The Brief

One year after UnitedHealthcare's CEO was shot and killed, the crisis in U.S. health care has gotten even worse — in ways both obvious and hidden.

People increasingly can't afford health insurance. The costs of both Obamacare and employer-sponsored insurance plans are set to skyrocket next year, in a country where health care is already the most expensive in the developed world.

Yet even as costs surge, the companies and the investors who profit from this business are also struggling financially. Shares in UnitedHealth Group, the giant conglomerate that owns UnitedHealthcare and that plays a key role in the larger stock market, have plunged 44% from a year earlier. (It was even worse before a rally in UnitedHealth shares on Wednesday.)

"UnitedHealth's reputation in the investment community, before December 4 last year, was [as] a safe place to put your money. And that basically got all blown up," says Julie Utterback, a senior equity analyst who covers health care companies for Morningstar.

Then, on Dec. 4, 2024, UnitedHealthcare CEO Brian Thompson was shot on a Manhattan street on his way to an investor event. The shocking act of violence sparked a widespread consumer outcry over U.S. health care costs and denied claims, and plunged UnitedHealth Group into a public relations disaster.

But that was only the start of the business woes for the company and its entire industry — which are facing regulatory scrutiny, tightening margins, and investor skepticism. Many of UnitedHealth's top competitors have also seen their shares suffer in the past year, at a time when the stock market in general has been hitting tech-driven record highs. The S&P 500's healthcare index has lagged the larger market. And some Wall Street analysts are bracing for another rocky year in the business of health care.

"Near term, there's a lot more volatility to come," says Michael Ha, a senior equity research analyst who covers health care companies for investment bank Baird.

Dec. 4 started to reveal the depth of U.S. health care problems

This wide-ranging crisis for both consumers and businesses underlines the brokenness of the U.S. health care system: When neither the people it's supposed to serve nor the people making money from it are happy, does it work at all?

"We're really at an inflection point," says Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation and the author of a book about the insurance industry.

"Every segment of the health insurance business right now is stressed," she adds.

These stresses became brutally visible a year ago — and persist today. Luigi Mangione, the 27-year-old suspect in Thompson's killing, was in court this week for hearings ahead of his trial.

But the crisis in U.S. health care is much bigger than his case. Here are three main ways it's playing out this year, from Main Street to Wall Street.

Prices are going up — and people are getting ready to go without medical care

No matter how you get your health insurance, it will likely cost more next year.

For the roughly 24 million people who get their insurance through the government's health care exchanges, Affordable Care Act subsidies are set to expire at the end of the year — sending premiums soaring. Another 154 million people are insured through their employers — and premiums for those plans are also set to skyrocket.

Costs are increasing for several reasons: Drug companies have developed more effective cancer treatments and weight-loss drugs, which they can charge more for. More people are going back to the doctor after the pandemic kept them away, which is creating more demand and allowing providers and hospitals to increase prices. And some hospitals, doctors' offices, insurance companies and other businesses within the health care system have merged or consolidated, often allowing the remaining businesses to raise prices for their services.

The end result is that nearly half of U.S. adults expect they won't be able to afford necessary health care next year, according to a Gallup poll published last month.

Jennifer Blazis and her family are among them.

"It just always blows me away, how much I have to consider cost when something happens with the kids," the 44-year-old nonprofit worker and mother of four told NPR this fall in an interview for its Cost of Living series.

Blazis and her family live in Colorado Springs and get their insurance through her husband's small property-management business. She says she's postponing leg surgery that would address a condition that's causing her pain, but which her doctors say is not yet urgent.

"We wait to go to the doctor because we know if we do, we're going to get hit with just a massive bill," Blazis says. "And this is with … a really good health insurance plan that our [family] company pays a ton of money for."

Yet even the biggest businesses selling these services are struggling

Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem.

UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It's one of the largest companies in the world, and it's involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill.

It's also one of the most influential stocks on Wall Street. UnitedHealth Group is one of 30 companies that makes up the blue-chip Dow Jones Industrial Average — so what happens with its shares helps determine what happens with the overall stock market.

The company has had a miserable year on both fronts. The reasons come down to profits, more than PR: UnitedHealth and its competitors have been facing rising costs in the Medicare Advantage businesses that allow private insurers to collect government payments for managing the care of seniors.

These programs were once widely seen as moneymakers for big health insurers, but now they've gotten UnitedHealth embroiled in financial and regulatory trouble, including a Department of Justice investigation into its Medicare business. The company abruptly replaced its CEO in May, a few months before it acknowledged that it was facing the government probe.

Now UnitedHealth is trying to get rid of about 1 million Medicare Advantage patients — and otherwise move on from the past year's many problems.

"We want to show that we can get back to the swagger the company once had," Wayne DeVeydt, UnitedHealth's chief financial officer, told investors last month.

One prominent investor is betting it can: In August, Warren Buffett's Berkshire Hathaway disclosed that it had bought more than 5 million shares in UnitedHealth Group. The news helped lift the stock from its depths — but it still has a long way to go for both its share price and its profits to recover from this year's slump.

Chief Executive Stephen Hemsley acknowledged as much in October, promising investors "higher and sustainable, double-digit growth beginning in 2027 and advancing from there."

Spokespeople for UnitedHealth declined to comment for this story.

Wall Street used to think health care was safe. It's waiting for a turnaround

Health care spending accounts for about a fifth of the U.S. economy, making the for-profit companies that earn this money some of the most powerful in the world.

That's helped their appeal to investors, who traditionally tend to consider health care stocks "defensive," or safe, investments. That appeal sometimes overrides the industry's current financial challenges: In the past month, as Wall Street had its now-quarterly panic over the artificial intelligence bubble, health care stocks actually outperformed the broader market for a few weeks.

Still, health care is massively lagging the market in the long term.

Morningstar's Utterback is optimistic that the industry can eventually turn around its deeper financial, regulatory and reputational problems. She even calls most health care stocks "undervalued" currently — but she warns that investors will have to have a lot of patience if they want to see bets on the sector pay off.

"My explicit forecast period is 10 years. It's not three," she says. "There's a murky outlook here for the next couple years, at least."

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A federal appeals court has upheld a court order requiring the Department of Veterans Affairs to build more than 2,500 housing units on its West Los Angeles campus.

The U.S. Ninth Circuit Court of Appeals on Tuesday ordered the VA to construct 750 temporary units for veterans within 18 months and 1,800 permanent housing units within six years.

The ruling found the agency had “strayed from its mission” by leasing land to commercial interests like a UCLA baseball field and Brentwood School sports complex, instead of caring for veterans.

“There are now scores of unhoused veterans trying to survive in and around the greater Los Angeles area despite the acres of land deeded to the VA for their care,” Judge Ana de Alba wrote in the opinion.

Attorneys for the plaintiffs in the Powers v. McDonough case say the ruling could end veteran homelessness in the Los Angeles region, which is home to more than 3,000 unhoused veterans, according to official estimates.

"It's the most important ruling in the history of this country concerning the rights of veterans," said Mark Rosenbaum, lead attorney with Public Counsel, during a press conference Wednesday. “After this case, there should be no such thing as a homeless veteran.”

The VA did not immediately respond to LAist’s request for comment on the ruling.

‘Long overdue’

The appeals court affirmed most of U.S. District Judge David O. Carter's 2024 ruling, which found the VA discriminated against disabled veterans by failing to provide adequate housing on the 388-acre property deeded as a soldiers' home back in 1888.

The main plaintiff named in the class-action lawsuit, Jeffrey Powers, lived in a tent outside the gates of the VA Medical Center.

At a press conference Wednesday, Powers told reporters this week’s appeals court ruling delivers “about 80%” of what he wanted.

“We got the most important thing, which was to get veterans off the street,” Powers said. “And for that, I'm happy with the outcome.”

The case stems from a 2015 settlement in which the VA promised to build 1,200 housing units, with more than 770 completed by 2022. The department missed that deadline, prompting the new lawsuit.

Iraq War veteran Rob Reynolds came to the West L.A. VA for PTSD treatment in 2018, met veterans sleeping on the streets outside and began advocating for them.

During Wednesday’s press event, he called this week’s Ninth Circuit ruling “long overdue.”

"There should never have been a lawsuit filed in the first place,” Reynolds said. “ They were using the property for everything but what it was intended for, and that's housing.”

The veteran plaintiffs argued that lack of on-campus housing prevented disabled veterans from accessing physical and mental health services at the facility.

As of late 2024, the VA said there were 307 veteran housing units open on the West L.A. campus and 461 units under construction.

Robert Reynolds (right), a veteran advocate with AMVETS, walks with Los Angeles County Sheriff Alex Villanueva as they tour the Veterans Row encampment along San Vicente Boulevard in November 2021.

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Commercial leases

The appeals court ruling invalidated most commercial leases on the property, including Brentwood School's 22-acre sports complex and an oil company's drilling license.

However, the court overturned the district court's previous invalidation of UCLA's lease for its baseball stadium. Rosenbaum said he plans to refile that portion of the case, which had been argued on different grounds.

Reynolds criticized local leaders for what he said was inaction at the West L.A. VA Campus. He said local officials’ personal connections to Brentwood School and UCLA played a role.

“ A lot of these special interest groups on the VA land have so much influence politically in Los Angeles,” he said. "That's why you've had a lot of our politicians remain quiet about this."

In May, President Donald Trump signed an executive order instructing the VA secretary to declare the West L.A. VA campus a national hub for homeless veterans and develop a plan to house 6,000 people there by 2028.

That housing goal is even more ambitious than the court order, but local advocates say they haven’t heard anything from the Trump administration since it was issued.

“They need to speak to the people that actually live on that property,” Reynolds said. “I'm hoping now that we have this Ninth Circuit ruling in, that we'll be able to have some more discussion with the administration and with the VA leadership to try to figure out what the next steps are.”

As a result of this week’s ruling, the case has been sent back to the District Court judge to implement the housing order and oversee construction

On a chilly December night in Sandy Spring, Md., dozens of people crammed into the Woodlawn Manor for a Victorian-era Yuletide dance lesson, the wood floors creaking under the uncertain steps of 21st-century people learning 19th-century English country dances.

"Every good party has dancing," said Angela Yau, a historical interpreter for the parks department who was teaching the dances — and the Victorians loved a good Yuletide shindig.

Angela Yau, a site manager for the Montgomery County parks department who also works in cultural and natural history interpretation, wears an 1840s-style dress while teaching Victorian dances to the room.

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The merriment was emblematic of how many think of Yule; today, it's synonymous with Christmas. But centuries ago, before crooners sang about carols being sung by a fire, Yule meant something different: a pagan mid-winter festival around the solstice, dating back to pre-Christian Germanic people.

It was particularly important to Scandinavian communities during that time of year, beset by late sunrises and early sunsets, according to Maren Johnson, a professor of Nordic studies at Luther College.

"All these kinds of winter traditions are tied very intricately into small communities," she said. "You develop between yourselves a folklore about this winter time and this period of darkness."

In this week's installment of "Word of the Week," we travel back in time to the origins of Yule festivals, and trace those earliest traditions to modern-day Christmas celebrations.

Feasting, drinking and animal sacrifices

Scholars of these early pagan festivals don't have much concrete evidence of what actually went on at them, according to Old Norse translator Jackson Crawford, because much of the written record comes much later from Christians. But what is clear, he said, was that feasting and drinking were abundant.

Terry Gunnell, a professor of folkloristics at the University of Iceland, agrees. Drinking copious amounts of ale was not only encouraged but required, he said, and animals were slaughtered as part of the sacrifices to gods and spirits typical of these early festivals.

"The snow is coming down the mountains and in a sense, the nature spirits are moving closer," he said — and people wanted to appease them.

And then, there was the oath-swearing. Crawford said this was one of the major hallmarks of early Yule celebrations as recorded in myths like The Saga of Hervör and Heidrek from the 13th century. In it, a man swears to the king of Sweden that he'll marry his daughter with no real prospects of doing so.

"But your oaths during Yule are kind of sacred, extra binding," he said. "So he has to try to fulfill it," even though he eventually gets killed.

Crawford thinks that this oath-swearing could be where the word "Yule" actually comes from. The earliest roots could come from Indo-European words for "speaking," he said, and then Germanic peoples came to use it for more judicial purposes like admitting, confessing or swearing.

There's other theories out there, though, the dominant one being that the word could come from the Old Norse word hjól, meaning "wheel" — as in the "wheel of the year" that keeps turning with the seasons, Gunnell said.

Yule gets co-opted into Christmas

Christianization of this part of Europe, however, changed how people celebrated Yule. The church began to align its own holidays with pagan celebrations, Gunnell said. Easter replaced the festival at the beginning of summer, for example, and St. John's Day replaced midsummer. "And then we hear in Icelandic source material that [Yule] was replaced with Christmas," he said.

"So what the church is really doing is to allow people to go on doing what they had done before, but now under a Christian name," he added.

Around the 900s, Crawford said, Scandinavians started saying "Yule" and "Christmas" interchangeably.

"I think it suggests that, fundamentally, both of them are basically parties," he said.

That's not to say that Christmas was the exact same as the Yule celebrations of old. There was a new emphasis, Gunnell said, not so much on winter spirits but "a period of joy with the birth of Christ." But much of the feasting and drinking spirit of Yule stuck around — and became Christmas traditions throughout much of Europe.

Fast forward to the Victorian era, where the spirit of merriment became embedded in English culture, thanks to two important cultural influencers: Prince Albert, who imported traditional Yuletide customs popular in his native Germany, and Queen Victoria.

The queen fell in love with the traditions, Yau of the parks department said. And since she was a fashion icon, "These Christmas traditions really spread from the royal couple out through England and out through the colonies and everywhere else." And, as cultural customs are wont to do, the traditions morphed — creating, among other things, Santa Claus.

Still making sacrifices — just sweeter

Although slaughtering animals to please winter spirits is perhaps less typical of modern Yuletide celebrations, the spirit of sacrifice still remains, according to Gunnell.

That's particularly true in Scandinavian Christmas folklore. People leave out porridge for nisse and tomte, small trickster spirits who live in local forests, around the winter solstice in hopes of placating them or receiving gifts. (Though these days, Johnson said, many Scandinavians also celebrate the Julenisse, more of a Santa Claus figure.)

In Iceland, there's not really a Santa Claus figure at all, Gunnell said. Instead, there's the "Christmas Men," also known as the Yule lads. As the stories have told it, the mystic men – with names like "Window Peeper," "Sausage Swiper," "Bowl Licker" and "Meat Hook" — come one by one down from the mountains by your community, play pranks and steal things from homes. (To be fair to them, they'll also leave presents in windows for children.) On top of that, they have an ogress mother, Grýla, who eats misbehaving children "like sushi for Christmas," Gunnell said.

And although he doesn't swipe sausages or eat children, Santa Claus is not a completely dissimilar figure.

"The idea of sacrifices remains in leaving out a little bit of sherry or whiskey for Santa Claus and some food for the reindeer," Gunnell said.

It's something to consider the next time you leave out cookies and milk.
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Carmen Peterson's son Ethan is a big fan of Elmo and Mickey Mouse Clubhouse. And although Ethan is nonverbal, he loves to sing along in his own way.

"He's a really fun-loving 8-year-old. He doesn't speak, but he gets his point across," Peterson says.

Ethan has a rare genetic disorder — Syngap1 — which, among other things, causes a kind of seizure that can make him drop to the ground without warning.

"Everything just kind of shorts out for a moment," Peterson says. "And the danger of that — and I've seen this — is him falling on hardwood floors, concrete, off of stairs, like all of these things."

She says he's gotten hurt and she's had to rush him to the emergency room.

Ethan takes a medicine called Epidiolex that prevents these seizures. But last holiday season, a thief stole it off the family's front porch in Charlotte, N.C.

Peterson remembers finding the empty box and then checking her Ring doorbell camera footage. "I see this guy walking off … and I am just livid," she says.

Then, she had to figure out how to get this medicine — worth $1,800 — replaced so her son didn't miss a dose. It turned out to be a challenge.

How many stolen packages?

December is a busy time for package deliveries and for porch pirates who steal them. Sometimes the thieves run off with mail-order medication instead of getting an iPad or a Labubu.

E-commerce took off during the pandemic, and December remains the busiest time of the year for package deliveries, according to the U.S. Postal Service.

Still, it can be tricky to get the whole picture when it comes to package theft.

As easy as it is to buy stuff online, getting it to customers is actually really complicated. That's because so many people and companies interact with a package before it's delivered, according to Ben Stickle, a professor of criminal justice administration at Middle Tennessee University.

"So it's really hard to get, you know, what happens from the point that you click a button to when it gets delivered, all put back together with enough detail to find out when and where these thefts are occurring and then actually do something about it," he says.

Stickle worked on a study with the Postal Service published earlier this year, and says that victims of theft wind up reporting it to different places that don't share information with each other or even necessarily record the missing package as "theft." And sometimes victims don't report it at all.

"There's a lot of packages stolen," he says, explaining that according to security research company SafeWise, it's about 250,000 packages every day. Stickle has worked with SafeWise.

The Postal Service report estimated that at least 58 million packages were stolen in 2024. "So what are the odds that one of those, unbeknownst to the thief, has some type of medication in it?" Nobody really knows for sure, he says.

Ways to lower theft risk

So what can you do? Stickle says scheduling deliveries for when you're home and having a delivery spot that's hidden are good ideas. Even a locker for your porch that doesn't lock is a good deterrent.

"If a thief can see that there's a package, even if it's an envelope on your porch from the roadway, it seems to be far more likely that it's going to be stolen," he says.

According to Express Scripts and Optum Rx, which are two companies that offer mail-order pharmacy services, medication theft is pretty rare.

CVS Caremark, another company that ships prescriptions by mail, said it offers customers package tracking to prevent theft, but didn't answer NPR's question about how common medication theft is.

Pharmacies, including Walgreens, say they offer order tracking and use discreet packaging to help prevent theft. Customers can also opt to require a signature when their medicines are delivered.

Making sure patients don't miss a dose is a top priority, says Stryker Awtry, the director of Loss Prevention and Transformation for Optum Pharmacy, part of Optum Rx.

"Especially during the holiday seasons when deliveries surge, we want to make sure we build in peace of mind for our customers," he says. "So if a theft were to happen, No. 1, contact the pharmacy right away."

He says to also report the theft to your prescribing doctor and local law enforcement.

A lost prescription replaced  

As for Carmen Peterson in North Carolina, when she called her insurer's pharmacy to get Ethan's medicine replaced, the answer was no. But Ethan missing a dose and having a seizure that put him in the emergency room again? Not an option for her.

"It's just like it's one of those things that you just don't have a choice," she says.

If forced to, she would have found the money to buy the medicine herself.

"It was just unfortunate that the … company was so ready and kind of willing to just wash their hands of it because they felt like they had done what they were contracted to do, which is deliver the medication."

That company, Liviniti Pharmacy, said it couldn't comment on the Peterson family's experience because of patient privacy laws.

Unwilling to give up, Peterson reported the theft everywhere and made noise about it — including on her local news stations. That worked. Jazz Pharmaceuticals, the company that makes the drug Ethan needs, saw the stories and replaced it for her within a week.

Now, she recommends getting important medicines delivered to a P.O. box, a workplace or just going to the pharmacy to pick it up yourself.

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