On December 4, 2024, a shadowy figure, in a dark hoodie, waited for his opportunity, ran across the street, and then fired three shots. A married father of two stumbled to the ground as his killer fled the scene. Brian Thompson, the CEO of UnitedHealthcare was murdered and his killer allegedly a 26-year-old, disgruntled by botched a neck surgery that had left him in pain and disabled.
As father of two, husband of one, who had severe neck issues, and surgery, I had a lot of empathy for both men. Very clearly this was an act of misdirected rage. The killer, like most of us, wanted someone to blame for their life falling apart and a very wealthy insurance company chief executive made a convenient target, made a scapegoat, for a system that is broken at multiple levels.
When I was initially injured, in my twenties, I went to Dr. Rajjoub, he was known as one of the leading neurosurgeons in the area from what my mom found and we sat waiting in his office for a long time. When we finally got to the exam room, the doctor was very brisk, “physical therapy.”
My parents and I sat with our jaws open. And my mom, a bit faster on her feet, stammered a protest.
Rajjoub broke his stride. And he explained, very briefly, that better surgery options, like disk replacements, were on their way and I should wait. And amazingly enough, a little physical therapy would get me back on my feet again. He was right.
Fast-forward to a couple of years ago and a decade or so after this conversation and my neck pain was back with a vengeance. And this time physical therapy, after an ill-advised trip to a chiropractor, would not produce sufficient results. I knew with the numbness and loss of strength, the window of opportunity was beginning to close, there would need to be surgery soon or I may never be restored to full use of my right arm.
So I got an appointment with a specialist, at our local hospital, explained the history and my current symptoms. This neurosurgeon agreed that it was time to go under the knife and we began to discuss the particulars of the procedure he would do. What he would describe is a neck fusion. They bond a few vertebrae together, around the injury area, to bring some stability and restore the gap for the pinched nerve to travel through.
I was underwhelmed. I didn’t wait this long to get an inferior surgery. So, once again, I enlisted the help of my mom. And the goal was to find an alternative option who would do a replacement rather than a fusion. We ended up contacting Virginia Spine Institute and I was soon talking to a young energetic Bucknell graduate. We exchanged stories about my home town, and common experience at the local watering hole, before we got down to the business at hand.
One of the items to consider, going in, was that this medical group was out-of-network, my insurance would likely reimburse for a little and yet not nearly the whole cost. But, given I only have one neck to spare, and that VSI seemed state of the art—I went with my gut and bit the bullet.
The results were phenomenal.
My veteran physical therapist was totally amazed at the speed of my progress.
As if to confirm my decision, already on my way back to work, I went through the drive thru at Dunkin a few days after the surgery, still wearing the neck collar as precaution, and had a brief exchange with the cashier who gave an account of her own experience with neck surgery. She had the fusion, was still dealing with chronic pain, and validated every concern that I had with the outdated practice.
So why did she, and the killer of Thompson, have a surgery that should be discarded to the annals of medical history?
There are multiple contributing factors, as always, insurance companies slow in their acceptance of change, surgeons who don’t want to get trained in a whole different way of doing things when they have mortgage to pay plenty of work, but truly at the heart of it all is the FDA moving at a turtle’s pace. The agency has lagged well behind counterparts in Europe and who knows why. There is no Big Fusion industry lobby to blame as far as I can tell. So what’s the hold up?
This approval process really underlines the misplaced faith many have in government agencies. While Europeans were getting a far better option, literally for decades, those of us under the protective care of a Federal regulatory bureau, suffered the ‘cure’ barely an improvement on the disease. And really need to ask the question why. Why can the FDA work fast to approve a pharmaceutical and yet not to ban dangerous red dyes?
The answer is likely a combination of lack of political will and bureaucracy. The real problem is this notion these institutions are all science and not political or biased.
It is tempting to just call it incompetence (or cook up some cockamamie theory) but it is more than that. We do fusion surgery rather than risk replacements and that is because what is established seems less risky than a newer procedure. There is probably a big assumption that because an opinion exists there is no need to move quickly. And then an agency is made of people. It is not some monolith constructed of pure unadulterated science. No, it is rather like where you work, an institution that is really only ever as good as the management.
Many smart people work at the FDA. But it is not their job to make sure that the latest technology gets to the consumer. They do their assigned tasks. And thus some items may fall through the cracks.
The most tragic part of Thompson’s murder is that it targeted someone who was doing their job and working within conditions set by the industry and the government. This idea that removing a profit motive will just magically fix everything is wrong. What is truly needed is a major disruption of status quo for regulatory agencies. There is really nothing sacrosanct or unquestionable that the FDA does. Science needs scrutinized, the experts miss things and have their own private motives.
Furthermore, the rising cost of healthcare doesn’t have one singular cause. The left wants to explain everything bad as being a result of evil capitalism, whereas the right always wants a secret plot to destroy the health of America, but the reality is much more complex and not nearly as exciting as these two ideologically driven fantasies. It is simply the limits of system and cost of the technology in many cases, coupled with a crippling burden of compliance.
There is a big reason why the small medical practices are disappearing, swallowed up by giant politically connected and bureaucratic nightmares. There is also a reason why, in the age of the ACA requirements, insurance companies must push back against waste of invested resources. We’re all caught in a tangled ball of competing interests and may need our Alexander to take a sword to this gigantic seemingly unsolvable knot.
This is why I’m willing to give new Health Secretary Robert Kennedy Jr. a chance. We need reform and we needed it yesterday, it is decades overdue like the eventual approval of the disk replacement surgery that has allowed my return to an active and fulfilled life. And, if you don’t like it, then maybe you should try Canada where healthcare is free, if you can get through the line. Amazing how nobody blames public health officials—until you get one who goes against the status quo they claim to hate.
Irregular Ideation 