Profits Over Patients

Josie Kwak & Alena Rhoades • January 15. 2025

As per Isaac Newton’s famous third law, for every action, there is an equal and opposite reaction. Luigi Mangione — recent University of Pennsylvania graduate, affluent 26-year-old and alleged killer of a health conglomerate’s CEO — could be considered a reaction to the United States’ increasingly malevolent, for-profit health insurance industry. On Dec. 4, 2024, a masked individual fatally shot Brian Thompson, the head of UnitedHealthcare (UHC). The masked individual was later purported to be Luigi Mangione, who pleaded “not guilty” in New York courts on Dec. 23. Written on the shell casings were the words “delay,” “deny” and “depose,” phrases commonly used to describe the predatory tactics of insurance companies. Though Mangione has since been captured and is awaiting trial, the storm of scrutiny unleashed toward health insurers is ongoing, and their malignant practices deserve to be given more attention.

UnitedHealth Group, the parent company of UHC, is a Minnesota-based multinational healthcare company that traces its roots to servicing the elderly through its Evercare program, which was designed in 1997 to provide long-term care to nursing home patients and the chronically ill (United Healthcare). Since then, UnitedHealth Group has expanded and gained the illustrious title of being the largest insurance provider in the U.S., providing coverage for around 49 million Americans. Along the way, however, they appear to have lost their genuine commitment to care. While UHC rakes in billions of profit yearly and insurance rates continue to climb, Americans must jump through several hoops to receive essential services (Reuters). Those that are denied claims mostly give up their fights against these massive conglomerates due to a confusing and complicated appeals process; a 2021 study revealed that Americans file formal appeals on only 0.1% of claims denied by insurers under the Affordable Care Act (Kaiser Family Foundation).

Additionally, UnitedHealth has found itself embroiled in several lawsuits in the past few years, including an ongoing class-action suit alleging that the company mistakenly denied “elderly patients care owed to them under Medicare Advantage Plans” by utilizing an artificial intelligence model with a 90% error rate to analyze claims (CBS News). Although this matter is yet to be settled, the lawsuit has recently advanced to federal court and the Department of Justice has begun an investigation. It’s not only patients who are upset with UHC, either — healthcare workers have also criticized the insurance bureaucracies that slow down the healing process. Dr. Elisabeth Potter alleged that while about to perform reconstructive surgery on a breast cancer patient, she was interrupted by a UHC representative who “demanded information about her diagnosis and inpatient stay justification” (Newsweek). Potter said that the patient was already asleep on the table, and despite the procedure having been pre-approved, the representative did not have access to the patient’s full medical information. UHC later claimed that the representative asked to speak with the nurse caring for the patient, not with the acting physician (Reuters). Even if both claims are true, it still would not have been appropriate for UHC to interrupt a nurse preparing for the patient’s post-surgery care or subsequently deny the patient’s overnight hospital stay. For a DIEP flap surgery, which the patient underwent, several nights in the hospital are often recommended.

UHC isn’t the only health insurance company deserving of scrutiny. In general, the “prior authorization” practice made standard by health insurance issuers has proved detrimental to patients’ health in several cases. Physicians must obtain approval from providers for certain procedures, a process which could take anywhere from days to weeks. Dr. Bruce Scott, president of the American Medical Association, described his patient with a tumor in her sinuses being denied a certain surgical procedure “because she’d not been on an antibiotic and a steroid nasal spray” — methods that are standard for a sinus infection, not a tumor (NPR). After speaking with a medical director on the phone, the surgery was ultimately approved, but not without stressful hours wasted for the patient and physician. Additionally, it has been estimated that the U.S. spends around $35 billion on the administrative costs associated with prior authorization, with many hospitals employing full-time staff responsible for submitting and managing prior authorization requests (The New York Times). This cost is especially ridiculous in light of the 43% of people with recent illness who ended up with “serious” financial problems (NPR). As Harvard University economist David Cutler puts it, “we spend more on administrative costs than we do on heart disease or caring for cancer” (USA Today).

Though the American healthcare system is in definite need of fixing, even those placing Mangione on a pedestal likely wouldn’t wish to live in a world where vigilante justice is the norm; there’s no question that cold-blooded murder is a crime, no matter who is at the other end of the barrel. However, what has already been done cannot be reversed. Instead of playing into society’s current polarization on the issue and questioning Mangione’s morality, we must look closer at the environment that has reared this torrent of anger many feel toward UHC and companies like it. Like many other high-profile incidents, Mangione’s trial will likely become commodified as just another media fad that Netflix will make into a trite docuseries someday. Instead of falling into this trap, think about the countless victims that are still subjected to predatory insurance policies and the 41% of Americans still in some form of medical debt (Kaiser Family Foundation). Remember that everyone has agency: while Mangione’s actions aren’t to be followed, his sentiment of fairness in healthcare can live on. The healthcare system isn’t going to completely transform overnight, but with enough voices of dissent, we can lay the building blocks of reform — starting with urging representatives to implement greater restrictions on the penny-pinching tactics of health insurance agencies. Instead of constantly attempting to cut costs by denying claims or delaying procedures, UHC and companies like it need to acknowledge that human lives are more valuable than profit.