From the “careless bureaucracy” to high costs, the American health care system is broken. The murder of UnitedHealthcare’s CEO could mark a moment for reform.

The shocking death of UnitedHealthcare CEO Brian Thompson in December ignited a national debate: Is health insurance so bad it would drive someone to murder?

On a recent episode of Boston Globe Opinion’s podcast, “Say More,” host Shirley Leung talked to two experts to delve into why health insurance frustrates so many Americans and how there are rational solutions beyond vigilante justice.

Leung spoke with Casey Ross, an investigative reporter at STAT — a sister publication of the Globe — who was a Pulitzer Prize finalist for his 2023 series on how UnitedHealth Group used an unregulated algorithm to deny care. Joining the conversation was Dr. Vikas Saini, president of the Lown Institute, which advocates for social responsibility in health systems. He recently wrote a Globe op-ed about how American’s broken health system is fueling rage.

Listen to the conversation at globe.com/saymore or wherever you find your podcasts. Here’s an edited excerpt:

People hate their health insurers because of the ‘careless bureaucracy’

Ross: I’ve talked to so many different families and people who have encountered the bureaucratic process that surrounds health care. What makes it hardest for them is that when they are fighting for their life or the life of a loved one, they are made to go through a careless bureaucracy that forces them at every turn to put in more paperwork, search for more data, find different ways and more ways to justify the care their doctors have recommended that they can’t get because they’re being told no, or you don’t qualify for this, or there’s this exclusion you didn’t recognize. It’s really painful and it’s disempowering, and they don’t know how to fight back.

Are UnitedHealthcare and its parent UnitedHealth Group really the worst?

Ross: Because of its size, scope, and reach, UnitedHealth is responsible for a larger portion of the denials and the friction and care that people experience. A lot of people don’t realize how big and expansive UnitedHealth Group is. Myself and my colleagues at STAT have set out to take a look at the conflicts of interest that are embedded within its business empire.

It’s become very clear through our reporting there is a tremendous amount of angst among both doctors and patients about the difficulties they encounter in dealing with its bureaucracy. Because United owns the insurer and the provider, they’re able to bend clinical practices in ways that harm patients and providers while benefiting financially themselves.

UnitedHealth may be too big, and the government has been looking to break it up

Ross: The Department of Justice just sued to block its acquisition of a home health care provider. The company on that front is under an awful lot of scrutiny. The anti-trust investigator who’s in charge of that division within the Department of Justice, just gave a speech at Carnegie Mellon where he laid out a lot of the concerns that have unfolded from an economic perspective about the consolidation that’s occurred in the marketplace, particularly relating to UnitedHealth strategy, which is known as vertical integration, where you buy companies in adjacent markets to yours so that you’re controlling both sides of multiple transactions. And it’s just become a huge source of concern for economists and for government investigators.

Senator Elizabeth Warren ‘was not wrong’ in saying ‘you can only push people so far, and then they start to take matters into their own hands’

Saini: Her comments are directionally right in the broadest sense. This guy [Luigi Mangione, accused of killing Thompson] did what he did, and I’m not going to absolve him for his crime because somehow there was some injustice. But she’s not wrong that in a society where avenues for reform are closed down, when the ability to appeal to a human being is transferred to an interactive voice system that drives you crazy, it will boil over. The general trend of dissatisfaction, irritability, lack of an outlet or an ability to appeal to all these things in the mix. So in that sense, when Warren says you can only push people so far, she’s not wrong.

Health care is becoming too expensive, but people are sicker and the treatments are better

Ross: There’s so much more medicine can now do for you in terms of the interventions, medications, procedures, surgeries, and it’s gotten so expensive and people are so sick. There’s just so much collision happening between people needing care, the care being so expensive and capable of helping people. But that results in these really huge costs. And it’s a really complex problem, and it’s going to take a lot of really hard work by smart people to begin to make this better.

The US is a ‘complete outlier’ in terms of health care costs and outcomes

Saini: The US is a complete outlier. If you want to make America healthy again, there’s a lot of things that do need to get rebalanced and shifted. Certainly, there are a lot of things related to prevention and nutrition, but primarily a rebalancing of the delivery system, which means more primary care. If there were organized efforts to rebalance where care is delivered, how it’s delivered, by whom it’s delivered, and if people were engaged in that in their own communities, I think that would have a much bigger impact.

Will health care companies change because of Thompson’s killing?

Ross: There was a very interesting op-ed published by The New York Times, and it was written by Andrew Witty, who’s the CEO of UnitedHealth Group [parent company of UnitedHealthcare] after this murder. And there was some acknowledgment that we know the health care system doesn’t work. It’s not as good as it needs to be for people. There are parts of it that could be better, and we’re responsible for some of those things.

Saini: This murder is kind of a punctuation mark. I don’t know what this guy’s motivations were or what he was thinking. It’s kind of lunatic, it’s kind of a form of terrorism. And nothing is justified — no matter what he thought. The real conversation should be about what we are talking about, which is the mass sentiment around what happened. That mass sentiment has been there and is going to continue to be there. And in that sense, this is a moment for people to try to step up and address it.