The assassination of United Healthcare CEO Brian Thompson on the streets of Midtown Manhattan has spawned a cottage industry of apologetics for hating private health insurance companies. As a justification for murder, this is obscene. But it's also a misdiagnosis of the landscape of American health insurance.
To start with, most Americans remain happy with their own health insurance. The comprehensive Kaiser Family Foundation Survey of Consumer Experiences with Health Insurance found in 2023 that 81 per cent of Americans rated their own health insurance as "excellent" or "good." Other polls have found similar results.
In the nature of their business, insurers ration care and fight to control costs. These only rise when everything is subsidised, because healthcare providers never need to worry about pricing any customers out of their business. Insurers limit options. They deny claims that go outside what policies cover.
Nobody likes that, but in one form or another, all of these are inevitable features of any healthcare system, from nationalised single-payer to people paying only for what they can afford out of pocket. In some countries, rationing of care happens de facto through delays in treatment or in treatments not offered in the first place. But in spite of these unpleasant realities of life, most Americans are a long way from taking up arms against the insurers charged with these thankless tasks.
At the same time, public confidence in the American systems of health insurance and health care has plunged since Barack Obama turned the nation's politics inside-out to pass the Affordable Care Act in 2009-10. That speaks to the unintended consequences of those "reforms" for the people at the margins.
According to Gallup polls, public faith in the quality of American healthcare peaked at 62 per cent in 2010-12, and now stands at 44 per cent. Confidence in health insurance coverage peaked at 38 per cent in 2012 (before Obamacare was implemented), and now stands at 28 per cent. Both figures are the lowest since Gallup began polling the question in 2001.
"Reform" didn't deliver. Obamacare required insurers to cover everyone, and tried to force healthy young people to buy into the same risk pools as the old and the sick. Instead of using tools tailored to those with pre-existing conditions, Obama's plan insisted on spreading the cost of their care across all policyholders.
Predictably, this drove up the costs of policies faster than the political system could absorb demands for more subsidies to buy those policies. If you want something to get more expensive, subsidise it. Eventually, public resistance to being legally mandated to buy private health insurance policies - one of the key planks of Obama's plan - led Congress to repeal the hated mandate.
Obamacare was also accompanied by compelling insurers to cover an ever-increasing list of things in every policy, including a mandate for contraceptive coverage. Of course, if you require everyone to buy insurance for everything whether they intend to use it or not, it will cost the insurers more money to issue those policies. Predictably, they will pass on those costs to the people who buy the policies in the form of higher premiums.
Bureaucratic red tape means that ever more medical bills arrive months after the fact. Insurers have tried to combat "surprise billing" by requiring prior approval of non-emergency major procedures, so that people at least know when coverage is denied beforehand rather than get stuck with an unexpected bill they can't pay. But that, too, leads critics to claim that essential care is being denied.
Similarly, insurers have tried to speed up the processing of claims by using AI tools to evaluate them. But that just leads to criticism that machines are denying care to humans.
Money is never unlimited. If private or public insurers have to blindly cover everyone, as Obamacare mandated, they will try to limit what they will cover. If insurers are further compelled to blindly cover everything, they will look harder at specific claims. If they can limit neither whom they cover nor what they cover, they will either raise their policy premiums or get out of the business.
It's rich for progressives who have pushed for all of these developments - from guaranteed issue of policies to people with pre-existing conditions to mandates of what those policies cover - to now complain about increasing premiums and rising claim denial rates. What did they think would happen?
So now, they are reduced to cheering for literally shooting the messenger.
Dan McLaughlin is a senior writer at National Review