The Deadly Consequences of a Broken Healthcare System
The tragic shooting of UnitedHealthcare CEO Brian Thompson has unleashed a wave of outrage and frustration towards the insurance industry, reigniting the debate over healthcare in the US. While experts agree that the system is flawed, there is little consensus on how to fix it.
A System in Crisis
The US spends more on healthcare than any other country, yet has the lowest life expectancy among large, wealthy nations. Over the past five years, healthcare costs have skyrocketed, with insurance premiums, out-of-pocket expenses, and pharmaceutical prices all on the rise. Patients, advocacy groups, and experts alike agree that the system is broken, often prioritizing profits over people.
The Insurance Industry’s Role
Insurers like UnitedHealth Group, CVS Health, and Cigna dominate the market, operating as for-profit enterprises. Their primary goal is to generate profit by charging premiums and managing claims to minimize payouts. While this approach helps increase profit margins, it can lead to denied or delayed claims, higher premiums, and unexpected bills, leaving patients without care.
Tactics of Denial
Insurers use various tactics to limit payouts, including delaying or denying valid claims, increasing premiums disproportionately, and requiring prior authorization. They also rely on technology, including AI, to review claims, which can lead to inaccurate denials or improper payouts. Roughly half of insured adults worry about affording their monthly premium, and nearly one in five adults have had claims denied in the past year.
UnitedHealthcare Under Fire
UnitedHealthcare, the largest private health insurer in the US, has faced criticism for its handling of claims. In one case, the company settled a lawsuit brought by a severely ill student who claimed UnitedHealthcare denied coverage for medically necessary drugs, leaving him with a bill of over $800,000. Another lawsuit alleged the company used a faulty algorithm to deny elderly patients coverage for extended care.
Frustration and Outrage
The shooting of Brian Thompson sparked a flood of social media posts voicing negative experiences with insurers, with some even celebrating or justifying the killing. While condemning such reactions, experts acknowledge that people are frustrated with the system. “People just want the system to be fair,” said Caitlin Donovan, senior director of Patient Advocate Foundation. “They want to pay a reasonable amount and have their healthcare covered, and they want to be able to access what their trusted provider is prescribing them.”
Blame and Accountability
Parsing out which stakeholders are to blame is a complicated task. Some experts argue that insurers must control costs under the current system, while others believe the root issue is cost – a system built around maximizing prices and revenue, rather than helping patients.
Calls for Reform
Industry experts don’t expect insurance companies to make material changes to their policies in response to the killing. Instead, structural changes to the entire industry are needed, requiring harder, longer-term legislative efforts. This may prove difficult with a closely divided Congress. To decrease costs and barriers to access for patients, the government could more heavily scrutinize healthcare consolidation, pass laws to protect patients from surprise bills, and address shortages across the healthcare system.
Taking Control
Until significant changes occur, patients can take control of their own health by taking notes and asking questions during appointments, tracking insurance payments, learning more about their condition, and turning to third parties for help. As Michael Hinton, a patient who was diagnosed with a chronic digestive disease, said, “There are other methods of change – and that could look like trying to be your own advocate.”
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