Photo-Illustration: Intelligencer; Photo: NYPD
Christopher McNaughton needed care for his ulcerative colitis, which had already caused him to develop arthritis, diarrhea, fatigue, and blood clots that could kill him. The disease was one problem; his insurance company, UnitedHealthcare, soon proved to be another. As ProPublica reported in 2023, medical bills cost McNaughton nearly $2 million a year, and UnitedHealthcare had flagged his case for review as a “high dollar account.” In one recorded phone call, a nurse for United told a colleague that a doctor under contract with the company had concluded a drug cocktail that had “had brought McNaughton’s disease under control” was not medically necessary. “I knew that was coming,” said the colleague with a laugh, later complaining that McNaughton’s mother was “throwing tantrums” in calls with United.
Had McNaughton’s family not responded with a lawsuit, we might not know the extent of UnitedHealthcare’s obstinance. His case is unusual in only one respect: He fought back. As ProPublica noted at the time, insurers reject about 1 in 7 claims for treatment, but according to one study, Americans appeal only 0.1 percent of the findings. Millions of people know what it’s like for an insurance company to deny care. Millions of people have reason to be angry, even furious, with the insurers who control so much of their lives. The killing of UnitedHealthcare CEO Brian Thompson ripped the wound open. To some, the anonymous shooter is more folk hero than murderer.
As one popular post on X put it, “Today, we mourn the death of United Healthcare CEO Brian Thompson, gunned down…. wait, I’m sorry — today we mourn the deaths of the 68,000 Americans who needlessly die each year so that insurance company execs like Brian Thompson can become multimillionaires.” One woman who’d cared for her cancer-stricken mother told New York that she felt “a little surge of Schadenfreude” at the news of Thompson’s death. Though the shooter wrote the words “delay,” “deny,” and “depose” on his shell casings, we still don’t know his exact motivations. It’s obvious, however, that he meant to send a public message — and some appear open to it.
Cases like McNaughton’s help explain the rage so many feel. Sarah Palin once warned the ACA would usher in “death panels” across America. What made her so laughable wasn’t the fearmongering but the fact that death panels were already here. They are insurance companies. Life has improved since the ACA became law, and Medicaid expansion alone has likely saved many lives, but even the insurance-marketplace plans can cost hundreds of dollars a month. Still, according to the Commonwealth Fund, “the U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates” of any high-income nation. (In November, ProPublica ran another story about UnitedHealthcare, this time on its “playbook” for limiting mental-health-care coverage.)
To deny a person care is to abandon them. They will suffer, and they may even die a preventable death, but an insurance company will save money, and that’s the American way. Hidden within that “lack of sympathy” over Thompson’s demise is a note of surprise. We are used to a level of unnecessary and unnatural death in this country, a burden typically borne by the poor. The wealthy not only live longer than the poor; they often boast healthier years as they age. That phenomenon isn’t unique to the U.S., but it’s not hard to see why it would persist here or why few would openly grieve the killing of a health-insurance executive. An individual act of violence cannot solve an unjust system, but it is a symptom of social dysfunction that our decision-makers ignore at their peril. That system is not only unsustainable, it is already breaking down. It has killed, too.
In 1845, the writer Friedrich Engels accused English society of grave crimes against the working class. “When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder,” Engels wrote in The Condition of the Working Class in England. When a country deliberately subjects its proletariat to conditions that result in premature death, “its deed is murder just as surely as the deed of the single individual” — more specifically, a phenomenon that Engels called social murder. The offense can seem natural, he explained, since it is more “of omission than of commission.”
UnitedHealthcare does not pull a trigger and shoot its victims in the street. Instead, they suffer and may die of cancer, or of heart disease, or of some other treatable condition. Yet insurance companies like it bear some guilt nonetheless. A 2023 survey by the American Medical Association found that 9 percent of physicians blamed prior authorization — the requirement that a health-insurance company approve a treatment or prescription — for at least one patient’s disability or even death. Another ProPublica story documented the case of Forrest VanPatten, who died from complications of cancer after his insurance company refused to cover a treatment that could have extended his life. In reckoning with the murder of Brian Thompson, we must reckon, too, with its seeming inevitability: with all the choices that brought us here.
When democratic norms fail and justice feels unattainable, people will reach their limit. Some will file a lawsuit. Others will make jokes on social media. And in this country, overrun with guns and violence, a few will resort to deadlier means. Thompson’s death was preventable, as so many American deaths are. Until our political class concludes that life is more valuable than profit, there will be blood — if not in the streets, then in our hospitals and homes. Something has to give, and soon.
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