The UnitedHealthcare CEO killing: Broken promises create violent men

As you’ve doubtless heard, Brian Thompson, the CEO of insurance giant UnitedHealthcare, was assassinated this month. Thompson was gunned down in broad daylight outside a shareholders’ meeting in midtown Manhattan in a premeditated attack. The most Hollywood-esque twist is that the fatal bullets had words engraved on them: “delay”, “deny” and “depose”. After a massive manhunt, police claim to have caught the shooter in Pennsylvania.

Most gun violence in America is an occasion for grief, despair, and the rote offering of “thoughts and prayers”. But this shooting has given rise to celebration. If you’ve been on social media, you’ve probably seen people praising the shooter and hailing him as a folk hero. There was even a lookalike contest.

In case it needs to be said, I don’t endorse assassination as a means of change. I’m not an accelerationist. I don’t cheer for anyone’s murder or encourage others to do violence.

Even so, Thompson’s killing should be the least surprising thing imaginable. It’s an eruption of the rage that’s long been building against a cruel and broken system that’s thwarted every effort at reform.

Every American has experience with the infuriating illogic and inhumanity of our for-profit healthcare industry. Insurance companies throw up one hurdle after another: stalling, denying vital care, burying patients and doctors in a landslide of paperwork.

UnitedHealthcare in particular has been a rich vein of horror stories. Even in an industry that’s so widely despised, they stand out, and not in a good way.

They deny claims at more than twice the industry average. In 2021, they announced that they wouldn’t pay for emergency room visits if, in their opinion, the visit wasn’t a true emergency (as if people are supposed to diagnose themselves and figure out whether their complaint is serious enough to justify the ER). They scheme to deny care to people with expensive conditions. In 2023, they were sued for using an AI model to auto-reject claims, kicking elderly, sick and disabled people out of nursing homes. The plaintiffs claim the AI has a 90% error rate – but of course that’s not an error, it’s the intended result.

My family has personal experience with UnitedHealthcare. My wife Elizabeth has insurance through them. I’ve written about the time when, after a routine operation, they tried to charge us $32,000 for an “out-of-network” technician in the operating room. They only relented when she quoted New York’s surprise-billing law to them. Obviously, they knew what the law was; they were just playing dumb and hoping that we didn’t know our rights.

All this byzantine bureaucracy might be a worthwhile tradeoff if it guaranteed high-quality care at an acceptable price… but it doesn’t even do that. Americans pay twice as much for health care as other developed countries, and yet we have the worst outcomes.

For-profit insurance companies are the reason. In the name of profit, they’ve murdered tens of thousands of people: coldly, slowly, a little bit at a time, shaving off a few years of their lives with each denial. An estimated 68,000 Americans die each year because they can’t afford medical care. Those deaths may not be as sensationalized as this one, but they’re no less real and no less meaningful.

Brian Thompson didn’t have sole responsibility for this inhumane system. But in any list of who benefits from the status quo, his name would be near the top. We don’t know what specific grievance his killer had, but it’s not even a little surprising that someone eventually snapped. The only surprising thing is that it hasn’t happened before now.

The expectation of fairness is the thread that knits society together. The only reason anyone would want a society is because it protects their rights and treats them fairly, as opposed to an anarchy where the powerful can abuse others as they please. If people perceive that society isn’t keeping that promise, they’ll grow angry and aggrieved, and they’ll be more willing to take the law into their own hands.

In opinion polls, supermajorities of Americans express a preference for universal public health care. But the American political system has frustrated that wish for decades, thanks to rivers of lobbyist money and an antiquated, anti-democratic structure that permits minority rule. Obamacare reined in some of the worst abuses, but people feel with justice that it didn’t go nearly far enough, and soon even those modest gains could be wiped away.

When pledges of justice and fair treatment ring hollow, when people feel they have no recourse and their voices go unheard… then their sense of frustration transmutes into rage. They rightfully conclude that if the law doesn’t protect them, then the law is a sham that doesn’t deserve their allegiance. They want to avenge wrongs done to them by any means necessary. Again, what right do we have to be even a little surprised?

Whether this is going to bring about any real or lasting reform… I doubt it. More likely, insurance executives will just use their vast wealth to surround themselves with bodyguards, and carry on as before. However, if this story sticks in their mind – if they start looking over their shoulders more often; if they feel nervous and frightened, even just a little, the next time they propose a new way to get between human beings and the medical care they need – it’s not inconceivable that it will have some positive effects.

There’s some evidence of this. Another insurer, Anthem, recently put forth a horrible proposal to not pay for anesthesia if an operation takes longer than an arbitrary time limit. Anthem was already under fire from doctors and politicians over this… and, right after the shooting, they backed down. It’s not a leap to imagine that someone at Anthem didn’t want the next target to be on their back. Even if Thompson’s killing was only a small grain of extra weight, it might have been the grain that tipped the scale.

Again, this isn’t a question of right or wrong, justified or unjustified. It’s a question of cause and effect. You can only push people so far, you can only take so much from them, before they rise up against you. That’s the lesson from every revolution in history. It’s a lesson that America’s ruling class seems determined not to learn, and there will be more bloodshed because of it.

America has chosen acceleration

To be clear, I’m not an accelerationist.

Accelerationism, as you may know, is the ideology which argues that our present political system is corrupt and broken beyond redemption. According to this theory, which has advocates on both the left and the right, small improvements are like band-aids on an infected wound – they cover up the problem without curing the underlying rot. Accelerationists oppose all half-measures and compromises because, to their minds, at best they do nothing, and at worst they allow rotten institutions to stagger on just a little longer, prolonging their evil.

Instead, accelerationists believe we should root for things to get worse. They want people’s lives to be unbearable, so that they hit their breaking point and rise up in revolution. That way, we hasten the time when the whole rotten system collapses so something better can rise from the wreckage. (That “something better” might be a socialist utopia or a fascist ethnostate, depending on who’s espousing this idea.)

Like I said, I’m not an accelerationist. I don’t want people to suffer. More often than not, misery doesn’t lead to glorious revolution; it only leads to more misery. Even when revolutions happen, they create more chaos, pain and death. They can collapse into perpetual war, or harden into a junta seizing power and turning into a dictatorship that’s worse than what came before. I believe that incremental progress, as slow as it is, is a greatly preferable way to create a better world. Democracy is always superior to violence, if we have the choice.

However, it’s not my personal views that are relevant. The question arises: What happens when people choose acceleration for themselves?

We don’t know for sure what’s coming in the next few years, but we can make some educated guesses.

If Trump keeps his promises – which is never a sure bet – of slapping high tariffs on imports and engaging in mass deportations, the consequence will be sudden, dramatic inflation. There will be supply shocks, shortages and skyrocketing prices, especially food (because American agribusiness absolutely depends on undocumented workers to harvest crops and process meat, no matter how politicians try to ignore this reality). Consumer goods we take for granted will become scarce or impossible to find. The empty shelves of COVID days may make a return.

American businesses that depend on exports will go bankrupt as other countries impose retaliatory tariffs. Immigrant and minority communities who voted for Trump, believing they would be spared because they’re the good ones, are going to be unpleasantly surprised when they’re swept up in racist dragnets.

With control of Congress, Republicans will be free to pass their agenda of tax cuts, union-busting and deregulation, which will result in a massive upward transfer of wealth from the poor and middle class to the rich. Corporate profits will soar and the rich will get much richer, while people who work for a living are exploited more, treated worse, and paid less.

If they repeal or weaken Obamacare, it’s their own voters who will suffer the worst, as doctors flee red states and underfunded rural hospitals shrivel up and die. If they take a chainsaw to the safety net, older voters and rust-belt communities (both of whom depend on these programs for most of their income) will regress to Dickensian poverty and squalor.

If they pass national restrictions on abortion, women everywhere will find their access to health care drastically curtailed. Their freedom of movement may be restricted. They may lose the ability to get a divorce and to escape abusive spouses. Even if those laws don’t get passed, it’s certain that violent, misogynist men will feel free to be their worst, most hateful and nastiest selves.

Whatever Republican voters thought they were voting for, this is what they’re going to get. And, in a black irony, the best hope for America’s future may be that all these things happen as soon as possible.

All the policies I’ve described are deeply unpopular, for good reason. Our best chance is that, given unfettered power, conservatives so immediately and thoroughly wreck the country that the public rises up in revolt. That doesn’t have to mean violence – it could equally well be a massive popular movement to throw the bums out in the next election.

There’s precedent for this. California used to be a swing state, until the hardline anti-immigrant Proposition 187 sparked an uprising from immigrant communities and turned the state solid blue. I could imagine a scenario where America follows a similar path.

Granted, this would be a form of political shock therapy. There will be violence, chaos and pain. Millions of innocent people are sure to suffer, no matter how it turns out. It’s not the path to change that anyone should rationally prefer. But this is what America has chosen, whatever I might think about it, and Americans will have to live with the consequences of that choice.

New on OnlySky: The United Cities of America

I have a new column today on OnlySky. It’s a modest proposal for a novel solution to our intractably divided politics. Just think of it as a two-state solution for America.

It’s based on the observation that big cities are reliably liberal, while rural areas are reliably conservative. This holds true in both the “red” and the “blue” states. Trying to jam these two polarized regions together into one nation, with both battling to pull the nation onto drastically divergent courses, is the cause of our national bitterness and malaise. What would happen if, instead of engaging in this warfare every election cycle, we let the urban and rural parts of America both go their own way and see who does best?

Read the excerpt below, then click through to see the full piece. This column is free to read, but paid members of OnlySky get some extra perks, like a subscriber-only newsletter:

The last time America was this balkanized was in the lead-up to the Civil War. In that case, the separation was more or less geographical, between the free industrialized states of the North and the slaveholding agricultural states of the South.

Some have suggested a similar split today, but instead of North and South, it’s blue states seceding from red states (or vice versa), creating two nations, each with their own politics. But this won’t work because, unlike the Civil War era, our national enmity can’t be divided along such neat lines.

The line of demarcation isn’t between states, but between urban and rural areas within each state. Every large state has liberal cities and a conservative countryside. This is true in deep-blue states like New York and California and blood-red states like Texas. The only thing that differentiates the states is which region dominates its overall politics.

Continue reading on OnlySky…