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When The Mask Slips - A Clearly BROKEN System
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I want to start the video by acknowledging something which is that health care is an impossibly complicated subject. Countries all around the world choose different systems. People all around the world have different opinions, but the underlying foundation across all of it is that when someone is sick without the ability to fix that problem for themselves, they want help with it. I can't sit here and tell you what the system should be. I'm not even remotely qualified to do that. Very few people conceivably are. But what I can do is tell you when something is broken. To give a sort of extreme example here, I can't build a car, but I can tell you if the car won't start or if the brake pedal stops working. I wouldn't necessarily be able to tell you why that happens. But when something as obvious as the brake pedal completely fails, the issue stops requiring complex knowledge. Basically, anyone who gets in the car from that point forward can tell you this is broken. And you don't really get to argue with them. It's an imperfect comparison. If the car was healthcare and the brake pedal was wrongfully denied claims, as soon as you said, "This is broken," someone would slither out of the woodwork to complain about how the car is actually super wellmade and probably you did something to the pedal. So, the fact that it's broken doesn't make the car bad, it makes you bad because that car over there has even worse problems. Would you rather be driving that car, you socialist? The entire discussion is painfully derailed by politics. Which car or system is superior? what should or shouldn't be changed about it with millions upon millions of people arguing that don't even have the faintest idea what they're talking about. But looking past the surface level bickering once in a while if you're paying attention that is something will happen which is just so egregiously obvious it shatters the house of mirrors and lets everyone see what's actually there which in this case is a broken piece of the system that needs to change. Here we go. This is a man named Luigi Manion. Most people have probably heard the name before, who's currently on trial for the murder of Brian Thompson, CEO at the time, of a company called United Healthcare. Actually, it's a little bit of a technical spiderweb here. United Healthcare is one of perhaps hundreds of subsidiary companies incorporated across the United States, but the ultimate parent organization at the top of this corporate tree is called United Health Group. Well, United Health Group, aside from being a $350 billion industry behemoth, is also a substantial political donor. Over the past few years alone, they've donated tens of millions of dollars to various different lobbying groups. And something else that becomes clear rather quickly is that they do this across the entire political spectrum of the United States. This is what's called buying influence. And if we're talking about a broken system, companies paying tens of millions of dollars, mostly to exgovernment workers at these firms, who then go on to lobby current politicians as an effort to impact future policy. At a certain point, that company is no longer just a participant in the broken system. They're an architect of it. Regardless, United Health Group is no stranger to controversy. Back in November of 2023, the company was sued in a Minnesota class action lawsuit for allegedly and willfully using a highly flawed algorithm called NH Predict in order to quote prematurely and in bad faith discontinue payment for health care services for elderly individuals with serious diseases and injuries. End quote. Further down on page 11 of that lawsuit, we can also read this quote. The NH predict AI model attempts to predict the amount of post-accute care a patient should require, pinpointing the precise moment when defendants will cut off payment for a patient's treatment. The NH predict AI model compares a patients diagnosis, age, living situation, and physical function to similar patients in a database of 6 million patients it compiled over the years of working with providers to predict a patients medical needs, estimated length of stay, and target discharge date. End quote. That's already bad, if true. It's an AI model effectively deciding you should be done healing, therefore you are done and you get no more care. But something else I want to make note of is that this is far from the only healthcare company where it's allegedly happening. In July of 2023, a healthcare company named Sigma was sued for using algorithms to unlawfully deny patient claims. And in December also of 2023, a healthcare company called Humana was also sued for allegedly using AI programs to prematurely cut funding for rehabilitative care. Still focusing individually on United Healthcare, according to a stat investigation of the company in November of 2023, quote, "Three former case managers said the individual stories behind the algorithmic denials were haunting. An older woman found in the laundry room by her grandson after a stroke, her right side paralyzed, was allotted 20 days of rehab by the algorithm when the average for severely impaired stroke patients is almost double that." End quote. That's just one example, but for the sake of time, I'll focus on two additional segments from the investigation. First is this quote, the stringent performance goal was part of a broader effort to reduce expensive nursing home care for frail patients with privatized Medicare plans. The internal documents show the strategy was conceived and executed by former top Medicare officials whose policies became a blueprint for United Health to reap hundreds of millions of dollars annually by shredding the government's safety net with payment denials backed by an algorithm. End quote. Lastly, and I appreciate everyone bearing with me on this. I know some of it's dry and boring. Lastly is this quote from healthcare market analyst Spencer Pearlman, which I believe perfectly sums up kind of the whole problem. Quote, "You can maximize your profitability if you're able to get people out of expensive care settings as quickly as you possibly can." End quote. And that is the critical issue here. Say what you want about the system as a whole. Argue whatever you feel like in terms of other countries or structures or politics, but the stone cold fact here is that United Healthcare was already neck deep in over their alleged use of algorithmic systems to wrongfully deny patient care. That's what matters. Well, flash forward to December of 2024 and we have a very specific timeline of connected events. Here goes. On December 3rd, again, 2024, United Healthcare issued a financial guidance statement citing net earnings targets of roughly $28 per share and adjusted earnings targets of roughly $30 per share. December 3rd, 2024. However, on December 4th of 2024, CEO Brian Thompson was murdered in New York City at the annual investor conference. This is where things get technical. On January 16th, 2025, this time about a month and a half later, United Healthcare releases a statement reaffirming their previous net earnings estimate of $28 and adjusted net earnings of roughly $30, which is even further reinforced during the company's investor call transcript recorded by Mly Fool where we can see quote from chief financial officer John Rex. Next question. Given all that, are we confident in the adequacy of our pricing for 2025? The answer is yes, and here's why. to start for 25. The outlook we shared in December incorporates a view of care activity commensurate with what we saw in 24. Even the care activity we experienced as we exited the year. End quote. Now, there's a fair bit of corporate double speak happening here all over the place. But from what I see, he's basically pontificating about how the end of the year saw increased care activity, which means we had to pay a lot more money than we expected to help people. And that's where things get dicey. He gives all sorts of complicated reasons about why that might be the case. But something we have to consider is that the murder of CEO Brian Thompson was ideologically motivated. Luigi Manion, it would seem, had a deeprooted disdain for the healthcare industry at large, specifically United Healthcare. And one of the most obvious connections was inscribed directly on his ammunition. Deny, defend, depose. three famous words now carved on casings which refers to the tactical process by which insurance companies avoid paying claims. Remember, United Healthcare is already neck deep in credible allegations and ongoing lawsuits that they used AI programs to wrongfully deny patient claims and restrict important care for the sake of profit. Make sense? Hopefully, yes, it makes sense because there's more. But before I get to that part, I want to ask kind of a question. Should it matter for the company's financial bottom line if an executive is killed? Not to be callous here, but should it realistically matter if a company is merely conducting a legitimate business that one of their top level executives was suddenly taken out of the equation? To a degree, yes, obviously. Although some companies are only successful because of their founder or CEO or a top level executive. But many other companies, it's a revolving door. I mean, they're like Lego blocks. You can put them in and take them out. It's largely based on nepotism as well. None of them are even qualified and they're overpaid, highly overcompensated. But regardless, that's a whole separate thing. It shouldn't really matter or impact their immediate financial status or shall we say short-term earnings, right? Ideally, no. Sticking to our previous metaphor of the car, if the CEO of I don't want to get a cease and desist from a car company by saying a specific name, the CEO of car company X or Y or Z was suddenly incapacitated, it wouldn't really impact the short-term runway of cars being manufactured and shipped. Unless, and here's where things get sticky, unless he was killed by someone who was disgruntled over the fact that the brake pedals didn't work. Well, if the allegation and apparent motive for the crime was that the brake pedals didn't work while the company simultaneously faced other lawsuits and credible investigations over deliberately making a bunch of the brake pedals not work because it's way cheaper, then you suddenly do have a problem. If you keep doing it, which is the only way you manage to have profit margins that high in the first place, you run the risk of people getting even angrier with you or attracting the attention of regulators, which would be much worse. But if you stop, you have to actually pay the money you owe or should be paying in the first place. Enter this. This is a press release from United Healthcare, April 17th of 2025, which says, quote, revised 2025 earnings outlook to 24 to $25 per share with adjusted earnings of 26 to 26.50. End quote. Suddenly, things start making a little bit more sense, don't they? Obviously, yes, they do. But here's the part where it goes totally off the rails. On May 7th of 2025, in the Southern District of New York, yet another lawsuit gets filed. this time a class action investor lawsuit which specifically takes aim at the financial statements that I previously mentioned right altogether claiming that United Healthcare knowingly misrepresented their financial status thereby harming investors. But I want to read from pages 9 and 10 right now because the language here is where it just all falls apart. Quote, "The statement in paragraph 33 was materially false and misleading at the time it was made because it omitted that the company was no longer willing, as a result of heightened scrutiny against the company, as well as open hostility against the company from large swats of the general public to use the aggressive anti-consumer tactics that it would need to achieve $28 in earnings per share or 29.50 to 20. It's supposed to say 30, but that's a typo. There's actually a bunch of typos in this case, which is just super unprofessional from the Rosen Law Firm. But anyway, typo 20 supposed to say $30 in adjusted net earnings per share. As such, the company was deliberately reckless in doubling down on its previously issued guidance. End quote. So, that's a little bit on the nose, don't you think? The investors are suing the company because they were no longer willing, their words not mine, to use aggressive anti-consumer tactics. But wait, there's more. Now, from page 10, quote, "The statements referenced in paragraph 31, 33, and 35 above were materially false and/or misleading because they misrepresented and failed to disclose the following adverse facts pertaining to the company's business, operational, and financial results which were known to defendants or recklessly disregarded by them. Specifically, defendants made false and/or misleading statements and or failed to disclose that one, United Health had for years engaged in a corporate strategy of denying health coverage in order to boost its profits and ultimately its share price. Two, this anti-consumer and at times unlawful strategy resulted in regulatory scrutiny as well as public angst against United Health, which ultimately resulted in the murder of Brian Thompson. Three animous towards United Health was such that subsequent to the murder of Mr. Thompson, many Americans openly celebrated his demise, expressed admiration for his accused killer, and or otherwise demanded that United Health change its strategy even if they condemned Mr. Thompson's killing. Four, the foregoing regulatory and public outrage caused United Health to change its corporate practices. Five. Notwithstanding the foregoing, United Health recklessly stuck with the guidance it issued the day before Thompson's murder, which was unrealistic considering the company's changing corporate strategies. And six, as a result, the defendant's public statements were materially false and/or misleading at all relevant times. End quote. That was incredibly long, I know, but what the actual This lawsuit would not exist, period, if the company had just kept on doing what they were before. In 2023, when the class action lawsuit in Minnesota became public, the investors didn't care. But now, after the CEO is murdered and the public turns against them completely, suddenly we have a new lawsuit against United Health, specifically because they were quote no longer willing to continue using allegedly illegal, aggressive, and anti-consumer practices, which resulted in their earnings being substantially decreased. This is a complete mask off type situation in my view. Nothing legitimate is happening to this company on a regulatory level. The class action against them for wrongfully denying care through a manipulated and predatory AI algorithm probably won't go anywhere. I think five out of the nine claims so far have already been dismissed. But now after that company was so evil that they inspired vigilante justice against their own executives now because they stopped doing the predatory allegedly illegal things that made people hate them. Now, the people with the money are suing them because they're not making enough money. It is a sickly dystopian wake-up call as to this true state of corporate healthcare. Let's do a timeline recap. Okay. In 2023, United Healthcare along with multiple others in the industry get sued for allegedly denying claims with AI algorithms that they shouldn't be denying. At the end of 2024, they release an earnings estimate. Nothing out of the ordinary there. But one day later, their CEO is supposedly murdered by someone with an ideological vendetta against healthcare companies who are abusing the American people and most importantly wrongfully denying claims multiple times in the aftermath of that crime. They reassert that that same financial guidance from before until suddenly substantially downgrading it in 2025. But directly after the downgrade, investors open a lawsuit because the company is quote unwilling to continue using the illegal anti-consumer and aggressive monetization tactics. Once in a while, if you're paying attention, something will happen that shatters the house of mirrors, exposing a piece of the system for what it truly is. It could be subtle, like a few words in a lawsuit, or it could be bigger, like premeditated crimes with national headlines. And I believe that this is one of those moments. The structure of United Health Care in the United States is fundamentally at odds with the actual best outcome for its patients. Publicly traded health care companies are the direct embodiment of conflict of interest because the way that they earn more money is to care for people less. Obviously, the entire thing is just a quagmire of complexity because maybe the average cost of health care wouldn't be so damn high if people weren't so unhealthy to begin with in this country. If the food was better, the culture improved, tobacco, alcohol, drugs, crime, etc., or any number of other seemingly unrelated factors that are actually deeply related, which would make it so that customers didn't require more money from health insurance than they pay into it, which is before we even begin unpacking the maze of political arguments and different health care systems entirely. But the point I'm trying to make, okay, if you distill it down to the main point, is that even when you can't necessarily say this is how you fix the brakes in the car, sometimes it's just so painfully obvious that the brakes are in fact broken, people start disassembling things themselves. Of course, that's an extremely dangerous thing to have happening, and I would never, will never, and explicitly have not ever supported or condoned it. But at the end of the day, if someone asked me whether or not I'm surprised, I don't think I'd say yes. Echoing the sentiment at the start of the video, I can't sit here and tell you what the system should be. I'm not even remotely qualified to do that. Very few people are. But what I can do is tell you when something is broken, and the health care system in the United States is broken. For the sake of being much more specific here, because I know people will want that, we cannot allow a profit-driven algorithm, which is quite literally programmed to deny as much care as possible to patients, to make bottom line decisions about who is and is not medically cared for. That is an unacceptable system, regardless of individual politics. That's it. If you want to support the channel, check out the links down below. a special VPN deal, locals and Patreon, merchandise, social media, our own website with stories and articles posted there, etc., etc. But I'll cut it there and stop rambling. As always, thank you all for watching. Question everything and have a nice night.
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