A ‘Payday Loan’ From a Health Care Behemoth

Alex Shteynshlyuger, a urologist with a practice in New York City, feels surrounded by UnitedHealth Group. He has seen the company gobble up private practices and says it’s slow to pay claims. It also started offering cash-flow services that, Shteynshlyuger says, feel a lot like payday loans.

UnitedHealth Group is the largest employer of physicians in the United States. And it’s growing.

Has the company become too big?

In this episode of “An Arm and a Leg,” host Dan Weissmann looks into this “behemoth” company and the obstacles antitrust regulators face in keeping up with its rapid growth.

Dan Weissmann, Host and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

Credits

Emily Pisacreta - Producer

Adam Raymonda - Audio Wizard

Afi Yellow-Duke - Editor

Transcript: A ‘Payday Loan’ From a Health Care Behemoth

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.

The atmosphere inside the Allen House is easygoing as residents circulate freely through the hallways, meet in group sessions, or gather on a large outdoor patio that features a dirt volleyball court with an oversize net.

The 60-bed safety-net residential treatment center in Santa Fe Springs, run by Los Angeles Centers for Alcohol and Drug Abuse, has a dedicated detox room, on-site physicians and nurses, substance abuse counselors, licensed therapists, and other practitioners. It offers group counseling as well as individual and family therapy, and it endorses the use of medications for addiction treatment, such as buprenorphine and naltrexone, which are increasingly considered the gold standard.

Willard Sexton, a staff member and former Allen House patient, says the most important part of his job is speaking with each resident daily. Most of them, like him, came to treatment straight from jail or prison, and he knows as well as anybody how stressful it is to stop using.

“It’s similar to grief and loss,” says Sexton, 35. “The drug was their best friend for a long time.” Interacting with them, he says, helps him in his own ongoing recovery.

At a time when drug use is among the nation’s gravest public health crises, a visit to the Allen House offers key lessons: Addiction is a chronic illness requiring constant vigilance, there’s no one-and-done solution, and relapses are part of the journey to recovery. Peer mentoring is an invaluable element of drug counseling, since people who have plodded the difficult path from dependence to sobriety understand the mindset of patients on a visceral level.

And most importantly for those who feel despair in the grip of addiction, there is hope. “Recovery happens,” says Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “Every single day people come into treatment and succeed in addressing their substance use disorders.”

Drug-related overdoses kill almost as many Californians as lung cancer, more than diabetes, and two to three times as many as car accidents, according to a report by California Health Policy Strategies, a Sacramento consulting group. The report showed there were about 11 times as many fentanyl-related deaths in 2021 as in 2017, accounting for more than half of overdose fatalities. And addiction can ruin lives even if it doesn’t end them.

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