In Killing of Executive, a Health Reform Opening

Plus, Eurabia; the press’s situational solidarity

A sign at Boston Children’s Hospital. Photo: The Editors.

The right and even the sensible center’s main reaction to the brazen gunning down in Midtown of UnitedHealthCare executive Brian Thompson has been to denounce the far left for celebrating the violence.

Fair enough, under the circumstances. The celebrations are worth denouncing, and the violence itself deserves denunciation.

And at some point, once the homicide has been solved and prosecuted and Thompson has been appropriately mourned, someone will turn some creative energy to solving, or at least dramatically improving, the issues that have been so vexatious to so many users of health insurance.

Anonymous law enforcement officials told the Associated Press that, as the AP put it, “The words ‘deny,’ ‘defend’ and ‘depose’ were found emblazoned on the ammunition, echoing a phrase used by insurance industry critics.”

EconTalker Russ Roberts, the president of Shalem College in Jerusalem, posted, “A few years back when I was a full-time employee of Stanford, one of my family members needed an operation and Blue Cross Blue Shield refused to cover it. I spent hours in a Kafkaesque dance with BCBS bureaucrats debating medical issues and trying to explain our case. At one point I was so frustrated with the run-around and the miscommunication that I actually considered going down to BCBS headquarters in SF and going to the CEOs office and demanding to see him so I could explain how dysfunctional his organization was how unpleasant my experience had been. I was pretty upset.”

Roberts’s experience matches my own and that of many other people I know. Either they or their employer or both spend lots of money for health insurance, and then have to fight to get the insurance to pay for medical care when it is needed, or face significant, unpredictable, and opaque out-of-pocket expenses, with little opportunity for shopping around other than during a yearly “open enrollment.” No amount of regulating around appeals processes, outlawing of “surprise” billing, or mandating of price transparency seems to make a dent in the issue. Electronic medical records certainly haven’t solved it.

I understand many of the contributing factors. The patient is caught between the employer wanting to control costs, the physician or hospital provider wanting an adequate reimbursement, and the insurer trying diligently to make sure that procedures are indeed medically necessary. Yet it frequently seems like the insurers have a policy of denying all claims initially in hope that at least some customers won’t bother to appeal and will just pay the bills themselves out of pocket. And when you have the stress of a pressing medical issue, an insurance company that won’t pay what you think it should just adds to the stress. I’ve been on conference calls to try to sort out these issues where the hospital blames the insurance company, the insurance company blames the hospital, they both blame the system, and the customer-patient remains stuck with a larger-than-expected bill.

ObamaCare did not solve this. “Medicare for all” will not solve this. The best way to solve it would probably be to combine doctors, hospitals, and insurance company in a single system with a strong culture of doing what is best for the patient, and then try to encourage two or three of such systems to compete for market share by providing the best patient care and the best value. But there are plenty of parts of America where there’s a single local hospital or where doctors are scarce or where one insurance company has a dominant market position. Various retailers with operational and customer-service skill have eyed parts of the system—Amazon mail order pharmacy, Costco hearing aids—but would-be newcomers face real entry barriers. Regional incumbents are entrenched, and true national scale is unusual.

If President Trump wants to defeat Bidenflation, getting a handle on consumer and business health care costs is part of the story. It could also fit with his “make America healthy again” agenda. Yet the real fix in health care is unlikely to emerge from a politician. It is likely to come instead, eventually, from some entrepreneur who sets out with an ambition to be a health insurance executive who patients and doctors both want to hug and cheer rather than shoot and kill.

The press’s situational solidarity: “The Wall Street Journal is becoming more and more obnoxious and unreadable,” Donald Trump complains. “They haven’t written a good story about me in YEARS. Somebody over there ought to look at what they’re doing. The only one worse than them is stupid, China-centric Forbes Magazine!”