HJNO Mar/Apr 2025

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2025 35 to take shape as a variety of discoveries were making treatment of illness and injury a viable option for persons to receive actual care that healed. But the scientific discoveries that led to modern medicine not only created the possibil- ity of cures and healing from illness and injury, it also came at a cost. Like most things in life, healthcare isn’t free. In 1910, if a farmer broke his leg while working on his farm, his son might have run a few miles to summon the town doc- tor. That doctor would journey to the farm to splint the broken leg, thus enabling it to heal correctly. In return, the farmer might very well give the doctor some produce from his farm to pay for his services in the earliest rendition of fee-for-service payment. In fact, in the early 20th century, out-of-pocket payment was the simplest and most direct method of healthcare financing. With that in mind, some might assert that paying out of pocket is the best way to pay for healthcare. They might suggest that if ev- eryone were paying out of pocket, prices would become more transparent and physicians and other providers would compete for customers just like many other industries, thus transform- ing healthcare into a free market like most oth- er goods and services. That might sound good to some, but we would first need to reconcile whether healthcare is a need versus a luxury. I recently bought a new set of wireless earbud headphones that connect to my cell phone so that I could listen to podcasts or music during exercise. I was able to do some internet re- search to help inform my purchasing decision and was able to weigh how much I was will- ing to pay in exchange for the desired level of functionality. But were these ear buds a need, or a luxury? Let’s face it — we don’t need ear buds, but we might want them and value them enough to pay for a set. Alternatively, let’s imagine a scenario where a young woman is experiencing heavy menstrual bleeding and starts to feel lightheaded upon standing and short of breath when she exerts herself. She manages to save up just enough money to pay for a doctor’s visit and labs, with plans to pay for the services out of pocket, only to be told that she is very anemic and needs to go straight over the response to his colleague’s murder was justifiable, his statements failed to acknowl- edge a few fundamental facts. His company is valued at a total market capitalization of nearly $500 billion, making it the “richest” healthcare organization in the world. His company insures over 50 million people through a variety of in- surance products. His company is the single largest employer of physicians in the U.S. and works with over 7,000 hospitals and other care facilities, along with over 1.7 million physicians across the country. If his company is powerless to help redesign the system, then who can? Concluding our prior series on “Changing the Care of Chronic Conditions,” we will em- bark on a new series of articles that attempt to answer the question, “What’s Wrong with Healthcare?” And despite the tone-deaf na- ture of Andrew Witty’s response, there were a few sentences from his New York Times guest essay that should resonate, and that are 100% accurate: “No one would design a system like the one we have. And no one did. It’s a patchwork built over decades.” So, let’s go on a journey to find out what’s wrong with healthcare; and, like any journey, the only way to know where we are and where we are head- ed is to first understand where we have been. How did we get where we are? 1880s to 1920s Modern medicine has its roots in the 16th and 17th centuries when a series of advancements propelled us into an age of scientific exploration and deeper understanding of the science of the human body. With the development of the microscope in the 17th century, an entirely new world of microbes was discovered that set the stage for subsequent discoveries such as vac- cines in the late 18th century and eventually an- tibiotics in the early 20th century. The discovery of anesthesia and antisepsis in the 19th century made surgery a viable option, and the discov- ery of radiographic imaging in the 20th century allowed us to visualize inside the human body without the need for incision for the first time in human history. By the early 1900s, the scientific discipline of modern medicine was beginning The highly publicized homicide of a health insurance executive on the streets of New York City in early December 2024 was shocking enough. Any doubts as to whether the death of Brian Thompson, CEO of United Healthcare, at the hands of a lone gunman was a targeted assault were immediately laid to rest by a series of clues left behind at the scene. Bullet casings left behind had the words “deny,” “defend,” and “depose” inscribed on them, purportedly alluding to tactics of health insurers aimed at avoiding payment for healthcare services. Such clues and the subsequent search for the mur- derer captured the attention of the American public in dramatic fashion. But the shock of this storyline and the ensuing manhunt paled in comparison to the level of vitriol spewed by the public as many cheered the murder of this healthcare executive, who also happened to be a husband and father of two sons. The accused murderer, Luigi Mangione, quickly col- lected legions of adoring followers on social media, many even contributing to his legal defense fund. In the days and weeks that fol- lowed, story after story was written about the perceived injustices of our healthcare system, with health insurance companies — and their executives — featuring a starring role as the villains in this saga of an unfair, uncaring, and unjust system. But is that narrative accurate? And what exactly is so wrong with health insur- ance that the moral compass of many in our nation would resort to cheering the murder of the father of two boys and celebrating the accused perpetrator of such a horrid crime? Andrew Witty, CEO of UnitedHealth Group (and Brian Thompson’s boss) appeared on CNN days after the shooting, declaring that the U.S. health system “is not perfect” and that coverage decisions “are not well understood.” Witty went on to write a guest essay in the New York Times stating, “We know the health sys- tem does not work as well as it should, and we understand people’s frustrations with it. No one would design a system like the one we have. And no one did. It’s a patchwork built over de- cades.” Andrew Witty’s response was seen as tone deaf by many, and while his indignation “We are all better off when we lift each other up, for the strength of the collective is far greater than the sum of individual parts.” – Unknown