On a cold December morning in 2024, a man in a mask waited outside the New York Hilton Midtown with a 3D-printed gun. When Brian Thompson, the CEO of UnitedHealthcare, walked toward the entrance for an investor conference, the gunman opened fire. Thompson was killed.
In most cases, the targeted assassination of a high-ranking executive would trigger a wave of national mourning. This didn't happen. Instead, the internet exploded with something far darker. Within hours, the question brian thompson why was he hated began trending, not because people didn't know who he was, but because the reaction to his death revealed a massive, throbbing nerve in the American psyche.
While the industry mourned a "whip-smart" leader, thousands of people on social media were literally making "prior authorization" jokes about his passing. It was visceral. It was ugly. And it was deeply tied to the way we live and die in the U.S. healthcare system.
The Business of Denial: Why Was Brian Thompson Hated?
To understand the vitriol, you have to look at what UnitedHealthcare actually does. They are the biggest. As the insurance arm of UnitedHealth Group, they cover roughly 49 million people. That is a lot of power over who gets a surgery and who doesn't.
Under Thompson's leadership, the company was a Wall Street darling. Profits were up. Revenue hit $281 billion in 2023. But for the people paying the premiums, that success felt like it was being squeezed directly out of their pockets.
The word "deny" wasn't just a random insult thrown around online. It was literally etched into the shell casings found at the crime scene, alongside "defend" and "depose." These three words—Delay, Deny, Defend—are a well-known industry playbook described by critics as the strategy used to avoid paying out claims.
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The Algorithm Controversy
One of the biggest reasons for the animosity was the company’s shift toward automation. Basically, UnitedHealthcare was accused of using an AI algorithm called nH Predict to deny care to elderly patients in Medicare Advantage plans.
A 2024 Senate report was pretty scathing. It showed that the company’s prior authorization denials for post-acute care (like rehab after a stroke) were three times higher than other types of requests. Imagine a computer program telling a 90-year-old they don't need more physical therapy, even when their doctor says they do.
That creates a specific kind of rage. Honestly, when you’re fighting for your life or the life of a parent, and you get a form letter saying "denied," that person on the other end stops being an executive and starts being a villain.
The Massive Wealth Gap
Money talks. In this case, it screamed. In 2023, Brian Thompson’s total compensation package was around $10.2 million.
For the average American struggling with a $5,000 deductible, seeing a CEO make $10 million while their own claims are getting rejected is a tough pill to swallow. It felt like "corporate greed" personified.
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- Executive Pay: Thompson's $1 million base salary was bolstered by millions in stock options.
- Insider Trading Allegations: Just months before his death, Thompson was named in a lawsuit alleging he and other execs sold off $120 million in stock before a Department of Justice antitrust investigation went public.
- Company Profits: While patients complained about rising costs, the company was consistently hitting record earnings.
This wasn't just about one man. Thompson became a symbol for a system that many feel is "parasitic." Luigi Mangione, the suspect arrested for the shooting, reportedly carried a manifesto that used that exact word. He wasn't alone in that sentiment; a plurality of younger Americans in some polls actually found the killing "acceptable," which is a terrifying statistic that shows how broken the trust has become.
A "Stain" on Leadership
Fortune magazine once described the various investigations into UnitedHealthcare’s practices as a "stain" on Thompson's tenure. It wasn't just the AI denials. There were protests at the company’s Minnesota headquarters where people were arrested for demanding an end to "death by denial."
There was also the Change Healthcare hack earlier in 2024. It was a mess. Pharmacies couldn't process prescriptions, and doctors weren't getting paid. As the face of the insurance side, Thompson took the heat for the chaos that followed.
The Human Toll
The stories that flooded social media after the shooting weren't about the stock price. They were about the "little guy."
- People shared stories of being denied insulin.
- Families talked about losing homes to medical debt.
- Patients described the "prior authorization" loops that delayed cancer treatments until it was too late.
When someone like Brian Thompson is killed, these people don't see a father or a husband first. They see the gatekeeper who said "no." It's a disconnect that the corporate world is still trying to wrap its head around.
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What This Means for the Future
The hatred directed at Thompson was a symptom of a much larger disease. You can't fix it by just hiring a new CEO or increasing security at investor meetings.
If you are a policyholder or just someone watching this play out, here is the reality: the scrutiny on "value-based care" and AI denials is only going to get more intense. The "deny, defend, depose" era is under a microscope now.
Actionable Insights for Navigating the System:
- Appeal every denial. Data shows that a huge percentage of initial denials are overturned on appeal. Most people just give up, which is what the insurers count on.
- Get your doctor involved early. Ask them to perform a "peer-to-peer" review with the insurance company’s medical director.
- Document everything. Save every letter, name, and date. If you suspect an algorithm denied your care unfairly, mention the "nH Predict" controversy to your state’s insurance commissioner.
- Contact your representatives. The only way the "prior authorization" culture changes is through legislative reform, like the bills currently being debated in Congress to limit AI-driven denials in Medicare.
The death of Brian Thompson was a tragedy, but the reaction to it was a wake-up call. It proved that for millions of Americans, the healthcare system isn't just a service—it feels like a war.