A few days ago, Brian Thompson, CEO of UnitedHealthcare, was murdered on the streets of Manhattan outside the New York Hilton, where a stockholders’ meeting was to take place. Some newspaper articles referred to it as an assassination. I’m not sure what the difference is, but I think assassinations usually target someone famous or important, and often have dramatic results (think WWI after the assassination of the Austrian Archduke, or JFK). Thompson may not have been particularly famous, but he was important, being in charge of one of the largest health insurers in the US and a leader in denying claims. Thompson himself is credited with instituting (he probably didn’t actively develop) a system using artificial intelligence (AI) to deny claims.
Most people, patients and physicians, don’t like having a claim for their medical treatment denied, whether by AI or a human being. In general, insurance companies denials are first done by a lower-level employee (or even, as at UnitedHealth, AI). Then if it is appealed by the patient or the physician (which it often, even usually is not, because it takes time; this is what the insurer counts on) it may go to a physician reviewer to decide. That physician does not necessarily have the expertise to make a medical decision regarding the treatment, and often doesn’t, but is strongly motivated by various insurance company practices to deny. These practices include pressure to review lots of cases, to deny a certain (high) percent, and bonuses for high denial rates, which have been well-described by many former physician reviewers (e.g. https://kevinmd.com/2021/10/for-doctors-leaving-clinical-practice-consider-utilization-review-jobs.html) and former health insurance executives like Wendell Potter.
The “principle” behind delaying and denying claims is that this makes them more money, so there are people who think it is good -- the owners and executives of insurance companies – if they can be assured that their privileged position means that it will not happen to them or to their families when they are sick. We read that the cartridges found from the assassination had words including “deny” and “delay” scratched on them; this is pretty good evidence that the killer was motivated by the same angry frustration that so many of us have, even if we would not commit murder. To be sure, Thompson – and his ilk, it is not just him, and he will be replaced by another heartless monster – were also murderers, killing hundreds or thousands by denying the care that their doctors said they needed. We imagine that if the killer is caught, we will find out that his child or spouse died as a result of such UnitedHealth action. It is, frankly, unconscionable and is a system that does not exist in other countries.
The almost unanimous reaction that people have had to the murder exposes the depth of the hatred we have of the health insurance industry and the system of denial and delay that is at its core. While few would commit or even condone murder, there is an almost universal feeling that Thompson was a really bad guy. The extent and breadth of this reaction is, I think, much greater than that leaders of insurance companies and their stockholders and the politicians in their employ expected. I mean, they don’t think that they are really bad guys (and note that several of the health insurance CEOs are women). They just think that they are doing their job, and following the dictates of capitalism, making the most money possible for their companies. And, yeah, getting well paid for it (at about $10.2 million in 2023, Thompson was not even in the top tier of “healthcare” CEO pay, many of whom made over $20 million, including his boss at UnitedHealth Group, Andrew Witty). We even see posts like the one below describing a sudden (although, I am certain, quite temporary) drop in denials in the last few days.