The shooting of the United Healthcare CEO exposed the hatred people have for American health care. This is how bad things have gotten.

Many people online reacted to the shooting death of UnitedHealthcare CEO Brian Thompson with a sense of morbid inevitability. The often indifferent nature of the U.S. health care system has long been widely debated, and evidence is mounting that the way the country delivers health services comes at significant costs in both money and lives. Executives in the healthcare industry, from insurance companies to pharmaceutical companies and even hospitals, have become popular villains.

Killing humans is a morally abhorrent act, please stop it. However, I noticed that many people still have questions such as: “Would it be surprising if, as is often the case, it turns out that the shooter's primary motivation was the injustices in America's health care system?”

On the same day as the shooting, news broke that another insurance company would limit coverage for anesthesia during surgery, providing a kind of cosmic confirmation of this idea. In New York City, a health insurance executive was (supposedly) shot and killed for the industry's greedy practices, while another insurance company suffered the worst stereotypes with seemingly arbitrary limits on anesthesia benefits during surgery. affirm.

However, the reality is more complex. As Vox's Eric Levitz covered, this policy doesn't actually result in higher bills for patients. Rather, it is a type of cost control often guaranteed by policymakers when the public's interests are elsewhere, aimed at reining in high payments to health care providers. But public and political outrage did not stop at making the connection, and insurance companies quickly reversed course.

All aspects of this tragic episode taken together reveal the rotten core of American health care. The ongoing blame game between the brutality of the U.S. health care system and the private industry that profits from it has left patients angry and confused, with no one to blame, fair or not. trying to inflict

No one person, or even one industry, is to blame for America's health care failures. Finger pointing is a distraction. All parties are responsible. The only way forward is to consider that collective failure. If we have any hope of creating a world that the Thompson shooting truly couldn't imagine, we need to start working towards a more rational and just system.

Distracting Medical Liability Game

In the early days of the modern American health care system, the private industry that made up the bulk of the health care sector was a collaborator.

In the mid-20th century, physicians in particular were passionate defenders of private insurance. The American Medical Association and its brethren strongly lobbied to suffocate the latter in their cribs, with the state strongly preferring to cover most people with employer-sponsored private insurance rather than government programs. They supported the creation of Medicare and Medicaid in 1965 to cover the uninsured population, but would unite again in the 1990s to block Clinton's health care reform efforts.

All involved were invested in preserving the free market system. Hospitals and drug companies can raise prices, insurance plans can pass those increases on to employers, and thanks to Congress, health benefits are now tax-free, making price hikes easier to tolerate. Medicare and Medicaid limited spending, but created opportunities for the private portion of the market to increase profits, working together whenever the status quo was threatened. At least for a while.

But prices continue to rise due to an aging baby boomer generation and important but costly medical advances. As we all know today, health care costs in the United States can be prohibitive, even for those with insurance. Nearly 4 in 10 Americans say they didn't receive needed medical care because of cost, and millions of people have medical debt from past cases.

The passage of Obamacare over industry opposition was the first sign that the political vice of the private sector was loosening, with President Obama targeting cuts to insurance companies and hospitals, effectively overriding pharmaceutical companies' opposition. He succeeded in dividing the industry against himself by buying the faction. Recent anti-inflation legislation includes provisions that allow Medicare to negotiate prices with drug companies, reducing costs and allowing the program to cap out-of-pocket costs for seniors. . This would have been unthinkable a generation ago when Big Pharma lobbied Congress to ban such policies. Lawmakers from both parties continue to look hard at ways to overhaul the health care system and cut costs.

This political realignment pitted insurance companies, pharmaceutical companies, and the hospital industry against each other. I have been covering health care for over 10 years, starting shortly after the ACA was passed. During this time, the battle lines became sharper, with each sector blaming the other for patients' dissatisfaction with the health care system.

This leads to misplaced anger towards Anthem's anesthesia policies. Doctors portray this as insurance companies trying to police patients, but it's actually a plan to lower overall costs and save patients money. It will be difficult to do anything to reduce costs, and dissatisfaction with the system will metastasize until we see what happens after the murder of UnitedHealthcare CEO Brian Thompson.

Collective failure of US healthcare

Let's be clear: health insurance companies have received a lot of scorn. Before the ACA was enacted, they simply denied coverage to people with high medical costs. Now that the ACA is law, insurance plans are more constrained, but new reports continue to emerge of new tactics by insurance plans to deny coverage to patients. They even use AI to do it. UnitedHealthcare has been the subject of recent ProPublica revelations, including for the company's use of algorithms to deny claims for mental health services.

Similarly, pharmaceutical companies are sitting on the sidelines for now. Their critique of how health insurance companies, PBMs, hospitals, and their entities steal money in the drug reimbursement process has some merit. But drug companies also exaggerate how much the high prices they charge are needed to fund research and development for new treatments. When pressed about how they exploit loopholes in patent law to maintain price monopolies on popular drugs such as the diabetes drug Humalog, they deflect.

It's no surprise that the insurance and pharmaceutical industries cite hospitals and physicians as the biggest contributors to U.S. health care costs. Most doctors are very generously compensated, and entry into the field is restricted, leading to fewer doctors, less access to care, and higher costs per patient. Masu.

But health insurance companies have legitimate complaints about the way they roll out their networks to limit coverage. For example, health insurance companies must overcome prior approvals and other bureaucratic hurdles to receive compensation for patient care. Doctors in the United States may earn more than doctors in other countries, but they spend more time and money on administrative tasks.

And round and round it goes.

People are fed up. The health care industry saw a brief surge in popularity during the pandemic, but its approval rating, as measured by Gallup, has returned to 31% and disapproval to 51%. The percentage of Americans who approve of the quality of health care they receive has fallen to an all-time low. Only 18% of Americans view the pharmaceutical industry favorably. 60% have a negative opinion. According to KFF, most people are satisfied with their insurance plans, but they are less likely to approve coverage if their claims are high, and most still report having problems accessing their insurance benefits. It is said that they are doing so.

Providers enjoy the highest approval ratings, which may be why many people instinctively opposed the Anthem policy. However, while the majority of Americans still prefer nurses, their ratings of doctors and hospitals have declined, from 81% in 2003 to 69% in 2023, and over the same period for hospitals. It has increased from 70% to 58%. The passage of the No Surprise Act targeting hospital billing was a sign that their political influence was weakening.

America's health care failures are collective, the result of a system that was haphazardly put together over decades rather than thoughtfully planned from the beginning. Even ordinary people often have conflicting desires for both more choice and guaranteed coverage. The conflict between these two impulses helps explain the difficult fight for health care reform in the United States and the history of voters punishing politicians who try to change the system.

Some progress has been made. The uninsured rate remains too high, but 10 years after the ACA was instituted, it is at its lowest level ever. Medicare can negotiate drug prices, and for the first time there is a cap on out-of-pocket drug costs for seniors.

More work needs to be done, and to do so we need to overcome the industry's tough calls. Some kind of reform is required in every field.

Only by looking at this system as a whole and figuring out how to make it economically viable while providing the necessary care to everyone who needs it can we keep up with systems in other wealthy countries. This system can be saved. There are many ways to achieve a version of universal health care. The United States, like other developed countries in Europe and Asia, still needs to decide that this is actually what it wants. Many Americans have no concept of a world where people go bankrupt over medical bills, which is a daily reality in the United States.

No one, not even the CEO, is responsible for all of the nation's health care problems. These problems have been festering long before most of us were born. No one has all the answers either. But it has long been clear that the entire system is deeply flawed. Fixing this requires better policies across all industries that make up the so-called American health care system.