Unpacking the anger against insurers

The December murder of UnitedHealthcare CEO Brian Thompson and the often laudatory response online has left the industry grappling with how much anger can be directed at an industry that claims to keep people healthy.

The murder was gruesome and unjustified. The social media backlash reflects the frustrations that have been building among patient-consumers for decades with a healthcare ecosystem that is increasingly seen as indifferent and unresponsive. The insurance segment was at the heart of that sentiment.

Anger about the healthcare ecosystem is growing. While some of the hostility is specific to the insurance industry, much of it reflects broader frustration with a healthcare system that is becoming increasingly expensive and complex without a corresponding increase in positive health outcomes.

In one questionnaire from NORC at the University of Chicago: “About seven in ten adults say that denials of health care coverage by insurance companies, or the profits made by health insurers . . . bear at least ‘a modest amount’ of responsibility for Thompson’s death.” Alarming, according to another study Emerson College Polling shows that “41% of voters between the ages of 18 and 29 find the killer’s actions acceptable.”

Apart from the recent murder, other signs point to the same anger. According to pollThe US rating of healthcare quality in the US is at its lowest point in Gallup’s survey since 2001, when they started keeping the statistics.

Healthcare workers are five times more likely to experience workplace violence than workers in other sectors reports from the federal government, and there are cases of violence to rise. Hospitals across the country have been forced to take dramatic measures increase the number of security staff and training clinical staff in dealing with physical threats.

These are not just isolated incidents. The growing resentment is a response to deep problems with the entire ecosystem.

Misaligned incentive structures are one reason anger builds up throughout the system. Insurance companies report quarterly to their shareholders on their financial prudence, so they have every incentive to ensure they manage usage, without which insurers believe there would be abuse on the provider side as some would try to maximize billing through upcoding or unnecessary procedures. Yet insurance companies make more money the more claims they deny. If patients die as a result of utilization management, whether in the form of requiring step-by-step therapy or prior authorization, or outright denial, there is little consequence for the insurer.

At the same time, providers operating under a fee-for-service model are incentivized to do more and bill more as they face declining reimbursement. These dynamics have pushed insurers to implement more strategies, such as prior authorization barriers, step-down therapies, and outright denials, increasing patient frustration and distrust.

Until we realign the incentives in the system so that outcomes matter to the insurer and to healthcare organizations, the consumer will continue to be the one left behind. The structure of today’s insurance incentives actively encourages risk avoidance and cost savings, rather than any analysis of total economic and clinical value across a continuum of care.

This is further compounded by the fact that for the average commercial insurance plan 1 in 5 members disenrolled each year, creating little long-term accountability for insurers to invest in patients’ health outcomes across the lifespan.

Denying coverage for necessary treatments often produces immediate cost savings, while the long-term health consequences – worsened conditions, higher future costs and avoidable suffering – are externalized to patients and the wider system.

Another cause of increasing confusion and frustration is the lack of transparency in the healthcare industry.

As I write in my book Adding value to healthcareit is extremely difficult for consumers to obtain information about the costs, quality and outcomes of healthcare because the necessary information is not readily available. Even after undergoing a procedure and reviewing their insurer’s explanation of benefits, they aren’t always sure what services they received, how much those services actually cost, or what they may owe.

In a New York Times op-ed Published in the wake of Brian Thompson’s death, Andrew Witty, the CEO of UnitedHealthcare’s parent company, UnitedHealth Group, admitted as much, saying: “Health care is both intensely personal and deeply complicated, and the reasons behind coverage decisions are not properly understood. understood.”

Lack of transparency in health insurance has created a system where patients are kept in the dark about crucial decisions that affect their health and financial well-being. The lack of standardized, easily accessible information on pricing, coverage policies and claims decisions means consumers cannot make informed choices or effectively challenge denials.

This opacity allows insurers to deflect responsibility while patients are faced with unexpected bills and limited recovery options. When we buy a car or a home appliance, we can easily compare the options and take something back if we don’t like it. This is not the case in healthcare, where plans and processes are shrouded in mystery and we have to pay more to fix something that shouldn’t have failed the first time. True consumer empowerment requires full visibility and visibility into costs and quality. Without this insight, the cycle of mistrust will only deepen.

Breaking this cycle requires creating a healthcare model that aligns incentives with patient outcomes. Until patients understand what they are being charged for and why – and know that their doctors and insurers have financial interests aligned with their own – hostility and frustration will continue to rise.

It’s clear this system is broken. The frustration directed at insurers and the broader healthcare industry is not just about individual incidents, but is a reflection of systemic issues: perverse financial incentives that reward denial of care, a lack of accountability for poor outcomes and an opaque system that leaves patients feeling powerless .

Addressing these challenges requires more than surface-level adjustments; it requires a system-wide correction that realigns incentives with patient health and transparency at every level.