America’s Health-care Fury Isn’t Going Away

Two very ugly, uniquely American things happened yesterday: A health-care executive was shot dead, and because he was a health-care executive, people cheered.

UnitedHealthcare CEO Brian Thompson was murdered yesterday outside his hotel in Midtown Manhattan by an unknown assailant. In response, a post on X wishing that the murderer would never be caught racked up 95,000 likes. Social media was littered with jokes about Thompson’s pending hospital bills, and the tragedy of him not returning to his “mcmansion.” The mood was summed up by the journalist Ken Klippenstein, who posted a chart on X showing that UnitedHealthcare refuses to pay a larger percentage of users’ health-care bills than any other major insurer. “Today we remember the legacy of UnitedHealthcare CEO Brian Thompson,” he wrote.

There’s no excuse for cheering on murder. But Americans’ zeal for the death of an insurance executive demonstrates both the coarsening of public discourse and the degree of rage Americans feel over the deficiencies of the U.S. health-care system. Gallup polling shows that just 31 percent of Americans have a positive view of the health-care industry. Of the 25 industries that Gallup includes in its poll, only oil and gas, the federal government, and drug companies are more maligned.

America’s entire health-care system is designed in a way that makes some level of fury unavoidable. Although the governments of most wealthy industrialized countries provide all of their citizens some level of insurance, the majority of Americans rely entirely on the whims of private health insurers. The system is supposed to keep costs down enough to turn a profit. The insurance industry’s eagerness to save money by denying people care is a feature, not a bug, of this country’s system. Americans, in their anger toward Thompson and other health-care CEOs, are expressing frustration with a system that causes real and preventable harm. Those cheering Thompson’s death are arguing that taking away sick Americans’ pills or denying them needed surgeries is immoral and should be punished by death.

That logic is indefensible, but people do have a reason to be angry: Roughly half of Americans report difficulty paying for their health-care costs. A single denied insurance claim can force a patient into financial ruin, and health insurers have gotten more clever at finding ways to deny claims. Until Congress intervened in 2020, patients were frequently being saddled with unexpected medical bills for hospital visits all because the specific doctor on rotation, unbeknownst to them, was out of their insurance network. And even less egregious maneuvers, such as step therapy, which requires patients to try cheaper medications before insurers will pay for more expensive therapies, can delay treatment needed to stave off suffering.

UnitedHealthcare is particularly infamous for its aggressive use of these tactics. Reporters at the health publication Stat (where I worked until September) spent the past year documenting the myriad ways UnitedHealthcare has extracted profits at the cost of patients’ lives. They found, for example, that the company has used AI algorithms to justify kicking elderly patients out of nursing homes, despite evidence that some of those patients still needed round-the-clock care. Doctors who worked for United (which has also been buying doctors’ offices) told Stat that the company applied pressure to see more patients and diagnose them with additional conditions, presumably to increase the company’s profits. United has also faced lawsuits from patients and from the federal government regarding its aggressive business tactics. (United has refuted the claim that it relied solely on AI to deny care, and has said in response to Stat’s reporting that it trusts its doctors to “make independent clinical decisions.”)

But the issue is the health-insurance system, not the CEOs. As long as the majority of health insurance in America is run as a private enterprise, it will work according to this logic. UnitedHealthcare’s aggressiveness is exactly the reason its parent company is now the largest health insurer in America. It has undeniably been successful in its primary business goal to deliver profits for its shareholders.

Compassion and capitalism can coexist, and this country has operated on the premise that the government’s job is to mediate between companies’ profit-making and citizens’ unassailable needs. Insuring people with high-cost conditions wouldn’t comport with thinking merely in terms of profit, which is why it took the Affordable Care Act to require companies such as UnitedHealthcare to insure people with preexisting conditions. The recourse that unsatisfied Americans are supposed to have is to either switch insurers or elect politicians who will reform the current system. The ugly reaction to Thompson’s death shows how many people clearly feel that neither of those options is serving the country’s true needs.

The identity and motivation of Thompson’s killer are still unknown. His death could have nothing to do with the U.S. health-care system. (Though shell casings reportedly found at the scene, and inscribed with the words deny, defend, and depose, seem to suggest otherwise.) Even if the killer targeted Thompson for a reason unrelated to his job, the act has laid bare that Americans are so angry about their health care, they would publicly celebrate a man’s death. Cheering on a vigilante may be cathartic for those who are fed up with the rot of America’s current health-care system, but it won’t fix a thing.