Earlier this month, the CEO of UnitedHealthcare was murdered during the morning rush hour in a busy Midtown Manhattan area; that of the alleged killer confession went viral, particularly the phrase “The United States has the most expensive health care system in the world, but we rank about 42nd in life expectancy.”
The murder gave rise to a massive diffusion of grievances with American insurers and, among those who thought the industry had succeeded, a haunting moment of collective joy. But this has not led to a focus on policies that could improve the functioning of health insurance and the health system as a whole. The horrific act of violence and the resulting casual response seemed tragic to me, because there are, in fact, many ways to make things better. The system is broken. But its problems are not insoluble. Nor are American politicians incapable of making sensible, even bipartisan, improvements.
The problems are serious, to be clear. Americans spend more on health care than citizens of any other country, and get less for that. Insurance doesn’t really work like insurance here, in that it fails to protect policyholders from the debilitating costs of health care. The premiums are obscene: the average family paid $23,968 for an employer-sponsored private plan in 2023. The same goes for personal expenses. Nine out of ten workers benefit from health insurance through their work have a franchisecompared to six out of 10 15 years ago. The average deductible for individual coverage is $1,735, meaning workers must pay $1,735 of their own bills before insurance kicks in. The government allows family plans to have deductibles of up to $16,100 per year.
Due to high out-of-pocket expenses and limited coverage in the country, 41 percent of U.S. adults have medical debt. Hospital bills are a major factor in bankruptcy deposits. And many Americans with coverage still avoid doctor visits and forgo prescription drugs because they can’t afford them.
Additionally, the nation’s insurers are increasing overall health care costs, instead of keeping them low, as they are supposed to do. Excessive administrative costs cost the country an estimate $248 billion a year, according to one estimate. THE political analyst Matt Bruenig noted that in the United States, out of every $100 paid to a private insurance company, only $68 is spent on health care. In a single-payer system, such as Britain’s National Health Service, the figure is $87.
The nation’s insurers represent a major problem for consumers, as well as employers, hospitals and doctors. The Kaiser Family Foundation found that more than half of insured adults have difficulty using their coverage. every year: being denied a claim, having difficulty finding an in-network provider, not obtaining pre-authorization in a timely manner. The sicker a person is, the worse their opinion of their insurance. Insurers also stand in the way of critical care and necessary medications.
What to do? While condemning the killing, progressive stalwarts Bernie Sanders and Elizabeth Warren acknowledged the pain insurers’ cause. Both suggested the country radically change its policies single payer system. Medicare for All and similar proposals would eliminate private insurance and instead enroll Americans in the popular and effective program covering seniors today.
The benefits and dangers of such proposals lie in their disruptive nature. On the one hand, Americans would never have to worry about losing coverage or negotiate with an insurance company again. Companies would not need to manage their employees’ health policies or pay their share of workers’ premiums. The government would have a much greater ability to control costs, negotiate drug prices and invest in public health. On the other hand, Washington would recode a sixth of the U.S. economy, putting dozens of insurers out of business and possibly wiping out their shareholders. As popular as the proposal is, it is not that popular– this is likely a failure, especially with divided government or Republicans in charge.
There are many beneficial but less disruptive measures policymakers can consider. The first would be to allow individuals to enroll in Medicaid, lower the age of eligibility for Medicare, or automatically enroll children in Medicaid regardless of their parents’ income. Create a public option, a popular layout hit of the Affordable Care Act, would be another possibility. Millions of Americans prefer Medicare to private insurance: there are fees and premiums to pay, but they are much lower than in private insurance. And Medicaid, provided to low-income Americans, has extremely limited out-of-pocket costs.
The country could also do what most European countries with private health insurers do: regulate them much more strictly. Prescribe in more detail and forcefully what insurers must cover. Set costs and reimbursement rates. Make insurers competitive – really competitive – for consumer business, with broad provider networks, low overhead and simple billing programs. Most Americans to want maintain the private insurance system; they just want it to work better.
Many Republican healthcare proposals made so far would backfire and give insurers more power deny participants’ claims or increase their premiums. But the Trump administration is ideologically heterodox. Elon Musk, perhaps Donald Trump’s most prominent political advisor, suggested that the country should make drugs like Ozempic widely available at a “very low cost to the public.” Washington could negotiate directly with drugmakers; it could do this for all prescription drugs, if Congress wanted.
Elected officials have avoided making these changes – for ideological reasons, fierce lobbying from insurers or simple inertia. But many of them are popular across the political spectrum. Americans, apparently so tired of the system that they are willing to view vigilante violence as an appropriate response, should instead call their representatives. There are better solutions than a gun, which left one person dead and no sick American improved.