Fatal Outcome: When US Healthcare Failures Become Violent

The assassination of UnitedHealthcare CEO Brian Thompson has not only sent shockwaves through the corporate world but has also ignited a critical examination of the systemic failures within the US healthcare industry that might breed such acts of extreme violence.

The alleged perpetrator, Luigi Mangione, a 26-year-old with an Ivy League education, is now facing multiple federal and state charges, including murder, prompting widespread concern and triggering a debate about the underlying societal issues at play.

To understand the origins of such violence, Wyoming Star spoke with Alan Sager, Professor of Health Law, Policy, and Management at Boston University School of Public Health, seeking to illuminate the profound failures within the US healthcare system and the currents of public sentiment they have stirred.

Tragedy background

Brian Thompson was murdered on December 4 in his driveway in Tuckahoe, NY. The suspect (Mangione) was apprehended in Pennsylvania and is now facing both federal charges, including murder and a firearms offense, and state charges, including first-degree murder in furtherance of terrorism.

Authorities believe Mangione acted alone, driven by anger toward the healthcare industry. The case has sparked public fascination, with a defense fund for Mangione raising nearly $190,000 and supporters gathering outside the courthouse with signs critical of the healthcare industry.

“Under-Insured,” Left Behind

When asked about the link between the incident and the issues of the country’s healthcare system, Professor Sager firmly states:

Murder is a crime.

However, he argues that there is a serious problem of healthcare inaccessibility and affordability in the US. While the Affordable Care Act (ACA) has reduced the number of uninsured Americans, he explains, “But two-fifths of Americans say they have trouble affording or obtaining care. They are under-insured.”

Sager elaborates on what this “under-insured” status means by stating that these are Americans who:

• Can’t afford high out-of-pocket deductibles, co-insurance, or co-payments;
• Can’t afford their share of premiums;
• Can’t find a doctor or hospital nearby — because care is too sparse or because their insurer has created tiny narrow networks of doctors; or can’t get needed care owing to insurer denial of prior authorization or refusal to pay legitimate claims.

This struggle is felt across the spectrum, Sager says.

“Lower-income people suffer the greatest difficulty in obtaining needed care. But increasing numbers of middle-income people can’t find primary care doctors who are taking new patients, wait for long hours in emergency rooms and long weeks or months for specialist appointments, and can’t identify a mental health professional who takes their insurance.”

Systemic Failures, “Anarchy”

Sager goes further, questioning the very structure of the US healthcare system.

“The US healthcare spending is more than five times our defense spending. It is also double the per-person average across the world’s rich democracies. Those other nations deliver more hospital and doctor care. They live longer. So we can do better.”

He is especially critical of relying on private insurance companies.

“I think insurance is a great idea — for homes, cars, businesses, and the like. It does not work in health care. No other nation relies on insurers like United Health, Anthem, and the rest.”

According to Sager, the root of the problem lies in “failures of the market and incompetent government action,” leading to a state of “anarchy” where “almost no one in health care is accountable for anything that happens outside the building where they work.

Without working markets or governments, US health care suffers anarchy.

Profit Motives vs. Public Wellbeing

Sager suggests that the fundamental issue is the inability to balance profit motives with the need to provide adequate care.

“In a competitive free market, companies earn profits by efficiency (holding down costs), innovating to make better products, and producing the goods and services people want to buy. Free markets legitimate profits. Without a free market in health care, profits are not legitimated.”

According to Sager, the emphasis on profits has created a system where people are not fully safe when it comes to medical care.

The challenge in US health care is to make sure everyone is solidly protected against cost of needed care, that spending is capped, that adequate supplies of needed doctors and hospitals are located as near as possible to where Americans live and work, and that emergency services are available.

Call for Reform

Sager advocates for a complete overhaul of the system, drawing inspiration from other countries where governments play a more active role.

“In other rich democracies, governments cap spending and ensure that all people are covered. They pay doctors, hospitals, drug makers, and other caregivers in more trustworthy ways. In particular, doctors are asked to work to spend carefully.”

Sager also outlines the enormous waste within the system:

One-half of our nation’s vast health spending is wasted on ineffective clinical care, administrative waste, high prices, and theft. We have to build health care that we can trust to turn as much as possible of this fat into clinical bone and muscle. Americans are not yet getting the care we all need — for which we already pay such enormous sums.

The murder of the UnitedHealthcare CEO has provoked a maelstrom of public reactions, a tragic wake-up call revealing a painful truth. While the inherent wrongness of violence remains undeniable, the systemic failures of the US healthcare system – failures that have left so many Americans struggling, feeling marginalized, and in some cases, facing fatal consequences – demand an urgent overhaul.

Only through a complete restructuring can we hope to address the deeply entrenched issues and begin to rebuild a system worthy of its purpose.