On murder and healthcare in America

In one of the biggest news stories of the week, Brian Thomas, the CEO of United Healthcare (UHC), was gunned down and murdered early one morning on a Manhattan street. Bullets with the words "Deny," "Defend" and "Depose" were found at the scene of the crime. The suspect is still at large. 

News of Thomas' murder sparked a huge response on social media – some saw the murderer as a "folk hero;" many expressed no sympathy for the man gunned down on his way to an investor meeting; some in news media took the opportunity to chastise anyone who did not express appropriate sympathy for the murdered man; many people shared on social media their perspectives on the murder - here are a few found on Threads and Twitter: 

A big question prompted by this murder - who are we as a nation? Why are so many people expressing such enormous lack of sympathy for a father of two boys in high school? What has happened that so many are cackling and crowing over Thomas' death? 

Brian Thomas, as CEO of an insurance company responsible for a very large number of claims denials, made $10 million a year in salary and his company in 2023 had, according the the UHC annual report, $23 billion in net earnings and gross revenue of nearly $372 billion. 

How does an insurance company rake in such profits? In part, and in ways that hugely impact their customers, they do so by denying coverage. And why wouldn't a health insurance company follow that model? Healthcare companies in America are considered successful by the profits they reap, not by the number of patients they help. United Healthcare, under Thomas' leadership, was an extremely profitable company. 

What happens when coverage is denied? Americans go without needed healthcare or they face financial challenges paying out of pocket for needed healthcare. Dealing with claims denials is enormously time consuming and frustrating for the insured person. I know, as do millions of Americans, from personal experience what it is like to be denied coverage. 

Nearly 25 years ago, when my son was born, UHC provided our insurance. I was pregnant - we filled out all the necessary paperwork to let the company know I was pregnant and expecting a new person to arrive a week or so after the New Year (I was having Y2k baby!) But when my son arrived, UHC denied coverage because he was not listed as an insured party on my policy. One cannot list someone on a policy until they are born but that turned out to be the reason UHC denied coverage. I was a new mom, recovering from a difficult labor and delivery, exhausted from the lack of sleep and yet every month, when bills arrived, I had to gear up for battle with the insurance company. 

It took months to resolve. And though a quarter of a century has passed since then, I feel once again, when writing of my experience, all the stress and fear and bafflement that I felt whenever I talked to a UHC rep throughout that first year of my son's life. They were always polite; they could only share their first name - company policy - but I was sucked into the black hole of an incomprehensible health insurance claim denial and that was a horrifying experience to be constantly put off over and over and over again as the customer service reps claimed they were working to solve the problem. 

My coverage issue was not enormous - I was not facing medical bankruptcy - but it was awful to have to fight month after month to get the insurance company to pay for covered expenses - it's just not the thing a new mother needs to be doing when taking care of a newborn. 

We were self-insured for a long time, my husband and I. We ended up looking for jobs that provided health insurance because to be self-insured in America was an expense we could no longer afford. Our premiums rose significantly every year and what was covered by the premiums seemed to shrink. At the end, all we could afford was a Health Savings Account, which lets you use pre-tax dollars to pay for healthcare the insurance company won't cover. We paid $650 a month for the privilege of paying the first $7500 PER PERSON in deductibles. That was $7500 x five people, including small children prone to ear infections and strep throat. We were never ahead of the game; we never reached our deductibles and there were many nights when I brooded about the financial catastrophe that would ensue if all of us were injured in a car accident. 

In part because of the costs of being self-insured, we some years ago made the decision to uproot our family, move across the country because we (my husband and I) landed jobs that provided health insurance. We are, in my family, relatively healthy and have had few issues with getting coverage for healthcare, in part, because we have not needed lifesaving treatments, like cancer therapies, etc. We do not have chronic illnesses like hemophilia or Crohn's or serious immune deficiencies that require expensive treatments in order to live. I was bumped from coverage once because I had something that was not Crohn's but could possibly lead to Crohn's - that was a very scary time. But I was able to go for some time without any intestinal issues and was able to get covered again, though expensively. 

In that none of us have been diagnosed with cancer or other serious diseases, we are extremely lucky thus far. (Knock wood - don't jinx it!!) 

Obviously, Brian Thomas was not CEO at that time when I was dealing with coverage denial for my newborn son - he assumed the CEO role in 2021. But he was the CEO of a health insurance company that reaped in massive profits in part by denying coverage to people in need of healthcare. And clearly, his murder has triggered rage in many, many Americans who've had to deal with denials from companies like UHC. 

As a family man, Thomas was able to purchase two expensive homes - he lived apart from his wife "for years." I'm old enough to remember the housing crash of 2008, caused by predatory lenders and a corrupt culture on Wall Street. Housing today is priced out of affordability for too many people. And yet a man leading a health insurance company was able to afford two expensive homes. Who got bailed out in 2008? The banks. Not the homeowners. Who can afford two expensive homes? An insurance executive, while many of the people his company covers cannot find affordable housing in America. 

Why has Thomas' murder set off so many people? Because according to data, the United States has the most expensive healthcare system in the developed world with the worst outcomes. We have the lowest life expectancy, the worst maternal outcomes, the highest infant mortality rates when compared to other wealthy nations. From a 2023 article in the Commonwealth Fund, the US is a "world outlier when it comes to healthcare spending:

When people who've been denied coverage see how much Thomas was paid to lead a company in a sector known for denials, it triggers a particular sense of rage. It's not pro-life to deny needed coverage to people in need of healthcare. The profit motive leads to a system that wins when it denies coverage. In a September 2024 article on Healthcare Dive, a study shows that "Nearly three in four providers surveyed by Experian Health said the number of claims denied by payers shot up between 2022 and 2024." So not only are patients feeling the pain of denials, so are healthcare providers, who then have to provide additional paperwork, etc., to get a claim covered for their patients. 

And so – who ARE we as a nation? 

We are a nation that bailed out Wall Street after their behaviors led to the worst financial crisis since the Great Depression. We are a nation that shrugs when children are slaughtered in schools. We are a nation that has made treatment of miscarriage to be illegal in some states due to abortion bans - and women are dying as a result. We are a nation that rewards health insurance companies for the profits they earn. 

No one deserves to be murdered in cold blood - not a CEO of a profitable company, school children, and concert goers slaughtered by gun violence, pregnant women denied treatment for miscarriages in states with abortion bans (it is murder to delay treatment for miscarriage because of abortion bans - perhaps not legally, but at the very least, delaying treatment for miscarriage until a woman is near death is not a "pro-life" policy.)

What we're seeing in the wake of Thomas' murder - a great many Americans feel that no one deserves to die either because their health insurance company denied coverage in order to protect their profit margin. 

My hope is that the murder of a wealthy healthcare executive prompts a real national discussion on the significant flaws of our healthcare system in ways that tilt the process in favor of patients instead of profits. The history of capitalism in America, unfortunately, suggests that my hope is likely not to be realized because profits are the measure by which success is measured.