Social Media’s Assassination of Brian Thompson

Before dawn on Wednesday, December 4, United Healthcare’s CEO Brian Thompson approached the Hilton Hotel in Midtown Manhattan for an investor meeting. Thompson had arrived early to prep for the session.

Just before entering the hotel, a masked assailant emerged from the shadows and shot him multiple times. Doctors at Mount Sinai West Hospital pronounced Thompson dead shortly after. The assassination’s location and timing — in America’s financial capital before an investor meeting — were not coincidental. Bullet casings found at the scene had the words “Deny,” “Defend,” and “Depose” written on them.

By all accounts, Brian Thompson was a talented, hard-working and honorable man who rose from modest circumstances to become CEO of the nation’s largest commercial health insurance company. BT, as his friends called him, grew up in a middle-class home in Jewell, Iowa, was valedictorian of his high school class and graduated from the University of Iowa in 1997. He then became a C.P.A. and worked for Price Waterhouse Coopers before moving to United Healthcare in 2004.

Colleagues and coworkers described BT as “the smartest guy in the room” with a self-deprecating sense of humor who listened and synthesized information remarkably well. UHC tapped Thompson to become its CEO in April 2021 at the tender age of 46. With a workforce of 140,000 people, UHC reported $281 billion in 2023 revenues and $22 billion in profits. He leaves behind a wife of 25 years and two sons.

As news of his death went viral, Thompson morphed from a victim into a villain; from a prototypical American success story into a symbol of a greedy, callous and parasitic health insurance industry. Social media blew up almost instantaneously with millions celebrating Thompson’s death, speculating on the killer’s motives and urging people with information not to share it with authorities. Before UHC limited comments on its Facebook announcement of Thompson’s death, 75,000 out of 80,000 reactions consisted of a laughing emoji.

What exactly is going on here?

‘Self-Evident’ Flaws

Despite the Declaration of Independence’s famous proclamation, “We hold these truths to be self-evident, that all men are created equal…,” the United States tolerated, even encouraged, human bondage during its first 250 years. The gap between its stirring self-descriptive rhetoric and reality was profound. By the time of the Civil War, one-eighth of the U.S. population counted as enslaved people.

On March 4, 1865, just 41 days before his own assassination, President Abraham Lincoln delivered his Second Inaugural Address. In it, Lincoln wrestled with the religious meaning of the devastation and human suffering caused by the Civil War. Engraved into the Lincoln Memorial’s north wall, the speech’s hallowed words speak to Lincoln’s wisdom, compassion and commitment to post-war reconstruction.

In the body of the address, Lincoln describes slavery as a “particular and powerful interest” that was “somehow the cause of the war.” He takes note of the irony that “both sides [the North and the South] read the same Bible and pray to the same God, and each invokes His aid against the other.”

Believing human beings cannot understand divine provenance, Lincoln wonders if enslaving people could be an offense for which God requires retribution. He amplifies the point with this fatalistic resolution,

The Almighty has His own purposes… Fondly do we hope, fervently do we pray, that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue… until every drop of blood drawn with the lash shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said, “The judgments of the Lord are true and righteous altogether.”

Slavery was the nation’s original sin. American society continues to struggle with race in its aftermath. As with slavery, U.S. healthcare contains fundamental and foundational flaws that have caused incalculable physical, emotional and financial harm to the American people.

The healthcare system’s artificial economic model and its capture by special interests make U.S. healthcare grotesquely expensive, breathtakingly inequitable, ridiculously fragmented, almost impossible to navigate and dangerously imbalanced. All resources flow into treatment. Little flows into prevention and health promotion.

In essence, U.S. healthcare pays for treatment volume, not health outcomes. A vast network of intermediaries parries payment back and forth as all parties seek to optimize revenues and profits. Healthcare’s original sin is that its practitioners and their enablers do not see a human being at the receiving end of its transactions. Instead, they see a diagnostic, a treatment, a bill, a referral and/or a cost.

The result is that U.S. healthcare is in a class by itself in terms of underperformance. It contributes to the increasing fragility of the American populace. Examples of this are manifold. Overall life expectancy is declining. A recent Pentagon study found that 77% of young adults would not be fit for military service.

America likes to think of itself as the land of the free and the home of the brave. It’s well on its way to becoming the land of the sick and the home of the frail.

‘Mad as Hell’ at Healthcare

Virtually every family in America has horror stories about its encounters with the healthcare system. These range from medical errors to overcharging to neglect to overtreatment to lack of access to illogical billing. Americans’ anger with the healthcare system is now boiling over. It manifests in disquieting survey results:

• A recent Gallop study found that trust in the U.S. medical system had dropped to just 34%.
• A NORC survey found that more Americans fear paying a medical bill than contracting a serious illness.
• A JAMA study found that over 20% of adults 65 and older did not fill prescriptions due to cost.
• A Kaiser Family Foundation survey found that 73% of adults worry about their ability to access care and that 40% have some form of medical debt.
• A Commonwealth study found that nearly a quarter of working adults have insurance that leaves them underinsured.

The picture that emerges from these studies is a burdensome patchwork of health insurance coverage through which consumers struggle to gain access and information. None of these dismal realities justify the killing of a good man like Brian Thompson. They do, however, begin to explain the outburst of exuberant social media posts in the wake of his murder.

Mission statements for healthcare organizations extoll their commitments to putting patients first and building healthy communities. As with the Declaration of Independence, these statements do not align with reality. The gulf between rhetoric and performance is profound. The U.S. healthcare industry, the largest ever created by human beings, is heading toward a reckoning.

In the immediate aftermath of Thompson’s death, U.S. healthcare organizations tightened their security measures and removed pictures of senior executives from their websites. Let’s also hope their leaders recommit to increasing the value, affordability and convenience of their service offerings. Failure to do so will further amplify the public’s animosity.

Forces for revolutionary change build gradually before unleashing suddenly. Trigger events can accelerate their onset and impact. Brian Thompson’s assassination has the potential to become this type of trigger event for system transformation.

“With malice toward none and charity for all…,” Lincoln closed his Second Inaugural Address by urging the nation “to finish the work we are in.” Lincoln’s admonition applies to U.S. healthcare today. It’s time to stop talking about value. It’s beyond time to make it happen. Otherwise, Brian Thompson will have died in vain.