apathy, or retribution. How can we survive, much less surmount, the needs to make a difference and try to change systems? None of us can elude judgments about right and wrong. In an entangled complex world, it isn’t often so clear cut. Even harder will be making choices and living with them. Our actions—and inactions—can either harm or help another person. Few ethics classes address how we are to be ethical in unethical systems, or how we bear the consequences of our ethical choices. My worldly teenager asked me years ago what I would have done if I had been a single mother and needed money to take care of my children. What would I do or not do to feed them? Are there times when we cannot afford ethics? Maybe morality is a luxury, something one can live only if it is easy and costs little—or preferably nothing.” (Voice Lessons)
The French philosopher, Emmanuel Levinas once wrote that the justification of another’s pain is the source for all immorality.
So, I did not become a “physician executive.” I did not acquire stock options or bonuses. I did not break glass ceilings. Instead, for the love of medicine and the needs of others, I risked everything—from my professional advancement to my personal life—but that sacrifice is a gift, not a burden. Despite this, however, things only got worse. I began to watch so many others—doctors, lawyers, legislators, and even advocates who were supposed to help people—find ways to benefit from a system growing more lucrative from its brokenness. Still, I slogged along with so many others, trying with all the forces we could muster, to protect patients. It was hard, exhausting, and mostly futile. Yet, the numbers of patients and doctors who suffered from corporate plundering skyrocketed.
So, I went back to Congress again.
Warning Three: Congressional Hearing, September 16, 2009: “In 1996, when I came as a former medical director to talk about the way I had caused the death of a patient, I naively expected the country to be shocked into action. Little change happened since we are here again…I am here today… to urge you to force open the black box of corporate health insurance and to hold them (executives) accountable for the practices that destroy the lives of patients, families and communities, and the health professionals who must bear the consequences of their damaged care.”
After that testimony, I nearly gave up. By this point I was angry, resentful, regretful and just plain tired. I had given up clinical medicine—a love deep and hard-earned—to stand up for the care of those who did not know, understand or have the means to fight. I tried to be a voice for those who couldn’t or wouldn’t speak. I had failed, and the despair nearly killed me.
Just when I thought I was at my end point, I was “saved” by two family catastrophes: one of my daughters had a series of cerebral aneurysms and required multiple neurosurgeries and I assumed much of the rearing of my granddaughter. As these domestic duties bound me to home and part-time work to pay bills, I began to teach in an allied health school. These students reminded me that they are part of the heart and soul of healthcare, and they renewed my love of medicine and the care required for patients. When Covid came along, I lost one of my daughters and learned even more acutely how healthcare systems and decisions manifest painfully in the lives of people. Not numbers, people.
Once my granddaughter left for college, I retreated within my house full of books, two cats, and dozens of feathered companions and other critters. I began to walk miles and miles each day in the woods. I started planting trees all around my little oasis, hoping that I could blunt a sense of deep failure.
It could have been an idyllic life if it weren’t for this vexing sense that everything around me—mothering, grand-mothering, teaching, my animals, and even the trees—conspired to remind me that we can never sever our connections and responsibilities for one another. I continued to receive calls and emails from patients and families, other professionals, lawyers, journalists, and sometimes a troubled student here and there pleading for help or advice. There was no way to hide from the effects of health systems gone deadly haywire.
How could I walk in the woods, plant trees and flowers in my gardens, pick up a new book, spend an afternoon with my granddaughter, or just sit quietly and watch a sunrise and suppress the awareness of suffering also around me?
You see, unlike people like Mr. Witty, who can spin thousands of slick excuses and rationalizations for pillage, I agonized over what was happening to medicine. I took seriously the words of Heschel, who told the American Medical Association in 1964, that a doctor’s role goes beyond caring for the sick to serving all people, the ill and the well. “The Doctor,” he wrote, “is a major source of moral energy affecting the spiritual texture and substance of the entire society.” That means at bedsides, as well as in corporate boardrooms.
Over the last 40 years of Managed Care, people like Mr. Witty have pushed The Doctor—the doctor with a heart and soul—out of the board room and management intentionally. But I know this is a level of moral responsibility beyond what someone like Mr. Witty is unlikely to ever accept. He will go into the Congressional hearing room smug, smooth, and well-dressed. He’ll sit before United States legislators, many who are complicit and have made it possible for healthcare executives, like Mr. Witty, to execute the Denial of Care/Harm-for-Profit business model unchecked. A few will ask some probing questions, but Mr. Witty’s PR team will have worked out all the clever, glossy, charming talking points. For him, it will be polished theatrics. His hands will not shake. Nor will his heart skip beats like mine did when I was in that seat. He will not tear up the way I did as I walked out alone and frightened. For him, it is likely to be a wasteful interruption to his very important, demanding job.
However, I want Mr. Witty to know this: Years ago, in 1996, I warned we would be at a place like this. I warned about people like him. I warned about what would happen to the practice of medicine, our ethical foundation, and our care of each other if we didn’t wake up and make corrections. He and his executive board members, his 440,000 employees globally, and all of their victims have proven me right.
Mr. Witty and others like him may think they have broken medicine by remaking us into powerless consumers trapped in their rapacious, deadly marketplaces, but they are wrong. I can assure them that they have not broken my spirits. They fuel them. And they are fueling others. There is a force rising to resist the corporatization of healthcare and to reclaim and reinfuse human compassion, care, and connection into the practice of medicine and the care of patients.
Medical residents are unionizing in record numbers. Nurses are presenting Healing Greed Agendas. Statewide and National Single Payer movement actions are at record levels. Even the heads of big corporations are now supporting the National Improved Medicare for All Act as they’ve come to realize how hyper-inflated and irrational health insurance costs have become in order to benefit shareholders and investors rather than their employees and companies.
Just this week, a bipartisan, multistate coalition of 22 attorneys general in a letter to UnitedHealth Group urging the corporation to take immediate action to protect providers, pharmacies, and patients who have been harmed by the recent catastrophic outage of Change Healthcare.
Mr. Witty may elude accountability to legislative, legal, and economic authorities, but I am making a solemn vow to devote the last phase of my life to do whatever I can, with as many others who will join me, to hold him and others accountable for the human suffering they have wrought.
Despite our many divisions in this country, the need for compassionate medicine unites us all. Regardless of income, or other advantages, we are each imperfect, vulnerable and mortal. We are all potential patients, and at the moments of our greatest, most intimate needs we do not need healthcare mercenaries at our bedsides, exploiting our lives and deaths for heartless profits.
Warning Four: Congressional Hearing, May 30, 1996: “We have enough experiences from history to demonstrate the consequences of secretive, unregulated systems which go awry…One can only wonder: how much pain, suffering and death will we have before we have the courage to change our course? Personally, I have decided that even one death is too much for me.”
Our bodies should not be for sale or traded on Wall Street and our health should not be decided by investment firms and Private Equity quants. Be clear: Companies like UnitedHealth Group are investment firms, not healthcare companies. We need to enact the National (improved) Medicare for All Act—A deprivatized Single Payer Universal Healthcare for All. That will remove shareholder Return on Investment (ROI) from healthcare and prioritize The Patient, The Doctor, and Do No Harm medicine.
Our very lives—and those we love—depend upon it.
References:
“Managed Care Ethics: The Close View,” Linda Peeno, MD, U.S. House of Representatives Committee on Commerce, Subcommittee of Health and Environment, May 30, 1996.
“The Menace of Managed Care: A Guide to How Avoidance, Denial, and Control Can Result in Patient Harm,” Linda Peeno, MD, U.S. House of Representative Committee on Commerce, Subcommittee on Health and Environment, October 28, 1997.
“Between You and Your Doctor: The Private Health Insurance Bureaucracy,” Linda Peeno, MD, Domestic Policy Subcommittee of the Oversight and Government Reform Committee, September 16, 2009.
Linda Peeno, “Voice Lessons”- The First Person with Michael Judge, July 6, 2022.
Abraham Joshua Heschel, The Insecurity of Freedom: Essays on Human Existence, “The Patient as a Person.”
Michael Ignatieff, The Needs of Strangers.