When United Healthcare CEO Brian Thompson was murdered in the street last month, people rushed to defend the action despite knowing nothing about the murderer or his motives. However, Luigi Mangione, who has been arrested for the crime, fits none of the theories. He was not a United patient, he recently had successful spinal surgery (which was covered by his insurer), and he is far from the working-class hero many imagined. In fact, he’s a member of a wealthy, powerful family who lived a life of privilege.
That hasn’t quieted his supporters or the big-name politicians who are essentially defending his actions. Elizabeth Warren, Alexandria Ocasio-Cortez, Bernie Sanders, and Chris Murphy were among the legislators who claimed not to condone violence while then going on to offer excuses and explain why the violence was understandable. Missing from the conversation, and countless others lionizing Mangione, is an acknowledgment that there are reasons health insurers can’t pay out whatever a provider wants, automatically and on demand. While an insurer’s job is to ensure healthcare is paid for the individuals they insure, they are not just a payment processor. They also have to keep costs down for the insured, something providers have made more difficult in recent years.
Hospital systems have been pursuing huge, inflationary increases in the rates they charge
insurers when treating insured patients over the last 18 months, despite hospitals doing just fine through COVID. Insurers from Oregon to Florida are losing contracts because they won’t pay reimbursements high enough above the rate of inflation. In Colorado, Anthem claims that CommonSpirit threatened to leave if Anthem does not agree to reimbursement rate increases more than three times the rate of inflation. Anthem’s State Plan President said, “Any sort of cost increase like this, like three times the rate of inflation, has a direct impact on what employers are paying, and what the members who are covered under those plans are also paying.” In Nebraska, Aetna said CHI Health followed CommonSpirit’s lead and is also demanding increases more than three times the rate of inflation.
These contract negotiations have huge repercussions for personal budgets. According to United Healthcare, UNC’s requested reimbursements would mean an increase of $570 million in costs over a three-year contract. Those costs will necessarily be passed on to patients, local business, and taxpayers through higher premiums and cost-sharing.
Aside from these way-above-inflation pay increases, providers are finding other creative ways to increase revenue. Dishonest billing is when a hospital misrepresents the site of service, the type of service rendered, or the length of time someone was treated just to get higher negotiated payments from insurers. The only recourse insurers have is prior authorizations, which refers to a process in which doctors and providers are required to provide written justification for extraordinary care they’re prescribing in order to get paid.
Remember, the average doctor’s salary is $363,000. To make insurance premiums remotely affordable for the average American, insurers must constrain how much is paid out. In Medicare, the federal government is doing something similar, adopting many of the same cost-saving tactics insurers use, including prior authorization, to keep healthcare costs down for those paying bills in the private sector.
While it’s easy to blame “big insurance,” healthcare companies and hospital systems are responsible for two-thirds of healthcare spending and deserve their share of the blame. While the former took in $25 billion in profit in the last year, hospitals collected $900 billion. “It’s become quite clear how angry the public is with health care costs,” said Rice University economist Ho. “I’m glad people are voicing their anger against insurers, but they should be directing equal anger against hospitals, particularly since so many are nonprofit.”
Let’s not treat murder as a heroic act. Mangione is no Robin Hood figure; he’s a wealthy young man who shot a father in the back. Brian Thompson did not create the system for which he was punished, and the system is not even what most people think. There are many valid complaints to be made about the cost of American healthcare, and they should be made. There might not be a hero in this story, but it should be easy enough to see who the villain is.
Amelia Hamilton is a writer and communications professional from Michigan with more than a decade of experience in messaging to promote liberty. Through her work with different organizations and publications, she knows how to craft the right message for each audience to help them connect with policy issues. Amelia has undergraduate and master’s degrees in both English and 18th-century history from the University of St. Andrews in Scotland.
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