memorial day essay

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Memorial Day

By: History.com Editors

Updated: May 24, 2023 | Original: October 27, 2009

Memorial Day is an American holiday, observed on the last Monday of May, honoring the men and women who died while serving in the U.S. military. Memorial Day 2023 will occur on Monday, May 29. 

Originally known as Decoration Day, it originated in the years following the Civil War and became an official federal holiday in 1971. Many Americans observe Memorial Day by visiting cemeteries or memorials, holding family gatherings and participating in parades. Unofficially, it marks the beginning of the summer season.

The Birthplace of Memorial Day and Early Observances 

The Civil War , which ended in the spring of 1865, claimed more lives than any conflict in U.S. history and required the establishment of the country’s first national cemeteries.

By the late 1860s, Americans in various towns and cities had begun holding springtime tributes to these countless fallen soldiers, decorating their graves with flowers and reciting prayers.

It is unclear where exactly this tradition originated; numerous different communities may have independently initiated the memorial gatherings. And some records show that one of the earliest Memorial Day commemorations  was organized by a group of formerly enslaved people in Charleston, South Carolina less than a month after the Confederacy surrendered in 1865. Nevertheless, in 1966 the federal government declared Waterloo, New York , the official birthplace of Memorial Day .

Waterloo—which first celebrated the day on May 5, 1866—was chosen because it hosted an annual, community-wide event, during which businesses closed and residents decorated the graves of soldiers with flowers and flags.

Did you know? Each year on Memorial Day a national moment of remembrance takes place at 3:00 p.m. local time.

Decoration Day

On May 5, 1868, General John A. Logan, leader of an organization for Northern Civil War veterans, called for a nationwide day of remembrance later that month. “The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village and hamlet churchyard in the land,” he proclaimed.

The date of Decoration Day , as he called it, was chosen because it wasn’t the anniversary of any particular battle.

On the first Decoration Day, General James Garfield made a speech at Arlington National Cemetery , and 5,000 participants decorated the graves of the 20,000 Civil War soldiers buried there.

Many Northern states held similar commemorative events and reprised the tradition in subsequent years; by 1890 each one had made Decoration Day an official state holiday. Southern states, on the other hand, continued to honor the dead on separate days until after World War I .

History of Memorial Day

Memorial Day, as Decoration Day gradually came to be known, originally honored only those lost while fighting in the Civil War. But during World War I the United States found itself embroiled in another major conflict, and the holiday evolved to commemorate American military personnel who died in all wars, including World War II , The Vietnam War , The Korean War and the wars in Iraq and Afghanistan .

For decades, Memorial Day continued to be observed on May 30, the date General Logan had selected for the first Decoration Day. But in 1968, Congress passed the Uniform Monday Holiday Act, which established Memorial Day as the last Monday in May in order to create a three-day weekend for federal employees. The change went into effect in 1971. The same law also declared Memorial Day a federal holiday.

Memorial Day Traditions and Rituals 

Cities and towns across the United States host Memorial Day parades each year, often incorporating military personnel and members of veterans’ organizations. Some of the largest parades take place in Chicago , New York and Washington, D.C.

Americans also observe Memorial Day by visiting cemeteries and memorials. Some people wear a red poppy in remembrance of those fallen in war—a tradition that began with a World War I poem . On a less somber note, many people take weekend trips or throw parties and barbecues on the holiday, perhaps because Memorial Day weekend—the long weekend comprising the Saturday and Sunday before Memorial Day and Memorial Day itself—unofficially marks the beginning of summer.

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The Real Meaning of Memorial Day and Why it's Important to Know

6 minute read

Memorial Day is ultimately a day of respect and remembrance for those who sacrificed their lives in military service and the immeasurable loss to their families, friends, and communities. It's also a day of respect for all of us to savor and not take for granted the opportunity to do what we love to do because of those sacrifices.

Tony Caldwell, a TD Bank Specialized Human Resources Manager, and veteran who served with the U.S. Army and U.S. Army National Guard for 27 years, embodies just that. He starts the day by visiting a local cemetery in Charlotte, North Carolina, where he meets with both past and present work colleagues who are veterans. The group honors the lives lost by putting flags on the graves of soldiers. Afterwards, they have a hearty breakfast where they catch up and share both the joys and complaints of everyday life.

"It's hard and somber, going to the cemetery," he said, " It's personal to those of us who have served. My brothers and sisters volunteered. They knew what they were getting into, and they still did it. Memorial Day is about loss. But we also enjoy ourselves at the breakfast. I really think that's kind of the point. Do those things you want to do. Go buy a new mattress if you need one and save money. Nobody's going to fault you for that. Just take a moment of reflection about somebody who gave up everything, somebody's family lost their person. Whether that moment is one you have privately, or if it's with a group and everybody reflects together, that's up to you. I am also going to enjoy every ounce of a frosty beverage because somebody didn't get to, and somebody's family doesn't get to do it with them."

Ways to show respect

While Tony and many other veterans appreciate the sentiments behind people thanking them for their service that day or saying, "Happy Memorial Day," it misses the true meaning. The confusion about the purpose of Memorial Day and Veterans Day is common. Memorial Day is designated to specifically honor those who died in service to our country. Veteran's Day in November is considered a celebration of all American military veterans, living and dead.

"If a veteran explains to you the difference between Veteran's Day and Memorial Day, and they sound like a grouch, forgive them, they don't mean to, they just want you to know what the day is about," Tony said.

So, what is the right thing to say?

There are varying answers depending on the veteran, according to Army veteran Robert Opp, TD Bank's Sourcer for Veterans and Individuals with Disabilities, based in Pennsylvania. He suggested that if a veteran is wearing a uniform, you could strike up a conversation about their service, but do not thank them on that day.

Sarah Decker, a TD Bank Marketing Manager in Mount Laurel, New Jersey who serves with the Marine Corps Reserves as a Staff Sergeant, acknowledges the day by reflecting on its true meaning and taking a moment of silence to remember the fallen, both those she knew personally and those she did not. She agrees with Robert that each veteran may have a preference on the best ways for people to express acknowledgement on the day.

"While saying 'Happy Memorial Day' can be saddening, it is most important to me that people recognize the day's importance, rather than get caught up in how to correctly wish someone well on this day," Sarah explained.

"Social media is a simple and effective way to acknowledge the day by posting a meaningful quote, memory or a message such as, 'remembering our fallen heroes' or 'wishing you a meaningful and memorable Memorial Day,' " Sarah said. "Other ways to show respect for the fallen is through gestures, for example, placing flags on graves or getting involved with charitable organizations that benefit the families of the fallen."

For in-person Memorial Day greetings, Sarah understands that it can be difficult to find the right words. "I might use phrases like, 'Have a great weekend memorializing our heroes', or 'Wishing you a memorable day/weekend.' While it's important to be sensitive to the phrasing, the true meaning is to remember our fallen heroes, and that's what I hope people choose to do this Memorial Day weekend."

There are many ways to acknowledge the day rather than simply saying "Happy Memorial Day," according to Sarah. Red Poppy Flowers are worn in remembrance of those who died fighting for our nation. Flags are flown at half mast until noon to symbolize it is a day of "National Mourning." You can visit memorials and cemeteries to pay your respects or participate in laying battlefield crosses, wreaths, flowers and/or flags at their gravesites.

TD Bank colleagues support Memorial Day Flowers Foundation

"Memorial Day is a day that we focus on our utmost gratitude for the soldiers who died protecting our great nation and the families who lost their loved ones, " said Paul Bajus Head of U.S. Contact Centers and Executive Lead for TD's D&I Veterans pillar. "As a veteran, I acknowledge the great importance of a day where we are all united in recognizing sacrifices made by our armed services. I ask that all of us take a moment to remember that we can live our lives freely because of these fallen heroes."

TD Bank encourages people to reflect on the day.

“At TD, we celebrate the dedication and bravery of all military personnel and are deeply appreciative of their commitment to our country," said Ernie Diaz, Head of U.S. Distribution, Wealth and TD Auto Finance and Management Committee Sponsor for the Veterans Pillar at TD. "Memorial Day is a particularly important day for us as we collectively pause to reflect and honor the service members who gave their lives for this great nation, as well as the families and friends they left behind."

Robert usually has a quiet day because of a feeling that many who put on the uniform share – survivor's guilt. He often goes to a Memorial Park near where he lives and walks around while remembering a soldier he served with who didn't make it home. This year, Robert, along with about a dozen other TD colleagues will be going to Arlington Cemetery for the Memorial Day Flowers Foundation (MDFF) program which TD has supported since 2013 .

As the father of two very young children, Robert hasn't yet fully explained his military service experience. But as his children get older, he considers what he would want them to learn.

"There are a lot of honorable people out there who have given up so much so you can have your way of life, " he said. "That is what is important."

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Memorial Day

By Mikaela Maria

Memorial Day, the last Monday in May, has been observed in the Greater Philadelphia area since the 1860s. The springtime holiday is considered the United States’ first multiracial, multiethnic commemoration and the kickoff of the summertime season. However, Memorial Day’s meanings and origin stories have been debated since its creation, and the holiday’s roots have been both contested and deeply enmeshed with the remaking of American memory in the decades following the Civil War. Each spring, generations of Philadelphians have participated in Memorial Day traditions upholding the meanings of the holiday’s past and shaping the direction of celebrations to come.

In the years during and immediately following the American Civil War (1861-65), grave decoration, the ritual of adorning burial sites with flowers or small tokens for the dead, led to Memorial Day’s original name, Decoration Day . In the former Confederacy, the Columbus (Georgia) Ladies’ Memorial Association is often credited with originating Memorial Day on April 26, 1866. Founding member Mary Ann Williams (1821-74) declared the purpose to “. . . keep alive the memory of the debt we owe [the Confederate dead].”  Similarly, in northern cities and towns local and state governments created cemeteries for Union dead and heeded the call from the Grand Army of the Republic (GAR) and its commander-in-chief John Alexander Logan (1826-86) to designate May 30, 1868, “for the purpose of strewing with flowers or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion.” The late May date was chosen so the flowers used to decorate graves would be in full bloom. Community participation in Decoration Days often included speeches, church services, musical performances, and parades to honor veterans.

In Bucks County , the city of Doylestown has claimed to host the oldest continuous parade, citing a start date of May 30, 1868. In Philadelphia, Laurel Hill Cemetery was the site of the first Decoration Day observance, also on May 30, 1868. The bucolic burial grounds became the final resting place of several Civil War veterans, including General George Meade (1815-72), who defeated Robert E. Lee (1807-70) and the Confederate army at the Battle of Gettysburg .

While Decoration Day observances in the North and South shared many practices in common, including grave decoration, the “Decoration Day” holiday’s connections to the GAR and the valorization of Union soldiers led many Southerners to alternately use “Memorial Day” or “Confederate Memorial Day” to commemorate their dead. Still, not all Southerners chose to memorialize the Confederacy. On May 1, 1865, a group primarily composed of recently emancipated African Americans honored 257 Union troops left behind at a Confederate mass grave site in Charleston, South Carolina. The group organized the remains and reburied the bodies, created headstones, and decorated the graves with flowers, as almost ten thousand people gathered to march and mourn the soldiers.

The Twentieth Century

By the start of the twentieth century, Decoration Days had grown in popularity and gradually lost their association with the Civil War as the generations directly involved died and the rift between the Union and the former Confederacy significantly diminished. Americans subsequently moved on to mourn those who had died fighting overseas in World War I (1914-18). During this period, the poem “ In Flanders Fields ” by Canadian Lieutenant Colonel John McCrae (1872-1918) became a popular mourning text and red poppies, associated with the poem, became the flower of choice for decoration of graves or one’s own clothing. “Memorial Day” also supplanted “Decoration Day” as the more popular title for the holiday, as it encompassed a more general theme of remembrance.

In the years following both World War I and II, Philadelphians erected statues and sculptures to memorialize fallen soldiers, including the Smith Memorial Arch (1912) on the Avenue of the Republic in Fairmount Park , Civil War Soldiers and Sailors Memorial (1927) on the Benjamin Franklin Parkway between Twentieth and Twenty-First Streets, and the World War I Aero Memorial (1939) in Logan Square. Some sites, like the Tomb of the Unknown Revolutionary War Solider in Washington Square (1957) and the Vietnam Memorial (1987) hosted annual Memorial Day ceremonies that included the solemn laying of wreaths, singing of the national anthem, and a twenty-one-gun salute to honor the dead.

In 1950, the United States Congress passed a joint resolution requesting that the president proclaim a “Prayer for Peace” on each Memorial Day. In 1967, Congress officially declared May 30, “Memorial Day,” a federal holiday. In 1968, the passage of the Uniform Monday Holiday Act moved Memorial Day to the fourth Monday in May, creating an annual three-day weekend for federal employees. This development notably delighted the travel industry and dismayed some veterans’ groups, who worried the long weekend would overshadow the holiday’s traditionally solemn purpose.

Throughout the second half of the twentieth century across the Greater Philadelphia area, the somber act of grave decoration or tributes to fallen soldiers increasingly gave way to parties, cookouts, and leisure activities that signaled the official start of summer. In New Jersey, while many towns hosted Memorial Day parades, the holiday was most popular as the official opening of the beaches and boardwalks in towns along the shore. In 1964, the winner of the “Miss Mermaid” competition symbolically held the “key to the Atlantic Ocean” in Atlantic City, New Jersey , to signify the start of the summer. In Pennsylvania, Memorial Day Weekend marked the opening of pools at many state parks, as well as Philadelphia’s spray grounds. In Philadelphia, the long weekend also offered festivals, fireworks, and special programs at local museums for tourists and residents alike. In the Bridesburg neighborhood, the local VFW and American Legion chapters raised funds for their Memorial Day parade through a Memorial Day 5k and 1 mile Honor Race.

• Twenty-First Century

By the twenty-first century, many Americans marked Memorial Day with recreation or shopping rather than paying homage to those who died while fighting in the armed services. However, local VFW, American Legion, and other veterans continued to host traditional Memorial Day ceremonies. At the Philadelphia National Cemetery in the West Oak Lane neighborhood, graves have been decorated with American flags. In Laurel Hill Cemetery, attendees annually have recreated the original GAR Decoration Day Service of 1868 with speeches, music, and grave decoration. In 2021 President Joseph Biden (b. 1942) visited New Castle, Delaware , and addressed those gathered in observance at War Memorial Plaza on Memorial Day Weekend.

For some, the holiday had grown to encompass memorializing Americans who have died outside of war. Memorial Day 2020 fell on May 25, the same day George Floyd (1973-2020), an unarmed Black man, was killed in the custody of a white police officer in Minneapolis, Minnesota. Video footage of Floyd’s murder quickly circulated online and inspired protests in cities and towns across the country. Participants demanded an end to police brutality, racism, and white supremacy, often while repeating the names of those killed extrajudicially by police. In Philadelphia, protests lasted from May 30 to June 23 and resulted in the removal of a mural and memorial statue honoring Frank Rizzo (1920-91), a former police chief and mayor accused of perpetuating racism and bias in the city. The protests shed light on the ongoing debate over how and why we choose to memorialize the past.

By May 2021, after half a million Americans had died from Covid-19 caused by the SARS-CoV-2 virus and vaccines became more widely available, Pennsylvania and New Jersey “reopened” for Memorial Day by lifting almost all Covid-19 gathering restrictions. Philadelphia, while keeping some restrictions in place, encouraged tourists to visit the city. In South Jersey, Absecon, Glassboro, Vineland, and Wildwood hosted parades and the Battleship New Jersey in Camden hosted a wreath ceremony on the Delaware River.

Despite optimistic Memorial Day reopening celebrations, rising pandemic death tolls prompted calls across the United States for a “Covid Memorial Day” at the beginning of March. Across the Delaware Valley, groups came together to remember lost community members in various ways throughout the year. The Delaware COVID-19 Garden Remembrance Memorial at the First Presbyterian Church of Dover opened to the public on Memorial Day weekend in 2021, and the “Rami’s Heart COVID 19 Memorial” was dedicated at Allaire Community Farm in New Jersey on September 17, 2021.

As Americans updated Memorial Day practices to encompass modern feelings of grief and loss, they continued to redefine the act of remembering and who or what is worthy of memorial. In the face of national tragedies, cities and towns created and recreated the traditions of the past to better reflect their present reality and hopes for the future.

Mikaela Maria is a public historian and administrative professional living in Philadelphia, Pennsylvania. (Author information current at date of publication.)

Copyright 2023, Rutgers University.

Bearings Decoration Day Races, 1890

Library of Congress

Memorial Day traces its roots to Decoration Day traditions, which honored the dead of the American Civil War. Decoration Day traditions began shortly after the war. Mourners visited the graves of Civil War soldiers in late May to plant flowers in memorial. Within three years of the war’s conclusion, Philadelphians observed their first Decoration Day at Laurel Hill Cemetery. Over time, the association with the Civil War diminished and the holiday became associated with veterans of other wars and with recreation instead. By the turn of the twentieth century, the name Memorial Day surpassed Decoration Day in popularity to encompass a broader theme of remembrance rather than strictly the gravesite observances.

This poster from 1890 show the transitional period from Decoration Day as a time to honor the dead and Memorial Day as the herald of summer recreation. Created as an advertisement for a late spring bicycle race, it frames the cyclists with rows of Union and Confederate soldiers with shouldered rifles above and aging veterans holding canes and walking sticks below.

Decoration Day at Glenwood Cemetery

Early Decoration Day observances centered on decorating the graves of fallen Civil War soldiers, often with flowers but sometimes with flags or other adornments. In the years immediately following the war, this task often fell on the widows or children of the men who died in the war, as depicted in this 1876 engraving of Philadelphia's Glenwood Cemetery. The caption beneath the engraving identifies the children placing flags on the grave as the orphans left behind when their fathers were killed.

Glenwood Cemetery opened in 1849 at Twenty-Seventh and Ridge Streets in North Philadelphia. Hundreds of Union and Confederate soldiers and veterans who died in Philadelphia hospitals were interred at Glenwood, making it an early place for Decoration Day observation in the city. In 1891, Glenwood was one of seven city cemeteries to disinter Civil War veterans and relocate them to the Philadelphia National Cemetery in Northwest Philadelphia. At the end of the nineteenth century, the cemetery became the resting place to over 150 veterans of the Spanish-American war. By 1923, the cemetery had reached capacity and fallen into disrepair, prompting a move from its central location in Philadelphia to the nearby suburb of Broomall, Delaware County. In 1927, the remaining veterans' graves were reinterred in the Philadelphia National Cemetery. The Philadelphia Housing Authority took the cemetery's location by imminent domain and became the site of the James Weldon Johnson public housing.

All Wars Memorial to Colored Soldiers and Sailors

Wikimedia Commons

Pennsylvania state legislator Samuel Beecher Hart succeeded in passing a bill to create a monument to Black war veterans in 1927. Hart's first attempt in 1925 coincided with the proposed requisitions for the Sesquicentennial Exposition which was to open the following year, but was defeated. A second attempt two years later saw $50,000 requisitioned for the creation of the new monument. Originally the city's Art Jury planned to erect the monument adjacent to the existing Civil War monument on the Benjamin Franklin Parkway, then later in Fitler Square at Twenty-First and Pine Streets amidst complaints by residents and landlords in that neighborhood, who feared the erection of a "Colored" war memorial would lead to loss of tenancy and property value. Finally a location in West Fairmount Park was selected. The completed statue featured Black uniformed veterans looking up towards a figure of Justice, depicted as a caucasian woman. After many proposals, the statue was moved to its intended location on the Benjamin Franklin Parkway in 1994, sixty years after its dedication.

Miss Mermaid unlocking the Atlantic Ocean

Special Collections Research Center, Temple University Libraries

By the mid twentieth century, Memorial Day’s somber roots faded and the holiday gained a new identity as the first official day of summer. The holiday’s new status was bolstered by the Uniform Monday Holiday Act of 1968, which moved observances to the fourth Monday of May and granted federal employees a three-day weekend amidst outcry from veterans’ organizations. The new date encouraged a focus on travel and recreation with Philadelphians increasingly choosing to celebrate the long weekend with barbecues and beach visits.

This photo shows the winner of the 1964 Miss Mermaid contest symbolically unlocking the ocean at Atlantic City, NJ with a giant key, opening it to beachgoers on Memorial Day weekend. The long holiday weekend has become one of the busiest annual periods for the area’s seaside resorts.

Frank Rizzo Statue

Protests erupted throughout Philadelphia on Memorial Day weekend 2020 after the death of George Floyd, an unarmed Black man, while in police custody. Protesters called for an end to police brutality and racism. During the three-week long protest, many called the legacy of controversial Philadelphia Police Commissioner and Mayor Frank Rizzo into question. Rizzo served as police commissioner from 1968 to 1971 and as mayor 1972 to 1980. During his tenure the Philadelphia Police Department faced allegations of racism and brutality, a legacy which critics allege continued into the twenty first century. Protesters began demanding that a monument to Rizzo, erected in 1998 in front of the Philadelphia Municipal Services Building on John F. Kennedy Boulevard in Center City. While activists initially called for the removal of the statue in 2016, the mayor’s office did not agree to pay for its removal until protestors attempted, unsuccessfully, to pull the statue down in June 2020 amidst these protests.

Related Topics

Time periods.

• Nineteenth Century after 1854
• Twentieth Century after 1945
• Twentieth Century to 1945
• Benjamin Franklin Parkway
• Civil Rights (African American)
• Fairmount Park
• Laurel Hill Cemetery
• Martin Luther King Jr. Day
• Mother’s Day
• National Freedom Day
• New Year’s Traditions
• Saint Patrick’s Day
• Thanksgiving
• Veterans and Veterans’ Organizations
• Vietnam War
• War in Afghanistan
• World War I
• World War II

Related Reading

Blight, David W. Race and Reunion: The Civil War in American Memory . Cambridge, Mass.; London: Harvard University Press. 2002.

“ The Evolution of Memorial Day .” n.d. The National Endowment for the Humanities. 

Kalifa, Heather. “ A look at the ceremonies and cemetery visits marking Memorial Day .” Philadelphia Inquirer. May 31, 2021.

Litwicki, Ellen. 2013. America’s Public Holidays 1865-1920. Smithsonian.

McAneny, D., 2021. “ Dover church debuts memorial for lives lost to COVID-19 in Delaware .” 

“ Memorial Day in Philadelphia: 8 City Landmarks That Commemorate Fallen Heroes .” n.d. Billy Penn .

Neiburg, Jeff. “ President Joe Biden to Attend Memorial Day Observance Sunday near New Castle .” Delaware News Journal. May 28, 2021.

“ The Origins of the First Memorial Day .” 2021. The Philadelphia Sunday Sun. May 28, 2021 .

Perez, Walter. 2018. “ Thousands Celebrate the 150th Year of the Doylestown Memorial Day Parade .” 6abc Philadelphia. May 29, 2018.

Purcell, Dylan. “ On Memorial Day, gathering to honor many who sacrificed .” Philadelphia Inquirer. May 30, 2016.

Roman, Jackie. 2021. “ First Permanent National Memorial for Covid-19 Victims Unveiled at N.J Farm .” NJ.com, September 22, 2021.

“ South Jersey Memorial Day Celebrations .” New Jersey Leisure Guide. Accessed February 22, 2022.

Waxman, Olivia. 2018. “ Lots of Places Claim to Be the Birthplace of Memorial Day. Here’s the Truth, according to an Expert .” n.d. Time .

Related Collections

• Laurel Hill Cemetery Archives Laurel Hill Cemetery 3822 Ridge Avenue, Philadelphia
• Pennsylvania Historical and Museum Commission, Grand Army of the Republic Collection Pennsylvania State Archives 350 North Street, Harrisburg, Pennsylvania

Related Places

• Laurel Hill Cemetery 3822 Ridge Avenue, Philadelphia
• Smith Memorial Arch Avenue of the Republic, Fairmount Park, Philadelphia
• Civil War Soldiers and Sailors Memorial Benjamin Franklin Parkway between Twentieth and Twenty-First Streets, Philadelphia
• All Wars Memorial to Colored Soldiers and Sailors Logan Square, Philadelphia
• World War I Aero Memorial Logan Square, Philadelphia
• Vietnam Memorial South Front and Spruce Streets, Philadelphia
• Korean War Memorial South Front and Dock Streets, Philadelphia
• George Floyd Memorial Mural 5600 N. Fifth Street, Philadelphia
• Crown Mural Municipal Services Building, 1401 JFK Boulevard, Philadelphia
• Delaware COVID-19 Garden Remembrance Memorial at the First Presbyterian Church of Dover 54 S. State Street, Dover, Del
• “Rami's Heart COVID 19 Memorial,” Allaire Community Farm 1923 Baileys Corner Road, Wall Township, N.J

Backgrounders

Connecting Headlines with History

• A history of the origin of memorial day as adopted by the Ladies' memorial association of Columbus, Ga., and presented to the Lizzie Rutherford chapter of the Daughters of the confederacy

Connecting the Past with the Present, Building Community, Creating a Legacy

Essay: On Memorial Day, Honor the Military Sacrifices of All Who've Served

Memorial Day is more than a holiday that kicks off summer and leads to a three-day weekend. For me and thousands of others, it has personal significance and meaning.

In 2005, my squadron mate and friend gave his life during Operation Iraqi Freedom. The tragic news quickly spread amongst our group of buddies who shared the unique bond that comes from wearing the uniform together in training and in combat. Those of us who were not deployed made our way to Arlington National Cemetery to say our goodbyes. It was a somber day in Washington D.C. as I watched my friend be buried with military honors, the formality and traditions of ceremony carried out with precision.

His ceremony was one of many that day, all completed with respect, honor, and dignity. I saw three other processions along with his, each with families and friends in mourning. And for each, servicemen and women ensured a proper tribute.

It is a day I’ll always remember and think of each Memorial Day. This is how our country must honor our fallen warriors.

Since that day, I’ve visited Arlington many times. Walking through the cemetery always feels like an exercise in unexpected pauses, allowing you to absorb the magnitude of the stories within the seemingly endless fields. Moving through the fields of white headstones is like a journey through decades of stories that are ever present.

The white headstones are simple: each include the name, branch of service, date of birth and death, and perhaps a detail about rank or awards. But each is a journey in time; each is a narrative; each is a story of sacrifice. Everyone is unique but they have so much in common because of their dedication to their country.

As I stop and think about my experiences at Arlington, I find that the one thing I’ve never done is imagine what the servicemen and women laid to rest there looked like. Having viewed hundreds of headstones, I can say that I have never tried to picture the person; I’ve only pictured a uniform. I see a Sailor, Soldier, Airman/woman, Coast Guardsman/woman, or Marine — perhaps with the minor uniform changes that represent the era in which they fought.

I’ve wondered why. Perhaps not imagining a face of an individual is a product of the military culture, one that simply relied on trusting the members of your team, regardless of where they came for or what they looked like. And perhaps seeing the green, blue, white, tan, or khaki uniform is all I really needed to know because people of all races, creeds, color, and religions have fought for our country.

In the politically charged climate of 2017, Memorial Day is a way to remember that we need to honor the men and women of our armed forces and that they are comprised of diverse backgrounds from across our country and the world. Each and every one of them took the same oath to defend our Constitution, and made a commitment to be a part of our nation’s military.

Our military services are truly a societal and global melting pot. According to the Pew Research Center , minority groups made up 40 percent of the active duty military in 2015, up from 25 percent in 1990.

Military service also provides a means for immigrants to serve the country. According to the official website of the U.S. Department of Homeland Security , through fiscal year '15, the Immigration and Nationality Act (INA) that authorizes U.S. Citizenship and Immigration Services (USCIS) to expedite the application and naturalization process for current members of the U.S. armed forces and recently discharged service members has naturalized 109,321 members of the military from 34 foreign countries.

This is an incredible testimony to our freedoms. Imagine believing so strongly in the constitutional principles and fundamental beliefs of a nation that you would give your life to be a part of it.

As an Asian American, I am especially thankful at the opportunity provided for my family. I am thankful that my parents were able to find a meaningful and rewarding life for themselves and my siblings. I’m thankful that I could don a U.S. Navy uniform and serve. I’m thankful for the Asian Americans that went well before me and demonstrated their commitment to our country.

I am thankful for units like the 442nd Regimental Combat Team , the most highly-decorated unit for its size and length of service in the history of American warfare that proved ethnicity was not a requirement for service. The 442nd's 14,000 American men of Japanese ancestry fought in Europe during World War II, earning 9,486 Purple Hearts and were awarded 21 Medals of Honor . While many of them may have been viewed as the enemy, history has correctly recognized their bravery, sacrifice, and belief in our nation.

So as we reflect on the significance of Memorial Day, as we participate in the “National Moment of Remembrance” by pausing for one minute of silence at 3 p.m. local, as we fly our flags at half mast on until noon, and as we remember those that have paid the price in defense of our nation, we should also take a moment to remember that there are many more that will come from all over our country and around the world as they always have, ready to protect our freedoms.

Art delaCruz served honorably for over 22 years in the United States Navy and enjoyed a career that included a broad range of assignments. Art commanded a Navy strike-fighter squadron, spent one year with McKinsey & Co. as a Secretary of Defense Corporate Fellow, served as a Topgun instructor, and made six combat deployments. After retiring, he spent two and a half years in the aerospace and defense sector in the roles of business development and strategy and planning. He maintains a honed “quick reaction” capability by attempting to keep up with his wife, four kids, golden retriever, and Labrador retriever puppy.

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Memorial day - over 150 years of remembrance.

Library of Congress

“Those who have long enjoyed such privileges as we enjoy forget in time that men have died to win them.”

- Franklin Delano Roosevelt

Memorial Day is often considered the unofficial beginning of summer. Parades take place, the grill is dusted off for the first time. Actually, it is more than that. Memorial Day is in remembrance of soldiers who fell in combat risking their lives for their country. It is about gratitude.

So where does the holiday come from?

Although placing flowers on graves is a very old tradition, the modern Memorial Day observance began with the end of the Civil War. In four years of fighting, more than more than 622,000 Americans, from the North and the South, had died. The government established national cemeteries for the Union fallen, while cemeteries were established in cities and towns across the country. With those cemeteries came mourners. They decorated the graves of their fallen heroes with flowers. They recited prayers. They held tributes. It began as a very solemn day.

With the conclusion of the divisive Civil War in 1865, there was a yearning for remembrance of those lost — for healing the wounds of war. A pharmacist in Waterloo Village, New York, Henry C. Welles is credited with the inspiration that “it would be honorable and appropriate to recall the sacrifice of the patriotic dead by displaying floral tributes on the gravestones of the fallen.” Many towns claim the privelege of being the first one to celebrate Memorial Day. Boalsburg, Pennsylvania, cites October 1864 as the beginning for cemetery decorating in the locale. Carbondale, Illinois, and Petersburg, Virginia, also vie to be first. Columbus, Mississippi similarly is not to be out done. The town was the site of a hospital and also a burial ground for Union and Confederate soldiers from the Battle of Shiloh. It was on April 25, 1866, that four women decided to honor the Confederate and Union war dead in the local cemetery with flowers. The Columbus, Mississippi, observance received further attention when lawyer Francis Miles Finch learned of the conciliatory gesture and was moved to compose the poem “The Blue and the Gray.” The Atlantic Monthly published it in 1867.

Another Columbus, in Georgia, asserts that the honor of the first Memorial Day should be theirs. It was held in 1866. Authors Richard Gardiner and Daniel Bellware presented their case in an academic study. Furthermore, the New York Times from June 5, 1868, states the following: “The ladies of the South instituted this Memorial Day. They wished to annoy the Yankees, and now the Grand Army of the Republic in retaliation and from no worthier motive, have determined to annoy them by adopting their plan of commemoration.”

However, one of the earliest and perhaps largest ceremonies was held in Charleston, South Carolina, in 1865. Dr. David Blight book, Race and Reunion:The Civil War in American Memory. He explains that in May 1865, newly freed African Americans reburied 257 Union soldiers, who had died in a prison camp and were hastily buried, in order to give them the proper honors in death. The new graves were blanketed by flowers and dedicated, with thousands of people parading down the racetrack that had been the site of the prison camp.

Despite these conflicting claims of who was first, the issue has been seemingly settled. Waterloo, New York, is the birthplace of Memorial Day as decreed by the state and federal governments. Governor Nelson A. Rockefeller signed a proclamation on March 7, 1966, recognizing the birth of the holiday there. The U.S. Congress agreed when both House and Senate passed House Concurrent Resolution 587 on May 19, 1966. President Lyndon B. Johnson endorsed the designation as he similarly declared the hamlet the birthplace of Memorial Day.

What helped Waterloo’s cause to be first was the consistency of the celebration from year to year in 1866, 1867, and 1868 and thereafter? Other municipalities did not have a tradition of annual celebration or observance where businesses closed as they did in Waterloo. Nevertheless, there still is contention that Waterloo was not first. Some assert that first observance there was actually in 1868 and not 1866.

Today the premier observance takes place in Arlington National Cemetery, where the president lays a wreath at the Tomb of the Unknown Soldier followed by an address in the amphitheater. There rites were first held in Arlington on May 30, 1868, four years after burials started at General Robert E. Lee’s former Virginia estate.

One hundred fifty years ago, in anticipation of the 1:00 ceremony, flowers, and wreaths were gathered from the general public, the botanical gardens, the President’s Conservatory, and the Treasury gardens. The floral tributes and attendees all crossed the Potomac River to Arlington via the Long Bridge.

The ceremony was called to order at Arlington House by W.T. Collins, Esq., in the presence of General and Mrs. Grant. The mansion once owned by General Robert E. Lee was draped in mourning. The proclamation issued by General John Logan of the Grand Army of the Republic that established May 30 as the official holiday was read by the master of ceremonies. The invocation was offered by the Reverend Byron Sunderland with a hymn following. Next U.S. Representative and future president James A. Garfield of Ohio delivered solemn, appropriate remarks followed by a patriotic song sung by the audience. Then, to close out the ceremony, a poem was read by the Honorable J.C. Smith, a dirge was played by the 44th United States Infantry band, and a national salute was fired from Arlington House.

With opening ceremonies concluded, a procession was formed that included the Children of Soldiers’ and Sailors’ Orphan Asylum and the Committee on Decoration with the public falling in line to decorate grave sites. Once the graves had been festooned with flowers, a final hymn and benediction closed out the new Arlington observance. Hence the tradition began in 1868 of a national celebration in a prominent cemetery.

This holiday has certainly evolved. It became more of a hybrid both before and since 1971. It can be both solemn and joyous, both formal and casual. In 1968, Congress created a three-day weekend encompassing Memorial Day through the Uniform Monday Holiday Act. In the intervening years since the change became effective, Memorial Day has been hailed as the unofficial beginning of the summer season. Inevitably, the holiday weekend has spawned merchandise sales, vacation getaways, and marked by swimming pool openings. Some of the solemnity of the day, in the eyes of some, was lost. Former U.S. Senator Daniel Inouye, a World War II veteran, saw it that way. In every session of Congress beginning in 1987, until his death in 2012, he introduced bills to move Memorial Day back to May 30.

Congress further left its mark when the holiday was no longer referred to as Decoration Day. Gradually, the “Memorial Day” designation took hold. First used in 1882, it wasn’t common vernacular until after World War II. Still, it wasn’t until 1967 that Congress asserted that “Memorial Day” was the official name of the holiday.

It would be a mistake to think that the eclectic, fun-loving observance of Memorial Day is something new. The holiday sprang from the ashes of the Civil War. When the last veterans died in the 1950s, it was released from its Civil War moorings. The day was once defined as an occasion to mark sacrifice of soldiers in the North to free slaves and preserve the Union. In the South, its rationale was entirely different. So, already in the immediate aftermath of the Civil War, there was a bipolarity to the day. One is inclined to recall the dead, but also to celebrate the cause of freedom.

What are appropriate festivities? By itself, a day off from work was celebratory, since there were few national holidays. As early as 1869, the New York Times warned that the original purpose of the day should not be lost. The paper remarked that “joy” was beginning to overtake solemnity. The New York Tribune in 1875 similarly stated that the tradition of Decoration Day was vanishing. Again in 1878, in the same newspaper, the lament was repeated. Historian James McPherson notes the trend continued in the 1880s: "Parades replaced processions. Commemoration gave way to celebration. Instead of doleful songs like 'Strew Blossoms on Their Graves' and 'Cheers or Tears,' veterans and their families sang spirited tunes like 'Rally 'Round the Flag,' 'Marching Through Georgia' and "Dixie.'"

As the 19th century advanced, it was commonplace to close businesses in Northern states. It became accepted to split the day: a visit to the cemetery in the morning was followed by relaxation and diversion in the afternoon.

President Grover Cleveland in 1888 went fishing, which prompted a few scalding headlines and is listed as one of the reasons for his defeat in the bid for a second term. By 1910, the Grand Army of the Republic considered ending Memorial Day to avoid controversy. A year later, the first Indianapolis 500 was held on the day without much of a whisper.

During the 20th century, Memorial Day evolved as a permanent holiday on the calendar. What it entailed changed. It became a remembrance of all service personnel killed in war balanced by leisure, thus changing the attitude and changing conditions have left their mark on Memorial Day. As religious historian Catherine Albanese observed in 1974, after the Vietnam War there was much debate about the meaning of a soldier’s death and the reason for war. Perceptions of Memorial Day have and will continue to change. In keeping with the spirit of relaxation and leisure, it is estimated that more than 41 million people will treat themselves to a trip of 50 miles or more this Memorial Day weekend.

The serious demeanor and spirit of the holiday extends beyond the last Monday in May. It should be noted that the number of people participating in the first Memorial Day ceremony at Arlington National Cemetery was around 5,000, which is approximately the same number attending today. Recalling that Memorial Day was originally a holiday for Union soldiers, some Southern states still have separate Confederate remembrances. General Logan had originally asked that soldiers who had “united to suppress the late rebellion” be remembered. The South was not largely on board with Memorial Day until after World War I, when remembrances were encompassing all those who died in the countries various conflicts. On December 28, 2000, President Clinton signed the National Moment of Remembrance Act which designated 3:00 PM as a moment of silence in honor of Memorial Day. So, when did it start…1865, 1866, 1867, 1868, 1968, 1971? Pick your date. What really matters is that we all remember, in our own way, Memorial Day.

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Last updated: June 2, 2019

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Memorial Day: Remembrance and Honor in American Culture

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When is Memorial Day 2024? Here's what day it fall on this year and why we honor it

As Easter has passed, two major holidays are approaching in May in the U.S.: Mother's Day and Memorial Day.

Only Memorial Day is a federally recognized holiday when banks, schools and many nonessential government offices are closed and employees get a paid holiday.

Memorial Day is always observed on the last Monday in May, granting many people a three-day weekend and traditionally marking the unofficial start of summer. It was created to honor military members who lost their lives in service to the country.

Mother's Day is not a federal holiday in the same sense as Memorial Day, but on May 9, 1914, President Woodrow Wilson signed a proclamation declaring the second Sunday in May as Mother's Day, according to history.com .

Here’s when Memorial Day is this year, how it originated and why we continue to celebrate it.

What holiday is after Easter?

In the United States, celebrations and holidays that come after Easter include Cinco de Mayo on May 5, Mother's Day on May 12 this year and Memorial Day on May 27.

What holiday is in May?

There are two holidays in May: Mother's Day and Memorial Day. Many people in the U.S. also celebrate Cinco de Mayo in May.

When is Memorial Day 2024?

Memorial Day 2024 is on May 27.

What day is Memorial Day this year?

Memorial Day is always celebrated on the last Monday of May. In 2024, Memorial Day is on Monday, May 27.

It was first observed on May 30, 1868, and for decades on that date after Gen. John A. Logan, the leader of the Grand Army of the Republic for Northern Civil War veterans, had called for a nationwide day of remembrance.

In 1968 when Congress passed the Uniform Monday Holiday Act – to give federal employees more three-day weekends throughout the year – Memorial Day moved to the last Monday in May. It was also declared a federal holiday in 1971.

When is Memorial Day weekend 2024?

Memorial Day weekend starts on Friday, May 24, 2024, and lasts through the holiday on Monday, May 27.

Is Memorial Day a federal holiday?

Memorial Day became an official federal holiday in 1971.

Is Memorial Day a national holiday?

Memorial Day is a national holiday observed on the last Monday of May each year.

What does Memorial Day celebrate?

Memorial Day originally was established as Decoration Day to commemorate those who lost their lives while fighting in the Civil War.

When the United States became involved in World War I, Memorial Day expanded to honor American military personnel who died in all wars, including World War II, the Vietnam War, the Korean War and the wars in Iraq and Afghanistan, according to History.com .

Reach the reporter at   [email protected] . Follow   @dina_kaur  on X, formerly known as Twitter.

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Memorial Day: What Is It About?

Table of contents, commemorating the fallen, reflecting on history, uniting a nation, honoring families and communities, renewing our commitment, conclusion: a day of remembrance and gratitude, works cited.

• History of Memorial Day. U.S. Department of Veterans Affairs.
• "The Meaning of Memorial Day." History Channel.
• "Memorial Day: A Time to Remember and Reflect." National Constitution Center.

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Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill.

A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.

By Chris Hamby

Chris Hamby reviewed more than 50,000 pages of documents and interviewed more than 100 people for this article. The New York Times also petitioned two federal courts for materials under seal.

Weeks after undergoing heart surgery, Gail Lawson found herself back in an operating room. Her incision wasn’t healing, and an infection was spreading.

At a hospital in Ridgewood, N.J., Dr. Sidney Rabinowitz performed a complex, hourslong procedure to repair tissue and close the wound. While recuperating, Ms. Lawson phoned the doctor’s office in a panic. He returned the call himself and squeezed her in for an appointment the next day.

“He was just so good with me, so patient, so kind,” she said.

But the doctor was not in her insurance plan’s network of providers, leaving his bill open to negotiation by her insurer. Once back on her feet, Ms. Lawson received a letter from the insurer, UnitedHealthcare, advising that Dr. Rabinowitz would be paid $5,449.27 — a small fraction of what he had billed the insurance company. That left Ms. Lawson with a bill of more than $100,000.

“I’m thinking to myself, ‘But this is why I had insurance,’” said Ms. Lawson, who is fighting UnitedHealthcare over the balance. “They take out, what, $300 or $400 a month? Well, why aren’t you people paying these bills?”

The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much so-called out-of-network medical providers should be paid. It promises to help contain medical costs using fair and independent analysis.

But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee.

Here’s how it works: The most common way Americans get health coverage is through employers that “self-fund,” meaning they pay for their workers’ medical care with their own money. The employers contract with insurance companies to administer the plans and process claims. Most medical visits are with providers in a plan’s network, with rates set in advance.

But when employees see a provider outside the network, as Ms. Lawson did, many insurance companies consult with MultiPlan, which typically recommends that the employer pay less than the provider billed. The difference between the bill and the sum actually paid amounts to a savings for the employer. But, The Times found, it means big money for MultiPlan and the insurer, since both companies often charge the employer a percentage of the savings as a processing fee.

How MultiPlan and Insurers Make Money on Fees

MultiPlan and health insurers typically receive a percentage of the “savings” on each claim, creating an incentive to recommend lower payments.

MULTIPLAN ADVISES A 20% PAYMENT

MULTIPLAN ADVISES A 50% PAYMENT

A lower payment

means bigger fees for

the insurer and MultiPlan, but also a bigger potential bill for the patient.

The patient is potentially on the hook for this amount.

To MultiPlan

share of the

(paid by insurer)

(paid by employer)

For a doctor’s bill of $1,000:

20% PAYMENT

50% PAYMENT

A lower payment means bigger fees for the insurer and MultiPlan, but also a bigger potential bill for the patient.

Based on a share of the difference

Fee percentages vary based on negotiated contracts.

By The New York Times

In recent years, the nation’s largest insurer by revenue, UnitedHealthcare, has reaped an annual windfall of about $1 billion in fees from out-of-network savings programs, including its work with MultiPlan, according to testimony by two of its executives. Last year alone, MultiPlan told investors, it identified nearly $23 billion in bills from various insurers that it recommended not be paid.

MultiPlan and the insurers say they are combating rampant overbilling by some doctors and hospitals, a chronic problem that research has linked to rising health care costs and regulators are examining . Yet the little-understood financial incentive for insurers and MultiPlan has left patients across the country with unexpectedly large bills, as they are sometimes asked to pick up what their plans didn’t pay, The Times found. In addition, providers have seen their pay slashed, and employers have been hit with high fees, records and interviews show.

In some instances, the fees paid to an insurance company and MultiPlan for processing a claim far exceeded the amount paid to providers who treated the patient. Court records show, for example, that Cigna took in nearly $4.47 million from employers for processing claims from eight addiction treatment centers in California, while the centers received $2.56 million. MultiPlan pocketed $1.22 million.

Confidential Pricing and Fee Data

Itemized payments and fees for thousands of claims were made public in a lawsuit against Cigna after The Times petitioned the court. The insurer and MultiPlan opposed the release, calling the data “highly confidential.”

Payment amount

For providing outpatient

substance abuse treatment,

the facility received $134.13 .

Fee for Cigna

For processing the claim,

Cigna received $658.75 ,

nearly five times as much

as the treatment center.

Fee for MultiPlan

For recommending a payment

amount, MultiPlan received

$167.48 , slightly more than

the treatment center.

For providing outpatient substance abuse

treatment, the facility received $134.13 .

For processing the claim, Cigna received

$658.75 , nearly five times as much as the

treatment center.

For recommending a payment amount,

MultiPlan received $167.48 , slightly more

than the treatment center.

View the PDF .

MultiPlan, which makes nearly all its revenue from such fees, markets its calculations as “defensible, repeatable and completely transparent” and independent of insurance company influence. The firm estimates that its reach extends to more than 100,000 health plans covering more than 60 million people. Patients have encountered its pricing recommendations after a variety of treatments, including spine surgeries, physical therapy appointments and ambulance rides.

The company did not respond to detailed questions from The Times. In a statement, it said it uses “well-recognized and widely accepted solutions” to promote “affordability, efficiency and fairness,” by recommending a “reimbursement that is fair and that providers are willing to accept in lieu of billing plan members for the balance.”

In examining MultiPlan’s dominant role in this secretive world, The Times reviewed more than 50,000 pages of confidential corporate records, legal filings, claims information and other documents. The Times also interviewed more than 100 patients, doctors, billing specialists, advisers to employer health plans and former MultiPlan employees.

The Times found:

Patients hit with unexpectedly large bills sometimes forgo care or cease long-term treatment, and complain that appeals are fruitless. “They basically took away the mental health care I was getting,” said Olivia Henderson, who stopped her therapy sessions in New York when the cost spiked.

MultiPlan’s recommended payments not only push back against known overbillers, but can also squeeze smaller practices. Kelsey Toney, who provides behavioral therapy for children with autism from a clinic in rural Virginia, saw her pay cut in half for two patients. “I don’t want to say, ‘I’m sorry I can no longer accept you,’ especially when I’m the only provider within an hour,” she said.

Insurers pitch MultiPlan to employers as a way to control costs, but the fees can be onerous and unpredictable. New England Motor Freight, a New Jersey trucking company, was charged $50,650 by UnitedHealthcare for processing a single hospital bill.

Insurers can influence MultiPlan’s purportedly independent payment recommendations, according to MultiPlan documents made public by a federal judge after a petition from The Times. That generally means paying even less to doctors and making more in fees.

Former employees at MultiPlan, which has annual revenues of about a billion dollars, described a numbers-driven culture that encouraged locking in unreasonably low payments and tied their bonuses to the reductions. “I knew they were not fair,” said one former MultiPlan negotiator, Kajuana Young.

Regulators rarely intervene. The administration of employer-funded health plans is mostly exempt from state regulations. Enforcement primarily falls to an agency within the federal Department of Labor, which says it has one investigator for every 8,800 health plans.

In separate statements, UnitedHealthcare, Cigna and Aetna said MultiPlan helps them control costs for employers. A UnitedHealthcare spokesman said employers negotiate and accept contract terms, including the fee, and described the arrangement as “an industry-standard approach.” A Cigna spokeswoman also said the fee “aligns with industry standards,” adding that “it is fully transparent to our client” and has no influence on payouts to medical providers.

As to the issue of patients being billed for unpaid balances, Aetna said it offered employers “various options and strategies” to minimize the risk of unexpected charges. Cigna said that payment decisions could be appealed, and that it collected no fee if the patient was ultimately billed the balance. UnitedHealthcare blamed “egregious” charges by out-of-network providers and suggested that criticism of its work with MultiPlan had been stoked by a private-equity-backed medical staffing firm that is suing the insurer.

Determining what to pay when a patient goes out of network has long been a contentious issue. While such claims represent a small portion of all medical visits, they can be expensive, little understood by patients and difficult to avoid. Legislation that took effect in 2022 now protects patients from certain kinds of surprise bills but does not cover a vast majority of the claims directed to MultiPlan.

Insurers say that the traditional approach — paying a portion of what providers typically charge — no longer works because of dramatic price hikes. Cigna, in its statement, said some out-of-network providers last year tried to charge “up to 1,904 percent of what they charge Medicare.” Providers, meanwhile, argue that insurers and MultiPlan can’t be trusted to set fair rates.

The situation echoes a past scandal. Fifteen years ago, the New York attorney general broke up a pricing system that his office’s investigation concluded was “rigged.” The central player, UnitedHealth, agreed to pay $350 million to patients and medical professionals who said they had been shortchanged, and along with other major insurers, it agreed to reforms meant to ensure this wouldn’t happen again.

But the settlement left an opening.

An Industrywide Investigation

In 2009, a woman from Yonkers, N.Y., became a symbol of patients’ outrage and the promise of change.

Mary Reinbold Jerome had been diagnosed with ovarian cancer at age 62 and received treatment at Memorial Sloan Kettering. Because the hospital was outside her plan’s network, she was billed tens of thousands of dollars.

A tenacious woman who taught English to nonnative speakers at Columbia University, Dr. Jerome lodged a complaint with the state attorney general’s office, helping to prompt an industrywide investigation .

She stood beside Andrew M. Cuomo, then the attorney general, as he announced his office’s blistering conclusions : A payment system riddled with conflicts of interest had been shortchanging patients, and at its core was a data company called Ingenix. Insurers used the company, a UnitedHealth subsidiary, to unfairly lower their payments and shift costs to patients, the probe found.

UnitedHealthcare, Cigna, Aetna and other major insurers agreed to replace Ingenix with a nonprofit that would provide independent pricing data. Dr. Jerome was featured on news programs and hailed as an agent of change, while senators held hearings and blasted insurers for cheating patients.

In 2010, Dr. Jerome died.

“She was thinking beyond her own situation,” her daughter, Eva Jerome, said in an interview. “She was hoping it would have a broader impact.”

But amid the triumph, a key detail in the attorney general’s agreements with insurers largely escaped notice: The companies were required to use the nonprofit database for only five years.

When that term expired in 2014, MultiPlan was well positioned to capitalize.

‘All for Naught’

For decades, the company, founded in 1980, offered a traditional approach to managing out-of-network claims by negotiating rates with doctors. Insurers got discounts and assurances that patients would not have to make up the difference.

But after MultiPlan’s founder sold it to private equity investors in 2006, the company pursued a more aggressive approach. It embraced pricing tools that used algorithms to recommend lower payments, and no longer protected patients from having to pay the difference, documents show.

Meanwhile, private equity ramped up investments in physician groups and hospitals and, in some instances, began billing for extraordinary sums. Once insurers were no longer obligated to use the nonprofit database, FAIR Health, they began looking for ways to combat that billing and other charges they considered egregious. Because FAIR Health’s data was based on what doctors typically charged, insurers contended that overbilling would skew payments too high.

Cigna was particularly concerned with what it considered overbilling and fraud by substance abuse treatment centers. It halted some payments, opened investigations and met with a public relations firm “to precondition public support for any next steps we may need to take,” internal documents show.

In a 2015 email, unsealed after The Times’s request and over Cigna’s objection, a Cigna executive reminded colleagues of a key consideration.

“We cannot develop these charges internally (think of when Ingenix was sued for creating out-of-network reimbursements),” wrote Eva Borden, a chief risk officer at Cigna. “We need someone (external to Cigna) to develop acceptable” rates, she wrote.

UnitedHealthcare developed talking points to “position UnitedHealthcare as an advocate that is helping consumers push back on excessively high physician and facility bills,” a 2016 internal memo said.

Both insurers increasingly turned to MultiPlan. Internal documents show that UnitedHealthcare began a campaign to persuade employers to switch from FAIR Health. In a 2019 email, a UnitedHealthcare senior vice president emphasized creating a “sense of urgency” and helping companies still using FAIR Health “understand they don’t want to be on that program anymore.”

UnitedHealthcare had a big incentive to encourage this change. When it processed claims from employer plans using FAIR Health, the insurer collected no additional fee, according to legal testimony. But when it used MultiPlan, documents show, it typically charged employers 30 to 35 percent of the difference between the billed amount and the portion paid.

MultiPlan, too, charged a percentage of the savings, meaning it could make more by recommending lower payments. (FAIR Health charged a flat fee.)

While UnitedHealthcare was MultiPlan’s largest customer, Cigna and Aetna also embraced its tools and fee model, records show. Other insurers that work with MultiPlan include Kaiser Permanente, Humana and some Blue Cross Blue Shield plans.

Employers with self-funded plans administered by insurers include large companies like Coca-Cola and AstraZeneca and smaller organizations like school districts and union locals. (New York Times Company plans also operate this way.)

FAIR Health has expanded the types of data it offers and made it available online . Numerous states use the nonprofit when setting payments for government programs. Big commercial insurers still license its data, but they have largely shifted to other approaches, according to interviews, documents and statements from UnitedHealthcare and Cigna.

“If they’re able to go back to their old ways,” Eva Jerome said, “then it was all for naught.”

‘I’m Being Ripped Off’

When claims go through MultiPlan, some patients receive statements highlighting what their insurer calls discounts or savings — even as doctors or hospitals bill them for those amounts.

Cari Campbell, who received fertility treatment in Minnesota, was charged thousands of dollars that her insurer had labeled “you saved.” In Kansas City, Kan., Paul Haddix paid the amounts labeled “your discount” for his daughter’s occupational and speech therapy. In New Jersey, Jonathan Menjivar paid upfront for therapy appointments and saw his reimbursements plunge.

“I took a closer look at the explanation of benefits,” Mr. Menjivar said, “and noticed for the first time this column labeled ‘your discount,’ which is an interesting way of putting it.”

The supposed savings and discounts were the portions MultiPlan had recommended the employers not pay. Patients could still be on the hook.

Fact Check: An Explanation of Benefits

Insurance statements often identify savings or discounts. But sometimes patients can still be billed for that amount, as in this case involving the UnitedHealth subsidiary UMR.

Your discount: $871.78

Your plan negotiates discounts with providers and facilities to help save you money.

You saved: $1,293.74

82% of your service was covered by your

plan discounts, your employer-sponsored benefits plan, or other amounts for which you are not responsible.

82% of your service was

covered by your plan discounts, your employer-sponsored

benefits plan, or other amounts for which you are not responsible.

The burden can fall hardest on people with chronic or complex conditions who see out-of-network specialists. Justin Dynlacht, who has Crohn’s disease, paid extra for a plan that covered such visits. After seeing two in-network doctors about persistent abdominal pain, he went to an outside specialist who discovered a hernia containing abdominal tissue.

Aetna sent the specialist’s claims to MultiPlan, and Mr. Dynlacht was left with thousands of dollars in bills.

“I’m being ripped off,” he said. “It’s not right.”

Staying in-network can be especially difficult for mental health or substance abuse treatment.

A California woman whose teenage son was battling opioid addiction found only one treatment center that would accept him, and it was out of network. “When your kid has hit rock bottom, they’re dying, you get them in wherever you can,” she said, speaking on the condition that she not be named to protect her son’s privacy.

They had the most expensive health plan her employer offered, but her insurer, citing MultiPlan, left the family with tens of thousands of dollars in bills.

“I expected there would be some payment that wasn’t covered,” she said. “What I didn’t expect was the deceit that caused an even higher payment, an amount I never dreamed.”

Insurers sometimes suggest that a medical provider agreed to a lower payment, even when it’s not so. This patient was billed the amount that Cigna identified as savings.

You saved $370.62 . CIGNA negotiates discounts with health care professionals and facilities to help save you money.

Source: Read the PDF.

Some providers said they had begun requiring payment upfront or stopped accepting patients with certain insurance plans because appealing for higher payments can be time-consuming, infuriating and futile. Others have tried to sue insurers or MultiPlan. Dr. Rabinowitz, who repaired Ms. Lawson’s incision, hopes to collect the remaining balance from UnitedHealthcare in an ongoing case.

Surprise bills for some types of care are no longer an issue, insurers said, thanks to the law that went into effect in 2022 . Brittany Perritt didn’t realize the anesthesiologists at her 3-year-old’s brain tumor treatments in 2020 were out-of-network until the claims went to MultiPlan. If that care occurred today, she likely would be spared the calls from debt collectors, because she didn’t go out of network by choice.

But MultiPlan assured investors shortly before the law’s passage that it was likely to have “limited impact” on the company. In fact, MultiPlan said, 90 percent of its revenue involved out-of-network claims that wouldn’t be affected.

‘Lining Their Pockets’

Debra Margraf, a trustee for a union health plan covering about 1,500 Phoenix-area electricians, was stunned when she and her colleagues asked Cigna what they had paid for “cost-containment” services.

The answer: The fees had risen from just over $550,000 in 2016 to $2.6 million in 2019, according to a lawsuit the trustees filed.

“It’s very frustrating to go out and have someone pitch us that they’re going to save us money and then end up lining their pockets,” Ms. Margraf said.

Cigna did not respond to questions from The Times about specific employer plans.

Other employers have also questioned increased fees and complained about being kept in the dark. A UnitedHealthcare account executive emailed colleagues for help explaining the $50,650 fee charged to New England Motor Freight. The fee grew out of a $152,594 bill, of which just $7,879 was covered.

The trucking company “thinks these are a money tree for us in fees and we are milking them,” the account executive wrote.

One UnitedHealthcare executive suggested a partial refund and an annual cap on fees, but a colleague countered, “We have to be concerned about setting precedent.”

Inside an Insurer’s Debate About Fees

Internal emails show UnitedHealthcare employees grappling with complaints about high fees. When one executive suggested limiting the amount charged New England Motor Freight, a colleague resisted.

As a company we have been unwilling to enter into one-off agreements that cap our revenue, so we have to be very careful.

The way the fees were calculated was particularly galling: How could MultiPlan and insurers tie their own fees to bills they deemed unreasonable? It made no sense, one consultant for the trucking company wrote, to charge a 35 percent fee “if a hospital were to bill $20,000 for a flu shot.”

UnitedHealthcare did not respond to questions from The Times about the trucking company. In a statement, the insurer said it also offers fee arrangements not tied to billed amounts.

Cigna’s statement defended its fee, saying that “it enables us to administer the program, negotiate with providers and absorb the long-term risk associated with any challenging negotiation.”

Even verifying the accuracy of fees was difficult when UnitedHealthcare initially refused to provide the trucking company with the full underlying data. Cigna refused a similar request from auditors for Arlington County, Va., which it had charged $261,000 in one year. “There is no process for verifying the accuracy of any of these amounts,” the auditors wrote.

Large employers also have trouble getting data from insurers, said James Gelfand, head of the ERISA Industry Committee, which represents big companies with employee benefit plans.

Cost-containment programs can be a “revenue center” for insurers, Mr. Gelfand said, but are “extremely difficult for employers to police.”

‘In a Lot of Pain’

Patients have limited recourse. If they want to sue, they usually must first complete an administrative appeals process; even then, they stand to collect relatively modest amounts.

Regulators are unlikely to step in. Self-funded employer plans are largely exempt from state oversight. And federal regulators have limited resources and legal authority to police them.

Even when patients figured out where to direct complaints — the Employee Benefits Security Administration — they described the process as draining and mostly fruitless.

Patti Sietz-Honig, a video editor at Fox 5 in New York, filed a complaint in 2022. The cost of seeing a specialist for chronic back pain had spiked, and she faced roughly $60,000 in bills.

Ms. Sietz-Honig pressed for updates about her complaint and sent articles critical of MultiPlan from Capitol Forum, a site focused on antitrust and regulatory news. Last March, the agency emailed her that her employer and her insurer, Aetna, had agreed to a “temporary exception” and made additional payments.

“Unfortunately,” the agency wrote, the law “does not prohibit the use of third-party vendors” to calculate payments.

Meanwhile, her longtime pain specialist started requiring payment upfront. To save money, Ms. Sietz-Honig spaced out her appointments.

“I’ve been in a lot of pain lately,” she said, “so I’ve been going — and paying.”

‘Not a Real Negotiation’

As MultiPlan became deeply embedded with major insurers, it pitched new tools and techniques that yielded even higher fees, and in some instances told insurers what unnamed competitors were doing, documents and interviews show.

After meeting in 2019 with a MultiPlan executive, a UnitedHealthcare senior vice president wrote in an internal email that other insurers were using MultiPlan’s aggressive pricing options more broadly, and that UnitedHealthcare could catch up.

“Dale did not specifically name competitors but from what he did say we were able to glean who was who,” the executive, Lisa McDonnel, wrote, referring to Dale White, then an executive vice president at MultiPlan. She described how Cigna, Aetna and some Blue Cross Blue Shield plans were apparently using MultiPlan.

In recent years, MultiPlan’s top revenue generator has been an algorithm-based tool called Data iSight that consistently produces the lowest payment recommendations. Some insurers have used it as part of strategy MultiPlan calls “target pricing” or “meet-or-beat”: Insurers set a maximum price they will pay, and MultiPlan collects a fee only if its recommendation is lower.

In theory, many of MultiPlan’s recommendations are negotiable. But documents and interviews revealed tactics meant to pressure medical practices to accept low payments. Some offers came with all-caps admonitions and deadlines just hours away. Accept and receive prompt payment; refuse and risk an even lower payout. Practices and billing specialists said this often wasn’t an empty threat.

“It’s not a real negotiation,” said Tammie Farkas, who handles billing for her husband’s small New York-area practice focused on repairing blood vessels in the brain.

Insurers can set negotiation parameters for MultiPlan, including not negotiating at all, records and interviews show. Multiple providers and billing specialists said that in recent years they had increasingly been told their claims weren’t eligible for negotiation.

“It wasn’t this bad before,” said Tiffany Letosky, who oversees a small practice specializing in surgeries for endometriosis and gynecologic cancers.

Former MultiPlan negotiators said their bonuses had been linked to their success at reducing payments, incentivizing a hard-line approach.

Ms. Young, the former negotiator critical of the process, said she had occasionally called a provider from a cellphone — knowing that her work line was recorded — and advised against accepting her own offer.

Another former negotiator said the pressure to get bigger discounts had made her physically ill. “It was just a game,” she said. “It’s sad.”

Jennifer Pittinger, also a former negotiator, said she saw nothing wrong with the hard-driving approach because she believed she was combating overbilling.

“I was a bit of a viper,” she said. “Sometimes I just wanted to go in as hard as I could because my bonus is affected. If I can get a provider to accept 50 percent off, that’s great for me.”

But tools rolled out to combat price-gouging hospitals and private-equity profiteers, The Times found, have also been directed at people like Ms. Toney, the therapist in rural Virginia who treats children with autism.

She charges the rates that Virginia pays for people on Medicaid. But last year, she said, Meritain Health, an Aetna subsidiary, informed her that fair payment for her services was less than half what Medicaid paid, based on calculations by MultiPlan.

Ms. Toney has not billed the parents of her two patients covered by Meritain, but going forward she will not accept patients with similar insurance.

“It puts me in a tough position,” she said. “Do I want to pay myself a salary or be able to help people?”

Julie Tate contributed research. Produced by Guilbert Gates and Rumsey Taylor .

Chris Hamby is an investigative reporter for The Times, based in Washington. More about Chris Hamby

Photo essay: Remembering the genocide against the Tutsi

Philippe Kayitare survived the massacre at Nyamata church in which 10,000 people were murdered. Juliette Mukakabanga, a Hutu, saved the life of her Tutsi baby during the massacre at Murambi. In the hills of Bisesero, Antoine Sebiroro was among those who fought back. And in Gisozi, survivor Prisca Umwanankunda now works as an archivist helping to preserve records of such memories. Through their interactions with these landscapes, this photo essay offers not only an introduction to the sites themselves, but insights into the human experience which makes each of them so meaningful. 

In two days around ten thousand Tutsi were murdered in this church, 14-15 April 1994. 21 members of Philippe Kayitare’s family were among them, including his parents, four siblings, grandmother, uncles, aunts and cousins. Here he is seated where he lay injured during the massacre.

Beneath a corrugated roof studded with a star-scape of shrapnel holes, survivor Philippe Kayitare joins the Virgin Mary’s vigil over the clothes of the murdered. Thirty years on, victims are still being located. Foreground: Coffins containing recently discovered remains await burial.

Philippe Kayitare sits on a bench outside the church where he survived the massacre which took the lives of his family. “I was hit by machetes in the face, and a grenade caught my leg,” he says. “My pregnant mother was killed by a machete. My father was shot at the entrance of the church.”

Around fifty thousand victims of the Genocide against the Tutsi are buried here, including people murdered in the church and surrounding area. “I come here to remember them, to connect with them,” says Philippe of his family among them. “I chose to live close to feel their presence.”

Around 50,000 Tutsi fled to this unfinished school complex as genocide began in April 1994. A Hutu with a Tutsi husband and children, Juliette Mukakabanga came here on 10 April. “Mayor Félicien Semakwavu instructed us to go to Murambi School, promising army protection,” she says.

Juliette views pictures of genocide victims in the exhibition here. “I arrived with my husband, holding my two children and carrying my one-month-old baby on my back. With us were my mother-in-law and many of my husband’s family. We totalled 45 people. Only three of us survived.”

Juliette stands where she was during the assault on 21 April 1994. “The militia asked for my ID and found I was Hutu. I was carrying my baby on my back. They told me to hand over the Tutsi child to be killed. I refused. They said since I choose to be Tutsi, I will be killed with my baby.”

Juliette recounts what happened on this spot on 21 April 1994. “As the militia raised weapons to kill us, their chief blew a whistle signalling their work was done,” she says. “One took my ID card, my proof of Hutu identity, to ensure our future death.”

Hundreds of corpses are preserved in lime. Juliette does not know which if any are relatives. “My eight-year-old, six-year-old and husband were killed with machetes here, with other family. When I visit I am overwhelmed with sadness, yet it’s also where I feel closest to my loved ones.” Her infant daughter, Pauline, survived with her.

During the Genocide against the Tutsi, these hills became a centre of resistance. “We refused to die,” says Antoine Sebiroro. “We fought the militias for about a month. Aged 20 I was on the front lines, spying on the militia, noting their weapons, relaying information to those behind us.”

In May 1994, as Tutsi like Antoine Sebiroro continued to resist genocide with spears and rocks, soldiers joined the militia attacking them. “The darkest day came on 13 May, 1994, when over 30,000 Tutsis perished, including my parents, two siblings, and countless other relatives.”

“I could easily have been one of these,” says Antoine, resting battle-scarred hands on a case holding skulls of Tutsi who died here. “My father fell to a bullet from a Presidential guard, while my mother was slain with a machete as she carried my sister’s child, who also died.”

50,000 to 60,000 Tutsi are buried at this memorial. Antoine prepares to lay a flower in their memory. “Born into a family of seven, sadly only three of us survived,” he says. “Reflecting here reminds me of the battles we fought and the pain we endured witnessing our loved ones dying.”

The Kigali Genocide Memorial is the final resting-place of 250,000 people murdered across Rwanda’s capital city during the Genocide against the Tutsi. The birthplace of peace education in Rwanda, it is also home to the Genocide Archive of Rwanda. Survivor Prisca Umwanankunda works there.

Prisca Umwanankunda lays a rose on a mass grave at the Kigali Genocide Memorial. “In the genocide our lives were shattered beyond comprehension,” she says. “My mother, three brothers and elder sister perished, along with countless relatives. The brutality of their deaths still haunts me.”

Prisca views photos of victims in the Memorial. “I remember the day I was caught at a roadblock,” she says. “The militia subjected me to unimaginable brutality. I was put on a bus with other half-alive Tutsi to be drowned at the Nyabarongo river. I used every ounce of strength to escape.”

Prisca at work in the Genocide Archive. “The Genocide robbed me of my legs,” she says. “However much pain I feel every day, I push myself to progress. As an archivist here, I work to preserve the memory of those lost, honouring the lives of my loved ones.”

Prisca Umwanankunda in the Memorial Gardens. “This Memorial holds a special place in my heart,” she says. “A final resting-place for innocent souls, I vow to protect it at all costs, ensuring that their memory endures for generations. In this sacred space, I find solace and strength.”

Commissioned by UNESCO, this exhibition was created in 2024 by the Aegis Trust, which runs the Kigali Genocide Memorial on behalf of Rwanda’s Ministry of National Unity and Civic Engagement.

• International Day of Reflection on the 1994 Genocide against the Tutsi in Rwanda
• Commemoration of the 30th anniversary of the 1994 genocide against the Tutsi in Rwanda

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• International Day of Reflection on the Tutsi Genocide
• Civic education
• Country page: Rwanda
• Topics: Display
• Region: Africa
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• Criminal Law / LENS Essay Series / Terrorism
• LENS Essay Series: “From the Halls of Montezuma: The Promise and Pitfalls of Designating Mexican Drug Cartels as Foreign Terrorist Organizations”

by Charlie Dunlap, J.D. · 6 April 2024

Mexican drug cartels present a deadly threat to thousands Americans by trafficking fentanyl and other lethal poisons into the U.S.  A number of steps have been taken against the cartels, but should the U.S.. also formally designate them as Foreign Terrorist Organizations (FTOs) like Hamas ?

Consequently, it might seem that designating drug cartels as FTOs is the obvious answer but like so many things in the law, the issue is more complicated than it may first appear. 

In today’s addition to the LENS Essay Series Duke Law 3L Casey Witte unpacks the question for us in his essay, “From the Halls of Montezuma: The Promise and Pitfalls of Designating Mexican Drug Cartels as Foreign Terrorist Organizations” 

Casey walks us through the FTO designation process and analyzes its application to select cartels.  After considering the “promise and pitfalls” of the designation, he concludes “for legal, practical, and political considerations…we should not seek to designate cartels as FTOs.”

Importantly, however, Casey goes further with his analysis.  Noting that “cartels are dynamic, sophisticated, and often ruthless organizations” he argues that “any enforcement strategy will need to be multi-faceted in its approach.”  He then offers “three alternative policy or enforcement actions that could form part of that multi-faceted approach,” and contends they could be a “better use of resources than FTO designation.”

This is an extremely thoughtful essay that deserves to be part of the national discussion regading what to do about the vile organizations that are fueling the drug scourge that is killing tens of the thousands of Americans .   You can (should!) read Casey’s stud y here .

Here’s the abstract of Casey’s essay:

A common rhetorical refrain in American politics is to treat malignant groups “like terrorists.” Today, this language is often applied to Mexican drug cartels. Seeking to curb cross-border violence and fentanyl trafficking, scores of policymakers have urged the federal government to designate these cartels as Foreign Terrorist Organizations (“FTOs”). Using this trend as a jumping-off point, this essay examines the FTO designation framework as-applied to Mexican drug cartels. Specifically, this essay addresses whether these cartels can be designated as FTOs and, if so, whether designation would be in the best interests of the United States. Ultimately, this essay argues that Mexican drug cartels can be designated as FTOs, but for a variety of legal, practical, and political considerations, this would be an imprudent move. Further, this essay notes that there are a variety of arguably more effective alternatives if policymakers remain interested in aggressively pursuing cartel activity.

About the Author

Remember what we like to say on  Lawfire ® : gather the facts, examine the law, evaluate the arguments – and then decide for yourself !

Tags: Casey Witte Mexican drung cartels

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