Privatized Healthcare in the United States

Human Rights Research Center

5 days ago5 min read

February 4, 2025

On December 4th, 2024, at 6:45 AM, the CEO of United Healthcare (UHC) Brian Thompson was shot to death on his way to an annual investors meeting. The primary suspect is currently Luigi Mangione, a 26 year old Italian American who suffers from a spine condition called spondylolisthesis. Although Mangione was insured by Blue Cross Blue Shield, many within the disability community are speculating that overcoming barriers to receiving healthcare for his condition radicalized Mangione - if he was indeed the killer. While there was an outpour of support for Thompson from politicians and his previous colleagues, many Americans found their rage less targeted towards the killer and more targeted towards the harmful practices of United Healthcare and other private insurers. What sparked this response?

Inside United Healthcare

An insurance “claim” is submitted when someone receives a service that their insurer is usually then set to cover. If a claim is denied, the responsibility for payment goes to the consumer. With the high costs of receiving medical care and treatment, medical debt accounts for nearly half of bankruptcies in the United States. Claims can be denied for a variety of reasons, and an insurer with little to no medical experience can deem a treatment “not medically necessary.” Coincidentally, the same day as Thompson's murder, Blue Cross Blue Shield publicized a new policy that would only cover anesthesia for a certain amount of time during a surgery - a policy that has concerning implications for surgeons and patients. This policy led many to ask the question: why are insurance companies, many of whom lack the representation of trained medical professionals on staff and have demonstrated high concern for profit, deciding how long a surgery should last?

Although data for how many claims are denied by each insurer is not public information, ValuePenguin analyzed the limited data the federal government collected on insurance claim denial rates. This data was collected after the passage of a 2010 federal regulation - part of the Affordable Care Act - requiring that insurance companies are more transparent about their claim denials. The federal government has only collected a small portion of this claim denial data, and what they have collected does not paint a complete picture. Nonetheless, ValuePenguin found that United Healthcare denies up to a third of its claims - a ratio that might differ if more transparency was required and this data was more accurate. These claim denials can be the difference between life and death for many Americans; let alone the difference between lower and higher quality of life.

United Healthcare's excessive claim denials have led to lawsuits, one significant lawsuit being for potentially using Artificial Intelligence (AI) to deny claims. United Healthcare faces a lawsuit in a Federal Court in Minnesota for allegedly using an AI model called nH Predict which has prematurely denied care to elderly patients. This use of AI may contradict the judgments of doctors and the needs of patients; many patients prefer that their doctor makes decisions about their need for treatments - not their insurance company. Lastly, United Healthcare was sued by a chronically ill patient with ulcerative colitis; they had flagged this patient's account as a “high dollar account” due to his pricey treatment, and arbitrarily decided to stop covering this effective doctor-ordered treatment; forcing him to transition back to a treatment that was ineffective, yet cheaper. This patient is not alone in this experience, and many other insurance companies have denied coverage for effective treatments in favor of cheaper ones.

The bigger picture - Inside the U.S.

The U.S. is the only developed nation without universal healthcare, and tens of millions of Americans remain uninsured. Throughout the 20th century, movements for a more public health insurance system were inspired by other countries such as Canada and Great Britain shifting in this direction. However, facing pushback from private health beneficiaries such as the AMA and private equity hospitals, this movement never gained a lot of traction. In the 1970’s, employers were mandated to purchase health insurance for their employees. Having employees relying on employers for health insurance may ensure a loyal workforce, but where does this leave part-time or seasonal employees or those without access to employment?

This leaves them with Medicare - however, only those 65+ or who qualify for disability have access to Medicare. A person’s income also has to be low in order to qualify for public health insurance in the US. This is why in 2010 former president Obama introduced the aforementioned Affordable Care Act - also known as Obamacare - to give those without access to Medicare or employer healthcare affordable options. Donald Trump has indicated intent to revoke the Affordance Care Act, and many of his voters are unaware that their healthcare might be at risk.

Tying it Back to the Recent Murder

The words “deny, defend, depose” were found on the shells of the bullets used to murder CEO Brian Thompson. This is based on the slogan of many healthcare insurance companies known as “Delay, deny, depose,” referring to insurance companies dragging out court cases similar to the ones outlined previously to avoid being held responsible for denying crucial healthcare to Americans and “practicing medicine without a license.”

Many have justified the murder of CEO Brian Thompson by stating that denying patients life-saving healthcare is an implicit act of violence in itself that health insurance companies in the US are responsible for. Many may argue that it is important to hold all who end lives accountable - whether by the shot of a gun, or the click of a mouse. There is ongoing conversation about whether healthcare should be afforded to all who need it, without having to jump through paywalls or be employed full-time, or whether healthcare is a privilege - and people will not be incentivized to work if they have healthcare regardless of whether or not they work. Many also argue that public healthcare systems are more flawed than private healthcare systems, and increase wait times - however, a recent study demonstrated this effect to be very minimal. This conversation is exacerbated by many drugs being cheap to produce, but price gouged by pharmaceutical companies - and hospital bills being similarly inflated. Regardless, we must own up to the fact that we are the only developed nation who does not consider healthcare an essential human right, as reflected by our healthcare system.

Glossary

Aforementioned: Mentioned before.
AI: Artificial Intelligence - or the use of algorithms and predictive models by technology.
Anesthesia: Is given to patients to make them fall asleep during surgery.
Arbitrarily: Making a decision without a good explanation or reason for it.
Bankruptcy: A legal process for debt relief.
Beneficiaries: Someone or something who has good outcomes from someone or something.
Contradict: To say or do the opposite of what someone else has said or done.
Chronically: For a very long time, without a cure or a break.
Coincidentally: A series of events that may seem interconnected, but are not.
Consumer: A person who buys goods and services for personal use.
Exacerbated: Made more severe, fed into.
Implications: Results that are not overtly outlined, but may occur.
Incentivized: Being motivated or wanting to do something.
Insurance claim: Submitted for reimbursement or coverage by the insurance company when someone seeks healthcare.
Medical debt: When someone is unable to pay their medical bills, they have medical debt.
Prematurely: Something happening before it should have happened.
Privilege: A special right or advantage that someone gets.
Ratio: Compares one quantity to another, as in one number is a fraction or is divisible by the other number.
Slogan: A short memorable phrase or motto associated with something.
Spondylolisthesis: A spinal condition which causes chronic pain and may require surgery.
Transparent: To be clear and honest about something.

Sources

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Privatized Healthcare in the United States

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