CEO’s Killing Prompts Broader Discussion over America’s Broken Healthcare System

It’s been an interesting week in corporate healthcare. But I want to start with some context. First, it’s important to recognize that the purpose of a corporation is shareholder enrichment. UnitedHealthcare (UHC) does this by collecting more in premiums and investments than it pays for the care of its 29 million insured Americans.

Next, it’s important to realize that UHC is the largest health insurance company in the world. Because it insures almost 9 percent of Americans, it exercises enormous influence and control over delivery of and compensation for healthcare.

Under former CEO Brian Thompson, UHC has been very successful. In 2021, UHC posted a $12 billion profit. That rose to $16 billion in 2023. Over about the same timeframe, denials for claims for post-acute care rose from 8.7 percent in 2019 to nearly 23 percent in 2022. And, according to one source, UHC denies 32 percent of claims, compared to an industry average of 16 percent.

Under Thompson’s leadership, UHC stock roughly doubled in price. But this was amidst increasing complaints related to denials, overwhelming bureaucracy, and increased premiums. At the shareholder meeting Thompson was to attend before being fatally shot on a New York City sidewalk, UHC was expected to announce expected sales for 2025 in excess of $450 billion. That’s the equivalent of $100/month for every person in the U.S. for a year.

This all occurs while insurance CEOs seem to reap significant rewards. Thompson’s salary (not total compensation) is reported as $10 million. Other CEOs receive similarly generous total compensation, such as those heading Centene at $18.5 million, Elevance at 21.8 million, CVS Health at $21.6 million, Cigna Health at $21 million, and Humana at $16.3 million.

This financial pulchritude for executives and shareholders arises at a time when providers are confronted with increased systemic barriers to efficient delivery of effective healthcare to beneficiaries. Physicians often have multiple employees whose only job is to wait on interminable hold while someone with minimal knowledge of the patient checks boxes seemingly for the sole purpose of saying “no” to the care that beneficiaries and their providers feel is needed. Indeed, the beneficiaries feel as if their premiums entitle them to the care their physician recommends. These feelings of unfair denial are not always wrong. We should recall the Aetna medical director who admitted, in deposition, that he denied claims without ever reviewing the medical records.

Hospitals deal, every day, with absurd inpatient denials for critically ill, mechanically ventilated, ICU patients or inpatient denials for parturients – in violation of federal law. In particular, Medical Advantage payers flout the Two-Midnight Rule and ignore the inpatient-only list. These denials force additional costs onto hospitals and confound patients.

Finally, hapless patients are condemned to the first level of Dante’s Hell, where they wait for some cog in the insurance machine to grind through their pre-authorization. In many cases, the patient is seeking ongoing coverage of a chronic care medication. The payer will be motivated to change the medication to a drug with a higher margin, regardless of patient impact.

Now we get to Brian Thompson’s murder. As of now, we do not know the identity or motive of the killer. But I’m not sure that motive will change the fact that Thompson has become a lightning rod for all that is wrong with modern American healthcare financing. The U.S. has the most expensive healthcare in the world. But that’s not because it’s the best. According to the CIA world factbook estimate for maternal mortality for 2020, the U.S. was 122nd out of 186 countries ranked. We’re in the same tranche with the West Bank, Gaza, and Iran. But it costs us much more money.

The social media world in the immediate aftermath of the murder was a mix of horror and irony. Many Internet sleuths who would typically jump in and start scanning available public documents and streams have openly announced that they won’t help find the shooter. Others posted comments such as “Brian Thompson was still human and had a wife and kids!” which evoked many responses such as “so were the people he denied coverage to that died.” One commenter noted that Thompson should not die “just for doing his job.” This provoked the response that “doing his job” was the Nuremburg defense.

The visceral horror of this killing is simply overshadowed by the resounding lack of sympathy for the man who, in death, has become the face of a fundamentally dysfunctional healthcare financing system.

Regardless of whether Thompson’s killer is found, “justice” may have a novel meaning in the wake of his murder. We can all hope that this tragedy leads to re-prioritization of patients over profits.

Perhaps this will drive meaningful examination of healthcare priorities and start shifting to patient-centric care. I’m hopeful, but not particularly optimistic.