The Very Notion of a Medical 'Marketplace' is Sick

People who are ill, had a chronic disease, or are injured don't have the time or energy to shop around for care.

Slain United Healthcare CEO Brian Thompson and ‘person of interest’ in shooting. (UHC photo on left, hotel surveillance video still)

The vigilante assassin of United Healthcare CEO Brian Thompson killed his victim with bullets whose casings, found on the sidewalk, were discovered by New York City Police detectives to have been carerully etched by his assassin with words that are the motto of the medical insurance industry: Deny and Delay, as well as a word of resistance: Defend. This has struck justified fear into the hearts of top managers of the trillion-dollar vampire companies that do nothing for people’s health but that enrich Wall Street investors by a business model based upon algorithms that deny and policies that delay rather than provide care.

“Are we going to be killed next?” other industry executives were reportedly asking each other anxiously as they were were heading to attend the same meeting at the New York Hilton as Thompson was approaching — a meeting which was abruptly cancelled after the shooting.

They are right to be worried. Right too are the private security execs now rubbing their hands with glee at the prospect of new clients to guard, as they did as leftist groups like the Bader-Meinhoff Red Army Faction in Germany and The Red Rossa (Battalion) in Italy were gunning down big capitalists during the 1970s - 90s.

The anger that has been simmering over the insurance industry profiteering that has made the US the costliest place in the world for health care, and the richest country with the largest percentage of its citizens who cannot afford to see a doctor or go to a hospital without ending up bankrupt has suddenly erupted. volcano of fury follows word of this particular gun murder, which is strikingly different from the almost routine street shootings that plague our nation’s cities.

This shooting appears to have been the work of a young white man, and was not about robbery or a gang grudge or a road-rage incident. Nor was it something that was the result of a sudden fit of rage at some perceived insult or desire to commit “suicide by cop.” This was, by all the evidence reported so far, seemingly a carefully planned out act of retribution against the leader of a corporation who was seen as responsible for the denial of some as yet unidentified care, treatment or medication to somebody, perhaps someone known to the shooter.

According to Census figures, over 200 million Americans are over 18 and under 65. In our country, that means that if they want to have medical insurance they have to buy it on their own or get it through an employer or through the Affordable Care Act. According to the Commonwealth Fund, in 2024 44% of that working-age demographic, or some 88 million adults, had either no health insurance (9%), were underinsured, meaning they didn’t have access to needed healthcare with whatever plan they had (23%) or had a gap during the year during which they had no insurance coverage (12%). And remember, these individuals are often parents of children who also likely don’t have health coverage when the parent doesn’t.

As one cold-hearted wag put it in a posting in the comment section of a story about the Thompson shooting, “That’s 50 million or more potential suspects that police have to consider.”

This shooting has opened a door that America hasn’t really seen inside of since the Weather Underground and other small armed groups were blowing up banks, science labs and robbing Brinks trucks.

One might wonder why the public in this case seems to be responding with such understanding rage, not at the killer, but at the victim and his company. Why not the oil and gas industry executives, whom we know have been deliberately pumping out more and more carbon-based fuel and worsening the already dreadful climate change the Earth is experiencing and facing, all the while lying about how “green” their businesses are? Or why not the arms industry execs who are behind and lobby for the trillion-dollar-a-year military monstrosity that is sucking up all the taxes collected from hard-working Americans to create wars, death and chaos around the world?

The answer I think is that so far, those who suffer from climate change are mostly in remote arid or flood-prone regions like western Africa, Bangladesh, the Caribbean, or superheated regions like parts of the Indian subcontinenand the Middle East, and the threat here won’t be undeniable for at least another decade or maybe longer. Meanwhile, expensive corporate PR campaigns are funded to convince people of the lie that the dangers of climat change aren’t real or can be avoided. Similarly, the arms industry is great at appealing to fear and patriotism to make Americans believe that there is a dangerous world out there that only massive arms spending can protect us from.

With healthcare, however, the evils of the profit-crazed capitalists running the insurance scam are identifiable and the impacts are as plain as day in their perfidy when they deny needed cancer medication or treatment to a dad or mom with a third- or fourth-stage malignancy, or rehab therapy to a chronically weakened grandmother living alone, or emergency treatment for a wife with severe bleeding from endometriosis. When a loved one suffers terribly because of a denial of care by an insurer or even dies, it’s clear right away who is the guilty party. This kind of abuse is happening all the time and the harm and injury are personal.

United Health Care, the fifth largest industry in the Fortune 100, got there by dint of its algorithms to deny care and it leads the pack with 32 percent of its clients’ claims denied. But it is not alone in its denials. As a chart in an article by Jeffrey St. Clair on Dec. 6 in Counterpunch shows, not too far behind UHC were Medica and Anthem, which boasted denial rates of 27% and 23% respectively. BlueCross/BlueShield, the not-for profit that I discovered personally subcontracts with a for-profit company to handle its denials, is in the mid-range with a denial rate of 17 percent of claims. (Given the industry denial rate average is 16 percent, so much for the Blues claim of being more caring because they are “not-for-profit! Although, not-for-profit Kaiser Permanente did have the lowest denial rate at 7% of claims denied, a rate which UHC would define as worst, not best.)

The Kaiser Family Foundation, a health research organization, reports that one-in-five Americans has experienced a denial of care by their insurer within the 12-month period studied. That’s a rate twice as high as with Medicare and Medicaid, which reportedly have a denial rate of 10%. Often those denials leave patients and their families bankrupted if they decide they have to pay themselves for denied but needed care , as often happens. (The leading cause of bankruptcy in the US is unpayable medical bills.)

It needs to be noted here that United Health’s rapid growth and profitability under Thompson’s leadership is intimately linked to the giant Medicare privatization scheme of government-promoted encouragement of Medicare Advantage plans, the insurance industry replacement of Government Medicare. These plans trick the elderly into leaving the government plan with a promise to have a private insurance product that offers perks like free gym membership, dental coverage and no deductibles, but left unsaid is that they restrict coverage of serious medical conditions by requireing prior approval authorizations, gateway doctor referrals, and use of doctors within an approved group list, making them essentially HMOs. If they don’t have the specialist you need or no gateway doctor will authorize a specialist or costly test you need, you’re out of lock. And one of the biggest companies that does the deciding about that on a subcontractor basis is United Healthcare, which also handles an enormous amount of the care coverage decisions for Medicare and Medicaid, getting rewarded for the denials it issues.

It’s easy to see how in a country where violent and deadly road rage is epidemic, and there is a tradition of going back to the country’s early days of vigilante justice, health care denials by health insurers could lead to more cases of planned retaliation for perceived injustice.

Of course the people who knew Brian Thompson are saying what a “warm and loving person” he was, and what a loving father to his two sons. I’m sure that’s all true. He might even have convinced himself that by denying care to 32% of his company’s insured clients he was aiding society at large by helping to keep medical costs down for the other 68% (until they start getting care denied too). But I’m reminded of a conversation I had with a reporter for the NY Times who had covered the bloody civil war in El Salvador and who remarked at how Roberto D'Aubuisson, the leader of the right-wing death squads in that country who nightly led his men out to slaughter and butcher hundreds of peasant backers of the guerrillas, and was behind the murder of liberation theology Archbishop Oscar Romero and six priests. He said D'Aubuisson was a neighborhood Cub Scout den leader, a good neighbor, mowed his own lawn and seemed like a “nice suburban guy.“

At this point reading the comments following reports on the case of the Brian Thompson assassination, it’s looking like the still-at-large shooter is being increasingly viewed as a potentially sympathetic figure — perhaps a Jesse James-type folk hero — even before it’s known what in his life happened that might have driven him to plot and carry out such a violent act of murder. This young man has, with a single act, opened Americans’ eyes to the sickness of capitalism in one huge industry: healthcare. That awakening is not going to fade away. And it may well spread to the rest of corporate America and to the corruptness of the supposedly democratic government in Washington that is actually owned lock, stock and barrel by corporate money and the wealthy.

If he ends up eluding capture and disappears, Thompson’s killer will likely become a legend. Meanwhile, if he is identified, located and not killed in the process of capturing him, and then goes to trial, he’d be advised to demand a jury. One wonders whether the case might, with good lawyering by the defense, end up resulting in a jury nullification.

If that sounds preposterous, consider what happened with the Camden 28, a group of mostly Catholic anti-war activists who raided a Camden, NJ draft board in 1971 and destroyed thousands of records of young men classified 1-A (suitable to be drafted). Although their guilt was documented by FBI agents who had secretly monitored the whole break-in, the jury, convinced by a defense team led by New Jersey liberties lawyer Marty Stolar and by the testimony of defense witness and leftist activist historian Howard Zinn that their principled act of civil disobedience against an unjust war merited jury nullification, the 28 were acquitted despite their admitted guilt.

It was a unanimousv verdict of innocence the government couldn’t appeal or retry.