Since the tragic shooting of UnitedHealthcare CEO Brian Thompson last month, Americans have voiced their growing frustration with private health insurers. Stories of delayed and denied claims, all in the name of profits, have sparked widespread outrage across the nation.
If the U.S. is serious about fixing the health care system, we must confront an uncomfortable truth: a significant portion of the money Americans pay for health care—whether through premiums or government-funded programs like Medicare—ends up enriching corporate executives and Wall Street investors, not funding the medical care patients so desperately need.
As a family physician and assistant professor of medicine at the University of Pennsylvania, I witness daily the financial strain health care costs impose on families. According to a 2024 survey by KFF, nearly half of U.S. adults report that health care is unaffordable, and one in four have delayed or skipped necessary medical care due to cost. In fact, 60% of American adults face issues with their health insurance, from denied claims to unaffordable premiums, with many unable to resolve the problems.
These financial burdens often lead to severe psychological distress. Consider the elderly diabetic patient wondering if they can afford the copay for a new treatment, or the new mother overwhelmed by medical bills after a cesarean section. For parents of children with chronic conditions, the fear of mounting medical debt while struggling to make ends meet is all too real.
While expanding insurance coverage has long been the focus of health policy debates, this alone is not enough to alleviate the financial strain. Over the past decade, premiums, deductibles, and out-of-pocket costs for Americans with private insurance have skyrocketed. Between 2013 and 2023, the average family premium increased by almost 50%. These rising costs disproportionately affect low-income and Black patients, further exacerbating inequalities in health care access.
In my clinic and as a health policy researcher, I’ve come to understand that following the money is essential to understanding this crisis. My research shows that health care companies are spending vast sums of their profits on shareholder payouts instead of lowering costs, improving care quality, or investing in research and development.
Take UnitedHealth Group, the nation’s largest insurer. It has used various tactics to extract billions of dollars from taxpayer-funded programs like Medicare, while sending billions more into shareholder pockets. Similarly, pharmaceutical giant Pfizer spent over $140 billion on shareholder payouts between 2012 and 2021—almost twice what it spent on research and development—while raising the price of critical medications like Eliquis by over 100%.
A key driver of this problem is Wall Street’s growing influence on health care companies. The shift towards prioritizing shareholder returns over patient care can be traced back to the 1980s and 1990s, when regulatory changes allowed companies to distribute capital to shareholders in new ways. These changes, particularly under Presidents Reagan and Clinton, have led to a culture where corporations, including health care giants, focus more on increasing shareholder value than improving services or making care affordable.
Today, nearly 70% of total U.S. health spending comes from taxpayer-funded sources, including Medicare and Medicaid, as well as tax breaks for employer-based insurance. Yet, instead of reinvesting these funds into better care or lower costs, health care companies are using these taxpayer dollars to enrich executives and shareholders.
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