Health reform in the United States is difficult to pass. Can the brazen assassination of a CEO change that? | Healthcare in the United States

Rage, frustration and bitterness were all visible in comments on social media following the fatal shooting of UnitedHealthcare CEO Brian Thompson.

Even though Thompson was brazenly murdered in midtown Manhattan just before the company's annual investor conference, leaving behind a widow and two sons, many Americans struggled to find sympathy for a man whom they saw as complicit in the refusal or postponement of what they saw as a rage for necessary care. a prominent political expert can understand.

Dissatisfaction that the system isn't working is at an unprecedented level, said Ezekiel Emanuel, one of the architects of the law better known as Obamacare and a Perelman professor of health policy. School of the University of Pennsylvania. Medicine.

Everyone hates the system today even more than when we passed the Affordable Care Act.

Police said the suspect arrested this week, Luigi Mangione, 26, was also in possession of a manifesto of sorts, a three-page handwritten document that professed ill will toward U.S. companies, including references to care health.

Retirees demonstrate in front of New York City Hall on October 12, 2022. Photograph: Shawn Inglima/New York Daily News via Getty Images

Last week, police said shell casings recovered at the scene were scrawled with the words deny, file and defend words many Americans associate with health insurance denials and recovered a potentially related backpack to the Monopoly money-filled shootout.

The incident alarmed violence researchers, who said the killing represented an extension of political violence into the business realm and had shaken business leaders. UnitedHealth Group, for example, is committed to strengthening its campus, the CEO told employees.

No matter how deep our grievances or how righteous our anger, violence has no place in our society, Wendell Potter, a former health insurance executive turned reform advocate, wrote in his weekly newsletter.

Yet, he added, this corporate assassination is a symptom of a nation buckling under the weight of systemic dysfunction.

Passed in 2010, Obamacare was arguably the most ambitious health reform law in a generation. The ACA prevented insurers from discriminating against sick people, expanded health insurance to millions more people, and kept the total cost of health care (usually expressed as a percentage of gross domestic product) relatively stable.

It's truly a paradox, Emanuel said, reviewing a list of incremental changes that have taken root since the ACA took effect. This does not mean that the system works well. This is hardly how we experience it.

Instead, he says, consumers' experience with the law is often characterized by prior authorization, inability to find a doctor, shortages of common medications like amoxicillin and asthma products. what people need, and the level of burnout among doctors and nurses still characterizes the American health care system. said Emmanuel.

The health care industry has consolidated heavily over the decade, leading to higher prices and even more powerful special interests that lawmakers would have to contend with for any reform, no matter how incremental.

Thompson worked as head of the insurance division at UnitedHealth Group. The company is now the fourth largest American company, behind Walmart, Amazon and Apple, according to Fortune, a fact mentioned by Mangione himself in his so-called manifesto.

UnitedHealth Group is also ranked the eighth-largest company on the Fortunes Global Index, ahead of ExxonMobil, Google parent Shell, Alphabet, Volkswagen, GM and JPMorgan Chase. This is up from 10th in the world in 2023 and 63rd in 2012, a year after Obamacare was passed.

Other healthcare giants are also among the largest companies in the United States and around the world: CVS, a pharmacy that now also owns health insurance company Aetna and pharmacy benefits manager Caremark, is sixth in the American list.

No entity in history, and certainly not a company listed on the New York Stock Exchange where profit margins are all that matters, has been able to deny or delay essential health care on a scale such as UnitedHealth does it day in and day out, Potter wrote this. week.

With partisan gridlock and entrenched special interests, such as health insurers, now more powerful than ever, he added, it's difficult to know how to move forward.

One of our problems right now is that it's not clear what the overall reform of the U.S. health care system will be, Emanuel said. People didn't understand it, he added, saying it was not the public's fault but that of political pundits like me.

In some cases, wildly popular policies appear to be going nowhere, such as Vermont Sen. Bernie Sanders' proposal to add vision, dental and hearing benefits to Medicare, the state health insurance program for seniors. Polls suggest the policy has support from 84% of the public. But it hasn't progressed significantly, Sanders says, in part because of industry opposition.

I don't need to tell you that insurance companies and pharmaceutical companies have millions of lobbyists here in Washington, Sanders told the Guardian in May. He later added: The function of our healthcare system is not to provide high-quality care, but to generate huge profits for pharmaceutical companies and insurance companies.

The ACA required the federal government to track insurance company denial rates, data that was supposed to be shared with state insurance commissioners.

Yet until now, such information collection has been haphazard and limited to a small subset of plans, and the data is not audited to ensure it is complete, a KFF Health News editorial reported in 2023.

Today, there is little data to support patients' suspicions that they are being denied higher rates, a problem that has become even more pressing as insurers use artificial intelligence to deny claims in batches.

In some cases, problems persisted despite legal reform. California enacted one of the first laws against ghost networks, inaccurate and misleading insurance networks that make it appear as if there are more providers than are actually participating in the network. Despite the new law, only one insurance plan was fined $7,500, according to a ProPublica report.

People feel like the system isn't working for them, and in some ways that's reminiscent of the Biden team's experience. [when] Bidenomics works, Emanuel said. The overall data shows things are moving in the right direction, he added, but the American public is saying: We're not buying it.

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