BU public health and public policy experts say the public reaction is understandable but should be directed at politicians to create change.
aviation industry. cable and internet providers; Wireless telephone service. Consumers are outraged about all of this, but they seem to reserve a special level of hatred for the $800 billion U.S. health care industry, and the United Healthcare CEO's attack in New York City. The shocking killings put a spotlight on the hostile relationship between patients and health care providers.
Within minutes of the early morning shooting on Dec. 4, social media commenters began to speculate, without evidence, that the assassin was seeking revenge on an industry that had wrongfully denied health insurance claims. I didn't hesitate. The fact that the victim, Brian Thompson, is a successful businessman, husband and father of two garnered little sympathy online.
“We live in a country where one in five Americans goes at least one month each year without health insurance, and where even a brief loss of insurance can disrupt life-saving treatment and cause economic ruin. “There's understandable anger over that,” said Boston Interim Dean Michael Stein. He is a professor in the university's School of Public Health and professor of health law, policy, and management. “Add to that the system of profit maximization, the denial of prior authorization, that infuriates us and makes us feel most personal. And the ongoing toxic debate over the privatization of Medicare and Medicaid… Yes, these are political issues that affect the public's health, but killing medical executives will not solve any of them.
These are political issues that affect the public's health, but killing medical executives will not solve them.
Michael Stein, SPH Interim Dean
As for solutions to current problems, they are likely to come from Capitol Hill, another BU expert and academic says. “The federal government plays a central role in accelerating change, and it always has,” said James Levitzer, Peter and Deborah Wexler Professor of Markets, Public Policy, and Law in BU’s Questrom School of Business. says. “I think a lot of the improvements in payments and delivery will come from governments deciding they need to accelerate change.”
Stein takes a similar view. “Private insurers derive the majority of their revenue from Medicare and Medicaid contracts, so again, this is a government spending issue that needs to be politically debated. For now, until the model changes, is a commercial industry.”
As the vitriolic reaction to the shootings made clear, change does not come quickly in the public's eyes. Luigi Mangione, 26, who was arrested this week on suspicion of murder, failed to quell the public's anger or elicit an outpouring of sympathy for Thompson's family.
So far, there appear to be three clues that Mr. Mangione may have felt animosity toward the medical industry. Officials said shell casings found at the scene of the shooting were engraved with the words “denial,” “defense,” and “.” Inscribed there is a reference to Jay M. Feynman's 2010 book, “Delays, Denials, and Defenses: Why Insurance Companies Don't Pay Claims and What You Can Do About It.” Mangione reportedly suffered a back injury that required surgery. And the fact that he was reportedly caught with a three-page manifesto criticizing medical companies. CNN first reported Wednesday that police also found Mangione with a notebook that appeared to outline a plan for the shooting. Mangione's lawyer has denied any involvement in the killing.
But before that was known, all consumers needed to know was that a medical executive had been murdered to vent their anger. Here are some reader comments posted on CNN's article about the shooting: “My thoughts are with the family and the deductible. Unfortunately, my condolences are outside the network.” Another nurse wrote on TikTok, “When I think about the patient and his family, I can't sympathize with him.” Posted.
This kind of anger is nothing new. It's been years in the making. But the health system issues are far more complex and deep-rooted than the current dialogue, Levitzer said.
“An act of violence by an obviously insane and obsessive individual should not be the beginning or end of a discussion about real social policy issues,” he says. “The violence was terrible. The person who was shot did not deserve to die, and it is not clear that what motivated this person to shoot had anything to do with real, pressing problems in our health care system. do not have.”
However, that doesn't mean there aren't real problems in the industry. But he says it's reductive and wrong to simply blame Americans' anger and frustration with the system on the greed of health insurance companies, and there's a lot of blame to go around.
The lending system is “actually much better than it was in the 1990s, thanks in large part to Obamacare and the accompanying expansion of Medicaid,” Levitzer said. “If the Trump administration decides to get serious about reducing the deficit while cutting taxes, the obvious place they will look for[tax cuts]is Medicaid, which I can imagine will be a big flashpoint over the next few years. We don't know what will happen because the political costs will be enormous.”
Healthcare delivery systems such as hospitals and healthcare providers have been hit hard by the coronavirus and are now chronically understaffed, with many healthcare professionals facing burnout and exhaustion, he said. say. At the same time, however, large hospital systems, like large insurance companies, have gained significant market power through mergers and consolidations made possible by a relaxed regulatory environment.
“The health care system problem is not primarily an insurance company problem; it is just as much, if not more, a provider problem. ) is becoming increasingly difficult,” Levitzer said. “So UnitedHealthcare, the largest insurance company, owns the majority of physicians and physician practices.”
UnitedHealthcare, the largest insurance company, owns the majority of physicians and physician practices.
james levitzer
Attacking the greed of insurance companies or anyone else is “a poor way to understand what's going on. Greed is looking for the bad guys,” he says. “And I don’t think insurance companies and insurers are any greedier now than they were in 1980 or 1970. If you try to make this an issue, you’re missing out on what’s going on. It's a morality play with an easy villain and an easy virtue.''
Last year, Levitzer co-authored “Why Not Better and Costia?: Healthcare and Innovation'' with his twin brother Robert Levitzer, a senior advisor at Manatt Health and a fellow at Stanford University's Distinguished Career Institute. (Oxford University Press, 2023) has been published. And many years ago, he was an executive at United Behavioral Health, another division of UnitedHealthcare.
“The financing system under the Affordable Care Act has improved significantly,” Levitzer said. “There are many things we can do to further increase access, but what would provide more access without leaving some people frustrated by the difficulty of accessing the care they believe is essential? there is no.”
The system is “completely broken,” as U.S. Sen. Bernie Sanders of Vermont said nine months ago in April.
“This is not a system designed to provide health care to everyone in a cost-effective manner,” Sanders said. “This is a system designed to generate huge profits for insurance companies, pharmaceutical companies, and many other industries within the system.”
