The murder of UnitedHealthcare CEO Brian Thompson has triggered polarized reactions, reflecting deeper frustrations with the healthcare claims and dispute systems in the US. Allegations of systemic barriers—popularly encapsulated in the phrase “delay, deny, defend”—paint insurers as adversaries rather than facilitators in resolving claims. This tragic event underscores the urgency of viewing healthcare claim practices through the lens of Dispute System Design (DSD), an approach that seeks to prevent, manage, and resolve conflicts effectively and efficiently.
While my work as a researcher in DSD focuses on disputes in the creative sector, the principles of fairness, justice and accountability that underpin all dispute systems compel me to engage with this issue—as someone committed to improving how conflicts are managed across society. So, while the particulars differ, the DSD principles of fairness, accessibility, accountability remain critical to preventing, managing and resolving disputes in any context.
The Crisis of Trust in Healthcare Dispute Systems
Public reaction to Thompson’s death, including online ridicule, sympathy, for the suspect, Luigi Mangione (and even donations!), highlights great interest and widespread dissatisfaction in what the incident symbolizes. Such sentiments stem from recurring issues in health insurance, where denied claims, delayed payments, and forced litigation evoke a perception of injustice. CNN reported that according to a 2023 KFF survey, a non-profit health policy research group, “the majority of insured US adults had at least one issue, including denial of claims, with their health insurance in the span of a year,” reinforcing feelings of powerlessness. Nonetheless, as Francine Prose notes “the mess we’re in wasn’t his fault. Our problems are so much larger than he was. He was an unlucky, visible symbol of everything that’s gone wrong with our healthcare system.”
This erosion of trust can be seen as a failure of the insurance industry’s DSD. Instead of fostering resolutions, current systems amplify adversarial dynamics, pushing claimants into costly and demoralizing litigation. When disputes are poorly managed or unresolved, tensions escalate, as exemplified by this tragic incident.
DSD: Principles and Failures in Healthcare
DSD offers a framework to understand and address these systemic failures. As outlined in foundational works on the subject, effective systems must align with principles such as fairness, efficiency, stakeholder inclusion, and transparency. Current health insurance systems, however, often deviate from these ideals:
1. Lack of Accessibility: Claimants face opaque procedures, limited communication, and inadequate resources to challenge denials.
2. Power Imbalances: Insurers often control the design of dispute resolution processes, leaving consumers with little recourse.
3. Adversarial Processes: By focusing on legal defenses, a.k.a. “defend”, rather than equitable settlements, insurers deepen claimants’ frustration.
The popular phrase “delay, deny, defend,” rooted in Jay M. Feinman’s 2010 book, encapsulates these shortcomings. It reflects a system designed to minimize payouts rather than resolve disputes in good faith.
Systemic and Structural Reforms
To rebuild trust, healthcare insurers must reimagine their dispute systems. Drawing from DSD principles, potential reforms include:
1. Prevention through Early Resolution: Insurers could adopt proactive mediation strategies, addressing disputes before claims escalate.
2. Transparency and Communication: Clearer guidelines for claim processing, real-time updates, and detailed explanations for denials could empower consumers.
3. Independent Review Mechanisms: Neutral third parties should oversee appeals to ensure objectivity.
4. User-Centered Processes: Stakeholder engagement in designing and implementing dispute systems can create processes better aligned with consumer needs.
These measures can prevent disputes from escalating into public outrage or, worse, violence.
A Tragic Reminder and Call for Action
Brian Thompson’s death, while tragic and unjustifiable, serves as a reminder of the human cost of flawed systems. Public reactions, from negative social media sentiments to merchandise echoing the “delay, deny, defend” mantra, illustrate the depth of societal discontent.
These reactions also highlight how failures in dispute management resonate universally, transcending industries and borders. For example, in the creative sector where disputes over royalties, intellectual property, or contracts often pit creators against larger entities, poorly managed streams of disputes can similarly escalate into frustration and mistrust. Just as in healthcare, addressing these conflicts requires accountable, accessible, and user-centered systems. By learning from healthcare’s systemic failures, we can design more equitable systems that serve as models globally, including in countries like Nigeria, where dispute resolution mechanisms in emerging industries remain underdeveloped.
DSD offers a blueprint for this transformation, advocating systems that emphasize justice and fairness while reducing inefficiencies.
Conclusion
The tragedy surrounding UnitedHealthcare CEO Brian Thompson’s death is a symptom of broader systemic issues in the healthcare industry’s claims facilities and dispute systems. In other words, UnitedHealthcare is far from the only player in a broken system. But as the nation’s largest health insurance company, it has been described as “a key part of it”. By reexamining and redesigning these systems through the lens of DSD, insurers can restore trust, reduce conflict, and ensure fairer outcomes. The time to act is now—before another tragedy forces us to confront the consequences of neglecting these critical reforms.
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