“I have never seen so many Americans agree on a subject as when reading the comments section under the articles on the assassination of the CEO of UnitedHealthcare,” laughs a TikToker. The murder of Brian Thompson, the director of a private health insurance company, on December 4, relaunched the debate in the United States on the quality of health care, after revelations about the killer’s motivations. presumed. Luigi Mangione, 26, is said to have described mutual societies as “parasites” in a letter of confession, criticizing the fact that “the country has the most expensive health system in the world”, while “life expectancy [des Américains] is only decreasing”, according to a law enforcement report consulted by Associated Press. He himself would have dealt with insurers in the context of serious back problems.
Frustration built up over coverage denials and medical costs in the world’s top power fueled a wave of criticism against health insurance companies days after the killing. “Sorry, but I have a hard time having empathy for a company that makes billions, while denying patients access to care every day,” comments another Internet user. At the same time, a wave of testimonies share the difficulties of treatment, whether it involves heavy treatments against cancer, anesthesia for a surgical operation, or even a simple prescription for an antihistamine.
Last year, around 81% of Americans said they were dissatisfied with the cost of health care in the United States, according to the media. NPR. Caregivers, too, express their dismay: “I spend more time dealing with insurance than taking care of users. This benefits neither the doctors nor the patients,” complains an orthopedist, whose the testimony is relayed by the channel CBS. “I am being refused treatment without any medical justification,” comments another allergist.
A hybrid health system
The weight of private insurers is linked to the particularity of the American health system, operating on a hybrid model. Part of health insurance is in fact public, via two main programs: Medicare, which insures people over 65 or suffering from disabilities, and Medicaid, which finances medical aid for patients with limited income. . The other part is provided by employers, who cover 65% of the population.
The four largest intermediaries in medicines, the “Pharmacy benefit managers”, are also owned by the main health insurers, who control 70% of this lucrative market. Thus, the day before the murder of Brian Thompson, the UnitedHealthcare group anticipated a turnover of at least $450 billion in 2025, or almost 40% more over three years.
Some, like Democratic Senator Bernie Sanders, are calling for an entirely public system, but no approach aimed at exfiltrating insurers from the health sector has ever been undertaken across the Atlantic. Barack Obama managed to promulgate the Affordable Care Act – known as Obamacare – in 2010 with measures concerning prices and better coverage, but without affecting insurers.
Many Americans forgo health care
The control of these unscrupulous trusts on the health market is seen as the cause of the increase in the costs of care and medicines, well above inflation. In 2024, the average health insurance premium for families rose to $25,572 per year, where it cost $5,800 before the 2000s, according to CBS News.
25% of Americans would skip or postpone health care each year for financial reasons, the channel indicates. This share rises to 21% among people with mutual insurance and 61% among those who do not. Figures which reveal great inequalities in access to care and make Americans fear unforeseen medical costs, the main cause of household bankruptcy in the United States.
Recurrent refusals of support
Refusals of support are also regularly highlighted. Miranda Yaver, professor of public health policy at the University of Pittsburgh, discovered that out of a large sample of adults surveyed, a third had experienced at least one refusal of coverage. “What is frustrating for many patients is that there is a lot of opacity […] insurers don’t justify their decisions,” she tells NPR.
According to several American media, more and more insurance companies are using Artificial Intelligence to examine compensation claims and issue refusals. “Last year, UnitedHealthcare was sued by the families of two deceased patients who accused the insurer of knowingly using a biased algorithm to deny elderly patients coverage,” notes CBS. “One of the elements highlighted by the trial [d’UnitedHealthcare] is that 90% of refused requests were overturned on appeal, notes Miranda Yaver. This suggests that there is a high error rate.”
Health, the only factor in life expectancy?
However, this is not enough to justify the murder of the group’s CEO, the press nevertheless points out. “This action and the joy it sparked teach us that the health system is broken, but so are many of us,” writes Graeme Wood in The Atlantic. “Intelligent people don’t seem to realize that health care involves trade-offs, that countries without private insurance tend to ration it, and that many health systems healthier than ours still have private insurance administered by exasperating bureaucracies that sometimes refuse reimbursement requests.”
Others see the problem of social coverage as a whole and believe that it is not true, as Luigi Mangione asserts, that the decline in American life expectancy is solely due to the particularities of health coverage. in the country. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, believes the lack of social assistance programs to help people living in poverty or without stable housing, as is the case elsewhere, worsens mortality, while other researchers still point to the proliferation of firearms, child poverty, air pollution and more lax regulations on the quality of products consumed in the industry. If many morally denounce Luigi Mangione’s gesture, all agree on the fact that it will, at least for a time, spark debate in American society.