The fury over the state of U.S. health care isn't going away.
It's been a week since UnitedHealthcare CEO Brian Thompson was shot and killed in Manhattan. That shocking, targeted killing has also sparked a reckoning over the business he ran, in a country that has the most expensive health care in the world.
Thompson led the largest U.S. health insurer, part of a massive, for-profit conglomerate that touches almost every part of how Americans access health care. His company has been widely criticized for making health care more expensive and more difficult to access. And those frustrations have boiled over in the response to his death, ranging from widespread jokes to outright celebrations.
UnitedHealth has not directly responded to the widespread consumer criticisms since last week; a spokesperson for UnitedHealth declined to comment to NPR for this story.
This week, after police arrested Luigi Mangione for the fatal shooting, some even rushed to support him. An online fundraiser for Mangione's legal defense had raised more than $65,000 by Thursday evening. Meanwhile, social-media videos showed "wanted" posters for other CEOs posted in downtown Manhattan.
"We're facing an apocalyptic moment in the human story, where hundreds of thousands of Americans are going bankrupt because of medical bills – and the executive suites of these private health insurance [companies] are laughing all the way to the bank," says Sam Beard, an organizer of the Mangione legal-defense fundraiser.
This rhetoric echoes the last time that consumers broadly mobilized to protest against powerful corporations and their wealthy executives, in the Occupy Wall Street movement in late 2011 that swept the country after the financial crisis.
Those Occupy protests ultimately did not yield immediate consequences for the companies or CEOs they criticized; no Wall Street chief executives ever went to jail for the business decisions that led to the subprime mortgage crisis or the resulting waves of foreclosures. But those protests did articulate an overwhelming populist anger with the United States' stark income inequality.
Now the response to Thompson's killing "has become a kind of marker of our age of inequality, where people feel fairly powerless," says Helaine Olen, managing editor at the American Economic Liberties Project, an anti-monopoly nonprofit.
That populism and economic fatigue remains a powerful force in U.S. politics today, as inflation-weary voters recently demonstrated by reelecting former President Donald Trump. As Olen adds, "You've seen this really from the time of the financial crisis onward: There's just this sense of 'how can I get a fair deal'?"
Consumers' sense of powerlessness is often amplified when dealing with health insurance companies, which govern the care that patients receive. But navigating those huge and opaque companies can be maddening at best, and consumers rarely have much of a say; for about 154 million Americans, employers select and provide health insurance coverage.
UnitedHealth is the most dominant of these. It's the fourth-largest U.S. company by revenues overall, with divisions that employ doctors, provide pharmacy benefits, and process patients' medical claims. It — along with its largest competitors — is the subject of antitrust scrutiny, consumer lawsuits over widespread denials of claims, and bipartisan criticism. This week, Democratic Sen. Elizabeth Warren of Massachusetts and Republican Sen. Josh Hawley of Missouri introduced legislation that would break up large healthcare conglomerates, including UnitedHealth.
"The insurance companies are out of control. They need to be broken up," Hawley said on X. "No more buying up doctors' practices. No more owning pharmacies. Start putting patients first."
Everyone interviewed for this story emphasized the need for change, and many health care providers are hoping that some good can come out of this tragic event.
"This is not a heroic vigilante, and it's important that he be brought to justice," says Dr. A. Mark Fendrick of the University of Michigan. "That said, maybe there's a tiny lesson we could learn to move forward."
Fendrick studies ways to improve health insurance and advocates for a more wholistic approach of what is known as "value-based" insurance. He published an article in a medical journal last week urging the healthcare industry to rethink how it does business and the kinds of services it charges higher prices for.
"Now, in the wake of a tragedy that has captured the national conscience, might be the time to reframe the dialogue from how much we spend to how well we spend our medical care dollars," Fendrick wrote.
Dr. Diana Girnita, a rheumatologist in Irvine, Calif., is already trying a different approach. After years of fighting with insurance companies, Girnita started a direct-care practice that bypasses insurance and offers her services to patients for often-lower fees. She published an article on LinkedIn last week in response to Thompson's death. Its headline asked: "How many more lives must be lost before we change healthcare?"
Top executives at large healthcare companies have generally insisted that they are working to improve the quality of care available to all Americans.
In an email to employees on Wednesday, UnitedHealth Group CEO Andrew Witty remembered Thompson as "one of the good guys," and shared anonymous testimonials and notes of support from UnitedHealth customers.
"I am super proud to be a part of an organization that does so much good for so many," Witty said.
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