Breakingviews: UnitedHealth tragedy opens deep healthcare wounds

The murder of UnitedHealth insurance chief Brian Thompson in New York City on Wednesday morning has exposed deep social wounds wrought by U.S. healthcare. Public response in some venues has been stunningly callous: the $545 billion company’s Facebook post expressing sadness over the tragedy saw users register tens of thousands of laughing reaction emojis. In a nation deeply unsatisfied with its care, which spends double its peers for little clear benefit, it’s a warning of the industry’s stark political vulnerability.

UnitedHealth is the nation’s largest insurer. It is set to earn $25 billion this year, according to analyst estimates collected by LSEG, more than 10 times as much as two decades ago. In that time, the company expanded into everything from payments to doctors’ services. Its market power has drawn an antitrust probe and is reflected in its stock, which more than doubled the S&P 500 Index’s return over a decade.

Among the public, however, the industry is remarkably unpopular. Only 5% of respondents ranked the services provided by health insurers as excellent in a 2023 Gallup poll, with about a third classifying them as poor.

It is perhaps unsurprising. Insurers are people’s financial interface with a highly dysfunctional system. U.S. healthcare spending per capita exceeds $12,000 per year. Adjusted to reflect purchasing power, that’s about 2.5 times the average for countries in the Organization for Economic Co-operation and Development. Yet Americans have a lower life expectancy than most countries in the bloc. Insurance premiums and out-of-pocket spending by individuals have risen above inflation.

The United States also spends more money and time on insurance, administration, patient paperwork, cost disputes, and bickering over insurer approval for treatments, according to a 2014 study. There is little sign the public has seen any improvement since, with Gallup polling for healthcare writ large sinking in recent years.

Despite a thicket of regulation, there is little sign of a promising policy fix. The priorities of President-elect Donald Trump remain unclear, but the Republican establishment favors private insurers. Think-tank blueprint Project 2025 calls to expand privately administered versions of Medicare, the government’s insurance for the elderly, despite evidence that they reap billions in overpayments. But the outpouring of public anger, even in response to a murder, lays bare how tenuous this political equilibrium is. As discontent rises, change becomes more likely.