Deny, Defend, Depose

A message left on the shell casings of bullets used to murder a UnitedHealthcare executive

This morning, while reeling over an early morning murder in my hometown, my wife pointed out there was more news. The murderer had left a message inscribed on the shell casings of the bullets:

Shell casings found at the scene where the UnitedHealthcare CEO was shot dead by a masked gunman in front of a busy New York hotel had the words “deny,” “defend” and “depose” written on them, a senior New York City law enforcement official briefed on the investigation confirmed to NBC News on Thursday.

I made a video on TikTok about the news, and the comments were the kind of vitriol that should be reserved for never.

The words I said in this post were:

“I have terrible news. The CEO of UnitedHealthcare’s Insurance division, a man named Brian Thompson, was murdered today. He was shot to death in midtown Manhattan. As a critic of UnitedHealthcare, this is not the way.”

People were, in many cases, using their real names or accounts to share their thoughts, often with extra venom (comments from my TikTok):

• “Sending prior authorization, denied claims, collections & prayers to his family.”

• “Could not care less.”

• “This is in fact the way. This is the only way they’ll listen. History shows that violence is the only way for the people to get their voice heard.”

• ""terrible news"" 😅 that's adorable

• “couldn't of happened to nicer guy👍, also it actually is the way every right and bennift you enjoy to say was bout with the blood and suffering of people under the boot heel of guys just like him 🙃”

• “What is the way? Because insurance just keeps getting worse. And as a provider. I'm tired of fighting for what my patients need and then fighting to get reimbursed. after bcbs decision, what is the way”

• “I’m sorry thoughts and prayers are out of your network”

• “United Healtcare has unfortunately killed many people by denying critical coverage. While I agree this is not the way, insurance companies have done far worse to millions!! 😔”

As of this writing, there are 539 more comments; the vast majority are in that vein. The most telling might have been this one:

• “I currently work for Optum right now. We got this news last night (obv we hav opposite time) I wasn't aware many people hate him. But I saw lots of denied claims that should be covered everyday”

As a physician, I've had my life threatened. Many of us have. I had someone threaten to kill me on my birthday.

In the case of Mr. Thompson, somebody wanted to send a message. And we don't know who, and we don't know what exactly that message is. But a murder in broad daylight in the streets of Midtown Manhattan? That's some mafia $*&%.

Even if you think United Healthcare kills people for profit? Gunning them down in the street is the wrong answer. We had Nuremberg trials for Nazis. We have the 911 hijackers on trial. It's never justice to gun someone down in the street.

I don't know Brian, but I do know others who have worked at United and other insurance companies. It's not usually pleasant to work in an organization where the only decisions you get to make are hard ones. Some jobs only come with hard decisions. Some people don't get to be only saints all day long.

When people talk about ethics, it's easy to forget that ethical principles are always in conflict. That's the point. There's a built-in conflict in every ethical decision. Justice and Beneficence are almost axiomatically in opposition in a world of scarce resources.

These may be obvious sentiments, but they are not the main thrust of my argument today. For healthcare companies, and very specifically, United Healthcare, you have a real problem. People hate you. People hate you with a uniformity of opinion that is traditionally reserved for people who are literal mass murderers. And I think that kind of public relations problem isn't going to go away— absent radical changes. America has gotten more dangerous, and the world has gotten more dangerous. We have seen more assassination attempts and more assassinations. I don't like this, but it's also true. I don't get to choose what's true.

People are utterly fed up with having their care denied for reasons they see as only based on a nefarious profit motive. Thus, someone just shot an insurance executive in the street. The person who did it was good at his job when it comes to murder, but there are a lot more crackpots out there, and as life gets cheaper and cheaper; it's going to be harder to get decent people to try to turn the ship around.

I want there to be a better insurance system in America. There may be many people who want that kind of job, or are willing to try to tackle it. But we cut down the pool of available candidates to change things for the better if everyone has to worry they're going to be murdered for trying. In the world that we live in, our insurance executives are murdered in the street; the only people who are going to take the job of insurance executive are people who are cold-blooded enough to think, “The risk is worth it.”

This assassination creates a worse world; only the most callous will sign up for managing systems that require empathy and compassion. Without this compassion, we will be left bereft of people motivated to balance ethics and profit motives appropriately.

On the order of 140,000 people go to work knowing their boss was murdered in the street yesterday morning. These systems desperately need more good people driven by moral scruples and passion, not just piles of money. We're going to get less of those now. Because it's scary, and if you care about your family, you might not take a job where you're going to get killed just for doing it.

It's worth noting that bullets do a good job of preventing depositions. And so, for what it's worth, does rampant graft and political patronage. United Healthcare has donated a tremendous amount of money to elected representatives, which has kept a leash on the Department of Justice regarding enforcement. United Healthcare is under no apprehension that its deeds, no matter how criminal, will ever lead to personal consequences for its executives or meaningful consequences for its shareholders.

The public has also gotten the memo. The only justice left—when the government abdicates its responsibility to enforce the law- is street justice. The kind of justice we can do without. Enforcement actually protects everyone. If the public knows that wrongdoing will be appropriately prosecuted and people who break the law will be held to account, they're less likely to resort to murder. But the times have changed, it seems. $10,000 was offered for tips leading to the murderer’s arrest. Unfortunately, that wouldn’t remotely cover the average annual healthcare cost of $13,493 per person. Sorry, that was in 2022. My bad.