Last week, news sites were full of articles and videos covering the story of United Healthcare CEO Brian Thompson who was murdered in the street, outside a hotel in Midtown Manhattan. An awful event for sure, but what's been really notable is both the way in which this crime has been reported, versus other similar crimes and the way in which the public have received the news about the killing. I've been pondering the event this week and thought it might be an interesting topic for a blog.
I should start out by highlighting that Brian Thompson's murder, like any murder, was awful. He left behind a wife and two sons and they will have to live without a husband and father. As interesting as I find the debate around this topic, it's important not to lose sight of the fact that someone had their life taken and there are knock-on effects. I do not condone this act, nor would I want to be mistaken as someone who does.
Now that we've got that out of the way, there are a couple of things which stood out to me as notable, not in relation to the event itself, but in relation to the way in which the event has been reported and discussed. Firstly, there were multiple murders in Manhattan in the same timeframe, but I've not yet come across the name or details of any of the victims of these on any mainstream news site. In addition, it is estimated that there are between 44 and 55 murders every day in the USA. The killing of Brian Thompson received widespread coverage, presumably because he is a CEO of a major company and therefore viewed as a public figure, but he was far from a household name. How many people (particularly outside of the USA) had never even heard of United Healthcare, let alone it's CEO, before this event? I was certainly in that category. And yet he's considered prominent by the press, purely because of the job title he held.
For some reason, white collar crime or crime involving white collar workers is dealt with very differently in the press, to other crimes. What is it that makes the life of Brian Thompson more valuable or noteworthy than the lives of the many other people killed that same day or week? We're over a week on from the event and it's still receiving significant coverage. A suspect has been arrested and now the focus turns to that individual. Who are they? What is their background? What is their motive? It's a murder like any other, but it's given much greater significance by the press. I find that very interesting.
The second element that's been on my mind, has been the backlash against Thompson and his company since his killing. It's no exaggeration to say that in some quarters, his killer has been lionised. The murder has been held up as a symbolic act of normal citizens fighting back against the power and corruption of an industry which is viewed as predatory. Frustrations with high healthcare costs, along with the high numbers of denied claims have led to building resentment against these companies, particularly United Healthcare.
For many of us outside of the USA, health insurance is a concept we're not that close to, because we get our health care via nationalised health services where we pay through our taxes and not at the point of care. But I have lots of friends in America, who speak of high premiums, worries about their children being able to afford health insurance once they're too old to be covered on their parents plans, and concerns about meeting the individual cost (the co-pay in US terminology, like the excess in the UK, when you claim on home or car insurance) of any needed care.
When insured persons have a need for medical care in the USA, they claim for the costs of this against their medical insurers, to whom they typically pay a monthly fee. Sometimes this coverage is provided as a perk through employment but for many, they pay directly out of their pockets. This typically costs between $400-$900 per month, depending on state and provider. Medical insurance providers, such as United Healthcare, then assess the claim and decide whether to pay out. Brian Thompson's company were known for having the highest number of denied claims, refusing to pay out 33% of the time! That means that one third of the insurance claims that paying customers make against United Healthcare are turned down, leaving the patients to foot the bill themselves or to forego the treatment. Some of these denials are as a result of the treatments being experimental, others based on the treatments or ailments not being covered by the policy but many are denied based on administrative errors, such as mistakes in paperwork, not getting pre-authorisation or missing deadlines.
This situation has put them squarely in the spotlight of critics, in the wake of Brian Thompson's shooting and led many to speculate that it is their business practices which formed the motive. United Healthcare posted net income in the pre-pandemic year of 2019 of $13.8bn, rising steadily through the pandemic era (where hospital care was harder to come by due to restrictions) to $24bn in 2023 and back down to $14.3bn in 2024 after they experienced a cyber attack. They are viewed, along with others in their industry, as price-gouging at the front end (taking as much in insurance premiums as they can, from their consumers) and refusing to pay out at the back end, focussing on their profit margins over the care of the patients who need them.
I studied Moral Philosophy at University as an elective course for the first couple of years of my degree and one discussion I remember well was known as the relative moral weight of acts and omissions. The debate involves the comparison of an action and an inaction, both of which have the same consequence. So, for example, the act might be to push a friend into a river, which results in that person drowning. And the inaction might be to see a friend in a river, in distress, but decide not to do anything, resulting in that person drowning. The outcome in both of these situations is the same - someone has drowned. However different schools of thought will weigh these two things against one another differently. Under most legal systems, the act is punished more severely than the omission. Deontologists tend to agree and argue that moral rules prohibit acts more strictly than they require helpful acts. Other viewpoints, such as a Utilitarian stance do not make such a distinction and measure the two based on their outcome. In both cases there has been a death, therefore they are equal.
This line of reasoning has been invoked in relation to the killing of Brian Thompson. His company's denial of care will undoubtably have led to deaths, either directly due to care that individuals simply didn't get because they couldn't afford to pay for it themselves or because of the conditions caused from poverty, when patients have paid out of pocket and ended up in significant financial trouble as a result. There's no specific measure of the number of deaths caused by insurance providers denying cover, but studies estimate that the lack of health insurance in the United States contributes to between 20,000 and 45,000 deaths annually and so the number is certainly going to be more than zero. In addition, 530,000 families in the USA each year go bankrupt as a result of healthcare costs - a staggering 66.5% of all bankruptcies in America! A study from Northwestern University highlighted that a sudden loss of 75% or more of a person's wealth is associated with a 50% increased risk of mortality over the following 20 years, due to the combined effects of stress, depression, and reduced access to healthcare resources. All of this data strongly suggests that there will be many cases each year where denial of insurance claims by United Healthcare has lead to unnecessary death.
Now I'm not for a second suggesting that these deaths due to denied care are justification for the murder of it's CEO, but there are no shortage of people right now who do believe that. There is no doubt in my mind that there will have been cases where United Healthcare will have denied cover to individuals who have diligently paid their monthly premiums and whose needs SHOULD have been met by their provider. And there is also no doubt in my mind that the individuals who run United Healthcare, all the way from first line managers, right up to their CEO, will be aware of such cases. And there is ALSO no doubt in my mind that some of those leaders within the organisation will have had the chance to do something about situations like these, but will have chosen not to act, opting to toe the corporate line and focus on organisational profits ahead of patient care. That is the nature of any large corporation, despite what they might choose to tell us in their CSR reports and vision and values statements.
United Healthcare's stated mission is to help people live healthier lives and to improve the health system for everyone. They emphasise this commitment by focusing on improving access, affordability, outcomes, and experiences for its members.
Its vision aligns with creating a modern, high-performing health system that supports healthier communities. The company's core values include:
Integrity: Upholding high ethical standards in all actions.
Compassion: Empathy and care for the needs of people.
Relationships: Building trust with members, providers, and communities.
Innovation: Constantly seeking better ways to serve customers.
Performance: Delivering on commitments and driving measurable health improvements.
How much of that sounds like the vision, mission and values of the organisation that YOU work for? I've certainly seen similar where I've worked. But how much of sentiment has been borne out by the actions of United Healthcare? Is denying 33% of all claims (more than any other provider in the US) a great example of compassion and empathy? Is that driving measurable health improvements? Is it helping people to live healthier lives?
And in light of that, is it any wonder that some people see the murder of the CEO as a some sort of penance for the sins of the company? If you'd lost a loved one because they'd been denied care by a company whose CEO had a compensation package of over $10m last year, paid for in part by the insurance premiums that your mother, father, husband, wife or child had paid, for insurance cover which didn't help them when they finally called upon it, how much compassion and empathy would you have when you picked up a newspaper and saw that the company's CEO had been killed? Again, I'm not condoning the murder. That is inexcusable and should not be glorified. However, I am able to empathise with those in this situation, who feel the pain of loss, coupled with the pain of injustice that their loved one died unnecessarily because they were let down by a company they put their faith in and paid their money to.
Compassion and empathy are important in a civilised society and companies should not feel that they're exempt from displaying them, nor should their leaders accept the company paying lip service to these values. Don't just talk about it - be about it.
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