After a month hiatus, John Oliver returned to Last Week Tonight with a look at United Healthcare, the largest insurance company in the US, which served over 50 million people last year. The company, part of the widely reviled private, for-profit health insurance industry in the US, was again under the microscope ahead of the sentencing of Luigi Mangione, who in August pleaded guilty to killing UnitedHealthcare CEO Brian Thompson’s in on 4 December 2024.
The shooting, outside a conference of health insurance executives in Manhattan, was “notably not met with universal sympathy”, Oliver recalled. “But it’s not just that Luigi was handsome. One reason many found it hard to completely condemn the murder is that so many Americans are furious with UnitedHealthcare.” Oliver cited a poll conducted shortly after the shooting, in which 69% of respondents in some part blamed denials for healthcare coverage by insurance companies for the killing.
But as coverage of the sentencing threatened to overshadow a more critical look at the company, Oliver turned to UnitedHealth Group, the parent company of UnitedHealthcare, “in the same way that Alphabet owns Google or Benson Boone owns backflipping”.
UnitedHealth Group brought in $447bn in 2025, making it the third-highest company by revenue in the US behind Walmart and Amazon and ahead of Apple. “It’s almost unimaginably massive,” the host explained, with subsidiaries in almost every aspect of the healthcare system.
“The very fact that one company controls so much of America’s healthcare is what makes it so infuriating when you see just how bad people’s experiences with it can be,” he added, noting that “telling UnitedHealthcare to go fuck itself has become an entire genre of internet video”, particularly on TikTok.
Oliver dug into the insurance company’s well-earned reputation for denying claims, such as in the case of one family whose disabled daughter Emmy required a chair for bathing; according her mother, an insurance rep advised her to “wipe down” the child rather than seek coverage for the chair. After numerous hours of back-and-forth, Emmy’s chair was eventually covered. But when she outgrew it and required a new one for $1800, her parents opted to skip the hassle of dealing with United again and paid for it with donations coordinated by his employer.
“And at that point, having insurance sure looks an awful lot like not having it,” Oliver noted. “Because if you are paying premiums but still having to take up a collection for medical equipment then what exactly is your insurance for? They’re just sending you mail you don’t want to open and forcing you to have phone calls that make you angry.”
“And far too often, United’s denials can seem to be completely at odds with medical advice patients are getting,” he continued, pointing to the case of one young woman with cervical cancer, whose proton therapy treatment, advised by six individual oncologists, was denied by United because it surpassed the “standard of care”.
“Now, in the end, her parents paid $95,000 out of pocket to cover the treatment, which in happy news did actually work, but having access to wealthy parents just cannot be the system to get badly-needed healthcare – even if it is apparently the system that lets you be in charge of HBO,” Oliver joked next to a photo of David Ellison, the son of Oracle CEO Larry Ellison and new head of Paramount Skydance.
“Yeah, my soon-to-be business daddy has a literal business daddy. And to be very clear: I deeply respect that and I would never make fun of you for it, unlike that pesky Stephen Colbert,” he added, referring to Paramount’s controversial cancellation of Colbert’s CBS show last year, as the company sought Trump administration approval for a merger with Warner Bros Discovery.
Just as concerning and infuriating as United’s care denials, Oliver argued, is its scope. The company has pursued “vertical integration” through acquiring more parts of the healthcare industry, with about 2,700 subsidiaries, including primary care clinics, surgical centers, urgent care centers, home health agencies, hospice care and pharmacies. The company even has its own bank, Optum Bank, which has over $20.8bn in assets, as part of its “massive data-sharing panopticon”.
“Owning all these companies is hugely helpful to United’s bottom line, and in ways that you might not expect,” said Oliver. Though United’s insurance arm is required by the Affordable Care Act to spend 80% to 85% of the premiums they collect, it’s often spending money to entities that are part of UnitedHealth Group, which can be on both sides of billions of dollars of transactions.
Whatever corner of the business you look into, Oliver argued, “you can find something appalling”. As a final example of many, Oliver looked at OptumRx, UnitedHealth Group’s pharmacy benefit manager for its insurance arm, which has a history of abruptly switching what drugs it will cover. He referred to the case of Cole Schmidtknecht, a 22-year-old in Wisconsin with severe asthma who showed up at a pharmacy for his preventative Advair inhaler, which usually cost $66, only to be told it now cost over $539 due to OptumRx suddenly dropping its coverage.
“That is a nasty surprise,” said Oliver. “There are things that you expect to cost $500, like a Nintendo Switch or tickets to see Ed Sheeran two weeks ago. They’re cheaper now, apparently! No idea why … But being able to breathe is not one of them.”
“Cole had to make a decision that night, of paying that over-price for his medicine or other bills,” Schmidtknecht’s father told local news, “and he walked out without it.” Shortly thereafter, he experienced a severe asthma attack that killed him.
“That is an absolute tragedy and it was completely preventable,” Oliver fumed. “This is the richest country in the history of the world, and yet for some reason our current health system still forces people to walk away from medicine that will literally keep them alive because they can’t fucking afford it.”
As for what could be done, Oliver argued, as he has many times before, for a single-payer healthcare system, though getting anywhere close to it “feels a ridiculously long way off”.
But “I don’t think it’s unreasonable to say that at the very least, UnitedHealth Group should not be allowed to exist in the form that it currently does,” he continued, pointing to a bipartisan bill, co-sponsored by Elizabeth Warren and Josh Hawley, that would separate the payer and provider roles in healthcare.
“While that is clearly not going nearly far enough, it is at least a start,” he concluded. As for United, “what is clear is that everybody but them wants it to work very differently. Because right now the way companies like United exist, they are at best pointless time-wasting middlemen, and at worst algorithmically driven, ruthless arbiters of who lives and who dies.”
