Health insurers face an impossible choice with ultra-expensive treatments like gene therapies. When a $2 million therapy works only 1% of the time, the expected cost becomes $200 million per patient, forcing insurers to deny coverage and sparking dangerous public anger.
CEO of UnitedHealthcare was murdered by a guy named Luigi. How would someone get that angry to make that type of action?
The first time I ever had P&L responsibility for health insurance company, I was 31 years old, and I remember just being a few weeks into it. We had a really young woman who had a very young child, and the child needed an intervention that would cost upwards of $2 million. We're gonna talk about selling gene therapies. Obviously, my gut tells me we gotta help this child, but when you think about what you're running as an insurance company, you have a fixed amount of premium and you have to decide what you're gonna cover. When you make determination that that drug only works 1 out of every 100 times, it's not a $2 million cost, it's $2 million times 100. That's the problem, because the minute an insurance company says we're not going to do this, now you have a family that believes that you are now staying between them and the doctor.
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