The murder of Brian Thompson, boss of United Healthcare, the largest private health insurer in the United States, has become a confusing news story. The alleged murderer, Luigi Mangione, is suspected of having shot the victim. He would criticize the company United Healthcare for making enormous profits at the expense of policyholders. On social networks, many Americans say they stand in solidarity with the suspect and denounce the American private insurance system. Franceinfo answers four questions on this specificity of the American health system.
1 What are the criticisms of the American system?
These criticisms were highlighted almost 15 years ago in a successful book entitled Delay, Deny, Defend (in French “Delay, Refuse, Defend”). This book is currently in Amazon's best sellers. He told how private health insurance, widely used in the United States, uses all the tricks at their disposal to reimburse their policyholders as little as possible for their health costs. They “delay” files, they “refuse” reimbursements as much as possible and they “defend” themselves when it comes to compensation. Several American media reports indicate that the shell casings found at the crime scene were marked “delay” and “deny”.
2 How does this work in practice for an insured person?
The most common situation concerns an insured person who requests coverage and reimbursement following a doctor's prescription. His health insurance tells him that this is not going to be possible, that he should have requested prior authorization. The insured is often reduced to paying out of his own pocket.
Private insurance companies use well-codified techniques by accepting the least expensive reimbursement requests as a priority. On the other hand, they delay requests when policyholders want a large reimbursement, in order to discourage them. The latter are then reduced to initiating prosecutions, in a long process, which is often dissuasive.
3 How many Americans are privately insured?
In 2022, according to the Census Bureau, two-thirds of the 330 million residents had private health insurance. In the other third, there are those insured by the public system or those who are not insured. This last category represents 8% of the population. Most private insurance is provided through the employer, but there are also direct subscriptions. With this level of private insurance, the groups are huge. In 2022, private insurance companies collected $1.3 trillion in contributions. The health insurer United Healthcare alone, whose boss was killed, achieved a turnover of 281 billion dollars in 2023 and 16 billion in profits.
4 Is American life expectancy 42nd in the world?
On the alleged murderer, investigators found a document stating that the United States health system is the most expensive in the world, while the life expectancy of Americans is 42nd in the world. This is partly true, because Americans are by far the people on the planet who spend the most money on their health. This represents almost 17% of the country's gross domestic product. In France, it is 11% of GDP. In the United States, unsurprisingly, only 30% of this expenditure is financed by the public service, compared to 80% in France.
As for life expectancy at birth, the United States is not 42nd, but 35th in the OECD ranking. Life expectancy is currently 76 years, or two years lost since 2019, due in particular to Covid-19 and the opioid crisis. In France, life expectancy is 82 years.
