I have been consulting with America’s hospitals for 48 years. I have been inside every kind of hospital, from small rural hospitals and well-known regional systems to nationally important faith-based organizations and world-renowned academic medical centers. I have worked with hundreds and hundreds of hospital CEOs, CFOs and other C-suite members. I have collaborated with thousands of hospital board members as well as physician executives and medical staffers. In my long experience, I have found that the vast majority of these people are dedicated and caring individuals. They are committed to their communities and to the patients they serve. They try their hardest to deliver the very best care they can, given the limitations of our national healthcare system.
Given my background and experience, I was stunned—as many others were—by the reaction of much of the American public to the murder of UnitedHealthcare CEO Brian Thompson. The assassination triggered a wave of social media posts and press reports that laid bare the rage that many in this country feel toward, specifically, the large health insurance companies. But let's not be too smug here: This resentment is likely directed toward every component of the healthcare delivery system.
The reactions to Thompson’s murder were chilling. Cheers erupted from a Saturday Night Live audience during a joke made referencing the alleged killer, Luigi Mangione. The New Yorker quoted a Reddit post by a person who described herself as an ICU nurse: “Honestly, I’m not wishing anyone harm, but when you’ve spent so much time and made so much money by increasing the suffering of the humanity around you, it's hard for me to summon empathy that you died.”
Pennsylvania Gov. Josh Shapiro delivered a powerful rebuke to those who cheered Brian Thompson’s murder: “In America we do not kill people in cold blood to resolve policy differences or express a viewpoint,” he said, according to USA Today. “I understand people have real frustration with our healthcare system. . . . But I have no tolerance, nor should anyone, for one man using an illegal ghost gun to murder someone because he thinks his opinion matters most. In civil society, we are all less safe when ideologues engage in vigilante justice.”
How did we get here? And how do we get to some place much better? On a daily basis, what is the American healthcare system trying to accomplish? And why are these goals and objectives falling so dramatically short in the eyes of such a significant segment of the American patient population? American hospitals of all kinds try to deliver the best patient care. Those same hospitals try to help patients recover when recovery is possible and to show real compassion when recovery is not possible.
But the reaction to the Thompson murder suggests that America’s healthcare consumers may want something very different from the healthcare delivery system than what they currently believe they are receiving. It seems this moment might be the right time to determine what that difference might be.
My sense is that the overall healthcare system is no longer felt as personal by much of the American public; it is felt as distant. On a day-to-day basis, it is a care and payment system that is perceived to be hiding behind an impersonal technological wall. Examples of such rising impersonality include:
- Difficulty in getting timely medical appointments, especially for referrals to specialty care, leads to frustration and often outright anger—particularly since they come at times when patients and their families are most concerned.
- The introduction of electronic medical record (EMR) systems has diverted caregivers’ attention away from the patient and toward a computer screen. Patients become passive observers as caregivers fill out forms and check boxes to comply with requirements that have dramatically altered the dynamic of an office visit. This process has created a new patient visit—one that seems inattentive and doesn’t value the importance of eye contact. It diminishes the critical need for meaningful discussion between the clinician and the patient.
- On top of all this is a health insurance process that seems overwhelmingly complex to even the most informed and knowledgeable of patients. It’s a process that too frequently denies care or payment in a manner that seems capricious and arbitrary. In a recent Commonwealth Fund survey, for example, 17% of respondents said that their insurer denied coverage for care that was recommended by their doctor, and nearly 60% of those who experienced a coverage denial said their care was delayed as a result. The recent introduction of AI-based algorithms into that process has made the impersonality of all of the above infinitely worse.
This all brings me back to a presentation by Abraham Verghese, M.D., at the 2024 Kaufman Hall Healthcare Leadership Conference. Dr. Verghese is, of course, a world-renowned novelist, but he is also a distinguished physician and a Professor of Medicine at the Stanford University Medical School. At our conference, Dr. Verghese spoke on changes in care delivery in a brilliant presentation that, I think, is directly related to the uncivilized reaction to the murder of Brian Thompson.
Dr. Verghese discussed physician training and how the introduction of technology allows for an entirely different approach to patient diagnosis and treatment. He spoke of a care transition process that now often involves a group of doctors huddled around laptops, developing treatment plans sometimes without actually seeing or touching the patient. Dr. Verghese outlined the historical value of rounds—visiting patients and discussing their care at the bedside—and all he learned as a medical student and resident from the process of “rounding” with experienced, senior physicians. He concluded by noting how technology has interfered with this exercise, diminishing its quality and value. The notion that data can substitute for a clinician’s careful observation does not seem to benefit either patients or clinicians.
The American healthcare system is without question committed to doing better. It is trying to deliver equal and equitable care to 330 million Americans. There is no question that such a goal cannot be reached without the intelligent intervention of the best existing technology. But the reaction to Brian Thompson’s murder suggests that, for the moment, the balance of hands-on medicine, compassion and caring, and the use of technology to manage both the care process and the payment process is not calibrated in a way that’s acceptable to a large segment of the American patient population.
The reaction to Brian Thompson’s assassination was inappropriate and, in many ways, hard to watch, especially for clinicians and hospital executives—but this reaction demands close attention and must inspire a moment of the deepest reflection.
