Murder in the Name of Healthcare

Written By Zahra Ahmad

Murder should not be celebrated. By definition, the ‘unlawful, premeditated killing of one human being by another’ is declared unacceptable in religious doctrines, moral reasoning and the court of law. In reality, murder is not universally condemned. The death penalty may be considered state-sanctioned murder, lawful at different times and places. Changing societal attitudes means that legality aside, it fulfils the criteria of a ‘premeditated killing’. Furthermore, what is a hot war if not mutual premeditated killing between two or more groups of people? And by lawful, do we speak of civil or international law?

Killings on an individual level can serve as a microcosm of a broader conflict. At 06:44 EST on December 4^th 2024, Brian Thompson was shot in the back on West 54^th Street, Midtown Manhattan, New York City. At the time of his death, Thompson was CEO of UnitedHealthcare, the health insurance arm of the UnitedHealth Group conglomerate.

It is difficult to imagine the scope of UnitedHealth. The American Healthcare system runs on a mix of private and public funding with the majority of the population being covered by private insurance firms, of which UnitedHealthcare is the largest. This single corporation has been described by research directors and analysts as the ‘core health infrastructure’ of the US, effectively functioning as integral as ‘utilities’ – comparable to basic public services of electricity and water.

In 2023 UnitedHealth had a greater market capitalisation and revenue, meaning stock price value and money coming into the company, than JPMorgan Chase, the largest bank in the US. A financial powerhouse across the market, UnitedHealth had the tenth heaviest stock weighting on the S&P 500, a stock market index that measures the 500 largest companies registered on stock exchanges in the US.

Others in the US are covered by the publicly funded Medicare and Medicaid; under President Barack Obama’s tenure, the Affordable Care Act 2010 (commonly known as Obamacare) expanded the reach of these two schemes to cover millions more American citizens. As of 2023, 26 million Americans had no healthcare insurance, down from 49 million pre-Obamacare.

Conversely, the NHS provides healthcare ‘free at the point of delivery’ as stated at its founding in 1948 by Aneurin Bevan, Minister for Health. Private healthcare does exist in the UK, covering 4.7 million people through their employer in 2023, out of a population of 68.35 million. The key difference between the systems is that those with private insurance may still access free NHS care, whilst those without health insurance in the US can incur high costs for treatment.

With the advent of Obamacare, it could be presumed that, with widening access, attitudes towards health insurers in the US would improve. Watch any American medical series and the issue of excess hospital billing emerges, with terms such as deductibles, premiums, paperwork and an emphasis on the ‘bottom line’ of the healthcare business machine being the central focus.

Recently, significant controversy has been generated over the denial by insurance companies to fund treatment requested by the insured. Companies dismiss the claim for treatment as not covered by insurance, called in shorthand a ‘claims denial’. Some allege that claims denials have risen post-Obamacare. Safeguards were put in place by Obamacare, meaning that people with pre-existing conditions could not be excluded and state reviews of insurance premium increases were created. Therefore, profits for healthcare companies decreased, as they now had to provide cover for more people without being able to inflate insurance premium costs.

Claims denials can serve to mitigate costs and increase revenue. Insurers' reasons for claims denials may vary, including a treatment not being covered by insurance, administration errors or duplicate claims being filed. Some insurers advertise job roles or use computer systems to specifically deny claims. Claims denials used to be the reserve of expensive one-off treatment, but are now applied to emergency and repeat prescriptions. Examples include denying neonatal intensive care to a newborn and treatment for anaphylaxis being considered ‘not medically necessary’. Universally unpopular, the system has been satirised in US media, including a South Park episode when the characters take on the healthcare industry when they are told that the ‘Medical director says no’ to fulfilling their claim. They are repeatedly instructed to travel to multiple sites where they fill in paperwork at each one, gradually growing more and more exhausted.

Considering the perceived abuse of the insurance system on claims denials, strong feelings towards healthcare CEOs can someday lead to action. Thompson’s accused shooter, Luigi Mangione, was arrested on December 9^th in a McDonald’s in Pennsylvania. Born of a wealthy family, Mangione attended an all-boys private school and graduated as valedictorian, before studying computer science and working as an engineer. An X account attributed to Mangione contains an x-ray of a spine following surgery. Mangione is known to have suffered debilitating back pain that resulted in him struggling to do activities he enjoyed. At the time of his arrest, he was carrying a 3D printed gun, multiple false IDs and a 262 word handwritten piece of text purported as his ‘manifesto’, containing the line, ‘frankly, these parasites had it coming’.

Social media celebrated the killing as justice for the common man, vindication for the everyday American who has fallen victim to a system that propagates medical debt and denials over preserving the sanctity of life. Executives across industries sought additional security following the shooting. This was a spike in a trend from 2021 to 2023, which showed the proportion of S&P 500 companies hiring security for at least one executive rising to 27.6%. UnitedHealth stock rose to 610.79 USD on the day of the shooting, before dropping to 485.52 on the 17^th of December. As of the end of February the stock had not recovered to pre-shooting levels. Thompson was replaced as CEO, two months following his death.

It is intriguing that the murder has led to an increase in CEOs seeking security, and not a renewed interest by lawmakers in addressing the system that radicalised Mangione. Preventing the radicalisation that leads to violence is the only conclusion that guarantees that such a shooting would not recur. If there is no motive, there is no murder. However, a public healthcare system is not profitable, a principle that is antithetical to the US market economy. Proponents of public, private and international aid structures may deliberate as to whether healthcare is a basic right or a commodity. Caution must be exercised in the business of health, else it becomes a trade in people’s lives. After all, isn’t the purpose of healthcare to save?