Posted on 05/10/2006 4:08:25 AM PDT by sono
As Patients, Doctors Feel Pinch, Insurer's CEO Makes a Billion
By GEORGE ANDERS April 18, 2006
MINNETONKA, Minn. -- When William McGuire switched careers in 1986, he was so restless that a pay cut of more than 30% didn't faze him. Health maintenance organizations were booming, and Dr. McGuire wanted to help run one. So he jettisoned a six-figure income as a pulmonologist in favor of an HMO management job that paid about $70,000 a year.
Savvy move. Today, the 58-year-old Dr. McGuire is chief executive officer of UnitedHealth Group Inc., one of the nation's largest health-care companies. He draws $8 million a year in salary plus bonus, enjoying perks such as personal use of the company jet. He also has amassed one of the largest stock-options fortunes of all time.
Unrealized gains on Dr. McGuire's options totaled $1.6 billion, according to UnitedHealth's proxy statement released this month. Even celebrated CEOs such as General Electric Co.'s Jack Welch or International Business Machines Corp.'s Louis Gerstner never were granted so much during their time at the top.
Dr. McGuire's story shows how an elite group of companies is getting rich from the nation's fraying health-care system. Many of them aren't discovering drugs or treating patients. They're middlemen who process the paperwork, fill the pill bottles and otherwise connect the pieces of a $2 trillion industry.
(Excerpt) Read more at online.wsj.com ...
I got it- lets tax health insurance to make it cheaper!
Pure greed plain and simple.
Congressional outrage?!! Gimme abreak. How much of that goes to his congresscritter and Senator?!!There'll be NO congressional outrage unless Dr. MaGuire fails to pony up to
"his men" on Capitol Hill. Americans forget that this goes on only as long as the each of us chooses to allow it to....
As a medical biller I see how the carriers use stall tactics to not have to reimburse the doctors on behalf of the insured.
The stall tactics are so obvious which results in us who bill on behalf of the provider have to appeal again and again, month after month until we involve the insured and tell them as the insured they need to call their HR dept and report it and call the carrier and demand payment than the provider gets reimbursed.
You have to very large lobby groups, the insurance carriers and the AMA. Looks like the carriers are winning this round.
I don't mind somebody being paid well.
But when a company like United denies a request by a physician for a piece of medical equipment for a patient, and you have to appeal, over and over, to get reimbursed for something a physician has ordered, I do take issue (just relating a personal experience with United.)
The question is, are they "skimping" on patient care, denying claims or meds, in order to pay huge salaries and perks to CEO's. (What was the movie where the insurance company was told to deny all claims first time, LOL. I often wonder if all the claims that are "lost" and have to be resubmitted doesn't benefit the insurance companies by allowing them to collect interest on other people's money/premiums that have already been paid in, while denying or delaying payment of a claim.)
I understand, "let the buyer beware", but like many Americans, if your company chooses a specific healthplan, that's the one you go with.
As someone from a medical family, I hear you. The public and private sector use these tactics. The public sector is worse, but the private sector isn't far behind. For this reason and others, several of my friends and family see a total collapse of the healthcare industry as we know it in the next two to five years.
2 stories on HMO's; 1 bad, 1 good.
I work in a large Pediatric clinic, and handle obtaining prior authorizations/certifications for our patients. This week, I had to call a large HMO in Pennsylvania regarding a child's Remicade (a monthly IV infusion that is very expensive). She is on this to control Uveitis, a potentially blinding complication of juvenile rheumatoid arthritis. She has been on this for the last year, and it is the only drug that has controlled her symptoms (she failed all of the others, including Methotrexate, Cyclosporine, Enbrel, and Humira). When I reapplied for the yearly certification, it was denied, despite documentation that the Remicade was working. The lady at the HMO told me that it was certified "in error" last year, because they don't pay for Remicade for that particular diagnosis.
The good: I have an HMO (different than the previous), and went for an evaluation for a kidney transplant last June (still waiting). When I met with the financial person, he explained my HMO benefits: I would receive NO bills for ANY transplant-related visits or tests. If I did, I was to call this person, and he would take care of it. The HMO takes care of EVERYTHING related to my transplant. Why? It's cheaper to have a patient get a transplant, than it would be to pay for dialysis. Also, this HMO actually strives to provide the best HEALTH MAINTENANCE, unlike the insurance companies that call themselves Health Maintenance Organizations.
Another difference is that the first HMO is "for profit" and mine is "not for profit".
Plenty of blame to go around on this issue. The insurance companies want to improve their bottom line by not paying out, and they also put up "brick walls" because patients think that their insurance should cover "luxuries". E.g. the person with asthma requesting reimbursement for an air conditioner or air purifier for their house, or the obese person expecting the insurance company to pay for a gym membership or exercise equipment. I'm not sticking up for the insurance companies per se, but there is a lot of abuse out there by patients (especially Medicaid patients), so that when people like you or I need something, we end up getting screwed.
"looks like he earned it"
Good, a least someone has some common sense on this thread.
The real culprits here are the lawmakers and regulators, who have written so many rules and regs they are strangling our health care system. This guy has been doing the right thing, making money for his investors.
Looks like a lot of posters here could use a crash course in common sense and critical thinking.
Some days it's really discouraging to see how stupid some people are, even on FR.
True, I realize they have to deny "luxuries."
In our case, hubby had had joint replacement surgery, and had excessive swelling a couple days post op (we had opted to rehab him at home instead of a facility), so the doc said he could be readmitted to hospital to treat the problem, or they could prescribe an "ice machine" to use at home, that might limit the swelling. We wanted to try to keep him from being readmitted so opted for giving the cooling machine a try to see if it would help. The ice machine device worked, and he avoided readmittance, but the insurance company didn't like the idea that the doctor had sent the machine to our house (after hours, it was delivered at 10 at night because it was an emergency) and the doctor didn't get preauthorization for the machine. So they denied. We appealed and appealed and eventually won reimbursement for the rental on the machine (that's a whole other story, it was close to a thousand bucks for something that looked to me to be worth at $200.)
All we need to do is to shut down "K Street" -...heck with the new financial monitioring laws in place since 9/11 it ought to be easy for the people to figure out who's been bought or sold and by whom. "K Street" in Washingotn is what Wall Street is to New York. Its where the lobbyist sand Congress cut their deals.
It's rationing by hassle.
If your business model depends on denying benefits to premium-paying sick people on grounds that are essentially fraudulent, and then paying yourself over a billion dollars with the money you saved, well, you'll get what's coming to you.
Actually common sense is knowing the difference between blatant greed and having enough. If you read about this company you will find that there is some controversy about these options this person acquired.
Sounds as though this certainly wasn't a "luxury".
It doesn't take a rocket scientist to figure out that a $1000 (0r $200) ice machine to use as home treatment is MUCH cheaper than even 1 day in the hospital, not to mention the possibility of avoiding a hospital-acquired infection, which would be even MORE money to treat. I count my blessings that I have a great HMO.
That isn't at all what I was addressing when I mentioned stupidity.
I was reffering to the fact that the underlying problem of our health system lies in state capitals and Washington.
The gullibilty of even Freepers to denigrate those companies and people who are attempting to service the populace in spite of the roadblocks set in their way is disgusting and discouraging to me.
The health care business, with rare exceptions, is not a good place to invest money. This is one of those rare exceptions. Good for this guy. He has done more to help more people than many, and he's done it in the face of great odds.
They priced his stock options at the absulute low for the year. This guy is looting the company pure and simple.
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