UnitedHealthcare CEO’s slaying brings criticism of U.S. insurance industry to a boiling point
Patients are struggling to pay ever-increasing sums for health insurance as huge corporations such as
And then, for some, along comes a medical bill that the insurer won’t pay.
This juxtaposition can feel enraging to patients. While it doesn’t excuse the fatal ambush last week of UnitedHealthcare CEO
The six-day gap between the killing of Thompson and the capture of
Yet public understanding of Mangione’s motives were fast-evolving Monday and Tuesday, with new questions regarding class and wealth. Mangione’s biography suggests a privileged prep school upbringing that contrasts with the shooting victim’s small-town
What remains is a week of vitriol over a health care system where too many people feel powerless against insurers and their affiliates, particularly during times when health plans deny coverage for care.
“Health insurers have never been popular because part of their job is not paying for care believed to be ineffective or low value,” said
A majority of insured adults, particularly those in poorer health, say they’ve had trouble using their health insurance coverage, according to survey results published in 2023 by KFF, a
About one in six said they were unable to receive recommended care as a direct result of their coverage problems, the survey found, while about 15% said the trouble drove a decline in their health. Nearly three in 10 said they paid more than expected for care.
“The survey shows that the sheer complexity of insurance is as big a problem as affordability, particularly for those with the greatest needs,” KFF President and CEO
Another survey of consumers, this one conducted annually by Gallup, found just 28% of respondents reported their health care coverage as “excellent” or “good” this year — 4 percentage points lower than the average for that question going back to 2001.
The acrimony on social media has been almost palpable, with some posts suggesting other executives could be targeted next and others blatantly calling for such violence.
Safety concerns prompted
The threats are clearly wrong, said
Beyond health concerns, though, patient frustrations are rooted in the financial strains that come with uncovered medical bills and rising premiums. Some face crushing medical debts while many others are burdened by what seems inexorable growth in coverage costs, including out-of-pocket spending requirements. When claims are denied after the service is given, the bills often are so large that people can’t afford to pay and struggle to find help.
Last year, the
Such situations leave patients feeling vulnerable, Foley said. Then they’re outraged to learn about huge pay packages for top health executives, whether at companies selling insurance like the corporate parent of UnitedHealthcare or health care providers like
“There’s just that disconnect with people, feeding into this broader feeling of income inequality and powerlessness,” he said. “I think the money part is huge.”
While Mangione had medical problems, it’s not clear what role UnitedHealthcare may have played in his care or why Thompson was targeted specifically.
People who knew Mangione early in life said he played soccer in school. The suspect’s acquaintances in
According to acquaintances and Reddit posts from Mangione, he had a spinal-fusion surgery in 2023 to correct misaligned vertebrae that had possibly pinched a nerve, the New York Times reported. When the friend asked how the spine surgery went, Mangione replied “long story” and never elaborated. On Reddit, Mangione wrote that the surgery was not as scary as he feared, and “I knew it was the right decision within a week.” His posts mention a
When Mangione was arrested, he had a 262-word handwritten manifesto with him that condemned profit-seeking American companies, specifically citing UnitedHealthcare, whose market value he said has grown while American life expectancy has not.
Comprehensive data on coverage denials, and the reasons for these decisions, has been woefully lacking, health policy experts say. Some statistics are available on coverage decisions by insurers who sell policies to individuals, but analysts say this data is difficult to interpret, partly because it’s a much smaller market than the employer health plans and government programs that provide coverage to the vast majority of Americans.
KFF found about 85% of insured adults surveyed support a requirement for insurers to report the frequency of denied claims and to disclose their denial rate to consumers. Federal law requires transparency data from most employer health plans, but the requirement remains largely unimplemented.
Another KFF survey published in October found family premiums for employer-sponsored health insurance are up 7% this year to an average of
Patients, employers and the government pay because health insurance provides access to lifesaving and life-enhancing care. What many find unsettling, industry experts acknowledge, is how the underlying structure of this benefit is a highly technical legal contract between an insurance company and large “payers” ranging from employers to the government.
Coverage terms like “medical necessity” that are vague and open to interpretation set the stage for disputes, said one former physician executive at a
“The consumer gets caught in the middle — that’s probably the main problem,” said the executive, who requested anonymity due to threats against insurers. “And they don’t know their appeal rights well. ... All of this plays out in a setting where health care is ridiculously expensive. It’s such a mess.”
Patients can request the contract documents but don’t always know this, Foley said. The details can be hard to understand, ranging from prior authorization requirements to coverage exclusions. And patients find they get tripped up in a bureaucracy where automation can seem like a barrier to common sense.
“It’s often difficult for patients to understand — ‘Who’s really pulling the strings here?’ and ‘How do I make a difference?’” he said. It gets back “to this environment of the little guy versus the elites. ... People are probably quite certain that the higher-ups aren’t running into the same types of problems.”
”Vigilante justice is not the way to do it — plain and simple,” Schmidtknecht said. “Do I have sympathy for Brian Thompson’s family? Well, hell yeah. I just lost my son. … I feel that pain for them, but where’s the pain for Cole and everybody else in this country who’s being affected by the company the guy worked for? That’s how I think about it. I don’t think it’s just, not in any way shape or form. And I’m not happy for it, either, because that doesn’t make things better.”
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