Healthcare CEO’s Murder Reveals Lack of Trust and Responsibility in US Insurance Industry: ‘I Get It’

AAmericans are sharing stories of heartbreaking insurance denials — which have led to worse illnesses and deaths — in the wake of the murder of Brian Thompson, CEO of mega-insurer United Healthcare.

A rise in practices such as prior authorization and automated denials of coverage have made it more difficult for Americans to access health care, and changes are urgently needed to reform such practices and restore trust in the health care system, experts said.

“It is clearly morally reprehensible to kill someone, and civil rights are not justice. But I am not particularly surprised by the strong expressions of anger toward America’s health insurance system,” said Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh.

“When your life is turned upside down because you can’t get a test for something that’s really bothersome, or because you can’t get a drug that would actually solve your problems, it causes a lot of frustration, anger and loss of feeling. to trust.”

The killing in early December “has become a flashpoint for discussions about corporate power, bringing to the surface the public’s frustration with the industry,” said Anthony Grasso, an assistant professor of political science at Rutgers University Camden. “There is very little accountability.”

When Dianna H’s daughter was born in December 2016, doctors discovered heart and lung problems in the baby, who spent eight days in the neonatal intensive care unit.

Doctors wanted to give her the shot to protect against RSV (respiratory syncytial virus), an infection that can be fatal in children under two years of age – even in babies with no pre-existing conditions.

But her baby was not eligible because she wasn’t born prematurely or with any specific conditions, Dianna said.

Two weeks later, the newborn became ill with RSV and had breathing problems, Dianna said. Three hours away she was taken by ambulance to intensive care.

“We almost lost her several times,” Dianna said.

Patients caught up in insurance denials describe their frustration and helpless anger at feeling like they have little ability or resources to control companies.

“I’d be lying if I didn’t get a little bit of pleasure knowing that the insurance company had to pay out hundreds of thousands of dollars because they made the choice not to spend a few thousand on a preventative,” Dianna said.

It’s small consolation, she said, but the closest she’ll ever get to feeling like the insurer was responsible for a dangerous policy.

She has closely followed the response to Thompson’s killing and said that while “it’s not something I would do,” she “can understand how someone could be driven to do that.”

She has also struggled with a spinal cord injury that, if she had been able to receive preventative care, might not have required extensive surgery. After seeing X-rays of a spinal fusion that Thompson’s murder suspect Luigi Mangione posted online, Dianna said, “As soon as I saw that, I said, ‘I get it.’ Inadequate health care, pain, feeling lost and disrespected and ignored are dehumanizing and as a result you do inhumane things.”

Less than a third (31%) of Americans said they have a positive view of the health care system, compared to 51% who said the same in 2020, according to a Gallup poll released last week.

Cost and access to care are among the most pressing health issues in the country, respondents said, with people citing these issues far more often than health problems such as cancer or infectious diseases. About 79% of people said they were dissatisfied with healthcare costs in the US.

While healthcare spending has risen 67% over the past decade, UnitedHealth Group, Elevance and Cigna have soared profits. shot up by 262% in the same time. These rates once tracked closely together until they began to diverge markedly in 2016.

Has health care coverage reached its lowest approval rating since Gallup started tracking the problem in 2001. The decline in satisfaction is accompanied by an increase in the number of refused coverage.

Humana, Cigna, and United Healthcare have all been subject to class action lawsuits over their use of new AI tools to process and deny claims.

One lawsuit claimed that 90% of United Healthcare’s initial AI denials were overturned on appeal, “an astonishing number,” Yaver said.

California recently passed legislation with bipartisan support to regulate automated tools like these, which require physician oversight based on a patient’s records.

Nationally, a bill to accelerate decision-making on Medicare coverage for seniors was passed by the U.S. House of Representatives in September 2022 and recently reintroduced in the U.S. Senate.

“Even if we don’t reduce the volume of denials, we can at least mitigate some of these delays,” Yaver said.

Without “a wholesale rethink of America’s health care system, making it easier for people to navigate would be something that could help fix what’s broken,” she said.

Another area that could be reformed is the Employee Retirement Income Security Act (ERISA), which sometimes bars employees with certain employer-sponsored plans from suing insurers for damages or even attorney fees. Yaver said it “creates accountability issues because there is no major penalty, and there is no real cost associated with wrongful denials.”

Even if insurers lose lawsuits for denied care or face fines for violating regulations, any costs incurred can be passed on to customers by increasing premium costs.

“Many of the things we need to do to hold executives accountable are simply absorbed as the costs of business,” Grasso said, adding that “stronger punishment of corporate executives and corporate misconduct, harm and misconduct would be beneficial” .

There are also fundamental differences in how Americans understand and respond to harmful behavior, Grasso said.

“When someone is shot in the street, we define that as a crime. We must punish that act of violence,” Grasso said. “But when we look at the harm caused by corporate decision-making, such as denying life-saving medical care, we generally don’t consider it violence.”

But this shooting and the outpouring of response are changing that view, he said.

“It’s violence,” Dianna said of insurers denying life-saving care. “It is administrative violence.”

After her battle with RSV, Dianna’s daughter recovered, and she is now a happy, energetic eight-year-old. Yet those first days remain in her mother’s memory with every cough and sneeze.

There is now a new, highly effective injection to protect against RSV, and it is recommended for all newborns, not just premature babies with certain health problems. And there are RSV vaccines for pregnant people and the elderly.

Dianna hopes they make a difference – and that these types of medications don’t end up in insurance denials.

“Hopefully…no one has to go through what we went through again,” she said.