AI-driven healthcare is turning us into numbers on a spreadsheet
A few years ago, I was invited to a lavish dinner with dozens of America’s most powerful CEOs. I was asked to moderate a social media panel earlier in the evening and then invited to sit at a table, where I was joined by leaders of tech giants, retailers large and manufacturing giants. Right next to me was the CEO of one of America’s largest health care companies – a plump man who, to put it politely, looked as if he’d just stepped out of the middle of a recruiting class. interested in the role of “Healthcare CEO”. He spent much of the evening talking about his recent golfing and fishing trips, while eating a steak that looked like it was still raw. Finally, after hearing about his single-digit disability rate, I couldn’t help myself so I leaned over and politely asked, “Do you ever feel bad when your company denies you insurance?” for people and sometimes they die because of it?” Without missing a beat, he took another bite of his steak and replied, “Oh, you can’t treat them like people. You just need to think of them as numbers on a spreadsheet.”
I’ve probably replayed that encounter in my head a few hundred times since last week, when the nation was shaken by the murder of UnitedHealthcare CEO Brian Thompson. Not because I expected something like this to happen, but because of the incredible public support for the alleged shooter that immediately followed. It’s as if everyone in America knows that most of these healthcare companies don’t see Americans as people, but as what I was told: numbers on a spreadsheet. “His company left many of my family members in debt that they will have to pay for the rest of their lives and refused to take care of my uncle, leading to his death,” as a woman recalled on Twitter. “Brian Thompson committed murder. Full stop.” There are also thousands joke article (“I’m sorry, prior permission is required for thoughts and prayers”), while others simply captured the sheer nihilism of the American spirit (“I can’t even pretending to be interested, I hope he’s looking at us”).
It probably won’t surprise anyone to learn that, when you look at their spreadsheets, these health insurance companies have been doing pretty well. UnitedHealth Group, in particular, reported a whopping $22 billion in profits in 2023 alone, including $5.5 billion in the fourth quarter. While on the surface this could imply one of a handful of scenarios – perhaps more Americans suddenly become much healthier, or the health care insurer has raised premiums and denied more claims – but there’s actually something else going on here.
Last week (and coincidentally, the day after Thompson’s murder), Jennifer D. Oliva, a law professor at Indiana University Maurer School of Law, published one paper for Indiana Law Journal that reveals how artificial intelligence and algorithms are being used by health insurance companies to systematically deny care. The article points out a surprising report from ProPublica last yearwhich details how Cigna, one of America’s largest insurance companies, saved itself millions of dollars (resulting in billions of dollars in profits) by denying claims without Review patient records. To be exact, Cigna denied more than 300,000 requests in just two months in 2022, spending an average of just 1.2 seconds reviewing each case, according to ProPublica. As one former Cigna physician told the nonprofit: “We literally click and submit. It takes all of 10 seconds to do it 50 times at a time.” (In response to ProPublica’s article, Cigna said the investigative organization’s report was “misleading and incomplete,” adding that its review system was set up to “expedite the payment of claims.” claim for a certain number of routine screenings,” allowing the company to “automatically approve claims when they are submitted with the correct diagnosis code.”)
