Let me start with the obvious. The murder of United Healthcare’s CEO, Brian Thompson, on a sidewalk in New York City was a brutal, lawless and cowardly act.  It cannot be justified under any rationale and those on social media and other forums suggesting otherwise are just plain wrong. Furthermore, as a disciple of Jesus and a lifelong pacifist, I hold that taking the life of a human being can never be morally justified. God alone gives life and God alone is entitled to take it when and under whatever circumstances God will. Every human life is a work in progress. As long as life and breath remain with an individual, there is potential for that individual’s repentance, redemption and transformation. Murder deprives God of the opportunity to work the miracle of repentance, forgiveness and amendment of life. I am therefore saddened by the killing of Brian Thompson. My heart goes out to his family and all who loved him.[1]

That said, I believe we need to look beyond Brian Thompson’s murder and try to understand the explosive anger it has unleashed over the internet, in print and on the street. More attention needs to be paid to the plight of Thompson’s and his company’s victims. Take, for example, Christopher McNaughton, a young college student who suffered from a crippling case of ulcerative colitis — an ailment that caused him to develop severe arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. McNaughton was insured through a plan by United Healthcare for students at Penn State University. It was a great deal for United Healthcare. What could be more lucrative than a large pool of young, healthy students paying premiums, but who would not likely be incurring high medical bills? Of course, there are always exceptions. Even young students are subject to devastating illnesses requiring expensive medical treatment. That is precisely why one pays for insurance. You never know whether you will be that one unfortunate person like Mr. McNaughton.

But here is the thing. Private insurance companies are corporately owned by shareholders who want to see their stock go up. These shareholders elect a board of directors they expect to make that happen. The directors hire CEOs like Brian Thompson to ensure that the company maximizes profits for the benefit of its shareholders. You don’t need an MBA to understand the implications. Private insurers make money by charging as much in premium as they can get away with and paying as few claims as possible. This isn’t higher math. It is just simple addition and subtraction. Thus, as you might expect, when the cost of McNaughton’s care was nearing $2 million, United Healthcare flagged it as a “high dollar account” eating into its profit margin. The company began working aggressively on a strategy to deny coverage for the expensive cocktail of drugs crafted by a Mayo Clinic specialist, a treatment regimen that successfully brought McNaughton’s disease under control. It should come as no surprise, then, that the company’s staff doctors reviewed the case and found that his treatment was “not medically necessary.” Payment of his claim was thereafter terminated on that basis.

United Healthcare’s agents discouraged McNaughton from appealing the decision, telling him “we’re only going to say no.” This tactic usually works. One study found that only 0.1% of claims denied by private insurers are appealed.[2] McNaughton, however, was one of the few who refused to take no for an answer. He contested the denial and finally brought a lawsuit against United Healthcare. The wonderful thing about law suites is that they allow the parties to obtain “discovery” from each other in the form of witness testimony through depositions and by production of documents. McNaughton’s lawsuit uncovered a treasure trove of documentation for United Healthcare’s bad faith efforts to discredit his doctor’s diagnosis and treatment, misrepresent his medical condition to evaluators and intimidate him. In the end, United Healthcare settled with McNaughton, but only after a lengthy and costly battle that took a toll on his health and wellbeing.[3]   

United Healthcare attempted to justify its finding of no medical necessity for McNaughton’s treatment by appealing to the soaring cost of medical care generally and the need to be judicious in approving highly expensive treatments. To put this in context, the cost of McNaughton’s care at that point had reached $1.7 million. That same year United Healthcare reported more than $16 billion in operating profits and United Healthcare’s then-CEO David Wichmann was paid $17.9 million in salary and other compensation. The company’s priorities could not be any clearer. Shareholder profits matter. Compensation for CEOs who are successful in generating profits matter. The persons who finance these profits with their premium dollars and depend on the medical coverage they think they obtained from the company, not so much.

Christopher McNaughton is not the only victim of United Healthcare and the several other private insurers that demonstrate ruthless efficiency when it comes to collecting premiums but sluggishness in processing claims. Data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment. Insurers know that their claimants are sick people, often without assistance or advice. They understand that, by throwing in their way bureaucratic roadblocks, procedural hurdles and labor intensive appeal processes, they can likely wear down the resolve of their claimants. They know that bringing a lawsuit is costly, time consuming and beyond the physical and mental stamina of most of their claimants. Time, money and the law is on their side and they know it.

You might think I am being overly harsh and judgmental here. But I know whereof I speak. When my wife began working as a nurse in a large New York hospital, she took out a disability insurance policy from a private insurer[4] through her employer to protect the income she had worked hard to achieve in the event she became unable to work due to accident or illness. After more than a decade of work, an autoimmune condition flared up, causing severe inflammation of her joints, dangerous anemia and extreme fatigue. She was deemed unable to work by Social Security and awarded disability benefits. These, however, hardly compensated for her lost salary. The disability policy, pursuant to the contract, made up the difference. That lasted for about a year before the company decided, on the basis of an “occupational review” and notwithstanding Social Security’s determination to the contrary, that she was now able to work. Accordingly, benefits were terminated.

The long and short of it is that, after a fruitless appeal to the company, we retained a lawyer. We were forced, at our own considerable expense, to fight the company for two years in order to obtain the benefits for which my wife had been paying premiums for over a decade. In the meantime, her condition continued to deteriorate. Throughout this time, the insurer hired investigators to videotape my wife surreptitiously, follow my children to school and monitor my home. I will never forget the day when I received a call from the insurer to inform me that our case had been referred to their “special investigation unit” to be reviewed for possible fraud. At this point, my wife was recovering from a week in the ICU following a seizure that put her into a coma. I asked the insurance rep whether he had contacted the state department of insurance, a requirement when an insurer suspects insurance fraud. After a lengthy silence on his end, I offered to get the attorney general for the department on the line for him. He hung up and not a minute later I received a conciliatory call from the company’s legal department apologizing for the apparent “misunderstanding” on my part. He assured me there was no fraud investigation, no criminal inquiry or anything of the kind going on. Summoning up all the self control I could muster, I graciously thanked him for the clarification and added that if anyone from his company ever uttered the “F” word to me again they had best be able to prove it in a court of law. Eventually, the company rolled over and honored its contractual obligations.[5]  

So although I do not condone them, I can well understand the anger, the rage, the uncivil social media comments and threats made in response to the shooting of Brian Thompson. If you leave your dog tied up out in the cold, starve him and kick him around from the time he is a pup, you can’t pretend to be shocked, horrified and morally outraged when finally one day he turns and bites you. Instead of whining about all the anger and threats, instead of putting up barriers to protect its headquarters, perhaps United Healthcare should consider honoring its contractual obligations to its claimants, dealing honestly and fairly with people who are sick and desperately in need of the care their premiums were supposed to buy. Maybe it’s time to consider whether perhaps medicine should no longer be practiced by corporate overlords and driven solely by profit motive. Maybe it’s time to think about junking the whole corrupt private insurance cartel and replacing it with a single payer system answerable to the voters rather than corporate shareholders.

In conclusion, let me say again that I wish Brian Thompson had not been ruthlessly gunned down. I wish, rather, that he was still alive. I wish that he could have lived long enough to face all the people who have been wronged by his company, like Christopher McNaughton. He should have had to face parents whose children died without treatment that might have been life saving. He should have had to look into the eyes of people who have lost siblings, spouses and partners due to his company’s willful efforts to avoid its contractual obligations. Brian Thompson should have lived long enough to see face to face the human cost of his handsome compensation package and his company’s profits. He should have lived long enough for his heart to be broken and his mind changed. He should have had the opportunity to use whatever time he had left on this earth to make amends to the victims of his company as far as possible. But now that he has been robbed of that opportunity, I can only pray God will have mercy on his soul.       

---

[1] I also feel compelled to add that Thompson’s death from what appears to have been the bullet of a “ghost gun” is one more sad reminder of our country’s sick and twisted gun fetish fed by an industry flooding our streets with lethal weapons. For more on that, see “Our Real Problem with Gun Violence-It’s as American as Apple Pie and as Addictive as Crack Cocaine”.

[2] See “Claims Denials and Appeals in ACA Marketplace Plans in 2021,” KFF

[3] For the full story of Christopher McNaughton’s struggle with United Healthcare and the company’s shameful bad faith efforts to avoid its contractual obligations, see ProPublica Article, February 2, 2023.

[4] I have not named the insurer as I believe the settlement agreement might have contained an NDA or something of the kind. But sadly, I do not think this matters much as they are all basically the same.

[5] I should add that we never recovered the attorney fees we were forced to incur. Moreover, the contract of insurance required us to deduct the amount of all social security payments we had received from the settlement amount, but left us with the tax liability for said payments.