The insurance CEO shooting shines light on US health woes

Health Warning

The murder of Brian Thompson, CEO of health insurance giant UnitedHealthcare, by 26-year-old Luigi Mangione, shocked America. But perhaps more disturbing than the crime itself was the reaction on the left, which ranged from outright glee to sympathy with the killer’s sentiments: that private health insurers are extorting the poor, profiting from illness, and slow to pay out claims.

Unlike most other developed economies, the US doesn’t have any form of universal health care. While other countries subsidize health care either partially or completely, the US only has limited programs for the very poor and elderly; everyone else must pay themselves. That means obtaining health insurance to avoid being bankrupted by the eye-wateringly expensive American health care system.

Nothing justifies cold-blooded murder. But with renewed focus on America’s health care system, here is a snapshot of this complex and controversial structure, which tops the charts on cost, but results in only the 42nd-highest life expectancy.

Private Insurance

Employment-based – insurance coverage provided by an employer or union

Direct purchase – insurance purchased directly by the consumer from the provider or health care marketplace

Public Insurance

Medicare – federal program that helps pay health care costs for those aged 65+, or people with long-term disabilities

Medicaid – government-provided insurance coverage for those on low incomes

Paying Your Share

Even private insurance plans can entail additional costs:

Deductibles – the amount the claimant must pay before insurance kicks in and covers the rest

Copayments – a fixed payment (ranging on average from $26 to $44) for services like doctors’ visits

Coinsurance – a percentage of the cost of the service provided

Protective Ceiling

There is a federally mandated limit to the out-of-pocket costs insured consumers have to pay in deductibles, copayments, and coinsurance. Under Obamacare, this is $9,450 for individuals and $18,900 for family plans.

In numbers (2023)

Insured Americans

92%

Uninsured Americans

8%

Types of coverage

Employment-based

65.4%

Direct-purchase

10.2%

Medicare

18.9%

Medicaid

18.9%

Other

7.6%

The Figures

$8,435

Average yearly premium for an individual in 2023, 83% paid by employer and 17% paid by employee contributions

$23,968

Average yearly premium for family coverage in 2023, 71% paid by employer and 29% paid by employee contributions

$4.8 trillion

Total US health care spending in 2023

$576.1 billion – Total spending on Medicaid in 2023

$15,074

Estimated health care spending per person in 2024

Peace Talks

When Donald Trump first talked about a negotiated settlement to end the war in Ukraine, rather than pumping endless billions into a bloody war of attrition, Western allies howled about the evil of forcing Ukraine into surrendering its sovereign territory, thus rewarding Putin’s illegal invasion.

But nearly three years on, with the cash — and their electorates’ patience running out — European leaders are coming around to the new reality, and the conversation is turning inexorably to peace talks. After Trump met Ukraine’s Volodymyr Zelensky in Paris, France’s Emmanuel Macron suggested a European peacekeeping force, though Poland’s Donald Tusk dismissed the idea of a continent-wide deployment. Even Britain’s Keir Starmer, whose country has been Ukraine’s staunchest European ally, is talking about putting Ukraine in the strongest position for peace talks.

For all the talk of Trump-proofing European defense, without American largesse, European leaders must follow where Trump goes.

Big Tech Bust-Up

Big Tech has always drawn antagonism from Washington, whether for anti-competitive practices, tax avoidance, or perceived political bias, but some of Trump’s recent appointments signal a further ramping up of hostilities. His picks for the Federal Trade Commission and Federal Communications Commission, Andrew Ferguson and Brendan Carr, have both targeted Big Tech for its censorship of free speech. Their political arguments are in contrast to the Biden administration’s more technocratic approach, which focused on anti-competitive practices.

The Republicans are attracting a new cadre of tech bros — the plucky Little Tech founders, some of whom switched allegiances in 2024. Software engineer, serial inventor, and venture capitalist Marc Andreessen, and his cofounder Ben Horowitz, endorsed Trump, breaking with their past support of Democratic candidates. VP-elect J.D. Vance invested in multiple start-ups before entering politics, and has made no secret of his belief that Big Tech should be broken up and slapped with higher corporate taxes. Has Big Tech’s day of reckoning finally arrived?

15%

The total rise in revenue last year for Israel’s three largest defense companies. It’s unsurprising, given how the country’s been consumed by war on multiple fronts. This places Israel 4th in global rankings for defense industry growth in 2023.

(Originally featured in Mishpacha, Issue 1041)