Gunshots warn of anger rising underneath healthcare system

The murder of Brian Thompson, a 50-year-old father of two, was a holiday season reminder of a simmering anger in this deeply divided country, which could grow much hotter.

When he was running for president for the first time in 2016, Donald Trump boasted that he could stand in the middle of 5th Avenue and shoot somebody and not lose any of his voters. There was a similarly jolting response to last week’s shooting in Midtown Manhattan, but it was about who got shot, not who did the shooting.

Thompson was the CEO of the nation’s largest healthcare insurer, United Healthcare. His caught-on-camera shooting touched off a torrent, not of sympathy or the usual outrage over a public homicide, but bitter anger at the practices of the company he headed. Social media filled with stories of claims unfairly denied, leaving families destitute. The shooter became something of a folk hero.

By the following day, the announcement of Thompson’s death on the United Healthcare website had drawn more than 40,000 “laugh” emojis. Less than a week afterward, at least four different songs titled “Deny, Defend, Depose” have popped up on YouTube, and t-shirts and hoodies with the words are being sold online. Those are the words found scrawled on shell casings at the crime scene in what might be a reference to the title of a 2020 book by Jay Feinman about insurance company practices, “Delay, Deny, Defend.”

All this has generated a counterwave of alarm over the overall callousness of the response to Thompson’s public assassination and the possible threat to other executives. Some health insurers have removed executives’ photos from their websites and changed upcoming meetings to remote. 

As CEO at United Healthcare, Thompson was able to drive profit margins up dramatically, partly through the rapid implementation of artificial intelligence in the processing of claims. Between 2020 and 2022, the company more than doubled the rate at which it denied claims following hospital stays for rehab centers or home nursing services.

In October, a Senate subcommittee released a report sharply critical of United Healthcare and other insurers who have used the rules “to protect billions in profits while forcing vulnerable patients into impossible choices.” Until a day or so after Thompson’s murder, however, Wall Street remained impervious to these impossible choices. Shares of United Healthcare and other insurers dropped by the end of the week after the shooting, but market analysts were calling the dip a buying opportunity. In other words, the financial mechanics of the insurance industry aren’t going to change due to the murder of a CEO, no matter how unsettling that might be.

In a video message, Andrew Witty, CEO of United Health Group, United Healthcare’s parent company, urged employees to tune out the online criticism and praised their role in the healthcare system.

“We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable,” Witty said.

During the last presidential campaign, Trump repeated his intention to terminate the Affordable Care Act, saying he had “concepts of a plan” to replace it with. The reaction to Thompson’s murder is an indication of how volatile such a change in federal policy could be. While Americans have a lot of complaints about their insurers, approval for the ACA has increased steadily since its passage during the Obama administration.

With Robert Kennedy Jr. in line to lead Health and Human Services, a lot of healthcare issues that might have seemed long settled could also come into play, adding to the uncertainties that might fuel discontent over issues many Americans are deeply concerned about. Then there are the massive cuts in Medicare and Medicaid envisioned by Elon Musk and Vivek Ramaswamy’s cost-cutting project.

The unanticipated reaction to Thompson’s shooting also serves as a wider warning that populist brushfires can flare up along unexpected lines. Once lit, fires can spread.