What the reaction to a tragic shooting tells us about health care • South Dakota Searchlight

In spite of all the glitter, the dramatic headlines about stunning accomplishments and life-saving interventions as well as the raving of some politicians about the “best health care system in the world,” the U.S. health care system is, at its core, fundamentally dysfunctional.

How can I make such a provocative statement? The U.S. spends nearly twice as much per capita on health care as does any other developed country. In spite of this expenditure, 8-10% of Americans still have no health care coverage while most comparable countries provide health care coverage to all citizens.

Spending at this level would perhaps be acceptable if the population was in fact benefiting with better health outcomes. Here too we fall short. If we look at any of the usually cited metrics of population health such as life expectancy or infant mortality, the U.S. results are worse. Especially concerning is the fact that the U.S. rate of maternal mortality — women dying related to childbirth — is among the highest in the developed world and is getting worse.

U.S. residents increasingly express their dissatisfaction with the health care system. The Gallup organization recently reported that approval ratings on the quality of American health care are the lowest they’ve been in more than two decades.

All this has come to the fore with the recent tragic shooting of the CEO of UnitedHealthcare in New York. Though details continue to emerge, it appears the assassination-style killing was carried out by a young man intent on sending a message of both anguish and hostility toward the health insurance industry. He reportedly wrote in his notebook, “What do you do? You wack the CEO at the annual parasitic bean-counter convention.”

As disturbing and troubling as are the events surrounding the murder, the public reaction to it is similarly distressing. There has been a huge outpouring of support for the shooter almost as though he is being glorified as a folk hero. Additionally, online, there has emerged a range of merchandise (T-shirts, etc.) seeming to applaud the event. These reactions appear to confirm the broad-based unhappiness with health care services and how they are financed.

How can we understand or make sense of these developments? In the U.S., unlike many other developed countries, we have largely treated health care as a commodity to be bought and sold on a capitalistic, free-market model. In my view, this arrangement underlies many of the problems we have encountered.

I am not anti-capitalist. For a large part of the economy, this model has served us well. At the same time, I believe there are sectors of the economy where it does not work as well. We need to be smart enough — and tough enough — to sort out which is which.

In the classic capitalist model, profit and/or market share increase when the perceived value of the product or service increases. What we have too often seen in the health insurance industry is that in order to push up profits, the industry has restricted the services covered or, alternatively, has increased the barriers to receiving those services.  This has been highly successful from an industry perspective in that profits have soared, but for many patients who are all too often in a captive market, it has restricted or denied needed care.

What to do? There is no immediate, simple answer. It would seem, though, that the events of the last several weeks should serve as a wake-up call. We have serious problems that demand serious thinking and open-minded discussions.

The fundamental lesson from these events, I believe, is that when profit drives health care decisions, investors win and patients lose. We can and must do better.