What's a life worth?

On the murder of UnitedHealth CEO Brian Thompson

When I started writing this I had no intention of speculating about the motives of Brian Thompson’s murderer. I just knew what we all knew, that the CEO of the country’s largest health insurer had been coldly gunned down in the middle of Manhattan. But then, in the wee hours of the morning, news broke that the killer had inscribed the words “deny,” “defend,” and “depose” on his shell casings – and the picture got a little clearer. As many commenters quickly noted, these words, which may initially seem cryptic, appear to refer to denying claims, defending lawsuits, and deposing patients in court. This is the strategy used by insurance giants, including UnitedHealth, to avoid covering patients’ desperately needed care.

This procedure that has led to countless early deaths, nightmares for endless families, and a deep-seated hatred of the for-profit health insurance industry. Jay Feinman even wrote a book about the process entitled “Delay, Deny, Defend.” So the murder of CEO Brian Thompson appears to have been directly connected to someone’s visceral anger at UnitedHealth, and although there's some chance these words were merely a distraction the suspect pool will encompass the many millions of people the company denied care to, their relatives, and more.

As the search for the killer unfolds, what will continue simultaneously is the debate, the discourse, the conversation around Thompson’s killing. The single most helpful concept informing my thought process might be a little unexpected, it’s the Ruth Wilson Gilmore line: “Where life is precious, life is precious.” And where it’s not, it’s not. I’m writing to you today less about the murder of Brian Thompson and more about the response. Because this seeming assassination, cold and calculated though it was, reveals far less than the millions of responses it elicited. Regardless of whether or not the killer is found, and his full motive revealed, what we can grapple with right here and now are the shrugs, the celebrations, the remonstrances, and more. And they happen to reveal the deep and widening schism fracturing the structure of society.

Photo by Marcelo Leal on Unsplash

Within an hour or two of news of the assassination breaking, Tobita Chow posted something that shocked quite a few people. It was a slew of TikTok comments under videos of the news. In these comments people are saying “I’m sorry, prior authorization is required for thoughts and prayers” and “I just can’t find the care. Maybe if they ask for preapproval of my care. Then after they care their required deductible I might be able to supplement some care” and much more. Some had tens of thousands of likes in just an hour, and Chow later followed up by noting that the many sympathetic responses to his post appeared to be “coming from across the political spectrum: leftists, normie Dems, MAGA, a libertarian or two, and many people whose presence on here is otherwise entirely apolitical.”

To understand exactly why such a wide cross-section of society would mock a murder, we have to look at UnitedHealth. The company made $22 billion in profits last year, a staggering number, and one generated largely from denying people access to health care. A lawsuit filed last year will give you a hint of just how systemic and cruel UH’s denial system had become. The suit alleged that the insurance giant knowingly used a “faulty artificial intelligence algorithm” to deny elderly patients coverage for extended care deemed necessary by their doctors. The suit further claimed that UnitedHealth illegally denied elderly patients care owed to them under Medicare Advantage Plans (plans that are essentially privatized Medicare) by deploying an AI model known by the company to have a 90% error rate. And this lawsuit was filed by the families of two now-deceased former beneficiaries of UnitedHealth.

A 90% error rate. This nightmare was the company hiding its systemic denial of care behind a thin facade of AI. Where life is discarded, life is discarded. And all of the above is just one snapshot of a massive, sprawling company. A Senate report also found that between 2019 and 2022, UnitedHealthcare’s post-acute services denial rate increased from 8.7% to 22.7%. Brian Thompson took over in 2021.

Photo by Luis Melendez on Unsplash

The statistics are damning. Here is a company that dominated an industry based on making money largely by denying people the service they claim to provide. And this service happens to be the difference between life and death. But even more gripping and infuriating than the statistics, to many observers, have been the personal stories. A flood of comments, both new and resurfaced, show individual, agonizing stories of dealing with UnitedHealth. As one anonymous account wrote back in 2023, “You exacerbated my father's agonizing battle with cancer until his final breath and now you’re trying to throw my mother’s life away UHC just so your CEO Brian Thompson can take home tens of millions of dollars this year. You all deserve to rot in hell.” Thompson took home over $10 million last year.

I could pull story after story here of people denied care, of their parents denied care, or of families forced to take on tens of thousands in debt. But the truth is that most of us have either our own personal stories or stories from the lives of the people we care about. We know how the health care system works from painful, personal experiences. So what we’re called to right now, as the discussion about this assassination will surely rage on, is to reframe the conversation to one about why life has been rendered a commodity, why its value has been stripped by this society we live in.

What we’re called to ask is why the murder of one man must be described as unspeakable violence, but the systemic denial of life to 100,000 people is an acceptable business practice. We’re called to ask why profiting from the denial of life earns a person millions while the people denied care ought to accept drowning in debt and disease. We’re called to ask why only certain lives are precious, and only in certain circumstances. Why does playing by the rules render someone innocent, even when the rules produce a stream of death and devastation?

Photo by National Cancer Institute on Unsplash

We all understand that “just following orders” did not exempt the people on trial in Nuremberg. I’m aware how this might sound like a hyperbolic invocation to some, but when you look at how “More than 26,260 Americans aged 25 to 64 died because they lacked health insurance—more than twice as many as were murdered” in 2006, you begin to get the comparison. And when you see that more than 200 million Americans are covered by private health insurance, but insurers reject about 1 in 7 claims for treatment according to federal and state regulators, you see how following the rules of a life-denying system is actively hurting and killing people by the tens of millions.

We are charged, right now, to not just discuss one murder, but to take an intentional look into a system that condones and even incentivizes the denial of life on the biggest possible scale. Capitalists in the United States have worked for decades to deny us the care that our counterparts in other wealthy countries receive. The ruling class fights to deny us universal care and to instead tether us to our jobs with employer-funded health care, while the quality of that care simultaneously deteriorates. Blue Cross Blue Shield just announced that in multiple states they will no longer pay for anesthesia for the full length of some surgeries. If the procedure runs over a certain amount of time, anesthesia will not be covered for the duration. This is what we’re up against, our lives being devalued systemically so that the profit engine can keep churning and endlessly expanding.

Our work is to value life. Or rather it is not to just value life, but to enforce the value of life. Just as our health and lives have been rendered increasingly unimportant by the for-profit health system and the larger capitalist apparatus, we must conduct an opposite and overpowering reaction, a response that embeds the sacred nature of life, human and otherwise, into the foundation and the workings of a new system. It will take the construction of something radical, something fundamentally different, and in the absence of a new, caring system we can only expect violence against the current, profoundly violent structures to continue.

Make no mistake about it, violence happens on the largest scale in boardrooms, state houses, and other halls of power. And the response to it is inevitable, given the foreclosure of all other avenues. As Martin Luther King said, “Riots are the language of the unheard.” We must hear people, hear their anger, and build up a system in response that meets all of our needs. That is the one outlet that will not end in increasing violence. In short, ending individual acts of violence requires ending the mass violence of the profit system and the state. We will be sold police, cops, and more policing in the coming weeks. But that pitch will be a thinly masked effort to enable the continued violence of a system that eagerly exchanges our lives for profit, rather than an effort to reach the root cause of violence. For that, there is only one answer, abolishing a system that denies life and replacing it with a system where life is precious.