US healthcare financing impaired by 'very inefficient public-private partnership'

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00:00Next, New York prosecutors have announced new charges against the man suspected of

00:03gunning down a health insurance CEO, including a charge of second-degree murder as an act of

00:09terrorism. Luigi Mangione is also facing 10 other charges after the fatal shooting of Brian Thompson

00:16outside a hotel in Manhattan. The city's police commissioner also warns against what has been

00:22a morbid wave of appreciation and celebration of Mangione after the killing, particularly

00:28with regard to the U.S. healthcare system. Lauren Bershteker has this report.

00:36Already charged with murder in the first degree, Luigi Mangione, the man suspected

00:41of killing the CEO of UnitedHealthcare, will now be tried on terrorism charges.

00:47This was a frightening, well-planned, targeted murder that was intended to cause shock and

00:55attention and intimidation. It was intended to evoke terror. And we've seen that reaction.

01:02Mangione allegedly shot UnitedHealthcare CEO Brian Thompson as he was headed to an

01:07investors conference in midtown Manhattan on December 4th. After a five-day manhunt,

01:13the suspect was arrested in Pennsylvania, still in possession of the murder weapon

01:18and of a letter that denounced corporate greed in the health insurance industry.

01:23And while the 26-year-old's motivations remain uncertain, the killing unleashed an outpouring

01:28of anger against the U.S. healthcare system, with many sharing stories of being denied coverage

01:33or left with massive debt. Some social media users even portrayed the killer as a hero,

01:39setting up a fundraiser to pay for his defense, while wanted posters featuring other health

01:44insurance executives began appearing on New York streets. On Tuesday, the city's police

01:50commissioner slammed these reactions and warned against glorifying murder.

01:55Let me say this plainly. There is no heroism in what Mangione did. This was a senseless act

02:02of violence. It was a cold and calculated crime that stole a life and put New Yorkers at risk.

02:11Mangione is currently being held in a Pennsylvania jail and said he would fight extradition to New

02:16York, where he faces a maximum penalty of life in prison without parole.

02:24Well, as we've been mentioning, there has been an unsettling glorification

02:28of Luigi Mangione, with some calling him a 21st century Robin Hood. His actions have

02:33sparked a wider debate about the state of health insurance in the United States.

02:38Let's get more on this from Greg Shaw, who's a professor of political science

02:43at Illinois Wesleyan University. He's also the author of

02:46The Dysfunctional Politics of the Affordable Care Act. Greg, thanks so much for joining us

02:51on the program. Clearly, there's been a lot of anger and frustration with the US health care

02:57system. Give us your reaction to this morbid wave of appreciation and celebration of Mangione

03:02and this murder. Yeah, I think it's probably important to keep in mind if you take the long

03:08view that corporate greed is not a new thing. If instances of corporate greed were enough to

03:14trigger enduring social movements, I think we would have seen that already. While this is a

03:20horrific murder, planned as it was and so forth, I'm not sure I see here the makings of a narrative

03:29that will highlight this particular industry for sweeping reform. I don't think the culprit is

03:37quite that clear as some would think right now. So I think midterm, what we will probably see is

03:46more consumer upset about medical debt. But the fault for that goes in a variety of directions,

03:52not simply toward the insurance industry. Well, Greg, we'd love you to just explain to us some

03:57of the flaws in the US's health care system because, of course, the US is one of the world's

04:02wealthiest nations, yet it seems to be one of the weakest in terms of coverage in its health care

04:08system. Tell us why. That's right. So currently and for the last several years, we've had about

04:14nine percent of Americans remain uninsured with no health insurance. And, you know, they cobble

04:19together care however they can by showing up at emergency departments at hospitals with no

04:24particular ability to pay and so forth. And the system just has to eat that. So it's a long story,

04:30but it has an awful lot to do with the idea that there's a cultural element here that we

04:36in the US have nurtured this individualism myth, that we are all somehow, you know,

04:43individuals responsible for our own care. So that works against collective efforts.

04:49There's also a very inefficient public-private partnership that goes on around health care

04:55financing. So in brief, we have a lot of private providers who are profit-seeking,

05:02but who are paid through government systems that have very little ability to put downward pressure

05:07on prices. And so basically there are a lot of private providers out there who, you know, despite

05:12their ability to deliver really excellent care sometimes, are in it for the money for the most

05:19part. And government has very little ability to tamp down on that. So that's a big part of it

05:27right there. And we spend an obscene amount of money on health care. This year, the average

05:34American will spend about $14,000 on health care. And that's ridiculous given the mediocre

05:43health outcome data that we achieve as a country. Yeah, that's a staggering amount, Greg.

05:48Pretty much every developed country in the world is committed to universal health care.

05:54You spoke just about how the US has this individualistic stance. Is universal health

06:00care something you want to see coming in force in the US? Do you think it's even possible for

06:05the US to do that? Yes, I would love to see that. Is it possible? You know, it's sort of like

06:13achieving social justice generally. It's a little piece at a time. It's a long-term project. And

06:19we're gradually getting there. In the last decade, we've made a significant stride in that direction,

06:25you know, going from about 17% of Americans being uninsured down to about nine. But there doesn't

06:34seem to be much of an appetite for universal if by that we really need 100% of people covered.

06:41And that, again, is because of some of the incentives that are baked into our system.

06:46And, you know, the story of private insurance in this company goes back to the advent of the

06:50industry back in the 1930s and 40s. And so to take on that industry now and say we're going to do

06:58something like a Medicare for all or something like that universal that would wipe out the

07:05health care industry is to take on a multi-trillion dollar industry. And that seems, I won't say

07:12impossible, but certainly improbable in the near term. I think we'll continue to stagger along with

07:18a patchwork system that we have. And Greg, just a final word from you. Donald Trump is going to

07:24be returning back to the White House in January. That's likely to bring changes that could possibly

07:29scale back the US's public health insurance programs. Tell us about the impact that Trump

07:35will have once he gets back into the White House. Yeah, so that, you know, that administration,

07:40like the first one, will probably be an exercise in, you know, loosely controlled chaos. But,

07:45and disruption more than anything else seems to be his brand. I don't know that, you know, he

07:51even has the concept of a plan, as he would tell you about health care reform. But I think what we

07:57will most likely to see, rather than an outright effort to repeal the Affordable Care Act, I think

08:03you'll see a scaling back of assistance to help people take advantage of the health care insurance

08:10marketplace that the law created. I think you'll see a scaling back on various public health

08:15programs, perhaps prominently vaccine programs. And so I think that the core of it will, is very

08:21likely to succeed if for no other reason that we have literally tens of millions of people now

08:27who rely on that law to either get Medicaid, that is the program for lower income Americans,

08:34or subsidised insurance on the online exchanges. And so I think we'll see a slight notching down

08:40of enrolment because government will do less, this administration will do less to help people

08:46see their way clearer. But I would be surprised if the administration takes on the fight of trying

08:51to repeal the law outright, given how embedded it is. Greg, great to talk to you. Thanks so much for

08:57giving us your insight there. That's Greg Shaw, who is a professor of political science and also

09:01the author of The Dysfunctional Politics of the Affordable Care Act. Thanks so much, Greg.

09:07Let us move on because it's time.

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