The response to the murder of UnitedHealthcare CEO, Brian Thompson, last year in Manhattan exposed a torrent of anger by Americans towards the private insurance sector. And the stories of treatment denial shared on social media and legacy media were nothing short of nightmarish: many recounted losing healthcare coverage amid a health crisis, others told of watching their loved one die of a preventable illness as they essayed to secure treatments fighting a megalithic health insurance company that denied them treatment, and there have even been stories from those working within the field of healthcare who related their witnessing the struggles of patients to receive the most basic therapies whilst dying.
The problem of treatment denial is so dire that even American cancer organizations have had to devote part of their mandate to assisting patients in obtaining healthcare coverage from their insurers.
1.7 million Americans a year die of chronic disease. Americans pay more for healthcare than any other wealthy nation in the world yet Americans receive poorer care. According to the Peterson Foundation, US healthcare spending per capita is almost twice the average of other affluent countries. In 2022, U.S. healthcare spending reached $4.5 trillion, averaging $13,493 per person. With the rise of Health Maintenance Organisations (HMOs) in the 1980s, healthcare in the US has shifted towards a model that cynically puts profits before health such that these HMOs were able to score a profit from the delaying of medical treatments, thus prolonging of chronic disease.
The PBM (pharmacy benefit manager) structure was established in the 1970s as a tool to protect citizens from pharmaceutical inflation, with a mandate to drive down the costs of prescription drugs. However, as insurance companies grew in size and scope across the country, they started to purchase these PBMs which quickly became the profit-making centres of insurance companies. From the 1980s onward, the mandate of PBMs shifted radically from of keeping the costs of prescription medicine down to driving these costs upwards.
By increasing the price of prescription drugs the pharmaceutical companies pay the PBMs (approximately one-third of pharmaceutical costs), and pharmaceutical companies are ensured placement on a preferred contract with insurance companies whilst the PBM reaps huge economic benefits. In short, insurance conglomerates have profiteered from chronic disease from both sides of the "equation"—from insurance premiums and their stake in profits made through the sales of pharmaceutical products to the individual. And the profits made by Big Pharma are not negligible.
UnitedHealthcare, for instance, generated $371.6 billion in revenue in 2023. What is important here is that 60% of its revenue came from its PBM, a holding company that is obfuscated by the public and government. The profit margins of insurance companies, while not as high as Big Pharma, these companies are able to hide their profitability much of which is held at the PBM while artificially representing a small profit than in reality.
In 2023, sixteen of the largest drug companies in the United States reported $684 billion in earnings. According to GreedWatch, this figure is “higher than the gross domestic product (GDP) of 88 percent of the countries in the world.” And since the ACA (Affordable Care Act) passed in 2010, America’s largest health insurers have raked in more than $371 billion in profit. And of this profit, more than 40 percent went to UnitedHealth Group, a company whose annual profits have skyrocketed by nearly 400 percent as the company is on record denying nearly one in three medical claims from its policyholders.
UnitedHealthcare is one of many insurers that have set up shop for the purpose of capturing new clients due to Obama’s ACA which guaranteed this industry more—not less—business. In addition to the more traditional health insurance models, there is now the growth of new sectors from Embedded Insurance 2.0 (EI 2.0) to the company registration of various tertiary markets that feed the insurance market (eg. adaptable technologies, Health 2.0 technologies, and AI). Profitability within this sector is soaring.
And this is the crucial bit that many in Britain have failed to understand given how legacy media pushed the ACA (formerly known as Obamacare) as some sort of “golden goose” for socialized medicine in the United States: the ACA mandated Americans to buy insurance while providing government subsidies for such insurance policies. The ACA effectively forced poor Americans to purchase private health insurance where many politicians were clamoring for a far more socialist response: to change the eligibility for Medicaid (a joint federal and state program that helps cover medical costs for some people with limited income and resources).
Since the ACA was passed, more than $9 trillion of revenue has been discharged to the country’s largest health insurance companies which include UnitedHealth Group, Cigna; Kaiser Permanente, Elevance Health, the parent company of Anthem Blue Cross Blue Shield, and CVS Health, which acquired Aetna in 2018. From 2014 when the ACA was in vigour, the revenue and profits substantially increased.
Recent Gallup polling data shows how Americans’ rating of health care quality has declined to a 24-year low. Add to this the rising rates of bankruptcy due to medical debt resulting in roughly 530 000 medical bankruptcies annually or how approximately one million Americans go to Mexico for healthcare while being unable to afford it back home. As the facts roll in regarding Americans' extortionate medical system and the industries scoring a profit from keeping people chronically ill, the acrimonious response to the insurance industry triggered by Thompson’s murder in December becomes far more understandable.
More than two-thirds of all deaths in the United States are caused by one or more of these five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. According to the NIH (National Institutes of Health), chronic disease is killing more than 1.7 million Americans a year, more than the casualty of all wars the US has ever fought.
While the NHS has its struggles and private insurance is on the rise within Britain largely due to NHS queues, the situation in the United States serves as a warning of the dangers of private healthcare. What the Trump administration says it will do and what it will actually do regarding this pandemic of ill-health among the populace and the private insurance industry remains to be seen. But one thing is certain: Americans are more sick than they are tired of the situation.
