On July 15, 2024, medical advocacy groups protested the denial of medical care at United Healthcare in Minnetonka, Minnesota. The shooting of UHC CEO Brian Thompson sparked an online outcry over problems in the US health care system. David Berding/Getty Images for People's Action Institute/Getty Images Hide Caption
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David Berding/Getty Images, People's Action Institute/Getty Images
The murder of UnitedHealthcare CEO Brian Thompson has focused much attention on the dysfunction in the health insurance industry.
The shooting sparked a flurry of emotional posts online about health insurance denials. Police said they found a handwritten note on Luigi Mangione after he was arrested. The memo called health insurance companies “parasitic” and pointed to the disconnect between the country's expensive health care system and short life expectancy, according to the Associated Press.
While it's true that U.S. health care costs are uniquely high and often frustrating, experts say the reasons why America's life expectancy is lower than many comparable countries are complex.
The latest calculations from the Centers for Disease Control and Prevention put the average life expectancy in the United States at 77.5 years. According to the World Bank, this is far below the average life expectancy of 80 years in high-income countries. Life expectancy in the United States is on par with Ecuador and Croatia.
Dr. Stephen Wolf, director emeritus of the Center for Society and Health at Virginia Commonwealth University, says that although problems with access to health care cause suffering, health care is not the main factor in lower life expectancy.
“Research shows that about 10 to 20 percent of health outcomes are attributable to medical care,” he says. This includes “really serious flaws” in the system, such as lack of access to insurance and high costs.
“But most of the reasons for America's low life expectancy lie outside of the medical field.”
Social and “commercial” drivers of poor health
In the context of Thompson's death, there is an irony. Gun violence is a major contributor to America's declining life expectancy, killing Americans in their prime working years. (Thompson was 50 years old.)
Eileen Crimmins, a professor of gerontology at the University of Southern California, told NPR in 2023, “The two-year difference in life expectancy probably comes from the fact that firearms are so readily available in the United States.” Ta.
Mr. Crimmins was a member of a committee of researchers promoting a landmark study by the National Academy of Sciences, chaired by Mr. Wolf, on the issue of American life expectancy, titled “Short Life Expectancy, Poor Health.'' .
Other factors listed in the 400-page report include physical inactivity, child poverty, air pollution and road fatalities.
Wolfe says public policy also plays a role. He noted that other countries have social assistance programs to help people living in poverty or without stable housing, “so that they don't end up having negative health outcomes.” “We don’t have as extensive a support system as we do in the United States.”
He also points to what he calls “commercial determinants of health,” or examples of how lax regulation of industries and products causes health problems.
“We're seeing it in the food industry, we're seeing it in the firearms industry. The opioid epidemic started in 1996 with OxyContin, which was approved in Europe and other countries. “It's a drug that hasn't been used,” he says.
This contributes to a “social and political environment in this country that prioritizes profits over the public good,” Wolf said. “This is a systemic problem across corporate America. The healthcare industry is no exception, but it is not the only cause of poor health.”
Wolfe said none of this justifies Thompson's killing, calling it “obviously horrific.”
denial of care
This systemic problem is spreading among commercial health insurance companies in part because they deny claims for treatments deemed “not medically necessary.”
Miranda Yaber, a professor of public health policy at the University of Pittsburgh, told NPR Morning Edition that the experience of reporting denials is widespread. She is researching interview refusals for a forthcoming book. She interviewed more than 1,300 American adults and found that 36% had experienced at least one interview refusal.
“What's frustrating for a lot of patients is that there's so much opacity,” says Yaver, who writes a substack called Rationing by Inconvenience. “When people tried to dig into the basis for the claim denial, the insurance company came back and said this information was proprietary.”
UnitedHealthcare was sued in November for allegedly using AI to process pre-authorizations for Medicare Advantage plans. (Other insurance companies are facing similar lawsuits filed last year.)
“One of the things the (UnitedHealthcare) lawsuit points out is that 90 percent of denied claims are reversed on appeal,” Yarber said, citing the complaint's claims. “This is just a rough number because it actually suggests that the error rate is high.”
These lawsuits are still ongoing. UnitedHealthcare did not respond to NPR's request for comment on the lawsuit. The company's lawyers asked the court to dismiss the lawsuit.
Yarber told Substack that he had expressed “outrage, if not outrage, against private insurance” in the wake of Brian Thompson's murder, but that “this act is a change in policy for UHC and other private insurance companies.” It is almost certain that this will not lead to ”
“These are widespread problems that require systemic intervention,” she wrote.
Carmel Wroth edited and contributed to this work.
