A sign points visitors toward the financial services department at a hospital in January 2014.
A sign points visitors toward the financial services department at a hospital in January 2014.
David Goldman/AP/File

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CNN  — 

The cold-blooded assassination of a health care CEO has uncorked a torrent of public anger at the health insurance industry. Should the ugliness of that fact make Americans bottle the anger back up?

The suspected killer, Luigi Mangione, is preparing for a murder trial in New York, and his lawyer said he will plead not guilty. But the rest of the country has an opportunity, awkward though it is, to examine its long-festering frustration at a health insurance system that is unique in the developed world as it squeezes profits for private companies from patients.

CNN’s Tami Luhby gathered insurance horror stories from CNN readers, including a recent college graduate who had to simultaneously fight against cancer and her coverage provider’s decision that she should pay a $13,000 monthly copay for a life-saving drug. It’s no wonder that a sizable minority of Americans have reported being in medical debt.

A shift on whether coverage is the government’s responsibility

A Gallup poll released this week but conducted before the killing of UnitedHealthcare CEO Brian Thompson, found that most Americans, 62%, think it is the responsibility of the federal government to make sure that all Americans have health care coverage. A minority, 36%, said it’s not the government’s responsibility.

Gallup has been asking this question for years, and this new data reflects a gradual reversal from 11 years ago, during the troubled rollout of private health insurance exchanges created by the Affordable Care Act, or Obamacare. Back then, a minority, 42%, said it was the federal government’s responsibility to make sure people have health coverage, and a majority, 56%, said it was not.

There’s a partisan story behind those numbers, since nearly all Democrats, 90%, now say the government is responsible, compared with a little more than two-thirds in 2013. Just about a third of Republicans hold the same view today, although that is up from just 12% who said the government had a responsibility in 2013.

Regardless, any health insurance reform effort to increase government participation in the system would be met with fierce resistance, just like it was in 2010, when then-President Barack Obama signed the Affordable Care Act into law.

Satisfaction with the health system has dropped

The upward shift in Americans who say the government has a responsibility to make sure its citizens have coverage has tracked with a downward shift in satisfaction with the health care system overall in Gallup’s polling.

Back in 2013, a majority, 54% of Americans, were satisfied with the quality of health care in the US. Today, that’s down to 44%.

Satisfaction with health care coverage has never been high in the more than two decades during which Gallup has tracked it. It hit a high of 41% in 2012 and today is at 28%, the lowest since the early 2000s, the years before Obamacare drastically reformed the insurance industry and required insurers to cover preexisting conditions and keep young people on their parents’ insurance up to the age of 26, as well as greatly expanded Medicaid coverage.

A uniquely American system

No other country – certainly no other wealthy country like the US – does it this way, with its reliance on employers to provide optional health coverage to most of the country.

Some countries have government-run health care systems. Others require citizens to pay for more affordable private insurance. All, except the US, insure nearly all of their citizens.

More expensive health care for a shorter life span

Any number of studies say similar things, that the US pays a lot more per person and as a percentage of its gross domestic product, or GDP, to cover a much smaller portion of its population and achieve a much lower life expectancy – although life expectancy in the US is also affected by gun deaths, suicides and drug overdoses.

KFF, the Peter G. Peterson Foundation and the Commonwealth Fund all have detailed assessments comparing the US system with insurance in other countries. Takeaways include that administrative costs are much higher in the US than in other wealthy countries. It’s perhaps fed by a universe of insurers, one contributor to those costs.

One major distinction with the US is that those other countries require coverage for everyone and subsidize it to a greater degree than the US.

Here, the government only provides health care for the neediest, through Medicaid, and older Americans, who generally qualify for government-run health coverage in Medicare. Thanks to Obamacare, the government also subsidizes care for those up to certain income levels who don’t get coverage from their employer. The government also subsidizes employer-provided health care in the form of tax breaks.

A side story to watch is the rise of Medicare recipients opting for privately run Medicare Advantage plans that are run by private insurers. The Wall Street Journal has recently documented how Medicare Advantage plans can end up costing the government more and also that the sickest patients, rather than face denial of coverage from private insurers, return to Medicare when they need the costliest procedures.

Dropping satisfaction with a notable government-run system

Struggles with health insurance are not unique to the US. Perhaps the most notable government-run, single-payer system, the National Health Service in the United Kingdom, enjoyed a 70% satisfaction rate in 2010. That’s fallen to just 24% as of 2023, according to a national survey, although that survey found the British people want to improve the system to cut down on wait times for services rather than scrap it for something else.

Yet, the US political conversation barely turned to health insurance during the recently concluded presidential campaign, and the health care system was not at the top of voters’ concerns in public opinion polling.

President-elect Donald Trump was elected with only “concepts” of a health care policy. He beat Vice President Kamala Harris, who had proposed minimal expansions of Medicare rather than a major change to the system.

The last major change to the system was Obamacare, for which Democrats paid a short-term political price when they lost control of the House of Representatives. The law has slowly become more popular – 62% of Americans have a favorable view, according to a KFF tracking poll. But it clearly did not solve the problem of making health care affordable.

A major step toward lowering prescription drug costs came from Democrats during the Biden administration, when, after years of trying, they won Medicare the right to negotiate for lower prices on certain drugs. But that faces an uncertain future in the new Trump administration as it fills out its concepts of a plan.