The U.S. health care system leaves much to be desired.
It is convoluted, fragmented, complex and confusing. Experts have also raised concerns about quality, and disparities are rampant. And, of course, it is excessively costly – far more so than in any other developed nation. Given these failings, it is not surprising that Americans are unhappy with their health care system.
As the public reaction to the killing of UnitedHealthcare CEO Brian Thompson has made clear, however, many Americans are perhaps most unhappy with their health insurers. Indeed, just 31% of Americans have a favorable view of the health insurance industry, according to a 2024 survey.
Yet, given the recent tragic events, as a health policy scholar, I think it would be prudent to take a step back and reflect on the broader health care system and how the U.S. got to this point.
Many sources of health care frustration
Few with any personal experience or professional expertise would describe U.S. health care as the gold standard of health care systems.
For a number of historical and political reasons, it is barely a “system” but rather a complex patchwork with countless different approaches to covering the costs of health care that include splitting the costs between individuals, employers and governments.
Governments also extensively regulate health and health care and, although in a diminished role today, serve as the providers of care through state and county hospitals as well as the Veterans Health Administration.
The result is a regulatory amalgam made up of countless entities. The Affordable Care Act reforms only added additional layers of laws and regulations to an already complex framework.
Yet, even beyond this general structure, Americans face many challenges. Indeed, no other health care system in the world is pricier. This involves costs for medical services but also extremely high administrative costs. Pharmaceuticals are just one example of the excessive financial burden carried by Americans.
For many Americans, these costs are too high, with an estimated 530,000 medical bankruptcies annually.
And despite that high price, concerns persist about quality and access.
In addition, the system tends to be highly inequitable and subject to countless disparities that make it harder for many poorer, rural and nonwhite Americans to access care.
The role of insurers
In the United States, insurers play a crucial role in connecting – and at times disconnecting – patients with the care they require.
They are also at the forefront of many of the starkest frustrations that Americans experience – even the ones they are not directly responsible for. While medical providers and pharmaceutical companies charge the world’s highest prices, it is generally up to insurers to tell patients how much they still have to pay or that their care won’t be covered. Insurers are also the ones who determine whether a drug is not covered or a doctor is “out of network,” meaning patients can’t get the specific treatment or care they desire.
To be sure, insurers are not just the messenger – they also add to many of the frustrations patients experience every day. For example, a patient may have to travel very far or wait a long time for an appointment if their provider network is too narrow or simply does not have enough providers. Moreover, the directories and searches that insurers use to show what providers are “in network” may be inaccurate, as they rarely get updated.
For many individuals, this can mean delayed or forgone care, which has major implications for their health and finances. For some, it can even lead to preventable deaths.
Some of the practices insurers are most infamous for, such as rescinding coverage over minor clerical issues and refusing to cover preexisting conditions, ended under the ACA. But some of these issues could return if the incoming Trump administration seeks to undo some of the ACA’s protections.
Even today, so called short-term, limited-duration health plans promise good coverage for lower premiums, but even basic items may not be covered. Many plans, for example, do not cover prescription drugs or even hospital emergency rooms.
Blame the system, not just the insurers
Why do insurers act the way they do? For many, the answer may seem simple: to make money. This, of course, rings true – insurers in the U.S. rake in billions of dollar. However, while they tend to be profitable, their margins generally range only from 3% to 5%.
But the story is more complicated than that. With government power limited, insurers are perhaps the only force in the U.S. health care industry trying to rein in rising costs in a health care system where everyone seeks to maximize their profits.
That means insurers take on the role of bad cop, doing things such as limiting access to certain care or doctors. But there are several prudent reasons for doing so; for instance, it’s in the public’s best interest when insurers do not cover drugs that have been shown ineffective or of low quality. And ultimately this does keep premiums lower than they would otherwise be. Of course, insurers and their CEOs profit handsomely in the process. And at times, their methods are ethically and legally questionable.
Ultimately, many if not most of the frustrations Americans experience with health care have their origins in a poorly designed system that is highly inefficient and offers countless opportunities for profit. Yet insurers are only one – perhaps the most visible – part of that broken system.
Simon F Haeder is Associate Professor of Public Health, Texas A&M University.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
37 Comments
Login to comment
dagon
The lionization of Luigi Mangione is a symptom of how the American healthcare system is an unfair capital extraction mechanism with medical care as a byproduct. And how systemic murder and misery of thousands is excused under shareholder values.
And the sympathy for him is an organic reaction against the grotesque inequality of late stage capitalism today.
TaiwanIsNotChina
Healthcare costs are also out of control. Seems there is a lot of blame to go around.
sakurasuki
Finally elephant in the room being discussed.
HopeSpringsEternal
Insurance industry is your classic ZERO-SUM industry, consumers under Biden Harris have seen premiums skyrocket while benefits/payouts drop, no wonder their stocks are so strong....and many citizens so unhappy.
Cold blooded killing is NEVER the answer.
Can you believe US Auto Insurance is now up approx. 70% since Biden took office? Due to illegals in great part but just imagine how unhappy drivers are about that?!
wallace
The solution is universal healthcare for all.
dagon
And why healthcare should not be a commodity and have the engines of hyperfinancializtion involved, with medical bankruptcy the number one cause of homelessness.
https://www.abi.org/feed-item/health-care-costs-number-one-cause-of-bankruptcy-for-american-families
Of course coming back from bankruptcy is not so easy for most families, unlike some serial bankrupts at the top of the pyramid.
But they have concepts of plans! And universal healthcare is communism!
It took a once in a generation class traitor like Luigi Mangione to pull back the curtain on this late stage capitalism.
bass4funk
That is why we have bankruptcy laws to help you out of the financial debt.
Yes, and yes!!
If it weren't for Capitalism, the US would be another 3rd world crap hole.
bass4funk
No, not for the US it's not.
wallace
bass4funk
The solution is universal healthcare for all.
So your way is 40 million Americans who cannot afford healthcare and healthcare bankruptcies are the largest of them all. Even health insurance does not cover all the expenses.
America, the richest country in the world could have universal healthcare alongside those wanting private healthcare.
The EU, with 27 members and 500 million people, has universal healthcare across all member countries. If they can do it, so can the US.
wallace
bass4funk
The solution is universal healthcare for all.
You are happy to pay for and use Japanese universal healthcare for you and your family.
bass4funk
I know, but Universal Healthcare is not the way, again, that will never happen, like you or I ever becoming the next President, won't happen.
No, it could not. It can't even run the government efficiently, and then healthcare on top of that? It's not going to happen.
Not everyone is happy with the healthcare system, my sister almost died dealing with it, and it is not for everyone.
https://youtu.be/wb4WSZhsCvA?si=tF80BKRCXn5WfHK0
https://youtu.be/DCBB4-4E3OM?si=9hoZcTeMYtP1q3o9
wallace
The federal government already runs the healthcare system and regulates and controls it. There is a Secretary of Health. Soon to be a new Trump pick.
The US federal government spent nearly $1.5 trillion on healthcare in 2022, which was the largest share of total health spending.
The vast bulk of health care costs are paid through health insurance premiums and taxes. The study found that payments to finance health care were $9,393 per person, or 18.7% of average household income.
Japan has universal health insurance and its total health expenditure as a percentage of the gross domestic product is almost 50% less than that of the United States where 15% of persons under age 65 are uninsured.
bass4funk
Not well.
We know.
The US federal government spent nearly $1.5 trillion on healthcare in 2022, which was the largest share of total health spending.
Yes.
Yes
And? Using Japan as an example particularly when it is concerning financial matters is not the example I would go with, I’m still not convinced, and I still would never support universal healthcare for the United States. I like my private insurance, if they want to work on making healthcare better for those numbers of people that don’t have access to it, I understand that but overhauling the entire health insurance industry, and taking away my private care, no way!
wallace
In all countries with universal healthcare like in the UK, there is also private healthcare and private health insurance. You can go to an NHS hospital or you can go to a private hospital like the London Clinic if you can afford the fees. I worked there in the 1980s.
https://www.thelondonclinic.co.uk/
bass4funk
Different
Good for you, but it still wouldn’t work. And you have to remember one thing you are individual nations, the United States is one giant nation, it would never work.
kibousha
Big insurance scares you to take your money when you're healthy.
Big junk foods make sure you get sick while taking your money.
Big pharma's turn to take your money comes when you're sick.
Repeat the cycle.
America is such a lovely place to live.
wallace
bass4funk
In all countries with universal healthcare like in the UK, there is also private healthcare and private health insurance.
How?
You can go to an NHS hospital or you can go to a private hospital like the London Clinic if you can afford the fees. I worked there in the 1980s.
You lose out when 27 EU member countries with 500 million people provide universal healthcare.
TaiwanIsNotChina
This, but unironically. Where else do you have the ability to drive to and eat at so many different places, quite often run by the ethnicity in question?
TaiwanIsNotChina
That's pretty much what Obamacare would have achieved: universal health insurance, subsidized by the government if necessary. The problem is the MAGAs removed the mandate requiring purchase.
True, but they cover most of it if the garbage plans are removed from the system.
bass4funk
We don’t have the money for starters.
You said it now twice
They don’t all function the same way and that golden goose is running out, won’t last forever.
https://www.euronews.com/business/2023/12/13/where-in-europe-are-healthcare-costs-driving-poverty
wallace
bass4funk
How?
The US has more money than the EU for universal healthcare
You lose out when 27 EU member countries with 500 million people provide universal healthcare.
The member countries share their universal healthcare and as long as there is an EU it will exist.
bass4funk
So if they can’t run the government efficiently, which they cannot, they can’t even tell us what the drones in the skies are above NJ or even keep the poison out of our food, then how can they run a government controlled socialist universal healthcare system? The answer is, they can’t.
I disagree vehemently.
I pay for myself, I don’t want to pay for anyone else. Not my problem.
Daniel Neagari
@bass4funk
errr... I don't deny that the US has a LOT of money and if we are ranking countries first, second (are those exist??) and third world courntries only by their GDP and how much money they have sure the US is a first world country.
But if we take some other metrics such as cost of living, average life span, access to services, education and living conditions, levels of literacy, (everything of the entire population)... the US is more leaning to the 3rd world category.
wallace
bass4funk
The US has more money than the EU for universal healthcare
So you have said everything will change with the more than capable new Trump administration new Health Secretary
You lose out when 27 EU member countries with 500 million people provide universal healthcare.
How can you? All EU citizens have free healthcare in any EU country.
The member countries share their universal healthcare and as long as there is an EU it will exist.
You have numerous benefits from paying taxes like defense for example. Education is another. You have no problem paying into the Japanese system.
wallace
bass4funk
Living in Japan means you are not paying US taxes.
bass4funk
Yes and no, a bit more difficult to quantify, yes, you’re problem with the education system, that needs to be fixed, because the teachers are not doing their job, and that is teaching the kids and not teaching them the right things that’s one huge problem and that will be addressed with the next administration as far as living conditions same thing applies, people that live in abstract property, people that have been following same liberal standards and policies have put people into that position, another factor is the food that we eat, we have had too many of these corporation sneaking chemicals into our food. They have no reason being there, so if you minus all those then right back to the first nation, but there is just no way and there is more than enough evidence to show that the US government could never maintain proper care giving adequate treatment to 350+ million people, it just can’t, they can’t even do a good job to geopolitically, how will they be able to take care of the entire society?
I do pay them, but soon won’t with the incoming administration, that will change as well. Thank God!
bass4funk
We shall see
I disagree vehemently.
But it doesn’t all function the same exact way
And that won’t last forever either.
Japan is not Europe and Europe is not the U.S.
wallace
bass4funk
Living in Japan means you are not paying US taxes.
Americans only pay US taxes after earning more than $100,000 (¥15 million) and only on that portion of their earnings. The average salary for an American in Japan is less than ¥8 million.
bass4funk
Like I said, next year and within the next 4 years I won’t have to pay them anymore.
wallace
bass4funk
Americans only pay US taxes after earning more than $100,000 (¥15 million) and only on that portion of their earnings. The average salary for an American in Japan is less than ¥8 million.
You will still have to pay high-rate Japanese taxes. You claim to be a patriot but are happy to pay zero US taxes and still expect many benefits.
Ah_so
If you can afford to pay for all your healthcare yourself and not need insurance, good for you. But even in the US, for but a few, the small risk of requiring expensive treatment means that it is better to have insurance. And having insurance means paying for the treatment of others, and if you claim, having others pay for you.
It's a bit like a socialised system really, except with the hospitals and the insurers extracting additional profit.
TaiwanIsNotChina
You see, you don't get to just declare the government as inefficient and try to burn it down. Trump will be hamstrung if he goes hard on that route.
TaiwanIsNotChina
You already pay for the poor, the veterans, and the elderly and that is not changing.
TaiwanIsNotChina
With a lot of freedom as far as 3rd world crap holes go. Also what you are calling capitalism is really just low level socialism. Tons of things in the US are run by the government and that's a good thing.
Could be be some AHs pulled the rug out on trying to hem russia in?
ushosh123
In today's world price of everything is demand based. And certainly in a free market, health care would be no different.
TaiwanIsNotChina
Health care as a market is deeply flawed: people have to have healthcare to survive in many cases and there is no good way to compare healthcare providers. Not saying single payer is necessarily the answer, but there is no need to believe the invisible hand nonsense 100%.
bass4funk
Very true
Absolutely
I don’t expect anything, never have and never will.
Yes, and I don’t need to pay even more for the entire nation, also and to your point, if the government is so effective and efficient as they claim then why do we have poor people on the streets in urban first world cities in the U.S., particularly California, the entire West Coast. If the government was doing a good job at providing housing and healthcare properly, I would be more willing to support it, but they don’t.
No, not to the level you are talking about. Nice try.
Not healthcare, not the current house in distributing funds overseas, how is it that the government loses so much of our money and then when asked shrug their shoulders and says, we don’t know. They lost over 300k plus children who have illegally crossed the border, when asked where they are, complete silence. You kidding me?! They leave billions of dollars in Afghanistan weapons and hardware, tanks and helicopters, they have zero answers about the drones in the sky freaking people out every single night and then that piece of work Myorkas tells us don’t worry and what we are seeing is not real and this from a man who looks Congress in the eye and says with a straight face, our borders are secured while 10 million plus roll right in. So no, I would never trust the government and Democrats in particular to run healthcare. We fought so hard to get rid of the Obamacare mandate, still have nightmares about that.
No, more like years of failures from the party that claimed it fights for the underdog and the less fortunate, the people stopped believing it and decided to fire Democrats in a massive way. So no thank you to any government run healthcare system, at least not a takeover.