By Sam Pizzigati
Over 8,000 Americans, on average, die every day. Many of these Americans die unnecessarily. Their cause of death? The United States — our planet’s richest nation — still does not have in place a national health care system that guarantees everyone adequate medical attention.
One particular American’s death earlier this month has refocused attention on that absence. On December 4, a gunman murdered the chief executive of a corporate insurance powerhouse that regularly registers hefty profits denying health help to sick people who desperately need it.
That chief exec — UnitedHealthcare’s 50-year-old Brian Thompson — died on a Manhattan sidewalk after a short hail of bullets. A suspect in the case, Luigi Mangione, has been charged in the shooting.
The bullet casings from the shooting carried their own message. They read, according to police sources, “deny,” “defend,” and “depose,” a clear reference to the profit-first gameplan America’s giant insurers ever so relentlessly follow: deny the claim, defend the lawsuit, depose the patient.
Thompson stepped into the UnitedHealth empire over two decades ago and, notes the American Prospect journalist Maureen Tkacik, spent most of his career there “running its Medicare business, the cash cow around which much of the far-flung health care colossus essentially revolves.”
Three years ago, Thompson became the CEO of this “cash cow,” UnitedHealth’s biggest branch. His UnitedHealthcare unit’s 140,000 employees last year pulled down over a quarter-trillion dollars — $281 billion — in revenue. That intake helped his company’s annual profits jump 33 percent over their 2021 level. Thompson himself last year pocketed $10.2 million in personal compensation.
The chief exec of the overall UnitedHealth operation, Andrew Witty, at his end collected some $23.5 million, enough to rank him the nation’s highest-paid health insurance CEO. Witty’s take-home equaled 352 times the pay of UnitedHealth’s typical employee.
What’s been making UnitedHealth’s operations so rewarding for execs at the company’s summit? UnitedHealth operates in the shadowy world of “Medicare Advantage,” the program that gives America’s senior citizens the option to contract out their Medicare to private health-service providers.
These private providers collect fixed fees from the federal government for each of the senior citizens they enroll. They make money when the cost of providing health care to those seniors amounts to less than what the U.S. Department for Health and Human Services pays them in fees. And that core reality gives private providers an ongoing incentive to limit the care their patients receive.
No Medicare Advantage provider, the American Prospect’s Maureen Tkacik points out, has done more than UnitedHealthcare to systematically seize the opportunity that incentive creates — “by simply denying claims for treatments and procedures it unilaterally deems unnecessary.” Industry-wide, Medicare Advantage providers deny 16 percent of patient claims. UnitedHealthcare, the Boston Globe has reported, last year denied patient claims at a 32 percent rate.
The massive advertising campaigns that Medicare Advantage inflict upon the American people never, of course, mention anything about denials or the limits Medicare Advantage plans place on which doctors their enrollees can see and which hospitals they can use. That advertising instead, the KFF health care think tank detailed last year, typically urges viewers to call a toll-free “Medicare” hotline that has no connection whatsoever with the federal government’s official Medicare hotline.
Many of the over 9,000 ads that Medicare Advantage outfits run daily during the annual fall open enrollment period, the KFF researchers add, misleadingly suggest that seniors may miss out on financial savings or benefits “if they don’t sign up for a Medicare Advantage plan.”
For the Medicare Advantage industry, all this advertising has paid off handsomely. Just over half of Medicare’s beneficiaries have now chosen to take privatized care over the original public Medicare.
Seniors with the good fortune to stay healthy usually don’t give their Medicare Advantage plans much of a second thought. But those seniors enrolled in Medicare Advantage who find themselves needing medical help all too often find themselves facing one frustration after another. Years of those frustrations erupted bitterly onto the national scene after Brian Thompson’s murder.
“Thoughts and deductibles to the family,” read one online reaction to a CNN posting of a shooting video. “Unfortunately my condolences are out-of-network.”
“Compassion withheld,” read another reaction, “until documentation can be produced that determines the bullet holes were not a preexisting condition.”
Within hours after Thompson’s death, a research institute at Rutgers University had found scores of similar-in-spirit posts that together reached 8.3 million viewers across multiple platforms. UnitedHealth’s official Facebook report on Thompson’s death, meanwhile, quickly drew 35,000 responses using the social networking “Haha” emote — and only 2,200 emotes expressing “Sad.”
Some of the fiercest reactions to Thompson’s death came from within the medical community.
“This is someone who has participated in social murder on a mass scale,” a medical student wrote in one typical post.
“My patients died,” a nurse spat out in another, “while those bitches enjoyed 26 million dollars.”
“If there’s anything our fractured country seems to agree on,” mused Bloomberg’s Lisa Jarvis, “it’s that the health care system is tragically broken, and the companies profiting from it are morally bankrupt.”
“To most Americans,” agreed the New Yorker’s Jia Tolentino, “a company like UnitedHealth represents less the provision of medical care than an active obstacle to receiving it.”
That obstacle, the numbers show, has been devastatingly effective. The United States, a recent Commonwealth Fund study found, currently rates last in health among major high-income nations. Americans “die the youngest and experience the most avoidable deaths” despite living in a nation that spends almost twice as much on health care — as a share of gross domestic product — as any of its high-income peers.
Some 25 percent of Americans, Gallup polling adds, have people in their family who have had to delay medical treatment for a serious illness because they couldn’t afford the care. Some 79 percent of America’s nurses, for their part, say they’re working in inadequately staffed health facilities.
Thompson’s murder won’t change any of those stats. The system that enriched him lives on — and the incoming Trump administration figures to make that system even worse. The corporate-friendly Heritage Foundation, in its controversial Project 2025 blueprint for the second Trump term, is proposing that Medicare Advantage become the “default option” for all new Medicare enrollees.
A move along that line, notes analyst Heather Cox Richardson, would “essentially privatize Medicare” and significantly raise the program’s cost.
With Thompson’s death, America’s health care powers feel and fear the American public’s anger now more than ever. These giants, Reuters reports, have already begun enhancing the security they provide their top execs.
The challenge for the rest of us? We need to help channel the anger about health care that so many Americans feel today toward ending the system that has so failed America’s health. We need to remake health care into a vital and vibrant public service.
Our health care system, in the end, shouldn’t be making our rich richer. Our richest instead should be paying enough in taxes to help all Americans stay healthy.
Sam Pizzigati, an Institute for Policy Studies associate fellow, co-edits Inequality.org. His latest books include The Case for a Maximum Wage and The Rich Don’t Always Win. Follow him on Bluesky at @sgp.bsky.social.
PB says
Rome was arguably the greatest empire before the USA. It fell not by battle but by greed and corruption. I am 72 so may not see the fall, however I am seeing the slippery slope. Good luck to you all!
Pierre Tristam says
You are assuming that we have not yet fallen. I’m pretty sure that ship has sailed. We are where Rome was in the 300s, when Rome had that run of emperors whose names, the great Julian aside, are as forgettable as yesterday’s lineup on the History Channel.
KMedley says
There is not one single excuse , as to why many are fed up, angered with, ir frustrated by the healthcare industry, which justifies the cowardly act of murdering someone by shooting that person in the back!
PB says
You may be correct. Our time on this earth is just a moment, no more!
Sherry says
No doubt our country is already falling. The question is how low can we go? Unfortunately, I’m afraid we are about to find out.
Joe D says
As a retired Registered Nurse, and Master’s prepared Clinical Nurse Specialist and Certified Nurse Case Manager at a major internationally recognized East Coast university Teaching hospital, the farce of the term Medicare “ADVANTAGE” makes my blood boil, every time I hear one of the open enrollment ads, or have a Patient confused when their Medicare Advantage plan denies needed treatment or services…..”But I have MEDICARE!” I have to explain that technically they have signed over their Medicare benefits to a private “for profit” (AND HOW$$$) to pre-approve anything but routine basic care, and most limit access to a small network of doctors and hospitals to keep cost down. They’ve technically given up their benefit control!
It’s unfortunate that someone SNAPPED and focused on the CEO of the largest Medical insurer (bigger than BLUE CROSS now)….physical violence and murder are NEVER acceptable ways to deal with the issue, but in dealing with the delay/deny and LITIGATION in court…it had taken up the majority of my days! I had to retire to keep My sanity !
FlaPharmTech says
How do we, mere lowly citizens, effect change against the corporate behemoths?! Losing faith in USA, especially in light of the incoming dumpster fire.
Shark says
What’s the big worry ? Pretty soon we will have that beautiful health care that diaper don promised almost eight years ago.
Skibum says
Wake up, America… it’s our OWN damn fault!!! Americans, particularly our younger ones, glorify celebrities, athletes and social media “influencers” over those who really should be our nation’s role models. Starting even before many kids have reached puberty, they are getting their news and what they perceive as important information and their version of “truths” from TikTok! Far too many young people of voting age don’t see the importance or necessity of educating themselves about issues that will either affect them today or into the future, or are ambivalent about even taking the time to vote! Then all they want to do is complain about things that they COULD have had a say in changing. Americans keep electing some of the most horrible examples of humanity into offices of power. These disgusting elected politicians who proclaim they should be put into government positions because they “are successful businessmen”, then give millionaires and billionaires the power to dismantle government for their own benefit and enrichment instead of governing for the good of the American people were elected BY US!!! These same people, once their terms are up, become lobbyists for pharmaceutical and medical insurance companies, who pay them huge amounts of money to influence laws that favor the corporations’ profit margins. When our nation’s health insurance infrastructure has profits as their highest priority, then shareholder return as the next highest priority, and patient health and longevity as the lowest concern, we can expect the kind of healthcare that we currently have in the U.S. Each and every time there has been a push for national healthcare, the private corporations that manage the health insurance industry flex their large muscles and direct their many lobbyists to pay off and twist the arms of many elected “leaders” in Congress to do the bidding of corporations instead of looking out for all of us! NOTHING will change as long as our youngsters are not educated, informed AND voting for their own interests. Nothing will change as long as America keeps putting idiots in critical political positions of power who have their own self-interest, or the interests of billionaires as their prime objective! WE can change our national disgrace if we make better choices at the ballot box!
oldtimer says
Pierre, you constantly remind us of the failings of this country (of which there are many) but please point out somewhere that is a perfect place and I might consider moving
Deborah Coffey says
There is no perfect place. However, if you love democracy, there are much better democratic countries. You’ll be surprised where The United States ranks in 2024.
Here you go: https://www.democracymatrix.com/ranking
oldtimer says
I spent a career in the navy been to over 18 countries, some of the one’s you listed. They are not as free as you think they are, maybe go there and not just google someone else’s list
Jim says
The Medicare Advantage scam that is becoming the default Medicare coverage for seniors is just one portion of the major issues facing this country. I ask you to consider the following:
1. Three people in the US have more money than 50% of the population of this country!
2. In our “elections”, most of the money for the politicians is coming from PAC’s on both sides of the aisle.
3. Not too long ago, if you were employed by a medium to large company, you had a pension plan to go along with your 401k.
4. The Stock Market is now set up where you can “bet against” companies and make a profit. There are other sleazy things that are legal as well.
5. Our districts have been gerrymandered so completely that the odds of a Democrat being elected in a Republican district – or vice-versa are just astronomical.
So what am I trying to say?
We get told that taxing the rich at a higher rate than “average people” is somehow unfair. Why is it unfair? The CEO that was murdered make $10.2M last year. Who among us “average people” can make a good argument that he would have unduly suffered if his tax rate was higher than average. Even if it was 50%, he’d have taken home over $5M. I could struggle along with that. Do you know that they cut off the Social Security Tax at $174,900 in 2025. After that, if you make more than that, no more social security tax. Yet we get told constantly that social security funds are going to run dry and we must “do something”. Do something seems to be code for cutting benefits. Maybe we ought to be asking why the social security tax stops at $174,900. Again, I don’t pity the poor souls making more than that per year. I believe they’ll make it just fine on what’s left over!
Elon Musk gave over $250M to Trump’s campaign and now he’s attached at the hip to Trump. He’s even going to head a team looking at cutting the “red tape” and waste in government. Why is there no outcry about a guy who has government contracts with his companies rampaging through the government looking to change things? What’s stopping him from changing things he doesn’t like because it affects his income? There was a time where you couldn’t work in the government without divesting yourself of any financial holdings you had that might be impacted by your work. I guess we just trust Elon to do the right thing.
Do you think that any politician cares about what you have to say about the issues of the day? They’ll pay you lip service but they are listening to the people with the PAC money. That’s how they get elected over and over. You don’t bite the hand that feeds you.
“Back in the day”, you invested in the Stock Market based on companies (stocks) that you thought were being run well and likely to make money and give you a decent return on investment. In short, you were putting your money on the best companies you could find. Now, you can bet against a company doing well and make money! There are examples of the rich doing exactly that and running a stock value down through various means to achieve their goal. You can “buy” stocks for a percentage of their value and then sell them at the best time for you and collect the full value of the profits even though you never even came close to putting up the full value of the stock. I call this gambling, not investing. And this type “game” is typically done by the one-percenters among us who have the money and insider knowledge to pull it off. So much for a “fair” stock market.
Why are there no pensions anymore? Perhaps it’s because all the money that used to go to pensions now goes to the highest corporate officers and to buy up stocks to keep the values high. Companies make more money now than they ever have yet the middle and lower class have seen no significant improvement in 50 years.
How can any reasonable person be okay with knowing that the USA spends more money on medical care yet we’re at the bottom of all high income nations for longevity? Perhaps the reason “socialized” healthcare is such a demonic concept is because there are so many people making “killer” profits off the current system. United Healthcare is said to be denying 32% of claims – that’s one out of every three and twice the average. Don’t tell me the system is set up to help all of us with our health.
You can all keep drinking the Kool-Aid that “anyone can make it in America if they’re willing to work”; that Democracy is thriving in the US; that we’re all equal; and any other self-serving BS statement made by the “haves” to sucker the rest of us. Personally I’m tired of it and I will admit I really don’t know how this mess is going to ever get turned around.
I will say this, though. Over the next few years, as things get harder for everyone, I think you might be reading about more CEO’s and uber rich assholes getting shot, stabbed, blown up or sent to the great beyond by some means. It’s not right but you can only push people so far.
Laurel says
I see a possible American Revolution akin to the French Revolution, when we hear Trump, and his Vice President Musk, tell us to eat cake. That’s after the law suits become intolerable.
Yes, it’s true: Medicare Advantage is NOT Medicare! It is also a goal of the next admin’s “trimming” of government “waste.” Privatizing Medicare. That, and the public buying the bullshit of losing Social Security. Y’all are being set up to believe it.
Also, stop worrying about immigration is this uber white community! Seriously, you are being distracted.
You’d better start rethinking where this is all going to go, and soon.
Tony says
What about the hospitals. We have Advent Health overcharging everyone and where is the uproar, $ 329.00 for an office visit
Laurel says
We are being conditioned for all kinds of hurt.