Luigi Mangione suffered from severe chronic back pain that required a visit to the emergency room in 2023. He later had back surgery, leaving him with screws in his spine. Although the surgery was successful, Mangione’s experience with the healthcare industry throughout the process was extremely frustrating. He ranted about the U.S. healthcare system in handwritten notes, criticizing the U.S. for having the “most expensive healthcare system in the world” but “rank[ing] #42 in life expectancy.” Mangione’s negative experience is believed to be his primary motive for murdering UnitedHealthcare CEO Brian Thompson in Dec. 2024.
In the last month, the murder has been debated across the country, with some seeing Mangoine as a terrorist and others praising his actions as social justice. Regardless of the morality of his actions, it has brought more awareness to the serious issues within the American healthcare system, specifically access and affordability.
Americans have taken to social media, sharing stories of being denied healthcare coverage by their health insurance providers for seemingly nonsensical reasons. Denial of coverage is a common experience, with studies showing that 36 percent of U.S. adults have experienced denial of coverage at least once (NPR).
Patients being denied typically receive a letter explaining their claim was ‘not medically necessary,’ ‘experimental’ or some other vague reason. When further reasoning is requested, it’s often difficult to obtain due to being classified as proprietary.
Likely, the high rates of denials are partially due to artificial intelligence (AI) usage throughout the processing of insurance claims. Multiple health insurance companies, including UnitedHealthcare, were sued in 2023 for alleged AI use. The use of AI can result in an extremely high error rate, which led to the reversal of 90% of UnitedHealthcare’s denials in 2023 (NPR).
When claims are denied, not only do patients suffer financially, but their care is often delayed or taken away entirely, leading to worsening injury and health in 47 percent of patients, as seen in a study done by the CommonWealth Fund.
Long processing times, confusing jargon, baffling denials and shocking healthcare bills have all led to a lack of confidence among Americans, with only 28 percent of those surveyed by Gallup in 2024 answering that they believed that healthcare coverage in the U.S. is good.
Healthcare access has greatly improved in the past decade since the inception of the Affordable Care Act (ACA), also known as Obamacare, with the percentage of uninsured Americans dropping from 16 percent at the act’s passage to 8 percent in 2023. Unfortunately, 23 percent are still underinsured, leading to people either avoiding necessary care to avoid debt or being put into long-term medical debt (CommonWealth Fund). So, while improvements have been made, there is still much work to be done.
In 2021, Joe Biden strengthened the ACA by boosting marketplace premium subsidies, allowing people in high-cost employer plans to access more affordable coverage options (CommonWealth Fund). Movements like this to improve protection for the ACA are vital in continuing improvements toward more accessible and affordable care.
Another important action to make further improvements is increasing price transparency. This means that patients should be able to compare quotes for standard procedures with other providers in order to choose what works best financially. That change would also create competition among both hospitals and insurers, leading to lower costs for consumers.
Advancements towards price transparency were made while Donald Trump was in office in 2019. Trump’s administration put legislation in place to more fully define price-posting rules within the ACA. Those improvements became effective in 2021 but led to minimal price declines since they only include the average price people paid the previous month, not the price that that specific patient pays (NPR). Nevertheless, that kind of legislation is a step in the right direction.
As an institution, the U.S. government must work to eliminate the healthcare crisis. Small pieces of legislation can make a large difference in healthcare accessibility for millions long term, and continuing to bring awareness to the issue is just the start.
