It is just before 7 a.m. on a Wednesday in early December. A man in a dark hooded jacket stands outside the New York Hilton Midtown a few blocks from the Rockefeller Center, where the annual Christmas tree lighting will take place later that day. He’s wearing a face cover, but it has been cold and blustery, so it probably doesn’t seem too out of the ordinary to passersby. As the man waits in the dim light of the dawn, Brian Thompson, the chief executive of UnitedHealthcare, the largest medical insurer in the United States, approaches the hotel in a blue suit. He’s in town for a meeting with investors.

Security footage shows the masked man stepping from behind a car onto the sidewalk, flanking Thompson as he reaches the Hilton. He presents a suppressed pistol and then proceeds to slowly and methodically gun down the executive. He completely ignores a terrified pedestrian and calmly clears a malfunction with the single-mindedness of a practiced assassin. He points the barrel down at a dying Thompson one more time before hopping on a bicycle and disappearing into Central Park.

Days later, police arrest Luigi Mangione in an Altoona, Pa., McDonald’s and charge him with the murder. Allegedly, he wrote a manifesto detailing his anger at the health insurance industry and the treatment he and his mother received for their medical problems. He may also have been mentally ill and abusing psychedelic drugs. 

But the man and his motivations are less significant than the public’s reaction to his actions, which can be described with one word: joy. I want to be clear that I am not condoning what he did. Just before Christmas, a wife became a widow, and two children lost their father. This family suffered insult on top of their injury because Americans saw in Thompson the incarnation of the system they hate. 

It is important to understand why so many people felt no sympathy for Thompson’s death, because societies that have such massive psychic gulfs between the elites and the masses are unhealthy ones. Something awful has gone wrong when enmity between strangers is commonplace.

Some degree of callousness toward the fate of a wealthy CEO like Thompson is predictable. But the splenetic outpouring surprised even me. “F— his family too,” wrote Mike Figueredo, a podcaster who, ironically, tweets under the handle: @HumanistReport. As of this writing, that comment by Figueredo boasts 2.6 million views and 23,000 likes. 

It’s worth noting that the act of vigilantism Figueredo celebrated occurred in the same borough where Marine veteran Daniel Penny was involved in a fatal altercation with a violent homeless man, Jordan Neely. Unsurprisingly, Figueredo’s timeline indicates that he has no sympathy at all for Penny, who did not even mean to kill Neely. He retweeted a post with pictures of Penny and Thompson’s killer that was captioned, “MAGA really chooses which murderer to celebrate based on the race and the wealth of the victim.” Neely was black; Thompson was white, and so is Penny.

The fact is that vigilantism is always a sign of disorder, a symptom of some festering injustice or failure enabled by the system that is supposed to prevent those things from happening. In the case of UnitedHealthcare, there is a long history of practices so abusive and corrupt that it’s hard to believe the company has been around for as long as it has. Or maybe that’s the secret to its success. But that kind of success comes at a high cost in more ways than one. The nine-millimeter shell casings recovered from the scene of the crime were emblazoned with the words “deny,” “defend,” and “depose.” Together these words form a variation on the phrase “delay, deny, defend,” which describes the insurance industry’s tactics to boost profits by rejecting legitimate insurance claims. In fact, there’s even a book with that very title on the subject, Delay Deny Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It, by Jay M. Feinman. The word “depose” looks like a novelty the shooter used to describe his own act in eliminating a healthcare insurance CEO.

“Insurance is the great protector of the standard of living of the American middle class, but only when it works,” Feinman’s introduction reads. “Insurance doesn’t work when the insurance company fails to honor its promise of security or even the formal promise of indemnity in the policy, through the strategy that has become known as ‘delay, deny, defend.’” 

Feinman describes how insurers delay payment of a claim, deny part or all of a valid claim, and then defend their actions through litigation to avoid paying the policyholders’ claims. Giving someone what they are owed has been the very definition of justice since at least Simonides. UnitedHealthcare’s conception of justice is more in line with Thrasymachus’ view that “the just is nothing other than the advantage of the stronger.”

Boasting a market capitalization of nearly $500 billion, UnitedHealthcare denies the most claims of any major health insurer. It dismissed roughly one in every three claims in 2023, according to data from ValuePenguin. That is twice the industry average, a feat that could only be achieved with some technical ingenuity. Indeed, last year, the families of two elderly former beneficiaries who had died sued the company, alleging that it used “an AI algorithm to prematurely and in bad faith discontinue payment for healthcare services” to the victims. If that’s not the premise of a novel about a medical dystopia, it should be. 

“The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because [UnitedHealth’s] AI model ‘disagrees’ with their real live doctors’ determinations,” the filing states. That is just one of the many horror stories that are too numerous to recount. But one more stands out.

Back in 2019, a Miami-based cancer survivor named Richard Cole sued UnitedHealthcare after it denied him a critical treatment for prostate cancer. He had a hard time finding a judge to hear the case because so many had to recuse themselves. Why? They could not help but take his side ahead of time. Fellow prostate cancer survivor and U.S. District Judge Robert N. Scola Jr. wrote in his recusal order that to “deny a patient this treatment, if it is available, is immoral and barbaric.”

UnitedHealthcare denied Cole and an unknown number of other men coverage on the grounds that the prostate cancer treatment, proton beam radiation therapy, was considered experimental. But Judge Scola did not buy this excuse, based on his personal experience. The same remedy was recommended to him by medical experts years earlier during the judge’s own battle with cancer. “It is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation,” Scola wrote. But it also is more expensive than traditional cancer treatments—and there’s the rub.

Unfortunately, the case was too personal for Scola, and so he concluded, “The Court’s opinions in this matter prevent it from deciding this case fairly and impartially.”

In 2021, a federal judge denied UnitedHealthcare’s motion to dismiss Cole’s and two other lawsuits filed by cancer survivors, all having suffered different types of cancer and all alleging the same pattern of deceptive and unfair behavior to avoid covering proton beam radiation therapy. The judge felt it was plausible to allege that UnitedHealthcare “acted arbitrarily
and capriciously” in denying coverage.

Three years later, an even bigger scandal would come to light. This time it directly involved UnitedHealthcare’s CEO Brian Thompson, as well as the Justice Department and the City of Hollywood Firefighters Pension Fund.

Court filings from May show that the firefighters’ pension fund was engaged in a legal battle with Thompson, claiming that he had sold over $15 million of UnitedHealthcare stock “despite being aware of an active Justice Department antitrust investigation into the health insurance company that he did not disclose to investors or the public,” the independent journalist Ken Klippenstein reported. 

The lawsuit alleges that Thompson was aware of the federal probe since at least October 2023 but kept it hidden until a Wall Street Journal report blew the lid off the story in February 2024. “When news of the investigation broke, it erased almost $25 billion in shareholder value. But by then, Thompson had already cashed out, selling over $15 million in personally held UnitedHealth shares,” Klippenstein wrote. 

Another Justice Department lawsuit against the insurer’s parent company, UnitedHealth Group, alleged it cheated Medicare out of more than $2 billion by exploiting patient records. To say that the federal government has failed to curb the giant insurer’s corruption would be a multi-billion-dollar understatement.

In the aftermath of Thompson’s shooting death, UnitedHealth Group chief executive Andrew Witty denounced media “misinformation” during an internal company address obtained by Klippenstein. Witty was referring to the renewed corporate scrutiny triggered by Thompson’s death. Instead of attempting to understand why the public feels the way it does about his insurance empire, Witty recommended that employees not respond to the media and instead “simply refer them to our own media organization.” That only served to reinforce the image of an out-of-control titan, a Hecatoncheire rampaging across the landscape, batting away criticism and swatting down regulation with its lobbying and public relations hands.

Among lawmakers, only Rep. Dean Phillips, a Minnesota Democrat who represents the western Minneapolis metro district where the insurance giant is based, seemed to understand the public’s anger. “UnitedHealth is based in my district and employs 1000s of my constituents,” he tweeted. “Like other insurers, they play by rules allowing the industry to net >$100 billion/year while patients go bankrupt from medical debt. The real culprit is Congress and money in politics, and it’s time for change.”

He’s right. The real culprit is the system that is supposed to rein in these corporations but too often becomes an enabler of corruption. The medical insurance industry’s money and power can silence critics and squash regulations, but it cannot deny that its business practices resulted in the expression of rage that occurred in New York last month. ◆