In Fair Verona We Set Our Scene…
Here we go again.
Again the news world has exploded with a shocking headline crying horror and depravity, much to the delight of media outlets and opinion-hawkers everywhere. What happened? An angry young man named Luigi Mangione walked up to Brian Thompson, United Healthcare’s CEO, on a New York City street and shot him three times with a homemade pistol. Thompson died there on West 54th Street and Luigi fled the scene only to be picked up at a Pennsylvania McDonald’s 5 days later.
For context, the United States will experience about 14,000 intentional homicides in any given year. Most of these are gang and drug-related and confined to densely populated urban centers. Quiet a few are torrid crimes of passion, and these get true-crime documentaries on Netflix because they are much juicier than neglected young men killing each other over who gets to sell meth on a given street.
Mostly we ignore the murders. While the US murder rate (about 4.3/100,000) is higher than average for the G20, it’s still very low compared to most of the world. We have become accustomed to the meat-grinder created by generational poverty and a general malaise toward mental health care.
Every once in a while, though, we get an outlier. Brian Thompson was no inner-city gang-banger. He was not a meth-head or biker. He wasn’t even an abused spouse. He was a successful and wealthy businessman with a clean criminal record and a family life ripped right from a Hallmark movie about the American Dream. The Netflix documentary machine should have been firing on all cylinders but for one little wrinkle…
Zeitgeist
Many would argue that there is a bit of a, shall we say, disconnect between corporate America and 99% of the US population at the moment. COVID lockdowns and the subsequent economic shifts brought on by the pandemic exacerbated stewing financial time-bombs in housing, health care, and retail goods. The result has been a simmering financial strain on non-wealthy Americans that both politicians and business leaders have failed to account for with not-unpredictable results.
The economy has ever been a cyclical thing, but when times are hard our leaders are supposed to dig deep and be part of the solution. One can argue the merits of individual companies’ and their choices in the post-pandemic economy all day, but what is not arguable is the general public perception regarding those same leaders. (Hint: It’s not positive)
People are scared and angry because they see the rich getting richer while they get poorer. Brian Thompson was a wealthy man, and that alone put a target on his back. But there was another factor that makes his death even more palatable to the zeitgeist.
Thompson was in charge of a very large health insurance company. Healthcare in the US is a massive expense for the common person. The very structure of our privatized healthcare machine and the relationship between insurance companies and healthcare providers encourages price inflation on everything. The same MRI that costs $550.00 in Canada costs $15,000 here, for instance. For the most part, we are fine with that because insurance covers it. The companies negotiate the price downward after you get the bill, so that initial heart-stopper of a price is really just the provider giving the first number in what will ultimately become a haggling session. The customer never pays it anyway, right?
United Healthcare is a Bad Company
United Healthcare is universally known as one of the worst health insurance companies in the world. According to a 2022 audit of UHC records, UHC denied 32% of all claims made for healthcare by their customers. Let’s call it 1/3. One out of every three claims submitted to UHC in 2022 was denied. These are procedures and products that have already been ordered by doctors who have evaluated a patient and decided they needed a thing done. UHC decided that doctors were wrong at a rate of 32%. That is 2X the national average of 16% denial rate. Most of UHCs main competitors hover at 7-10% denial rate.
How did they make these determinations? How did those UHC people (who have never seen the patient and do not have MDs) decide that an item is not necessary? You’re going to love this: They used an algorithm. That is just a fancy way of saying they wrote a computer program to automatically reject claims based on criteria they have not made public. This is attractive to lots of insurance companies because you don’t have to pay humans to review claims, and you can tune the algorithm to reject whatever you want. There is no disincentive to denying claims, after all.
Most insurance companies use some level of algorithmic screening, but UHC took it to unprecedented levels. When they could not deny at any higher rate without legitimate legal risk, they found a new way to deny care. Just prior to the murder, UHC managed to piss off every hospital and provider in America with this little gem:
- In December, 2024, UHC unveiled a new process for provider claims that allowed them to deny any service it considers “routine.”
- This means that hospitals can no longer bill separately for care and products that UHC feels are part of the “room charge.” This targets medical equipment, surgical supplies, nursing care, and surgical rooms if UHC decides they are “routine.” This means that the hospital will have to eat those costs or otherwise pass them on to the patient. They won’t of course. The patients will simply stop receiving the care or supplies.
Except when they do have to pay it because the insurance rates get so high they can’t afford any coverage. Or in the case of UHC, when the insurance company decides that the MRI was unnecessary and refuses to pay for it.
Keep in mind, this is ON TOP of their already ludicrous rate of claims denial. Knowing they could not beat the ratepayer up anymore without risking serious lawsuits, UHC decided to force the hospitals and inpatient facilities to do it, too.
UHC has already come to its own defense, pointing out that all denials have an appeal process. I submit to you, dear reader, that if you have never tried to appeal an insurance denial, then you do not know true despair. The same algorithm that rejected your claim the first time will continue to do so, and algorithms don’t get tired or frustrated.
Deny, Defend, Depose.
Luigi Mangione allegedly inscribed these words onto the shell casings of the ammunition he used to kill Brian Thompson. This references a tell-all book by Jay Feinman about the tactics used by insurance companies to avoid paying claims. In short, if you make the process ponderous and expensive enough, people won’t be able to make an insurance company pay. It’s cheaper, and thus more profitable, to go to war against a few claims than it is to pay out all of them.
Brian Thompon understood this. As CEO, he helmed UHC to it’s current position as one of the worst, most predatory, and most profitable insurance companies in the world with these tactics. UHCs record-breaking profits (91 BILLION dollars in 2023) are a direct result of UHCs policies and procedures. Profit is directly connected to how little gets paid out in claims, after all. Under Johnson, those profits rose 28% between 2020 and 2023. Some of that can be attributed to people using healthcare less during lockdowns, but there were no lockdowns in 2023, when UHC profits rose 14.24% higher than 2022. UHC profits have levelled off in 2024, but that just means that Brian Thompson found UHC an extra TWENTY-THREE BILLION DOLLARS profit per year since the pandemic began.
Let’s do some math on that, shall we?
A 2009 Harvard study determined that roughly 45,000 Americans die each year as a result of denied medical claims. The National Institute of Health places the number at 26,000. In either case, Brian Thompson wasn’t just part of the machine that kills those people. He was the supreme leader of one of the worst offenders. If even 10% of those dead Americans were UHC customers, Brian’s reign as CEO caused the death of 6,500-13,500 people over three years. Let’s say 3,000 UHC customers per year DIED because they were denied care that they needed. That means that for every person UHC allows to die, they make 7.6 million dollars in profit. That’s what your death is worth to UHC, and that is a big, compelling number. Even if your family sues UHC, the average wrongful death award in these situations is one million dollars. Mathematically speaking, there is no reason to stop denying the claims. Sure, there’s human lives on the line, but how much is a human life worth when CEO’s need new mansions?
So when an angry young man inscribes those words onto bullet casings and murders the leader of a predatory corporate juggernaut indirectly responsible for the premature deaths of thousands, it can be hard to muster any shock, horror, or sympathy over it.
Are We Bad People?
America’s response to this crime has been fairly one-sided. With few exceptions, Luigi Mangione has not been reviled as the cruel assassin of a loving family man. By all accounts, Brian Thompson was a loving family man. He had no criminal record. He was not racist, or sexist, or any other form of socially unacceptable “-ist” that we know of. He did not kick puppies or write bad erotica. If you did not know about his job, you might like him very much.
Does that mean that the undeniable wave of schadenfreude washing over the nation makes us bad people? Social media is teeming with support for Mangione and derision for Thompson at the moment. People are simply delighted that a big healthcare CEO got gunned down in the street, and that does not feel like the reaction of an evolved society.
And it isn’t very evolved. We are supposed to be a nation of laws. Evolved societies do not settle their grievances with assassinations. In short: Of course murder is wrong and Mangione’s crime will be punished. Good news! Luigi Mangione is going to go to jail because he deliberately caused the death of another person. He woke up that morning, grabbed his weapon, and shot Thompson down in cold blood. He is a first-degree murderer, and he is going to prison. Prison is where murderers belong, right?
But what about Brian Thompson? Where does he belong?
Brian Thompson was never arrested for the deaths he helped cause. He never suffered any consequences for the reckless profiteering of UHC. Quite the opposite. He was rewarded with millions of dollars and the adulation of his peers for putting UHC profits well in front of human lives and misery.
And Brian Thompson chose that. As sure as Luigi Mangione chose to kill, Brian Thompson chose to Deny, Defend, and Depose his way to wealth and ease while thousands of people suffered and died. Thompson is not unique, of course. He is merely a convenient representative of the greater problem: Wealthy people can cause all the misery and pain they want to in the name of profit without consequence. They get to enjoy lives of ease and leisure while the rest of humanity struggles just to stay alive and get through the day. That is not a recipe for sympathy and it strains any person’s convictions toward law and order.
Does that mean Brian Thompson deserved to be murdered? That is a much tougher question; one that should not be answered too quickly or enthusiastically. However, if you find yourself struggling to feel bad about the murder, relax.
Thompson never felt bad about any of the people he helped kill, either.
