Americans' Rage at Health Insurance Companies Is an Opportunity
Democrats should start preparing now for the next health care reform push.
Thank you for reading The Cross Section, and if you find my work valuable and would like it to continue, consider becoming a paid subscriber. This site has no paywall, so I depend on the generosity of readers to sustain the work I present here. Thanks.
And read until the end for a special audio bonus!
In a shocking development, it turns out people are really mad about how health insurance works in this country, particularly the way insurance companies mistreat the 216 million of us who have to rely on them for our coverage. Perhaps this would be an opportune moment for the only major party that actually cares about health care to start planning a strategy — both political and substantive — to address the anger that led thousands of people to cheer on social media when the CEO of the country’s largest health insurance company got gunned down on a sidewalk in Manhattan.
You want a “kitchen table issue” that will help Democrats “connect to regular people where they live” and “show what their values are”? Well here you go.
Sixteen years passed between Bill Clinton’s failed attempt at health care reform and Barack Obama’s successful effort to pass the Affordable Care Act. This coming March will mark the 15th anniversary of the signing of the ACA, and it’s about time to start preparing for the next battle.
Despite the tremendous good the ACA accomplished (the elimination of preexisting conditions denials, tens of millions more with coverage), ours is still by most standards the worst health care system in the industrialized world. Not only do we pay far, far more than citizens of any other advanced democracy, we have middling health outcomes, we still have millions of uninsured, and we’re slaves to a system in which every consideration is secondary to the pursuit of private profit.
It took the murder of the CEO of UnitedHealthcare to bring home the fact that Americans are filled with a barely contained fury over the way this system works, even if it could be worse. Forget about the muddled politics of the suspect in the shooting of Brian Thompson, or whether you think people shouldn’t have celebrated his murder, or whether you think all the social media jokes (“Unfortunately, thoughts and prayers require prior authorization”) were in poor taste. The fact is they represent genuine and widespread sentiment, because people see UHC and its ilk as a bunch of blood-sucking lampreys draining them of every possible penny while withholding the care that could save the health or even lives of them and their families.
For the record, UnitedHealthcare is a particularly cold-blooded company in an industry full of heartlessness; it denies a higher proportion of claims than any other insurer, and uses artificial intelligence to determine which claims to deny, a system that couldn't possibly result in any needless human suffering. UnitedHealth Group (UHC’s parent company) made $23 billion in profit in 2023, and it looks like 2024 will bring a rain of even more riches for its shareholders and executives.
This is the time
The public’s anger at insurance companies is more a topic of discussion right now than at any moment since the debate over the ACA. At the same moment, the Republicans who are about to take complete power in Washington are circling around Medicare and Medicaid — the two extraordinarily popular government insurance programs — looking for ways to cut them.
Meanwhile, Donald Trump is desperately hoping everyone stops talking about health care, because he’s trapped by his own history and his party salivating at the thought of tossing tens of millions off their coverage. In an interview last weekend with Kristen Welker of NBC News, he said he still has “concepts of a plan that would be better,” and repealing the ACA is still on the table, “Because Obamacare stinks. It’s lousy.”
So this is the moment for Democrats to do two things: First, make a relentless push on health care, attacking the Trump administration, Republicans in Congress, and insurance companies as all one entity, a collection of villains whom voters can blame for everything that’s bad about our health care system.
Second, they need to start developing the framework for the next phase of reform and sell their politicians on what emerges. That’s what happened in the years between the Clinton and Obama reforms: Liberal policy wonks debated and discussed and produced white papers and reports, and eventually a rough consensus emerged around something like what the ACA turned out to be.
What should the next phase of reform look like? The answer will emerge from the internal debate among Democrats. My own preference would be for a hybrid system similar to what they have in many of our peer countries, including Australia, France, and Canada: A basic, government-provided insurance system that provides secure coverage to everyone but does so without a lot of bells and whistles, combined with a system of private supplemental insurance that anyone can buy and will be as gold-plated as you like. Liberals get the most important thing they want (coverage for all, insulated from the pathologies of the market), while conservatives get the most important thing they want (the ability of rich people to buy more benefits than the rabble).
Maybe that’s where the debate among Democrats will end up, or maybe not. But the solution has to involve, as a bottom line, some kind of public option, a way for Americans who have had it with rapacious insurance companies to say “To hell with those bastards, I’m signing up for a government plan.” You may not remember, but Joe Biden put out a public option plan when he ran for president in 2020, and it was surprisingly progressive; the only problem was that he tossed it in a drawer the day he took office and never spoke of it again.
Let’s rediscover our imagination
As Democrats move ahead, they have to keep from being constrained by the chief tactic of the GOP and moneyed health care interests, which is to convince us that we have no choice but to live with this awful system. To the millions of Americans who are angry, Democrats should say, “You’re right to be angry, and it doesn’t have to be this way.” They should tell voters that we don’t have to live with insurers that are happy to withhold care from sick people in order to pad their stock price. We don’t have to be condemned to always worrying about whether we’ll lose the coverage we have, or hope that we don’t ever have to use it because we can’t be sure it’ll pay for the care we need. It doesn’t have to be this way.
The strategy of the insurance industry has always been to convince us that we can’t have anything better, which they will do again. The complexity of the issue will be wielded as a weapon against imagination and an excuse for inaction. “How will you pay for it??” anyone who suggests reform will be asked, always in bad faith. The answer is that we’re already paying for it, to the tune of $4.5 trillion a year, or $13,500 for every man, woman, and child in America. The question is whether we want to go on spending that much for a system so cruel that it leads millions to smile and laugh when they learn an insurance company CEO has been murdered.
Every change to this system, large or small, requires a fight. That’s because of the very thing that makes our system so diseased in the first place: Too many people are making too damn much money, and they like things just the way they are. Insurance companies, drug companies, hospital corporations, device makers, specialist physicians — they’re all getting richer every day, and they are determined to keep it that way. So they will have to be fought, and criticized, and the villainous ones, of whom there are plenty, will have to be named and shamed.
If we have to pick out one villain to focus attention on, the insurers are as a good a choice as any, because they are indeed so villainous. And we know now just how deep the anger at them goes.
And yes, the next time we’ll have even a chance at real reform will be when Democrats control both the White House and Congress, and that will be years from now. So those years should not be squandered. Between the Clinton and Obama reforms, Democrats did the political and policy work required so that when they had the opportunity for comprehensive reform, they were ready. It’s time to start getting ready again.
Audio bonus!
I’m including here the latest episode of Boundary Issues, the podcast I co-host with my sister Ayelet. We talk with Talia Lavin about her new book Wild Faith: How the Christian Right Is Taking Over America; the conversation covers the roots of Christian nationalism, the incoming Trump administration, and why spanking your kids will turn them into fascists. You can listen here, or even better, subscribe wherever you get your podcasts.
This is a prime opportunity if the Democrats are bold enough to take it. With Manchin, Sinema and Lieberman gone, they may just. And given that we know that over the next two years (at least) Trump and his flunkies will be doing everything they can to undermine the ACA, Medicare and Medicaid. Thune and Johnson have already said they have no interest in extending the subsidies when they come up for renewal, instantly making health insurance unaffordable for millions. This is the time for Democrats to go for all the gusto - Medicare for All - expressing it in simple terms that even the dullest MAGA can understand. And make it clear that there will be no networks, no denial of claims, that everyone can choose the provider they want and he/she will be the sole decider, with the patient, of what the treatment plan is. And be clear, the health insurance companies are leeches, parasites, that add no value.
A quicker solution would be for the DNC to finance hits on another 6-8 health insurance CEOs. I guarantee that would lower the claim denial rate to near zero. These assholes deserve nothing less. And if you disagree you've clearly never been a cancer patient fighting to have your chemo treatments paid for like I was.