The shocking murder of health insurer UnitedHealthcare (UHC) CEO Brian Thompson has ignited a fierce debate about the United States’ uniquely for-profit, insurer-dominated health care system, with the assassin having been apparently motivated by rage at its many injustices. What has largely escaped notice is UHC’s decades-long efforts, in concert with other parts of the health care industry, to blunt attempts to reform the system in a way that would benefit consumers and assuage this roiling anger.

From the earliest days of the Bill Clinton administration’s tilt at health care reform, through wrangling over Barack Obama’s dog’s breakfast of a health care bill, to the rise of Bernie Sanders and his Medicare for All proposal, UHC has been a Zelig-like presence, taking a central role in beating back efforts to change an often capricious and cruel system. Working with other insurers and for-profit health care entities, UHC has marshaled considerable resources — its money, lobbyists, and political connections — to prevent anything approaching the kind of public health care systems that exist in other countries from emerging in the United States, and to preserve a market-oriented system where the government’s role, if any, is to feed the profits of companies like itself.

A bitter irony is that the reforms UHC and others have bitterly fought for decades, had they been enacted, may well have prevented the kind of boiling over of popular fury that erupted in the reaction to Thompson’s killing. It’s impossible to know, but perhaps these defeated reforms could have not only saved the lives of countless patients over the years but also that of the late UHC chief executive himself.

Shaping Hillarycare

UHC had a front-row seat to Bill and Hillary Clinton’s doomed attempt to reform the US health care system, which took the form of “managed competition,” a market-based concept pushed by a broad swath of the industry that aimed to lower costs and get to universal coverage by encouraging and regulating competition between private insurers.

The company was one of six major HMOs whose CEOs were part of the “Chicago Group,” an informal working group advising and supporting the new administration as it embarked on the make-or-break effort. The CEOs “unanimously” agreed that only “harnessing the power of competitive forces” could rein in ballooning health care costs and urged Clinton to embrace “managed competition” as the solution, according to an April 1993 document held in the Clinton Presidential Library.