Healthcare Is Broken. Fixing It Is Virtually Impossible.

Ten thoughts about the murder of Brian Thompson, the CEO of UnitedHealthcare.

1. An astonishingly large number of people have openly rejoiced in the targeted killing of Brian Thompson, the CEO of UnitedHealthcare murdered in midtown Manhattan on Wednesday morning. Anthony Zenkus, a lecturer at Columbia University who describes himself as “anti-violence” in his Twitter bio, wrote that “the working class is under no obligation to mourn the deaths of those who are actively trying to kill them.” Taylor Lorenz, a longtime reporter for the Washington Post who now runs her own publication on Substack, implied that Thompson’s murder was justified, and suggestively posted the image of another health insurance CEO. This is morally abhorrent. In a democracy, vigilante justice is never justified. An activist left that simultaneously believes in prison abolition and in empowering any American convinced of his own righteousness to decide whose life it is justifiable to end has totally lost its moral bearings. This is not a political ideology whose excesses happen to justify violence; it is a penchant for violence that dresses up its bloodthirst as a political ideology.

2. Thompson’s death has started a big debate about the state of healthcare in America. There is a lingering sense of bad taste in that sequence of events. But admonishments that “now is not the time” to talk about this or that topic never work. And the medical system is a genuinely important topic, not just because it consumes 17 percent of America’s GDP, but also because it touches on our most primal fears. So now is, I suppose, as good a time as any to share my own perspective on the American medical system in general, and the system of private insurance that stands at its center in particular.

3. There is something uniquely frustrating about the American health insurance system. I am a fluent English speaker with a PhD degree, high-quality insurance, and the financial reserves to cover a surprise medical bill in a worst case scenario. I have, so far, also been lucky enough not to need major medical care. And yet, the hours I have spent on the phone with my insurance company are by some margin the most infuriating bureaucratic experiences I have had since moving to the United States. The difficulty of getting clear answers to simple questions about what medical treatments are covered and how much they might cost is mind-boggling. I cannot begin to imagine how much more scary and humiliating all of that must feel if you don’t speak English fluently or lack the confidence to advocate for yourself, if a surprise bill could compromise your ability to make rent or if you are desperately seeking approval for a life-saving treatment. Allowing your fury to justify murder is a moral and political dead end; but the existence of that fury is easy to understand.

4. Insurers are not the only players with a major profit motive in the healthcare system; often, doctors are just as guilty of deliberately putting their patients into difficult positions designed to extract profits from them. A trivial example: When I had a wisdom tooth removed earlier this year, my dental practice discussed the costs with me upfront, even providing me with an accurate estimate of what my insurance would cover. But to my surprise, on the day of the procedure the dental surgeon urged an additional treatment, not covered by insurance, that would cost over $1,000. When I asked why the procedure was necessary, she vaguely hinted at the risk of nerve damage which could disfigure my face, and affected a look of disappointment that I would second-guess her advice. I asked her for a minute to consider and called my uncle, a dentist in Sweden, who assured me that the treatment was completely unnecessary. If my uncle hadn’t picked up, I probably would have agreed to it.

5. Healthcare is, at heart, a service industry. If you want a haircut that takes an hour, either you or somebody acting on your behalf will, among other expenditures, need to cover a typical hourly salary for someone whose job it is to cut hair. Similarly, if you need the attention of a medical professional for about an hour, either you or somebody acting on your behalf (such as your insurance company) will, among other expenditures, need to cover a typical hourly salary for

   somebody whose job it is to heal the sick. Hence, one of the key determinants of the affordability of healthcare is the salary that medical professionals typically command. And salaries for medical professionals in the United States are exceptionally high. According to a recent report on the international compensation of doctors, for example, an average American physician makes