When I saw the news of UnitedHealthcare CEO Brian Thompson’s stunning killing in Manhattan on Wednesday, my mind immediately went to the television show “Mr. Robot,” Sam Esmail’s dark, dramatic FX thriller series that had nothing to do with health care.
“Mr. Robot,” which aired from 2015 to 2019, starred Rami Malek as Elliot, a reclusive hacker who spends the show’s first season attempting to hack Evil Corp., a mammoth conglomerate that owns the bulk of the world’s consumer debt. The end goal: purging everybody’s financial records with the company, effectively erasing the world’s debts and freeing individuals from an exploitative behemoth.
We don't know for certain whether the motives of this fictional vigilante enacting his vision of justice against corporate behemoths reflect those of Luigi Mangione, the suspect who allegedly gunned down Thompson in front of a Midtown hotel. But on Monday, police charged Mangione with second-degree murder after they found him in Pennsylvania carrying a gun, a fake ID and a handwritten manifesto that criticized health care companies for putting profits above care, The New York Times reported. Bullet casings at the scene of the shooting reportedly had three words engraved on them: “deny,” “defend” and “depose,” which could refer to a tactic health insurers have been described as using to deflect claims.
Thompson's death — and the largely unsympathetic online reaction to it — has reignited a national conversation around rising medical costs, claim denials by the country’s largest private insurers and Americans' resentment toward them.
The industry has pushed back against the social media vitriol. UnitedHealth Group CEO Andrew Witty, who leads the parent company of UnitedHealthcare, urged employees in a video message to "tune out that critical noise that we're hearing right now. It does not reflect reality."
"Our role is a critical role," he said. "And we make sure that care is safe and appropriate and is delivered when people need it. And we guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable."
Rising premiums and profits, more claim denials
Frustrations with the insurance industry are nothing new, and they aren't limited to social media.
In 2023, The Commonwealth Fund, a nonprofit health care research foundation, surveyed 7,873 American adults about their ability to pay for health care. The findings showed that many Americans, “regardless of where their insurance comes from, have inadequate coverage that’s led to delayed or forgone care, significant medical debt, and worsening health problems,” according to the Fund's report. “While having health insurance is always better than not having it, the survey findings challenge the implicit assumption that health insurance in the United States buys affordable access to care.”
"The survey findings challenge the implicit assumption that health insurance in the United States buys affordable access to care"
The criticism has played out in Congress as well. Earlier this year, a U.S. Senate committee investigating Medicare Advantage plans found that UnitedHealthcare denied requests for nursing care to patients recovering from falls and strokes three times more often than it did for other services, while Humana denied at a rate 16 times higher. Those companies, along with Aetna’s parent company CVS, “were intentionally denying claims for this expensive care to increase profits,” according to The New York Times. UnitedHealthcare's rate of denials from skilled nursing homes increased by a factor of nine during the same time period, 2019 to 2022, according to the Senate commmittee. The company did not respond to the Times' request for comment on denial rates.
Health insurance companies aren’t required to disclose the number of claims they deny, so tracking down data on those rates can be difficult. ValuePenguin, a consumer finance comparison site, published an analysis on the major companies' denial rates, based on publicly available claim denials and appeals data from the Center for Medicaid and Medicaid Services. UnitedHealthcare was reported as having denied 32%, or roughly one-third, of in-network claims — the highest rate among companies indexed.
In 2023, the families of two deceased UnitedHealthcare beneficiaries filed a lawsuit in the U.S. District Court for Minnesota against the company, alleging it knowingly employed an artificial intelligence algorithm to disproportionately deny claims made by patients for care determined necessary by their physicians. The AI system used by UnitedHealthcare in those instances is reported to have a 90% error rate, CBS News reported. The case is still ongoing, and UnitedHealthcare filed a motion earlier this year to have it dismissed, arguing that the court does not have jurisdiction over complaints that may have violated federal law.
UnitedHealthcare has also increased the cost of its premiums. In 2023, the company’s premiums rose by 12% over 2022, according to The Wall Street Journal, which noted that total operating costs also increased at nearly the same rate. In 2024, the company expected premium increases between an average of 9.9% and 14.9%.
Profits have steadily risen in recent years. UnitedHealth Group reported a net income of $22.3 billion in 2023, $20.6 billion in 2022, $17.3 billion in 2021, $15.4 billion in 2020 and $13.8 billion in 2019, according to Forbes. The publication reported that insurance companies' profits soared during the pandemic as more people stayed home and did not seek medical care, leading to fewer claims.
Americans’ growing medical debt
Higher premiums and denied claims leave the individual covering the full cost of their claim, if they can afford it. It can also put more individuals at risk of incurring medical debt, which has been on the rise in recent years.
Between 2010 and 2020, medical debt usurped nonmedical debt as the largest source of Americans’ debt in collections, according to a study published in the National Library of Medicine. That study found that roughly 17% of individuals in the U.S. — nearly one in five Americans — had medical debt sent to debt collectors in 2020.
Collectively, Americans are carrying an estimated $220 billion in medical debt, according to the Peterson-KFF Health System Tracker. Between 2017 and 2021, the average amount of medical debt Americans owe increased by 50%. During that same time period, Americans in the lowest 20% of earnings brackets carried medical debt exceeding their annual income.
Social media's lack of sympathy
Online reaction to Thompson's death has been severe and widespread. “Social Media Has Little Sympathy for Murdered Health Insurance Exec,” declared Rolling Stone as platforms bubbled over with brutal jokes and contempt for UnitedHealthcare. In the days that followed, many shared their personal grievances with the company and other insurance giants, describing denied claims under dire circumstances.
"The jokes about the United CEO aren’t really about him"
“The jokes about the United CEO aren’t really about him,” journalist Ken Klippenstein posted on X. “They’re about the rapacious healthcare system he personified and which Americans feel deep pain and humiliation about.”
Witty, leader of UnitedHealth Group, said in his video message: "People are writing things we simply don't recognize [that] are aggressive, inappropriate and disrespectful."
"The mission of this company is truly to make sure that we help the system improve by making sure we help the experience with individuals get better and better," he said. "There was nobody who did more to try and advance that mission than Brian Thompson."
UnitedHealthcare has since removed its executive leadership page from its website. Other insurance providers, including Elevance, some state-level Blue Cross Blue Shield plans, Centene and CVS, have edited or removed portions of their executive leadership pages.
Michael Tuffin, president and CEO of America's Health Insurance Plans, a professional organization for health insurance professionals, posted on LinkedIn: "The people in our industry are mission-driven professionals working to make coverage and care as affordable as possible and to help people navigate the complex medical system. We condemn any suggestion that threats against our colleagues — or anyone else in our country — are ever acceptable."
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