Doctor writing on a clipboard in a hospital. Image by WavebreakMediaMicro/Adobe Stock.
Krista Gorham is a public health science major with minors in biology and studio art, and she is a 2024-25 health care ethics intern at the Markkula Center for Applied Ethics at Santa Clara University. Views are her own.
On December 4th, 2024, at 6:44am, Luigi Mangione fatally shot Unitedhealthcare CEO, Brian Thompson, outside of a hotel in downtown Manhattan. While I am not writing to condone or condemn the actions of Mangione, we cannot deny the fact that Thompson’s assassination sparked a perplexing nationwide celebration.
What makes this event conflicting for the American public is the century-old universal law of “do not kill,” and the acknowledgement that the killing of Mr. Thompson resembles a karma that has been brought forth through the harm of millions of Americans whose livelihoods are dependent on a system that is rarely functioning in their best interests. I too agree that it is unethical to kill, so let’s talk about the 45,000 Americans who die every year as a result of their inability to afford and/or navigate our health care system.
While I read discussions and opinions regarding who to blame for this unethical American catastrophe, I often come across, “don’t hate the player; hate the game”–in this case, don’t hate the private insurers; hate the government. While this does deem some validity, it is exceedingly more nuanced than this. We should first rather be questioning why America values health care as a privilege rather than a human right, which I contribute to our country’s deeply entrenched societal philosophy of individualism.
An individualist society increases the individual’s responsibility to navigate personal success through means of self-determination. This more often than not translates to the treacherous pursuit of amassing wealth, hence our renowned free-market approach. Now don’t get me wrong–these American values have led us to push the boundaries of technological creativity more than we could have ever imagined. However, only a select few have had the opportunity to push these boundaries. As a result of systemic discrimination, individualism has left entire groups behind as they were never seen as proprietors of liberty in the first place. This is mirrored in who we see has access to health care and who does not. While innovation grows, U.S. life expectancy declines. The most essential piece of the puzzle in our ability to achieve “life, liberty, and the pursuit of happiness”–our health–has been ingrained to be understood as a reward among those who never had the opportunity to be at the top.
Speaking of those at the top, in an interview with the CEO of Edelman, a global marketing firm regarding the public’s outburst following Thompson’s death, he asked, “are people really that angry?” For context, Richard Edelman reaps the benefits of a billion-dollar firm that was passed down from his father. In other words, it is fair to say that he is most likely untethered by health care costs. In fact, in a 2023 survey representative of around 251 million American adults who pay for health insurance, one-third report being impaired by medical debt. Forty percent of Americans postpone care due to high costs. And as a result, out of all high-income countries, the United States is home to the lowest life expectancy, the highest rates of obesity, chronic diseases, infant and maternal mortality, suicide, and homicide.
Not only is health care too expensive, private insurers rarely advocate for their clients. It is estimated that nearly 850 million health insurance claims are denied every year. While I can only speculate why Mangione went after Thompson, Unitedhealthcare tops the charts in insurance denials among private insurers. And they were under fire long before Mangione entered the picture. When it comes to claim denials, Unitedhealthcare takes the lead. What makes this even more jarring is that artificial intelligence is frequently utilized to review these claims, particularly pertaining to Unitedhealthcare’s Medicare Advantage enrollees. The corporation is currently under a class action lawsuit for the use of a faulty algorithm. Among those who have their claims denied, 60% report postponed care. This is what makes America unique–we are the only high-income country that does not have universal health care, as it is too threatening to our beloved individualist values.
So why does understanding individualism matter in dissecting our flawed health care system? Mangione is actually a victim to it in his manifesto. He states, “[health care corporations] continue to abuse our country for immense profit because the American public has allowed them to get away with it.” Have we? Or has the American public become so stressed, so depressed, so depleted, and so chronically sick by contributing to a system that values you depending on where you reside on the unequal playing field because the American public has no other option? Social cohesion and therefore change becomes drastically more difficult when most people are too busy trying to stay afloat for themselves and their families. The last thing we should be doing is blaming ourselves.
I recently had the opportunity to speak to an interviewee, who can relate to this all too well, as can a majority of Americans. They have requested to remain anonymous.
In an effort to find care to remove an unsuspected brain tumor that amassed to be around $150,000, insurance denied their claim. Care was postponed until vision was lost in their left eye. The grueling process of an appeal was the only way to navigate the costs following the procedure, all during radiation therapy. In the United States, less than 1% of patients appeal. In the same survey performed by the Commonwealth Fund, they found that over half of the participants were unaware that they had the ability to do so, 25% were unclear of how to initiate the process, and 25% report that they did not have the time to do so. What was jarring to me was that my interviewee, a highly-educated, middle- to upper-class American who has worked in insurance for 11 years, found the process to be nearly impossible. How could it be feasible for someone without this experience? The process to appeal or even remotely dispute medical charges is destined to be a maze–a win for a patient means a loss for insurance companies.
Fortunately, beyond the hassle of navigating unreasonable medical bills, it is important to note that the very few who do manage to go through the process of appealing, often win. We should always be critically questioning our medical bills, and this first comes with awareness. Although daunting, sharing our stories may be the first step. We cannot achieve health equity by continuing to conform to individualism regarding our health.
Achieving universal health care involves tapping into the collective. Millions of Americans have faced a dilemma regarding their health coverage, and although the actions of Mangione have not created change–he has the public talking. It is essential to keep up the momentum. By sharing our stories, not only do we find commonality and therefore validation in our experiences, we can begin to place pressure on the systems that reinforce systems of oppression–in this case, health insurers. Issues achieving affordable, quality health care provide such a significant commonality among Americans that it holds the potential to be the one thing we protest as a collective.