The assassination of UnitedHealthcare CEO Brian Thompson – and the unexpected support for his suspected killer Luigi Mangione – have provoked a long-overdue media focus on why people in the US are so angry at the health insurance industry.

One reason is an industrial scale denial of care. Millions of Americans have had the gut-wrenching experience of turning to their insurer in times of medical need only to be told that they are not covered – heaping acute financial stress on top of serious health problems.

In a macabre development, these life-wrecking decisions are increasingly automated. In recent years insurers have started using Artificial Intelligence (AI) programmes to cut off funding and send patients home, even when health staff object. According to a US Senate report published in October, from 2020 to 2022, UnitedHealthcare more than doubled the rate at which care is denied at the same time as it introduced an algorithmic tool to manage claims.

Meanwhile in the UK, AI forms a key plank of the government’s health policy with Labour intending to “unleash” it on the nation. This includes unlocking public data to help fuel the growth of AI businesses, and allowing companies to use anonymised patient data to develop new treatments, drugs and diagnostic tools. The emphasis is almost entirely on potential benefits with little attention to the many inherent risks.

Looking at AI’s application in US health systems gives plenty of cause for alarm. Four years ago, UnitedHealth’s fully owned subsidiary Optum bought NaviHealth, the firm behind the AI model “nH Predict”. The algorithm was designed to save money by predicting the date when patients would be ready for discharge, by comparing them to a database with 6 million care records.

UnitedHealth Group has repeatedly said that its algorithm is used as a mere guide. But former staff have claimed that it was used to set stringent targets and that deviating from the targets – for instance by insisting that a patient actually needs to stay in hospital for longer – led to being disciplined and possibly even fired.

An investigation by US healthcare website STAT found horrific stories of the harm this caused: A stroke patient allotted 20 days of rehab by the algorithm, when the average for severely impaired stroke patients is almost double that; a 78-year-old legally blind man who needed care for a failing heart and kidneys, and then fell in the nursing home, granted 16 days; an elderly man nearing his discharge date after knee surgery told to learn how to “butt bump” up and down stairs.

It should be a matter of concern, then, that United Health Group, the company at the heart of the AI scandal in the US, is deeply embedded in the NHS. Its wholly owned subsidiary Optum is paid by almost every Integrated Care Board for medicines management, primary care patient records or both, after its £1.2bn buyout of IT firm EMIS (Egton Medical Information Systems) was approved by the Competition and Markets Authority in 2023.

Concerningly, UnitedHealthcare’s subsidiaries are in the running to win contracts to provide the same services for the NHS that they have been criticised for in the US. The AI scandal happening in the US concerns insurers’ decisions that a patient’s care should end on a particular date. Here, Optum was accredited by NHS England to bid for contracts on that very subject – the  “provision of systems and solutions to automate the orchestration of pathways of care (including utilisation of AI)”.

Optum also acts as a pharmacy benefits manager or PBM in the US, deciding which drugs are eligible for Medicare and other state insurance schemes, and setting prices. In September 2024 the US Federal Trade Commission announced that it would sue Optum and two other PBMs for artificially inflating Insulin drug prices. The FTC acted after a series of individual states including California and Arkansas launched their own actions. In 2022 Arkansas sued the same firms, alleging a conspiracy to artificially inflate the price of Insulins. In the UK, Optum provides medicines management and prescription services.

Why would the UK government want to turn a blind eye to the activities of the biggest US health firm and its wholly-owned subsidiary? One possible reason is the depth of Labour’s commitment to a digital future for the NHS. Labour is banking on AI to rescue the NHS and the economy. In December, NHS England revealed that AI models will be trained on NHS data using the Federated Data Platform, supplied by notorious US spy-firm Palantir. The Data (Use and Access) Bill now passing through Parliament aims to weaken data safeguards, give private companies increased access to our health data, and reduce restrictions on AI-driven Automated Decision Making.

Labour’s commitment has history. Former Labour health secretary Alan Milburn – a pioneer of private sector involvement in the NHS under Tony Blair who then became a private healthcare lobbyist – now chairs the board of the department of health and social care.

Health secretary Wes Streeting is evangelical about AI’s potential and private involvement in the NHS. This may have some connection to the fact that 60% of donors to Streeting since he became an MP have links to private healthcare. He was also formerly Vice-Chair of the All Party Parliamentary Group on the “Fourth Industrial Revolution” – a term coined by Klaus Schwab of the World Economic Foundation to cover a diverse range of new technologies including AI.

The NHS has already introduced several aspects of care denying Accountable Care models developed and promoted in the US by UnitedHealth and other insurers. This is no coincidence. From 2014 to 2021, the CEO of NHS England was Lord Stevens, who was previously an executive at UnitedHealth.

While new technologies may indeed have the potential to deliver benefits for NHS patients, Labour seems determined to overlook the destructive activities of companies like UnitedHealth which are cause for alarm. But if the future of the NHS lies in part on new data-driven technologies, as Labour suggests, it must address the power of these companies head on.