“Good riddance and burn in hell!”
“F*ck him. I’m glad he’s dead.”
“Those gunshot wounds were preexisting conditions.”
How unpopular are America’s health insurance companies?
Those were just some of the thousands of social media posts flooding X and Instagram in the days after health insurance company CEO Brian Thompson – a husband, father of two teenagers, and leading supporter of the Special Olympics – was gunned down on a Chicago sidewalk last December.
Even Massachusetts Senator Elizabeth Warren danced on Thompson’s grave, saying, "Violence is never the answer, but people can only be pushed so far.”
Health insurance companies are often blamed for frustrations about high premiums, denied claims, and confusing policies. But blaming insurers alone for America’s healthcare woes disregards the reality that hospitals, doctors, and healthcare systems—not insurers—are the primary drivers of skyrocketing costs and inefficiencies. Ignoring the role of providers in this crisis does nothing to fix it. While insurers made $25 billion in profits in 2023, hospitals pocketed a staggering $90 billion—3.6 times more. Providers, not insurers, set the astronomical prices for medical services. Hospitals routinely charge outrageous sums for basic procedures and reclassify outpatient visits as inpatient care to pad their bottom lines. For example, a simple MRI that could cost $500 at an independent clinic might be billed at $2,500 in a hospital setting.
Even worse, hospitals often exploit their dominant positions through mergers and acquisitions. By buying out independent doctors’ practices and classifying them as hospital-based, they impose unnecessary premiums—sometimes as high as 300 percent more than the same care provided outside their network. This consolidation leaves patients with fewer choices and higher bills.
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Transparency is another area where providers fail miserably. Despite federal mandates requiring hospitals to disclose their prices, compliance is abysmally low. As of late 2023, only 21 percent of hospitals fully adhered to these transparency rules, down from 35 percent earlier that year. This lack of transparency makes it nearly impossible for patients to compare costs or make informed decisions about their care. The result? Surprise medical bills that can devastate families financially.
Dishonest billing practices further exacerbate the problem. Providers routinely charge for services they didn’t deliver or inflate the costs of those they did. One infamous case involved a Chesapeake, Virginia, hospital where a doctor performed unnecessary procedures, allowing the hospital to rake in $18.5 million in fraudulent reimbursements. Sadly, this is not an isolated incident but a systemic issue.
Critics of insurers often point to tools like prior authorization as examples of how they delay or deny care. While these measures can be frustrating, they serve two important purposes: keeping costs in check for their customers and members and making sure prescribed care is in line with the latest clinical evidence. Without such safeguards, insurers would be forced to pay whatever providers demanded, leading to even higher premiums for consumers. Patients could also be prescribed outdated or disproven medical care not guided by the latest research. Since it takes an average of 17 years for research evidence to reach clinical practice, it’s vital to continually update options and alternatives to best care for patients. Because of this, Medicare, often held up as a gold standard, uses prior authorization to manage costs and review care.
Specialist doctors also contribute to the imbalance in healthcare spending. Cardiologists, oncologists, and other specialists are paid significantly more than primary care physicians, incentivizing treatment of complex conditions over preventive care. Focusing on expensive interventions rather than keeping people healthy drives up costs for everyone. Medicare’s payment rates, influenced by a 32-member committee chosen by the American Medical Association, further exacerbate this issue by prioritizing specialist procedures over primary care. Reforming this system to better reward preventive care could improve public health while reducing reliance on costly specialists.
The adoption of value-based care offers a potential solution. Unlike the current fee-for-service model that rewards quantity over quality, value-based care emphasizes patient outcomes. Providing appropriate interventions early and efficiently could reduce costs and improve health outcomes. Encouraging insurers and providers to adopt this model for Medicare, Medicaid, and private insurance plans could lead to meaningful reform.
It’s worth noting that much of the outrage directed at insurers stems from a fundamental misunderstanding of what insurance is. Health insurance isn’t magic; it’s a payment mechanism designed to pool risk and cover medical bills when individuals can’t. Without insurance, most Americans would be financially ruined by unexpected medical expenses.
Lawmakers must shift their focus from vilifying insurers to holding providers accountable. Stronger enforcement of transparency laws, curbing the power of monopolistic healthcare systems, and incentivizing preventive care are critical steps toward reform.
Blaming all of America's healthcare problems on insurers while giving providers a free pass is unfair, counterproductive, and will do nothing to fix our broken healthcare system.
Drew Johnson serves as a budget and health policy expert at several public policy think tanks. He was recently the Republican nominee for Congress in Nevada’s 3rd district.
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