Will a shocking crime spur change in U.S. health care? Don't count on it

It's hard to envision anyone celebrating the shooting death of a doctor. Or, for that matter, a hospital administrator, a pharma employee, an average U.S. politician or voter. 

But Luigi Mangione's alleged act has revealed a wellspring of hatred for one specific actor among many in the U.S. health system: insurance companies.

How else to explain the 126,000 people posting laughing emojis on a Facebook page devoted to mourning U.S. health insurance exec Brian Thompson, who was shot to death on a Manhattan sidewalk last week. Meanwhile thousands more posted messages online praising his alleged killer.

Mangione, the alleged shooter, reportedly left a brief manifesto declaring that the greed of the health system is amply chronicled in works by filmmaker Michael Moore and Elisabeth Rosenthal, a trained physician and 22-year health reporter for The New York Times.

If you actually read Rosenthal's book, one unmistakable takeaway is that myriad actors squeeze patients in myriad ways, pumping up prices, then haggling amongst themselves about how to split the proceeds.

But insurance companies are the most conspicuous actor. When the bill arrives, they're the one rejecting the claim, hunting for excuses, now assisted by artificial intelligence.

"If this is related to the insurance industry, it was only a matter of time [before] something like this happened. It really was," Rosenthal, who now works for KFF Health News, told a CNN podcast. 

"There's anger at the executives. There's anger when people see, 'Oh, you didn't pay for my $1,000 test, but you're making $10 million a year.' "

This interview took place before news that the alleged shooter's manifesto included her name and Rosenthal later said that the murder was terrible, tragic and inexcusable.

But she also reiterated her ongoing frustration with the system — where 18 per cent of claims are denied by insurers, where 42 per cent of cancer patients exhaust their life savings. 

She cited horror stories she's collected. Like struggling newborn babies getting rejected by insurance companies questioning whether they really needed that fourth night in the neonatal ICU. This, she says, is an example of a computer-assisted rejection.

"The [baby's] first letter in life is a denial letter," she said. "You know a human didn't write that letter." 

So why doesn't the system get reformed?

Well, to some extent it does. Tiny reforms happen all the time. This year alone, 99 laws were enacted at the state level related to health costs: some states excused medical debt from credit reports, or gave tax exemptions for some non-profit care, or made things easier for patients by guaranteeing that one referral allows multiple specialist visits.