A CEO Is Murdered and Consumers Rage against the Healthcare Industry. Why?
BU public health and public policy experts say the public’s reaction may be understandable, but the government has to decide "it needs to jump-start change.”
Over the summer in Minnesota, healthcare advocates risked arrest protesting care denials at UnitedHealthcare, just one example of the rage directed at the industry over the years. Photo by David Berding/People’s Action Institute via Getty Images
A CEO Is Murdered and Consumers Rage against the Healthcare Industry. Why?
BU public health and public policy experts say the public’s reaction may be understandable, but the government has to decide “it needs to jump-start change”
The airline industry. Cable and internet providers. Wireless phone services. Consumers rage against them all—but they seem to reserve a special level of hatred for the $800 billion US healthcare industry, and the shocking murder of the CEO of UnitedHealthcare in New York City brought that hostility between patients and providers into a glaring spotlight.
Within minutes of the shooting early on the morning of December 4, commenters on social media did not hesitate to assume, without evidence, that the assassin was seeking revenge on an industry that must have unfairly rejected a healthcare claim. The fact that the victim, Brian Thompson, was a successful businessman, a husband and father of two children, garnered little sympathy online.
“There is rightful rage that we live in a country where one in five Americans spends at least one month each year without health insurance and even a brief coverage lapse can interrupt lifesaving treatment and cause financial ruin,” says Michael Stein, interim dean of Boston University’s School of Public Health and a professor and chair of health law, policy and management. “Add to that a system of profit maximization—prior authorization denials make us furious and feel the most personal—and the pernicious ongoing discussion of privatizing Medicare and Medicaid. These are political issues that affect the public’s health—but none of them will be solved by killing healthcare executives.”
These are political issues that affect the public’s health—but none of them will be solved by killing healthcare executives.
As for any solutions to the current woes, says another BU expert and scholar, they will likely have to come from Capitol Hill. “The federal government plays a central role in jump-starting change; it always has,” says James Rebitzer, Peter and Deborah Wexler Professor in Markets, Public Policy & Law at BU’s Questrom School of Business. “I think that much of the improvements in payment and in delivery are going to happen through the government deciding it needs to jump-start change.”
Stein takes a similar view. “Private insurers make the vast majority of their revenue from Medicare and Medicaid contracts, so again, this a government-expenditure issue that needs to be discussed politically. For now, this is a for-profit industry until our model changes.”
In the public’s eyes, as the vitriolic reaction to the shooting made clear, change can’t happen soon enough. The arrest this week of 26-year-old Luigi Mangione, charged with the killing, did little to quell the public’s venom or elicit an outpouring of sympathy for Thompson’s family.
So far, there seem to be three clues that Mangione may have felt his own animus toward the healthcare industry: the bullet casings found at the scene of the shooting, according to authorities, had the words “deny,” “defend,” and “depose” engraved on them, a reference to the 2010 book by Jay M. Feinman, Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It; reports that Mangione had suffered a back injury that required surgery; and the fact that he was reportedly caught with a three-page manifesto criticizing healthcare companies. Police also found Mangione with a notebook that appears to outline his plans for the shooting, CNN first reported Wednesday. Mangione’s lawyer denies his involvement in the killing.
But before any of that was known, consumers only needed to know that a healthcare executive was murdered to let loose their ire. One reader’s comment posted on a CNN story about the shooting: “Thoughts and deductibles to the family. Unfortunately my condolences are out-of-network.” And a nurse on TikTok wrote, “I just can’t feel sympathy for him because of all of those patients and their families.”
Such anger is hardly new; it’s been building for years. But the problems with the healthcare system are much more complicated and more deeply entrenched than the current dialogue, Rebitzer says
“An act of violence by, apparently, a deranged, obsessive person shouldn’t be the beginning or the end of a discussion about real social policy issues,” he says. “The violence was horrible. The person who was shot did not deserve to die, and it’s not clear that whatever motivated this person to do the shooting had anything to do with the real pressing problems of the healthcare system.”
That’s not to say the industry doesn’t have real problems. But simply pinning Americans’ anger and dissatisfaction with the system on the greed of health insurers is reductive and wrong, he says—there’s plenty of blame to go around.
The financing system is “actually much better than it was in the 1990s, largely because of Obamacare and the associated expansion of Medicaid,” Rebitzer says. “If the Trump administration decides to be serious about reducing the deficit while reducing taxes, Medicaid is the obvious place for them to look [for cuts]. I can imagine that becoming a huge flashpoint in the next few years, but the political cost will be huge too, so I don’t know how it will play out.”
The healthcare delivery system—hospitals, providers—was hit very hard by COVID and is now chronically understaffed and facing a lot of burnout and exhaustion among medical professionals, he says. But at the same time, large hospital systems, like the large insurance companies, have gained a tremendous amount of market power, in part through mergers and consolidations enabled by a looser regulatory environment.
“The problems in the healthcare system are not primarily those of the insurance companies, but equally, if not more so, those of the providers. And the distinctions between providers and insurers is getting harder and harder to [distinguish] because of the growing consolidation in the industry,” Rebitzer says. “So UnitedHealthcare, which is the largest insurer, owns a large fraction of physicians and physician practices.”
UnitedHealthcare, which is the largest insurer, owns a large fraction of physicians and physician practices.
Assailing the greed of the insurance companies or anyone else “is an inadequate way to understand what’s going on. ‘Greed is about a search for villains,’” he says, “and I don’t believe that either insurers or providers are more greedy now than they were in 1980 or 1970. You miss what’s going on if you try to turn this into a morality play with easy villains and easy virtue.”
Last year, Rebitzer published Why Not Better and Cheaper? Healthcare and Innovation (Oxford University Press, 2023), coauthored with his twin brother, Robert Rebitzer, a senior advisor at Manatt Health and a Distinguished Career Institute Fellow at Stanford University—and, years ago, an executive at United Behavioral Health, another arm of UnitedHealthcare.
“We had a huge improvement in the financing system under the Affordable Care Act,” Rebitzer says. “And there’s lots more that can be done to have more access. But there’s nothing that would give more access that wouldn’t leave some people frustrated at the difficulties of accessing care they believe to be essential.”
It’s a system that Vermont US Senator Bernie Sanders described nine months earlier, in April 2024, as “totally broken.”
“It is a system not designed to provide healthcare to all people in a cost-effective way,” Sanders said. “It is a system designed to make huge profits for the insurance companies, the drug companies, and many other industries within the system.”
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