A few thoughts on the shock killing of UnitedHealthcare's CEO - and the fallout

Reflecting on a divisive moment in America and what comes next

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The shocking killing of UnitedHealthcare CEO Brian Thompson this week unleashed an array of emotions — grief, scorn, mockery, fear.

I’ve talked to people who knew and loved “BT” and remain horrified, first by his public death and then the online reaction. I’ve heard from former UnitedHealthcare customers and others who insist the true horror is the health-insurance industry’s practices.

There’s also rampant media speculation about why Thompson was shot dead on a Manhattan sidewalk, and the still-unknown identity of his killer, helping keep the story in the news.

I’m among a group of Washington Post reporters who have been covering the shooting and the fallout, and there’s a moment that I keep reflecting on — not from this week, but from seven months ago.

It was the first day of May. Congress had demanded that Thompson’s boss — a man named Andrew Witty, who leads UnitedHealthcare’s parent company — come testify in Washington as a cyber-hacking crisis spiraled out of control.

We wrote about it here. Witty spent hours getting beat up by lawmakers angry about the hacking crisis but also frustrated by the size of his sprawling company, UnitedHealth Group, and its insurance-industry practices.

And there was a small moment — at the end of one long congressional hearing — when protesters confronted Witty as he tried to leave the room.

Several of those protesters, from a group called People’s Action, were particularly upset about UnitedHealthcare’s use of “prior authorization”¹ and how that had led to delayed or denied care. 

Here’s a clip of the CEO of the most powerful health-care company in America getting yelled at by one frustrated customer.

I’ve thought about that woman’s anger because I’ve seen versions of it online over the past few days.

Sometimes from people with personal grievances against UnitedHealthcare; often from others furious about the state of health care in America.

They have company. A Gallup poll released on Friday found that Americans now have the lowest-ever views of the U.S. health system in the 24 years that Gallup has been doing the poll. Just 28 percent of respondents rate the quality of health coverage as excellent or good.

Two perspectives on our health-care system

Before becoming a reporter, I worked at the Advisory Board Company, a health-care consulting firm and think tank that specialized in “best practices” — basically, what were the best health care organizations doing, and how others could repeat that.

Over the years, I got to know a lot of mission-driven people who truly cared about helping patients and providers, about improving the experience of receiving care, about fixing things across a broken system.

After I left, the company was acquired by a division of UnitedHealth Group. Some of my former colleagues ended up working closely with Thompson and thought he was a great guy. I’ve heard about staffers weeping in the office over his death and worried about the family he left behind.

And as a health reporter, the world is small; I’ve been on the phone for unrelated stories this week where health-care leaders at other organizations started reminiscing to me about “BT” and their good experiences with him.

But as a reporter, I also know people who can’t stand UnitedHealthcare — and it isn’t a short list. Patients who have come to me with stories about being denied care. Lawmakers and federal officials who want to crack down on the company. Other health-care industry players who say UnitedHealthcare and its parent UnitedHealth have grown too big to effectively regulate.

People’s Action, the advocacy group that helped organize the protests of Witty back in May, put out a statement this week condemning the shooting of Thompson, but also castigating the “crisis of denials of care by private health insurance corporations including UnitedHealth.”

The advocacy group’s campaign against health-insurance companies “gives people a productive, nonviolent, democratic way to create change on this problem,” Sulma Arias of People’s Action said in a statement.

Where we go from here

It’s important to stress: we don’t know why Thompson was killed. His shooting could be linked to frustrations around UnitedHealthcare — or completely unrelated to it. The bullet casings inscribed with words linked to the insurance industry might be a major clue, or a deliberate false flag.

But the public outrage and anger against health insurers is impossible to miss.

I’ve done some radio and TV programs the past few days where hosts asked me: will this outpouring of frustration change anything? Will this lead to health-system reforms?

I suppose anything is possible. But the reaction so far has been one of hunkering down, not opening up — health-insurance companies removing executive portraits and locking their doors, with leaders understandably worried about becoming targets. I see lawmakers offering condolences, but with a few exceptions, not eager to talk about health-industry reforms after a prominent industry executive was violently killed.

Having covered Washington for a while, I know the path toward reform can start with angry social media posts. But those efforts only succeed when channeled into constructive organizing — and don’t alienate leaders and activists turned off by the message.

There really are problems in America’s health system. At The Washington Post last year, we did a series on the crisis of premature deaths. The health industry’s incentives are skewed toward treating diseases, not preventing them. There’s a staggering amount of gun violence — with another reminder of that this week. And there’s little political will, and a lot of inertia, that keeps leaders from confronting these challenges.

UnitedHealthcare is far from the only player in this broken system. But as the nation’s largest health insurance company, it’s a key part of it.

Since Thompson’s shocking death, I’ve spoken with industry leaders and analysts who have offered a range of perspectives. Several gave me a robust defense of the health-insurance industry; others provided a catalog of the industry’s many sins.

Here’s one quote, from longtime health-care industry watcher Matthew Holt, that I used in a story a few days ago and has stuck with me since.

Holt: “I think the leaders of the industry should look at this and ask: Why does everybody hate us so much that when one of us gets killed in an assassination … we’re not hearing sympathy from the general public — we’re hearing scorn?”

1. A frequent tactic by health insurers to request additional paperwork and documentation before allowing medical procedures to move forward.