This is such a skillful evisceration of the largest company in US healthcare that I feel it's worth bending the forum rules and asking people to watch. However, to show a little deference to the discussion format here, here is a bit of transcript...

...and YT has in its wisdom chosen to block my copy/pasting of some introductory passages from the transcript they provide.

Can I get a variance here? (At least until I can copy it elsewhere)

32 minutes ago, TheVat said:

This is such a skillful evisceration of the largest company in US healthcare that I feel it's worth bending the forum rules and asking people to watch. However, to show a little deference to the discussion format here, here is a bit of transcript...

...and YT has in its wisdom chosen to block my copy/pasting of some introductory passages from the transcript they provide.

Can I get a variance here? (At least until I can copy it elsewhere)

I don't think we get that in Europe.

Is this the same video?

https://www.instagram.com/reel/DdoXjZtjprc/

Must be geolocked. Here is a Guardian article on that, if it helps. https://www.theguardian.com/tv-and-radio/2026/sep/21/john-oliver-united-healthcare

That being said, even without that I suspect folks from most countries have an idea how inherently weird and messed the US system is. I remember furious debates with my American colleagues when Obama tried to pass ACA, and one of the most common arguments I heard was: "but that would be socialism!"

via VPN/Nigerian access:

Chapter 1: The shooting of Brian Thompson

We're actually going to dive straight in with our main and only story tonight, which concerns health insurance. The thing supposed to cover anything bad that happens to your body, except eyes and teeth, as those cost extra. They are the guacamole of the face. Specifically, we're going to talk about United Healthcare, the country's largest insurance company. As you undoubtedly know, almost two years ago, its then CEO Brian Thompson was shot in Midtown Manhattan while going to an investor conference. And that killing was noticeably not exactly met with universal sympathy. In fact, in some quarters, there was even support for Luigi Manion, the suspect who since admitted to the shooting.

This Ivy League hottie named Luigi is the Robin Hood that we never knew that we needed. This is like regular everyday person becoming our hero, our vigilante. Universal healthcare now. Yeah. Or free Luigi. Yeah. Luigi had a lot of fans, many of whom, like that guy, supported him by wearing green hats, which must be so weird for Nintendo. This guy has been Mario's sidekick for decades now without controversy. It'd be like finding out that every Mario Kart game had OJ Simpson as a playable character. But that was just the beginning. A sign depicting Luigi as a saint was projected on a New York building like his album was about to drop. And supporters showed up at his arraignment dressed in shirts that said things like, "I love Italian boys and cougars for Luigi." And look, let's just get this straight out of the way. Luigi is hot. There is no way around that. In fact, he is so hot they even had to acknowledge it on the news.

So much of, you know, the clips we were watching at the top of this segment are driven by the fact that this is this is an attractive we got to drop the banner to show why. And and it's it is deeply troubling that we are celebrating this this person who's committed cold-blooded murder. Uh because, you know, he clearly went to the gym. Yeah. Someone on that panel said, "Drop the banner." So viewers can understand the full extent of Luigi's attractiveness. Cheeky pecs peeking out is insufficient. We are the fourth estate and we will show all four rows of abs. But it's not just that Luigi was handsome.

Chapter 2: The ubiquity of United Health

One reason many found it hard to completely condemn the murder is that so many Americans are furious with United Healthcare. In fact, shortly after the shooting, when a poll asked, "How much responsibility do you think each of the following had for the killing?" 78% said the killer held some responsibility, which of course, but 69% also blamed denials for healthc care coverage by health insurance companies. In fact, one of United's executives even coincidentally alluded to public anger at the investor meeting taking place on the day of the murder and claimed that it was all misdirected. There no way you would design something as complicated and as contradictory and as difficult to navigate as the system we all find ourselves in today because nobody designed it. It simply evolved. Oh, I get it. It's It's not United's fault the system is like this. Nobody designed it. It just evolved naturally. It presumably all started when this nasty crawled out of the ocean and they're therefore regrettably out of network. And and not long after that, that same guy gave an address to his company's employees and offered a pretty direct piece of advice to them. I encourage you to tune out that critical noise that we're hearing right now.

Wow. If someone shooting your insurance division CEO won't make you listen to critical noise, I'm not sure anything will because that is pretty much the ultimate Yelp review. That man is Andrew Witty and at that point he was the CEO of United Health Group. That is the company that owns United Healthcare. You know, in the same way that Alphabet owns Google or Benson Boone owns back flipping. I know that other people must have back flipped before him, but I cannot name a single one. And while you are undoubtedly familiar with United Healthcare as an insurer because it served almost 50 million people last year, you may be less aware of the sheer scope of its parent company, United Health Group. Last year, it took in $447 billion, making it the third largest company by revenue in the US. That's behind only Amazon and Walmart and above Apple. It's almost unimaginably massive as it doesn't just own United Healthcare. It now also has subsidiaries touching almost every aspect of our health care system. In fact, as the Washington Post put it, in many parts of the country, a patient could be a United Health customer from cradle to grave, starting with obstetric care and ending with hospice services. And you should know that was their aim all along. In fact, in 2007, United Health Group's then CEO Steven Hemsley, who's recently returned to that role, said the company was trying to be a health care system unto itself, which is a pretty far cry from, hey, nobody designed this. The system just evolved naturally from the fertile crescent of Mesopotamia.

And the very fact that one company controls so much of America's healthcare is what makes it so infuriating when you see just how bad people's experiences with it can be. In fact, if you just search for United Healthcare on Tik Tok, it will not take you long to find videos like these. I am frustrated. I'm I'm living in pain and you guys are denying everything.

What is wrong with you? United Healthcare, get it the together. I have a surgery that um has already been cancelled four times due to United Healthcare denying a claim. I want somebody to go tell United Healthcare to eat a giant dick.

Yeah. telling United Healthcare to go #### itself has become an entire genre of internet video, like unboxing products or horny whispering or someone doing a dance trend with their friend who's not quite as good at dancing as they are, which you feel is why they picked that friend in the first place. And look, Luigi's upcoming sentencing is obviously going to get a lot of media attention.

Chapter 3: The culture of claims denial

It is really important that that noise doesn't drown out the broader frustration with United that is case also revealed. So given all of that tonight, let's talk about United Health Group, how it makes so much money, how big it's gotten, and what that means for all of us. And let's start with the aspect of United that you're probably most familiar with. The fact that its insurance division has a well-earned reputation for denying claims. So much so, in fact, the shell casings for the bullets fired at Brian Thompson were inscribed with deny, delay, depose. A reference to a common criticism of the insurance industry that they delay, deny, defend. Basically, delay processing claims, deny paying them out, and if necessary, then defend that denial. Now, United will say that is completely unfair. It loves to repeat the argument that it actually pays out 98% of all eligible claims under the terms of members plans, which sounds great. But remember, the company itself is the one determining what is and isn't eligible. And the glimpses of data that are publicly available suggest a very different picture. For instance, when KFF examined a group of 37 million claims under United's Obamacare plans, they found that in 2024, nearly 1 in 5 in network claims were denied. But it is not just denials. There's also the practice of the company requiring prior authorization for certain treatments which can be the bane of both patients and doctor's existence. Just listen to this doctor who had to get permission from United to prescribe someone a cheap basic blood pressure drug. I just got a prior authorization from United Healthcare for Leinipro. I hope the whole board at United Healthcare gets diarrhea tonight.

Yeah. Yeah, I get it. And look, in the interest of balance, I should say that man does not speak for all doctors. In fact, one actually issued a response to that video that took a different tack. Now, as frustrating as it is for us to have to do prior authorizations and other ridiculous paperwork for the insurance companies, I don't think as health care professionals, it is appropriate for us to be wishing ill upon other people except for the board [laughter] of healthcare. Yes. May [cheering] they have explosive diarrhea, not just tonight, but everyone. [applause] Perfect. In fact, I'll even go a step further. I hope they get diarrhea every night and then have to pay a ton of money out of pocket to treat it because the gastrointestinal distress associated with the guilt of being a healthcare executive turns out to be a pre-existing condition.

Chapter 4: Overruling medical advice

And on the patient side, fighting claim denials or seeking prior authorizations can be a massive time suck, too. Take these parents whose workplace insurance is administered by United and whose child has a rare neurological disorder. Your experience with your insurer, if you had to sum it up in one word, what would that word be? Frustrating. Like her physical and occupational therapy, it's the same claim every month and every month they'll deny it because instead of looking at all of her diagnosis, they look at the top line and go punch it in the computer and say, "Nope, denied."

It's hours a week, if not more. And every time we have to call in, it's a different claims rep we have to deal with. To bathe without drowning, Emmy needs to be strapped into this chair. Amid the maddening fight to get one covered, Carrie says a United Healthcare rep had this suggestion. They said that we should find a way to give her a bath. Either us getting in the bath with her or just wiping her down was sufficient enough. Wipe her down. She's not an iPhone you just sneezed on. She's a human being. And while thankfully those parents did finally get that chair, it was only after a prolonged back and forth. In fact, when their daughter outgrew that chair and needed a new one that cost $1,800, they opted to skip the hassle of dealing with United again and pay for it with donations coordinated by his employer. But at that point, having insurance sure looks an awful lot like not having it. Because if you are paying premiums but still having to take up a collection for medical equipment, what exactly is your insurance for? They're just sending you mail you don't want to open and forcing you to have phone calls that make you angry. And we all know that is supposed to be your nana's job.

No. No. No. Nana New York is not under Sharia law. No. No. Also, what do you mean I sound like I put on weight? How is that possible? Exactly. And the thing is, far too often, United's denials can seem to be completely at odds with medical advice patients are getting.

Take this story of a woman who was fighting cervical cancer. Several years ago, Kate Weissman was diagnosed with cancer. Because her cancer was so close to her vital organs, her doctors wanted to use a very special type of treatment called proton beam radiation therapy. Basically, the radiation is beamed exactly where it needs to go, and it protects the organs. But guess what? Her insurance company, United Healthcare, said, "Nope, we're not paying for it." Yeah, that is maddening. That woman's own doctors got overruled by people who had no experience with her case. Which is just ridiculous. It's kind of like how sex ed at Catholic school is taught not by medical professionals, but by Sister Henrietta, who's never even had sex, except you know, that one summer in Italy, the convent center there to study, but it was so hot and the sea was so sweet and Valentina was so beautiful. They spoke in different tongues, but connected in a way that transcends language. It was perfect, pure. One could even say holy, but all too brief. And when the air cooled, and they parted for the final time, the pain was like nothing she'd ever known to this day. Whenever she sees a shock of red hair, she yearns to sprint down the street to spin Valentina around to take her face in her hands. But each time she lets the moment pass, they probably wouldn't even recognize each other now. And yet Henrietta still keeps her greatest treasure, a secret between the pages of her Bible, a white lily browned and brittle with time, nestled in the book of Psalms. And that is why you should never ever have sex. Not even once. [cheering and applause]

Chapter 5: Algorithmic decision-making

Now, United Healthcare insisted in that woman's case that three independent radiation oncologists agreed that protonbeam therapy was not safer or more effective than the proven standard of care. But here's the thing about that. She actually had six highly esteemed oncologists advocating on her behalf, including five who also teach at Harvard Medical School, with the sixth presumably sick of having to hear about how the other five teach at Harvard during every conversation. Meanwhile, one of United's OBGYns who helped deny that woman's appeals wasn't even boardcertified in gynecologic oncology. She did however co-found a tattoo laser removal business and apparently once violated the state's medical code by allowing an unlicensed individual to perform laser-based procedures. And I'll be honest, I personally would not want my cancer treatment being decided by that person, even if they are probably destined to become deputy secretary of health and human services.

Now, in the end, her parents paid $95,000 out of pocket to cover the treatment, which in happy news did actually work. But having access to wealthy parents just cannot be the system to get badly needed healthcare. Even if it is apparently the system that lets you be in charge of HBO. Yeah, my soon-to-be business daddy has a literal business daddy. And to be very clear, I deeply respect that and I would never make fun of you for it unlike that pesky Steven Colbert. And look, it is frustrating enough when United's medical experts are coming to bad decisions, but in some cases, there's evidence people are barely involved at all. Because former employees of one United company have said that when determining how long to cover patients stays in skilled nursing facilities to recover from injuries, they'd rely heavily on an algorithm called NH Predict, which would routinely come up with a date earlier than they felt was appropriate under Medicare guidelines. And as this former case manager explains, there were real problems if she tried to contest that.

You've got all this experience, can you use your human judgment instead if you saw that it was wrong? Wouldn't that be great? [laughter] Unfortunately, no. The expectation was I would stay within 3% of that estimated discharge date, but by the time I stopped working, it was down to 1%. 1% 1%.

Chapter 6: Vertical integration and profits

That's true. And employees have said that deviating from that 1% can mean exposing themselves to discipline, including possible termination. And look, United Health Group will claim those were individualized decisions made by the company's medical directors and that they were consistent with Medicarecoverage criteria. But here's the thing, if a company essentially forbids its case managers from deviating more than 1% from an algorithm, that company is run by an algorithm. And that is very dangerous because as we all know algorithms can make huge mistakes. It is why for instance HBO suggested that you watch this show after you caught up with euphoria. Why [laughter] would it do that? No one is hot here. No one's on drugs and no one is getting laid. I am the onlogical opposite of euphoria. And look, everything you've seen so far is basically part of the course in the insurance industry. United may be worse in some ways, but they're not that much of an outlier. Where United is genuinely different though is in its size because remember it is the third largest company in America. And the way it got that big was by expanding into other non-insurance areas of healthcare. Over the years, it's engaged in something called vertical integration. Basically, instead of acquiring more and more competitors in the insurance field, United focused on acquiring more and more parts of the healthcare industry. And to be fair, it's not the only company doing this.

CVS Health, for instance, has built a similar vertically integrated behemoth as, in addition to its drugstores, it also owns a massive insurer, Etna, and a pharmacy benefit manager, CVS Caremark, while also having its own medical clinics, all of whom subtly share the same heart in their logo. And honestly, I do appreciate that. When I'm picking up my prescriptions at CVS after spending 45 minutes asking someone to unlock every single shelf for me, it is nice to feel loved. I'm so sorry for wanting to shop at your store.

[laughter]

But amazingly, United is even bigger. It has about 2700 subsidiaries, including primary care clinics, surgical centers, urgent care centers, home health agencies, hospice agencies, mental health agencies, a pharmacy benefit manager, and plenty more. To name just a few, through its subsidiary, Optum, United Health Group directly employs about 9,000 physicians and has non-exclusive contracts with some 80,000 more. Meanwhile, another United subsidiary, Optum RX, manages 62 million patients prescriptions. The company even has its own bank, Optum Bank, which has $20 billion in assets. And the company will claim that all of its acquisitions have helped it coordinate and align incentives to deliver what industry leaders refer to as valuebased care. And that notion that all its subsidiaries really add up to more than the sum of their parts is something they love to hammer home in upbeat ads like this one about the company's prescription benefits. Before Mark even picks up his prescription, United Health Group goes into action. Mark's doctor gets real-time information to prescribe the most effective, lowest cost medication.

Mark's medical and pharmacy information are connected, allowing clinical experts to hone in on any possible risks with a prescription. And Mark's about to get a discount at the counter, working behind the scenes to ensure quality and savings. This is what healthcare can do when it's caring and smart. United Health Group. Oh, well that sounds nice, doesn't it? It almost makes United sound more like a farm-to-table restaurant instead of a massive data sharing panopticon.

But owning all these companies is hugely helpful to United's bottom line and in ways that you might not expect. For instance, if you ask United Healthcare the insurer, they'll insist they barely make money at all. They'll claim their insurance profits are only around 5%.

They'll also point out that their insurance profits are capped because under the Affordable Care Act, they're required to spend 80 to 85% of the premiums they collect directly on patient care or on quality improvements.

Chapter 7: The economics of upcoding

What they don't say quite as loudly, though, is that that only applies to the insurance side of the company. United Health Group, on the other hand, makes a ton of money. And one of the key ways that it can do that is through its vertically integrated model. Because it is often on both sides of billions of dollars in transactions. Very basically when United's insurance arm is paying out that mandatory 80 to 85% on healthcare, the company on the other end of that transaction is often also United and it can use its ownership of one part of the healthare system very much to its advantage in another. Take up coding. It is the practice making a patient look as sick as possible on paper to make more money. For an example of this concept, just watch this scene from the Fox medical drama, The Resident, where an outside consultant is telling a room full of doctors how she wants them to up code.

Now, to simplify, doctors and nurses at Chastain need to charge more per procedure. For example, ear infection typically build to insurance as service code one at about $200. But what if that ear infection took a trip to the brain? That's now a code four. Serious, costly. We can bill in the thousands. Illness is unpredictable.

So billing must be proactive, right? It's called up coding. fake cute code up to excellence. Yeah. It turns out up coding is so common they're making fun of it on network TV which is just wild to me. It is being explained in the same place where people watch Survivor Dancing with the Stars and Tracker. Oh, I'm sorry. You've never heard of Tracker? Over 16 million people watch it. More people have watched Tracker than have ever watched a single episode of this show.

[laughter]

What? What's it about? I don't know. Jeremy Tracker tracking things. There's just no way to know. But people love it. And while it is not strictly necessary for you to understand the rest of this story, I would be remiss if I didn't tell you that in that same episode that consultant gets in trouble after ordering a patient get an expensive MRI that he doesn't need. And then this happens.

Mr. Reynolds, do you know how an MRI works? It has incredibly powerful magnets. Magnets that will rip [music] anything metal out of your body. Anything at all. Do you have anything metal in your body, Mr. Reynolds? Mr. Reynolds has a penile implant. A metalbased penile implant. How much is your penis worth to you, Mr. Reynolds? Say a lawsuit. A million dollars? $5 million? Stop the machine.

Yes. War shows should be brave enough to have a character ask the question, "How much is your penis worth to you?" You know how many times The Pit has asked that? zero. Take back that Emmy.

Now, in that clip, doctors were the ones being encouraged to upcode so that their hospital could charge insurers more. But as we discussed in our episode on Medicare Advantage, insurance companies can also benefit from upcoding uh to get more money from the government. Very basically, under Medicare Advantage, the government will pay insurers a higher rate for patients with more serious conditions. That was meant to discourage them from cherrypicking only the healthiest people. But obviously that also means that the sicker insurance companies can make their customers look, the more money they can then claim. And it turns out, as United Health has gobbled up medical practices through its Optum subsidiary, doctors at those clinics have said it's placed enormous pressure on them to code patients intensively. Although, fun fact, they don't actually use the acronym Cute. That would obviously be ridiculous. Instead, their coding guide book tells doctors to use the pneumonic treatment, assessment, monitor, plan, evaluation, and referral or tamper. And I don't know, guys, personally, I might have picked an acronym with a less negative connotation because what kinds of things does someone tamper with? So far, I've got evidence and end of list.

And and while United will claim they have robust safeguards to ensure accurate coding, it's reportedly pressured its doctors to code as many conditions as possible by offering bonuses to those who coded aggressively and reviewing the performance of those who weren't coding as much. In fact, doctors have even described being emailed a kind of leaderboard that compared them locally and nationally by the percentage of their Medicare Advantage patients that they diagnosed with certain chronic diseases. And all this aggressive coding has made United a ton of money. In fact, one study found it receives $12 billion a year in additional payments because of higher coding intensity alone. And the thing is that's by no means the only way that United pressures doctors, those in formally independent practices acquired by Optum, have said it's also overhauled their schedules with some required to see three to four patients an hour and complaining that they barely found time to eat or pee. In fact, one doctor in Massachusetts who retired after Optum acquired her practice said, "I feel just like an Amazon warehouse worker where all I'm doing is 20 minutes, 20 minutes, 20 minutes, 20 minutes." Which obviously is not great. Doctors should not feel like Amazon warehouse workers. Not even Amazon warehouse workers should feel like Amazon warehouse workers. But that is a story for another show that we have already done.

Chapter 8: The perils of systemic dominance

And the thing is, because United is so massive, even doctors who don't work directly for them can wind up being negatively impacted by them and sometimes in surprising ways. Take Change Healthcare. It's a United House that processes more than a third of all US claims betweenies, doctors, hospitals, and insurers. That is a lot.

But there are real hazards to letting one company be that dominant. Something that became painfully clear in February 2024 when it was subject to a massive Russian ransomware attack.

At this busy New Hide Park medical practice, claims cannot get submitted. Doctors aren't getting paid. Procedures aren't getting needed.

Pre-authorization. Change Health owned by United Health, which handles much of the nation's medical records, was hacked three weeks ago. A huge part of that system is down, and the people responsible for making it work aren't stepping up to the plate.

Ronald Lazlo went 10 days without medicine he needs to prevent a transplanted kidney from being rejected because the pharmacy couldn't get authorization.

The bottom line is it could kill you.

Now, that is obviously awful. But what makes it especially infuriating is that apparently one reason the system was so easy to hack is that the company's portal did not have multifactor authentication, which is just insane. As a rule, medical record platforms should be required to have operational security at least as good as the Buffalo Wild Wings app. And notice I didn't even say better there. I just said at least as good as the app that lets you order a bacon smashed hatch chili burger with a whole chocolate fudge cake for dessert. At least meet that bar. Now, the good news for all those doctor's offices whose businesses were so massively disrupted by that hack is that United through its bank subsidiary quickly offered them no interest bridge loans.

Basically, it was using one part of its company to clean up a mess that another part had just made. Unfortunately, that bank then caused a different problem by demanding full repayment of those loans little more than a year later, even threatening to withhold insurance payments from United Healthcare if providers didn't pay up. And this caused a serious crisis for practices like the one owned by this pediatric brain surgeon, which got a loan of just over half a million dollars.

I really believed that Optum would give physicians a reasonable amount of time to repay the loan with the understanding that this financial crisis almost bankrupted us. Despite United saying the loans didn't need to be repaid until doctor's practices were back to normal, United Health told Missoula in January that she had five days to pay the money or it might start clawing back reimbursements.

We easily lost over a million dollars because of that hack. I'm just a pediatric brain surgeon, right? So, what do I know? But we didn't cause this problem. We were just financially devastated by it. Okay. First, I'm just a pediatric brain surgeon is one hell of a flex. But second, that that is one of those professions where if you are fighting with them for any reason, you're going to come out looking bad. It's like when Katy Perry was in court with those nuns over buying their former convent. That would have been a tough PR battle, even if one of them hadn't begged, "Katie Perry, please stop," before then collapsing and dying in the middle of court. It is amazing to me that we don't talk about that more. And by the way, that nun Henrietta, [cheering] her final words were, "I'm coming, Valentina." A sentence she hadn't uttered in 50 years. But that is the thing about United Health Group.

Chapter 9: PBMs and drug costs

Whatever corner of its business you poke into, you can find something appalling.

Which brings us to our final example tonight, which concerns its pharmacy benefit manager, Optum RX. Pharmacy benefit managers or PBMs are basicallycompanies that serve as middlemen between drug companies and insurers. And they have a lot of power because they decide which drugs your insurance will cover. That is why drug companies will often give PBMs what are essentially kickbacks in the form of rebates of a percentage of their sales to try and stay on their good side. And over the years, Optimx has engaged in some truly unsavory practices. For instance, when the opioid crisis was spiraling out of control, there were some who argued that PBMs should remove drugs like Oxycontton from their lists. But Optum very much did not do that. Instead, it asked Purdue Farmer to pay them higher rebates, going from about 23% of every sale to about 60%. And when a manager at Optimar suggested removing it from their list of covered drugs, saying of Purdue, they basically caused the opioid epidemic and were essentially rewarding their bad behavior. Another manager wrote back, "Valid point. We as a company looked into this, but the amount of utilization on Oxycontton and the rebates we collect prevented us from doing it." And honestly, I almost respect that level of honesty. It is not often that you get a confession that's essentially just, oh, we knew we shouldn't do this, but in our defense, we did really want to. If if Luigi's lawyers had just told him to plead that way instead, there's a nonzero chance he'd be walking free right now. But it's not just opioids. The company's decisions to abruptly switch out what drugs it'll cover has had utterly devastating consequences.

Take what happened to Cole Schmidnik, a 22-year-old with severe asthma who showed up at a pharmacy with a prescription for an Adviscus inhaler.

And then this happened. Cole had insurance through his Wisconsin employer. What he didn't know, his parents say, is that Optum RX, the pharmacy benefit manager for his plan, changed its list of covered drugs. The preventative Adver discus inhaler he had used for years cost no more than $66.86. Suddenly its price tag over $539.

Holy That is a nasty surprise. Cuz there are things that you expect to cost $500 like a Nintendo Switch or tickets to see Ed Sheeran two weeks ago. They're they're cheaper now apparently.

[cheering]

No idea why. But being able to breathe is not one of them. And frustratingly, Optimum RX even later admitted that it replaced that Advare disc is on its coverage list. Not for medical reasons, for based on rebates, the manufacturers of similar competitor drugs agreed to pay. Now, apparently, I have to tell you, the company claims its electronic system instructed the pharmacy to contact Cole's doctor to get him a prescription for a more affordable alternative, which they apparently didn't. But the thing is, even if they had, as anyone who has ever dealt with an overworked doctor's office can tell you, getting a new prescription is not a quick process. It takes time. And unfortunately, Cole needed those meds immediately because I'll let his father pick up the story from there.

His family's lawsuit says Cole repeatedly struggled to breathe and 5 days later had a severe asthma attack and began to esphixiate. I could, you know, sense that he was having an asthma attack. His purpose of the call was simply to ask about his insurance. And I said, "Don't worry about that. Just get to the hospital." A roommate drove Cole to the hospital, but Cole was unconscious by the time they got there. He died days later.

He couldn't get his Advare. And um we were told by his roommate that it was over $500. And you know, Cole had to make a decision of paying that exorbitant price for his medicine or other bills. Um, and apparently he not apparently, he walked out without it.

That is an absolute tragedy and it was completely preventable. This is the richest country in the history of the world and yet for some reason our current health system still forces people to walk away from medicine that will literally keep them alive because they can't afford it.

Chapter 10: Calls for systemic reform

So, so, what can we do about all of this? Well, as I've said before, I would argue the broadest solution is to find a way to transition to a singlepayer health care system that would solve many of the problems that you've seen tonight. And though getting anywhere close to that feels a ridiculously long way off, I don't think it's unreasonable to say that at the very least, United Health Group should not be allowed to exist in the form that it currently does. There's actually a bipartisan bill right now sponsored by Elizabeth Warren and Josh Hol that would separate the payer and provider roles in healthcare so that United couldn't be in the situation where it can just pay itself. And while that is clearly not going nearly far enough, it is at least a start. And I know United may well continue to try to tune out the critical noise or argue that nobody designed this system. It's simply evolved. But what is clear is that everybody but them wants it to work very differently. Because right now, the way companies like United exist, they are at best pointless timewasting middlemen and at worst algorithmically driven ruthless arbiters of who lives and who dies. And until such time as they've made significant changes, or much more likely had those changes forced upon them, then in the words of my new favorite health care provider, may they have explosive diarrhea not just [cheering] tonight, but everywhere. Exactly.