Healthcare at Gunpoint
The American healthcare system hit a dystopian milestone this week, as headlines broke with a corporate assassination alongside news of yet another policy that prioritizes profits over people. On one hand, the CEO of UnitedHealthcare, Brian Thompson, was shot by an assassin in what appeared to be carefully planned with a silencer attached and the gunman slipping away into the night. Upon crime scene investigation, three bullet casings bore the words “Deny,” “Defend,” and “Depose” referencing insurance companies’ infamous reputation for denying claims and defending against accountability. The NYPD is offering a $10,000 reward for the capture of the shooter. Many have pointed out that this is less than an average medical bill.
Simultaneously, another health insurance company introduced a policy limiting anesthesia coverage during surgeries to pre-set time frames, forcing patients to either endure pain or pay out of pocket if their procedure exceeded the insurer’s time limits. In the wake of the assassination, they decided against implementing this policy.
While violence is never the answer, and while it is shocking, it is very explainable. This is the culmination of frustration and despair within the American healthcare system. The outcry over these policies — and the assassination — resulted in the anesthesia policy being rolled back. However, it is a terrifying commentary on our society that change required such drastic events to spur action. This moment forces us to confront a painful truth: our healthcare system is broken, and it’s killing people. Literally.
The United States is the only developed country where people routinely go bankrupt over medical bills — even when they have insurance. 45,000 Americans die annually due to lack of access to healthcare. Americans also live, on average, much less than citizens of comparable nations, while paying twice as much for healthcare.
We reward doctors more for medical procedures than for keeping people healthy, keep costs hidden from customers and spend money on tests or treatments that have nothing to do making patients feel better.
Healthcare wasn’t always this way. Before the widespread adoption of health insurance in the 1920s, it was common for doctors to make house calls to patients’ homes or operate out of small, often “corner office” practices, and patients typically paid directly to the doctor at the time of service, with costs generally considered more affordable compared to today’s healthcare system. Medical school also wasn’t a price tag of a quarter million dollars. Doctors weren’t trained or given incentives by pharmaceutical companies to prescribe their medications. Healthcare simply wasn’t for profit. The rise of health insurance in the mid-20th century was meant to protect workers and their families. However, it quickly became a tool for profit. By 1950, pharmaceuticals had become the most profitable industry in the United States.
The U.S. healthcare system is also notoriously complicated, with insurance companies weaponizing bureaucracy against patients. In fact, in America, you can have a bachelor’s degree in “Health Administration” simply to learn how to bill people properly or defer to another coverage after providing medical care. In-network and out-of-network policies mean that even insured individuals can face astronomical bills if they unknowingly receive care from a provider not contracted with their insurer. Denials for necessary treatments and delays in approval have become so routine that Americans joke about paying high premiums only to be told “no.”
This dysfunction stems from classism embedded in the system’s very foundations. Some states like Kentucky have tried to implement a work requirement for Medicaid recipients. You have to be working or trying to find work, but it would cost more to verify everyone’s employment or search for employment than to just give them care.
The media and policymakers perpetuate the myth that some people deserve healthcare while others don’t, feeding into stereotypes that stigmatize low-income communities. They benefit as well through campaign donations or drug advertisements. Americans have been conditioned to resist universal healthcare because they fear “someone else” might benefit for free — even as they pay twice as much as citizens in other nations for worse outcomes.
The refusal to prioritize healthcare as a human right costs Americans not only their lives but also their livelihoods. In 2022, the U.S. could have saved $439 billion by adopting universal healthcare. Instead, people skip necessary treatments, endure preventable suffering, and miss work due to illness, further widening the wealth gap.
But as society clutches its pearls in shock that this CEO was killed, because after all he was still a father, husband, and someone’s son, it brings to mind Malcolm Gladwell’s “principle of legitimacy” which states that a functioning system where people follow the rules requires three things:
- People must feel they have a voice and will be heard.
- The law must be predictable.
- The authority must be fair, treating all groups equally.
Our healthcare system fails on all three counts. Patients have no meaningful voice, as their concerns are drowned out by corporate interests. Policies change unpredictably, leaving patients scrambling to navigate a labyrinthine system. And fairness is nonexistent in a structure that consistently prioritizes profit over people.
The deaths, bankruptcies, and despair caused by the current system are not accidents — they are features of a machine designed to extract wealth from human suffering. Healthcare must be a human right, not a stock market profit margin.
It is not enough to roll back policies after public outrage. We need reform that prioritizes people, dismantles the classism baked into the system, and ensures that no one dies or goes bankrupt because they cannot afford care. Universal healthcare is not a radical idea; it is a moral imperative.
Let us remember the 45,000 lives lost last year due to a lack of healthcare access and demand a system that serves everyone, not just the wealthy few. Change is possible, but it requires collective action, unwavering commitment, and a refusal to accept anything less than our right to stay alive.
“This is the defining challenge in the lives of millions, maybe tens of millions. And if not the defining one, then a secondary one in almost everybody else’s, right? Your health. Whether you can have a child or not and not have a $50,000 bill by accident. Whether something breaks or not, you can get it fixed. I know so many people — who actually have decent insurance, and have some financial cushion if something goes wrong — and still, things happen to them where they get a mysterious $100,000 bill for a shoulder surgery. A friend of mine, told me this after this happened the other day. A mysterious $100,000 bill — with insurance.
The reality in this country is if you kill people with a gun, it is very obvious to everybody what’s going on and you’re rightly deplored. And we should deplore that.
If people are being killed through PDF files and through claim denial letters, and through a deliberate practice of saying no to a certain form of care that you know you’re gonna end up granting, but if you say no, 80 percent of people will lose steam and not appeal successfully and you’ll only have to give it to 20 percent of those people and you factor that into your balance sheet.
And if that is not an incidental thing that happens or bad apples, that’s actually how you make money because the health insurance industry is an industry that doesn’t really exist in many other countries. After all, they just take care of each other as part of their society. You cannot expect to live in a society in which that rage goes nowhere, just fizzles out and dissipates. And we have to deplore violence and then be curious about where it’s coming from.”
- Anand Giridharadas
