Agatha Christie was onto something when she stated, “The truth, however ugly in itself, is always curious and beautiful to seekers after it.” Brian Thompson, the 50-year-old CEO of the United Health Care insurance company, was shot and killed in Midtown Manhattan on December 4th in broad daylight. His assailant, Luigi Mangione, has become a media-fueled darling, with multiple documentary projects already underway to explore the complexities of his crime. The allure of controversy and the American people’s fury regarding corporate power has led to Mangione’s permeation of pop culture coverage. Rather unsurprising considering the divisive country we live in, partisan divides have underscored the polarized public sentiment toward this young man charged with murder. The fascination with understanding Mangione’s motive for murder has captivated the country, as some Americans have painted him as a vigilante out for justice. An angry health care consumer who was potentially denied insurance coverage following a debilitating back surgery—sadly, a story many Americans can relate to. In this good-versus-evil storyline, health care insurance firms have become the villain.
The media continues to gravitate toward political figures, celebrities, and businesspeople who deliver drama that fuels both clickbait and nuanced debates on contentious topics. The coverage of Luigi Mangione has been fascinating to witness as he is equally revered and reviled, further fueling discussion as to whether he is a hero, a villain, or a visionary. To many Americans, he may symbolize a champion of the underdog or a truth-teller demanding corporate accountability, health care reform, and the forgotten ethical responsibilities of industry leaders. The motivation behind his crime has sparked yet another national debate, with Americans reacting to Thompson’s murder with passionate responses of both rage and joy.
Health care in the U.S. has been commodified and reduced to a transactional exchange where one’s ability to pay determines access to care. In a staggering finding, a recent study found that over half of all bankruptcies in the United States are tied to medical debt.¹ Health care insurance does not confer immunity: high premiums, sky-high deductibles, and exorbitant copays ensure that being insured is no guarantee of financial security. Contrastingly, insurance companies are thriving: the top five insurers collectively reported over $60 billion in profits at the end of 2023. Prior authorizations, coverage limits, and byzantine appeals processes are features of the system. These mechanisms, cloaked in bureaucratic jargon, are carefully calibrated to discourage the sick from seeking care or to transfer costs back onto patients. A delayed approval for a life-saving drug, a denied claim for an emergency surgery—these have become daily realities for millions of Americans.
How can we not balk at the injustice of forcing an ill patient to become their own health care insurance advocate while also anticipating potential surprise medical bills? The American health care system demands that you become an expert at its bureaucratic intricacies when at your most vulnerable. While private insurance was originally thought to foster competition and innovation, it has done very little to reduce costs or improve the quality of care. Instead, it has incentivized consolidation that stifles competition and creates monopolies, limiting patients to fewer options and higher costs. The administrative costs of the U.S. health care system far outstrip those of other nations; in Europe, single-payer modeling has eliminated the capitalistic system of corporate greed. If we take a close look at Denmark’s health care system, considered one of the best in the world, it is characterized by universal coverage based upon a tax-funded system designed to provide equitable access to all residents. Its decentralized administration is based upon management by five regional authorities responsible for hospitals and specialized care, while municipalities manage home care, nursing home care, and rehabilitation services.
In a recent and deeply concerning move in November 2024, Blue Cross Blue Shield (BCBS) implemented a policy denying anesthesia coverage beyond an arbitrary time limit set by the insurance firm. This decision was a stark reminder of the troubling prioritization of profits over patient care that continues to plague the American health care system. By setting such limits, BCBS not only undermines the autonomy of medical professionals but also places patients at significant risk. As a pediatric anesthesiologist, I can attest to the fact that the duration of anesthesia for even routine surgeries cannot be predicted with precision. Complex surgeries or unforeseen complications may necessitate extended anesthesia to ensure patient safety and procedural success. By imposing a rigid time limit, BCBS forces doctors and patients to navigate the impossible choice between financial stress and adequate medical care. This policy would have likely compromised the quality of care, as physicians may have felt pressured to expedite procedures or make less-than-optimal decisions to avoid exceeding insurance-mandated thresholds. On December 5th, one day following Thompson’s murder, Anthem BCBS reversed the policy amid widespread backlash from physicians, lawmakers, and the American Society of Anesthesiologists.
BCBS’s decision should serve as a wake-up call to all stakeholders in the health care system. Patients, providers, and policymakers must unite to push back against measures that prioritize corporate bottom lines over human lives. In the court of public opinion, insurance companies have largely come into direct conflict with universal human dignity. Although politically contentious, there are steps that will lead us toward a more patient-centered focus. Future steps to ensure a more equitable health care system should be predicated on stricter regulations to cap profits, mandate transparency, and hold insurers accountable for denying health care coverage—perhaps saving lives in more ways than one.
Irim Salik is a pediatric anesthesiologist.
