The U.S. health care system leaves much to be desired.
Author
- Simon F. Haeder
Associate Professor of Public Health, Texas A&M University
It is . Experts have also raised , and . And, of course, it is – far more so than in any other developed nation. Given these failings, it is not surprising that Americans are .
As the to the killing of UnitedHealthcare CEO Brian Thompson has made clear, however, many Americans are perhaps most unhappy with their health insurers. Indeed, of the health insurance industry, according to a 2024 survey.
Yet, given the recent tragic events, as a , I think it would be prudent to take a step back and reflect on the broader health care system and how the U.S. got to this point.
Many sources of health care frustration
Few with any personal experience or professional expertise would describe U.S. health care .
For a number of historical and political reasons, it is barely a “system” but rather a complex patchwork with countless different approaches to covering the costs of health care that include splitting the costs between .
Governments also extensively and, although in a diminished role today, through state and county hospitals as well as the Veterans Health Administration.
The result is a . The only added additional layers of laws and regulations to an already complex framework.
Yet, even beyond this general structure, Americans face many challenges. Indeed, . This involves costs for medical services but . of the excessive financial burden carried by Americans.
For many Americans, , .
And despite that high price, concerns persist about .
In addition, the system tends to be that make it harder for many poorer, rural and nonwhite Americans to access care.
The role of insurers
In the United States, insurers in connecting – and at times disconnecting – patients with the care they require.
They are also at the forefront of many of the starkest frustrations that Americans experience – even the ones they are not directly responsible for. While medical providers and pharmaceutical companies , it is generally up to insurers to tell patients how much they still have to pay or that their care won’t be covered. Insurers are also the ones who determine whether a drug is not covered or a doctor is “out of network,” meaning patients can’t get the specific treatment or care they desire.
To be sure, insurers are not just the messenger – they also add to many of the frustrations patients experience every day. For example, a patient or for an appointment if their provider network is or simply . Moreover, the directories and searches that insurers use to show what providers are “in network” , as they .
For many individuals, this can mean , which has major implications for their health and finances. For some, .
Some of the practices insurers are most infamous for, over minor clerical issues and refusing to cover preexisting conditions, ended under the ACA. But some of these issues could return if the incoming Trump administration .
Even today, so called promise good coverage for lower premiums, but even basic items may not be covered. Many plans, for example, or even hospital emergency rooms.
Blame the system, not just the insurers
Why do insurers act the way they do? For many, the answer may seem simple: to make money. This, of course, – insurers in the U.S. . However, while they , their margins generally range only from 3% to 5%.
But the story is more complicated than that. , insurers are perhaps the only force in the U.S. health care industry trying to rein in rising costs in a health care system where everyone seeks to maximize their profits.
That means insurers take on the role of bad cop, doing things such as limiting access to certain care or doctors. But there are several prudent reasons for doing so; for instance, it’s in the public’s best interest when insurers do not cover drugs that have been shown ineffective or of low quality. And ultimately this does keep premiums lower than they would otherwise be. Of course, in the process. And at times, .
Ultimately, many if not most of the frustrations Americans experience with health care have their origins in a poorly designed system that is highly inefficient and offers countless opportunities for profit. Yet insurers are only one – perhaps the most visible – part of that broken system.
