Health care advocates protested denials of care at UnitedHealthcare on July 15, 2024 in Minnetonka, Minnesota. The shooting of UHC CEO Brian Thompson sparked an online outcry over problems with the U.S. healthcare system.
David Berding/Getty Images for the People’s Action Institute
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David Berding/Getty Images for the People’s Action Institute
In the wake of the murder of UnitedHealthcare CEO Brian Thompson, the dysfunction of the health insurance industry has received a lot of attention.
The shooting sparked a flood of emotional messages online on health insurance refusals. Since the arrest of suspect Luigi Mangione, attention has focused on a handwritten note police say they found on him, which according to the AP called health insurance companies “parasites” and highlighted the disconnect between this country’s expensive health care system and low life expectancy.
It’s true that health care in the United States is particularly expensive and often frustrating, but experts say the reasons our life expectancy is lower than that of comparable countries are complex.
The Centers for Disease Control and Prevention latest calculations estimates life expectancy for Americans at 77.5 years. This is well below the average life expectancy in high-income countries, which is 80 years. according to the World Bank. Life expectancy in the United States is comparable to that of Ecuador and Croatia.
While problems of access to health care cause sufferinghealth care not the main factor explaining low life expectancy, according to Dr. Steven Woolfdirector emeritus of the Center on Society and Health at Virginia Commonwealth University.
“Research shows that about 10 to 20 percent of health outcomes are attributable to health care,” he says. This includes “really serious deficiencies” in the system, such as lack of access to insurance and high costs.
“But the majority of reasons for low life expectancy in the United States exist outside of health care.”
Social and “business” drivers of poor health
In the context of Thompson’s death, there is an irony: gun violence, which kills Americans in the prime of their lives, contributes significantly to declining life expectancy in the United States. (Thompson was 50.)
“The two-year difference in life expectancy probably comes from the fact that guns are widely available in the United States,” Eileen Crimminsprofessor of gerontology at the University of Southern California, told NPR in 2023.
Crimmins was part of a group of researchers – chaired by Woolf – behind a landmark study of the National Academy of Sciences on the problem of life expectancy in the United States entitled “Shorter Lives, Poorer Health”.
Some of the other factors listed in the 400-page report include physical inactivity, child poverty, air pollution and road deaths.
Woolf says public policy also plays a role. He notes that other countries have social support programs to help people living in poverty or without stable housing, “so it doesn’t affect their health,” he says. “We don’t have as extensive a support structure as the United States.”
He also highlights what he calls “business determinants of health” – cases in which lax regulation of industries and products leads to health problems.
“We see it in the food industry. We see it in the gun industry. The opioid epidemic began with (the availability of) OxyContin in 1996, a drug that other countries ‘Europe and elsewhere would not approve,’ he says.
This contributes to “a social and political environment in this country that puts profits ahead of the public good,” Woolf says. “This is a systemic problem that affects every American business. The healthcare industry is no exception, but it is not the only source of our poor health.”
Woolf notes that none of this justifies Thompson’s murder, which he considers “clearly horrible.”
Refusal of care
This systemic problem has particularly manifested itself among corporate health insurance companies through the denial of claims for treatments deemed not “medically necessary”.
The experience of denial of coverage is widespread, Miranda Yaverprofessor of public health policy at the University of Pittsburgh, told NPR’s Morning Edition. She researched cover rejections for an upcoming book. She surveyed more than 1,300 U.S. adults and found that 36 percent had experienced at least one coverage denial.
“What’s frustrating for a lot of patients is that there’s a lot of opacity,” says Yaver, who writes a Substack called Rationing by inconvenience. “When people tried to understand the reasons for claim denials, insurers came back and said this information was proprietary.”
UnitedHealthcare was continued last November for allegedly using AI to process prior authorizations in Medicare Advantage plans. (Other insurers face similar lawsuitsfiled last year.)
“One of the things highlighted by the (UnitedHealthcare) lawsuit is that 90 percent of the denied claims were overturned on appeal,” Yaver said, citing an allegation from the complaint. “That’s just a crazy number, because it really suggests there’s a high error rate.”
These proceedings are ongoing. UnitedHealthcare did not respond to NPR’s request for comment on its lawsuit; the company’s lawyers asked the court to dismiss the case.
Yaver wrote on Substack that while there have been expressions of “exasperation, even fury, toward private insurance” following the murder of Brian Thompson, “this act will almost certainly not lead to a change in policy on the part of UHC and other private insurers.
“These are widespread problems that require systemic interventions,” she wrote.
Carmel Wroth edited and contributed to this article.