The December murder of UnitedHealthcare CEO Brian Thompson and the often laudatory response to it online has left the industry grappling with how so much anger could be directed towards a sector that purports to keep people healthy.
The murder was horrific and unjustified. The response via social media reflects frustrations that have been building among patient-consumers for decades with a healthcare ecosystem that is increasingly seen as uncaring and unresponsive. The insurance segment has been at the heart of that sentiment.
Anger at the healthcare ecosystem is growing. While some of the animosity is specific to the insurance sector, much of it reflects broader frustration with a delivery system that gets more and more expensive and complex without a corresponding increase in positive health outcomes.
In a survey from NORC at the University of Chicago, “about 7 in 10 adults say that denials for health care coverage by insurance companies, or the profits made by health insurance companies . . . bear at least ‘a moderate amount’ of responsibility for Thompson’s death.” Alarmingly, according to another study from Emerson College Polling, “41% of voters aged 18-29 find the killer’s actions acceptable.”
Aside from the recent murder, other signs indicate the same anger. According to polling, Americans’ rating of the quality of healthcare in the U.S. is at its lowest point in Gallup’s study since 2001, when they began tracking the metrics.
Healthcare workers are five times more likely to experience workplace violence than employees in other industries, according to reports from the federal government, and instances of violence are rising. Hospitals across the country have been forced to dramatically increase the number of security staff and train clinical personnel to deal with physical threats.
These are not just isolated incidents. Growing resentment is a response to deep problems with the whole ecosystem.
Misaligned incentive structures are one reason that anger is building across the system. Insurance companies answer to their shareholders quarterly for their financial prudence, so they have every incentive to ensure that they manage utilization , without which insurers believe there would be abuses on the provider side, as some would seek to maximize billing through upcoding or unnecessary procedures. Still, insurance companies make more money the more claims they deny. If patients die as a consequence of utilization management, whether it comes in the form of requiring a step therapy or prior authorization, or outright denial there is little impact for the insurer.
At the same time, providers operating under a fee-for-service model are incentivized to do more and bill more, as they face shrinking reimbursements. This dynamic has led insurers to implement more strategies like prior authorization barriers, step therapies and outright denials –intensifying patient frustration and distrust.
Until we realign the incentives in the system so that outcomes matter to the insurer and to healthcare delivery organizations, the consumer will continue to be the one short-changed. The structure of contemporary insurance incentives actively encourages risk avoidance and cost cutting rather than any analysis of total economic and clinical value over a continuum of care.
This is worsened by the fact that for the average commercial insurance plan, 1 in 5 members disenrolled each year, creating little long-term accountability for insurers to invest in patient health outcomes over the whole lifespan.
Denying coverage for necessary treatments often generates immediate cost savings, while the long-term health consequences—worsened conditions, higher future costs and avoidable suffering—are externalized onto patients and the broader system.
Another cause of intensifying confusion and frustration is the lack of transparency across the healthcare sector.
As I write in my book Bringing Value to Healthcare, it is extraordinarily difficult for consumers to get information about cost, quality and outcomes in healthcare as the necessary information isn’t readily available. Even after they’ve undergone a procedure and are looking at the explanation of benefits sent by their insurer, they aren’t always sure what services they received, how much those services really cost, or what if anything they owe.
In a New York Times op-ed published in the aftermath of Brian Thompson’s death, Andrew Witty, the ceo of UnitedHealthcare’s parent company, UnitedHealth Group admitted as much, saying “health care is both intensely personal and very complicated, and the reasons behind coverage decisions are not well understood.”
Lack of transparency in health insurance has created a system where patients are left in the dark about critical decisions affecting their health and financial well-being. The absence of standardized, easily accessible information on pricing, coverage policies and claims decisions means consumers cannot make informed choices or challenge denials effectively.
This opacity allows insurers to deflect accountability while patients face unexpected bills and limited recourse. When we buy a car or a household appliance, it’s easy to compare options and take something back if we don’t like it. Not so in healthcare, where plans and processes are shrouded in mystery and we’re charged more to fix something that shouldn’t have failed the first time. True consumer empowerment requires full visibility and line of sight to cost and quality—without it, the cycle of distrust will only deepen.
Breaking this cycle requires creating a healthcare model that aligns incentives with patient outcomes. Until patients understand what they are being charged for and why—and know that their doctors and insurers have financial interests aligned with their own—animosity and frustration will continue to worsen.
It’s clear this system is broken. The frustration directed at insurers and the broader healthcare industry is not just about individual incidents but a reflection of systemic issues: perverse financial incentives that reward denial of care, a lack of accountability for poor outcomes and an opaque system that leaves patients feeling powerless.
Addressing these challenges requires more than surface-level adjustments—it demands a whole-system correction that realigns incentives with patient health and transparency at every level.
