The unseemly snark over the murder of UnitedHealthcare CEO Brian Thompson needs discussing. Some wonder what’s wrong with American society; some see a wakeup call for greedy health insurers. Both miss the point. The problem is not the companies but the system, whose foolishness is very clear to those, like me, who have spent decades abroad.
Almost every other economically developed democracy offers citizens baseline health insurance that guarantees most necessary medical procedures will be accessible and either free or highly affordable with a minimum of bureaucracy. There’s little quibbling; people accept they’ll need this one day and so don’t mind the taxman. Sure, the issue is complex, medical treatment options can be subjective, not everything works well and finances can go awry. But developed countries have largely made it work, and the people are grateful.
Except in the United States.
The United States boasts some of the best doctors, cutting-edge medical institutions, and unparalleled research facilities in the world—but many of its people struggle to access it. Other countries deliver better outcomes at a fraction of the cost, yet American politicians have convinced people that the dysfunction is unfixable. Their tool is an unhelpful skepticism about the state, which Americans call “the government.”
One fellow expat, a Texan who was proudly Republican, loved the famous quip about the most terrifying words in the English language being “I’m from the government, and I’m here to help.” Surely you agree that the state should provide every 6-year-old with a first-grade education, I tried. “Sure!” he replied. “As long as their parents can pay for it!” He wasn’t kidding. What he was, of course, was rich.
Such people have been persuaded that “socialized medicine” is a terrible danger that belongs in communist countries where you have “death panels” made up of faceless bureaucrats who will deny you needed procedures. That would not be the rubbish that it is if private options were banned in countries that have publicly funded systems, but this is exceedingly rare.
My longest stints abroad have been in Britain and Israel. Both have hybrid systems with a national insurance scheme that historically has worked quite well; but if a wait is too long, you go private, and while that can be expensive, it will not still ruin you like in America.
The health insurance in these places fixed broken bones and organized dental care and MRIs with great speed and efficiency for my family, and usually required no payment. Like everyone else in those countries we didn’t face the angst of wondering whether we could afford health care, didn’t confront absurd bureaucracy and paperwork, and didn’t have to worry about pre-existing conditions, pre-approved costs and non-approved providers.
And here’s another thing that doesn’t happen: People don’t stay in terrible jobs for health insurance. Take a step back and you’ll see the connection between employment and health insurance is illogical, like your socks depending on your plumbing.
So, in America, ridiculously, much value is attached to jobs that give you the privilege of being messed around by UnitedHealthcare and its competitors. I experienced the nightmare of that privilege when living in the U.S.: the copays, the paperwork, the tiptoeing around bureaucrats in hopes of not triggering some rejection.
If one suspects the companies are looking for any excuse to deny coverage, that’s because they are. As businesses, it’s practically their fiduciary obligation to shareholders to leave no stone unturned in the quest to deny claims. Brilliant minds deploy every trick, from impenetrable voice menus to disqualification of “preexisting conditions.”
Yo, people: Mortality is a preexisting condition!
A rational person would want nothing to do with this health care cabal. But blaming it for the outrage is like blaming a snake for being a snake.
People elsewhere tend to be happy with the alternative. Health care systems across Europe are a cornerstone of public trust. Despite growing challenges such as aging populations, workforce shortages, and rising costs, they remain broadly popular: a 2024 STADA Health Report finds overall satisfaction with European healthcare systems averaging 56 percent.
Countries like Belgium, Switzerland, and the Netherlands boast satisfaction rates above 75 percent, driven by efficient services and sustainable funding. France’s hybrid system, which combines state reimbursements with private insurance, is celebrated for its accessibility and quality of care. Germany’s social health insurance model emphasizes patient choice and short waiting times. The UK’s National Health Service (NHS) remains a unique and cherished institution; though it’s under significant strain due to austerity measures, mass immigration and poor planning, I’ve yet to meet a Brit who would trade with an American.
Keith Glassman, a 61-year-old photographer who moved to Israel as an adult, says “the health care in Israel helps me go to sleep at night, not worry about seeing a doctor, not worrying about getting hit by a bus and having to pay.” Two years ago, he was diagnosed with bladder cancer, and “it was efficient, I went to see a few professors … smooth as silk.”
Americans, meanwhile, are obviously unhappy about their variant, as reflected in the troubling reaction to the murder of Thompson and the outpouring of support for Luigi Mangione, the suspect held in the Dec. 4 shooting in Manhattan.
“Finally, someone’s holding them accountable,” said one keyboard jockey. “Poetic justice for all the lives they’ve ruined,” said another. One post read: “UnitedHealthcare denied my dad’s cancer treatment because it was ‘experimental’ and he died a month later. Excuse me if I’m not shedding tears for the CEO.” Another user wrote, “Insurance companies profit by finding loopholes to deny coverage. Karma’s a b****.”
There’s an obvious way forward. Americans over 65 (and a few others) benefit from state-run Medicare, which is something. It needs to be extended to everyone who wants it, and to be funded by taxes. It will involve some moving around of priorities, but Gallup finds 57 percent of U.S. adults saying the government should ensure Americans have healthcare coverage. The idea, which some dare propose, is called Medicare for All; I think there’s a conspiracy to call it a “single payer” scheme, as if to make it seem bureaucratic and expensive.
U.S. health expenditure is around $4.5 trillion—about a sixth of the economy—and that figure is frightening, but it also results from all these businesses—not just insurers but hospitals—that have an interest in pushing up the costs. Another scourge is hyper-litigiousness, which drives up doctors’ own insurance costs and benefits mainly lawyers (who typically form the largest professional group in Congress). UHC’s profits were $16 billion in 2023.
Those billions don’t need to exist. In Israel, where the life expectancy is higher (83 years versus 77 in the U.S.) health care spending is about 7 percent to 8 percent of the economy. Those billions actually don’t exist. They’re diverted to other things—some stupid, and some quite smart. Memo to Elon Musk: There’s your inefficiency, and it’s not in the government.
As a result of this inefficiency Americans spend more than $12,000 annually on health care, which is far more than in any other developed country. Anything Americans pay for directly is typically a big deal for anyone but the rich—so people tend to put procedures, office visits, and medication off. Gallup finds that that 40 percent of Americans skip doctor’s appointments because of price jitters; that doesn’t tend to happen in Japan. That explains the lower life expectancy.
The result manifests in embarrassing global well-being rankings and happiness rankings—dominated, can you believe it, by Nordic countries, Australia and Israel, all places with strong public health care. America is unique is many ways, and some are uniquely bad.
Sure, the devil’s in the details. But you know what? The saints are in the essence: America’s health care system is sick, and you’re being taken for a ride.
Dan Perry is the former Cairo-based Middle East editor and London-based Europe/Africa editor of the Associated Press, the former chairman of the Foreign Press Association in Jerusalem and the author of two books. Follow him at danperry.substack.com.
The views expressed in this article are the writer’s own.
The post When It Comes to Health Care, the U.S. Is Doing It Wrong appeared first on Newsweek.
