Brian Thompson murder highlights Americans' anger about health care

The killing of a healthcare executive on the streets of New York City has prompted a uniquely American response: some people are celebrating his murder because of his role in the country's broken healthcare system.

Brian Thompson, the chief executive of UnitedHealthcare, was slain execution-style on Wednesday as he headed into a hotel hosting the private health insurance company's annual investor conference. A masked assailant used a silenced handgun to shoot the 50-year-old businessman then rode off on one of the city's public bikes.

Within hours of his death, thousands of people had piled on to social media or into newspaper comment sections to react with macabre glee or to celebrate the shooter as some sort of vigilante hero. The reason? America's healthcare system is fundamentally flawed because it often seeks to maximise profits by denying patients coverage, or by overcharging them for any reason it can muster.

“For once in my life, I actually agree with a vigilante and have absolutely nothing I disagree with. If you are responsible for creating a system that gets people killed … People will try to kill you right back,” one user wrote on X.

A commenter on The Washington Post said: “I don’t condone it but I understand it. Anyone who sees their claim denied and has to face bankruptcy or cessation of treatment while the CEO of their insurance company travels on a private jet is going to have some rage. People with easy access to guns and rage will often do terrible things.”

“He died doing what he loved, not getting medical care in time,” another user posted on social media.

The disturbing sentiments underscore the fury many Americans feel about the country's healthcare system, and the indifference to a murder is a worrying symptom of an increasingly fractured and unequal society.

On Thursday, new clues emerged suggesting the killer held a grudge against the private healthcare industry. The words “deny,” “defend” and “depose” were found written in permanent marker on 9mm ammunition dropped at the crime scene, sources told the AP.

The words are a possible reference to an investigative 2010 book critical of the insurance industry, Delay Deny Defend: Why Insurance Companies Don't Pay Claims and What You can Do About it by Jay Feinman.

America is alone among industrialised nations in refusing to guarantee its entire population at least some level of healthcare coverage. Government-subsidised insurance is available for the very poor, for older people and for veterans. But the vast majority of people must navigate a confusing and opaque system that expects Americans to pay hundreds or thousands of dollars each month for coverage that often only covers the basics.

The US pays nearly twice as much for health care as other wealthy nations, but its outcomes are often far worse. In 2022, per capita health spending in the US was $12,555. In France it was nearly half that amount. Yet life expectancy in the US is 77.5 years, compared to 82.2 in France.

Most of the extra money Americans are paying for health care goes to administrators, middle men and billing agents who spend countless hours hounding patients for additional payments for services rejected by insurers like UnitedHealthcare. Medical bills are the most common cause of bankruptcy in the US and people often have to deal with an endless stream of payment demands when they are at their most vulnerable.

UnitedHealthcare provides coverage to more than 49 million Americans and raked in more than $281 billion in revenue last year. But a Senate panel has been investigating how often UnitedHealthcare and other insurers deny care to patients, and the extent to which they use artificial intelligence in help speed up those denials.

Mr Thompson's murder has brought the anger many Americans feel about the healthcare system to the fore, but it is the system that needs changing. Chief executives are always going to work to maximise profits for their companies, so blaming one man for a deeply entrenched system that fails millions of people is misguided.

Change needs to come from Congress and the White House, but don't expect meaningful fixes any time soon. President-elect Donald Trump recently admitted he only has “concepts” of a plan to address the costs of health care.