It was a cold Wednesday morning in December 2024 when the news broke, and honestly, the internet didn't react the way most people expected. When Brian Thompson, the CEO of UnitedHealthcare, was shot outside a hotel in Midtown Manhattan, the immediate response wasn't just shock—it was a strange, dark wave of collective venting. Usually, when a high-profile executive is killed, there’s a standard script of mourning. But this time? Social media erupted with stories of denied surgeries, bankruptcies, and the word "karma."
So, why was Brian Thompson disliked so intensely? It wasn't just because he was a wealthy guy in a suit. It was because, to millions of Americans, he was the face of a system that felt like it was designed to let them down when they were most vulnerable.
The face of "Deny, Delay, Depose"
If you saw the photos of the evidence found at the scene, you know the shooter etched three words into the shell casings: "Deny," "Delay," and "Depose." These aren't just random words. They are the holy trinity of insurance industry grievances.
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For years, UnitedHealthcare—under Thompson’s leadership since 2021—had been accused of using these exact tactics to pad their bottom line. People weren't just mad at Thompson the man; they were furious at the machine he ran. Think about it. You pay your premiums every month, you do everything right, and then when you actually get sick, a computer algorithm tells you that your doctor-recommended treatment isn't "medically necessary." That hits different when you’re the one lying in a hospital bed.
The AI controversy that changed everything
One of the biggest reasons Brian Thompson faced such heavy criticism was the company's aggressive pivot toward AI-driven claim denials. Under his watch, UnitedHealthcare reportedly leaned heavily on an algorithm called nH Predict.
The goal? Ostensibly to "predict" how much care a patient needed.
The reality? A class-action lawsuit alleged the system had a staggering 90% error rate.
Basically, the AI would suggest cutting off care for elderly patients in nursing homes far earlier than a human doctor would. When these denials were appealed to actual federal judges, the judges overturned them about nine times out of ten. But here’s the kicker: UnitedHealthcare knew that only a tiny fraction of people—roughly 0.2%—actually have the energy or resources to fight back and appeal. For the other 99.8%, the denial was final. They either paid out of pocket or, more likely, just went without the care they needed.
The wealth gap that felt like an insult
Let’s talk numbers. Because in the world of health insurance, the numbers are often what make people the angriest.
- Thompson's total compensation in 2023 was roughly $10.2 million.
- Some reports suggested his 2022 earnings were as high as $15 million when you factor in stock options.
- Meanwhile, UnitedHealthcare's profits surged from $12 billion in 2021 to $16 billion in 2023.
It’s hard to stay popular when your company is making billions by (allegedly) denying care to sick people. While Thompson was being rewarded for "efficiency" and "growth," regular families were filing for bankruptcy over medical bills. According to KFF polling, healthcare costs are the number one financial concern for American families after basic necessities like rent and food. When the person at the top of that system is taking home an eight-figure salary, it creates a level of resentment that is hard to overstate.
Inside the "Parasitic" reputation
The shooter, Luigi Mangione, reportedly left a manifesto calling the insurance industry "parasitic." While most people condemned the violence, a surprising number of people on social media seemed to agree with the sentiment. This speaks to a deeper, more systemic issue.
UnitedHealthcare isn't just an insurance company; it’s a massive conglomerate that owns the doctors (Optum), the pharmacy benefit managers, and the data. This vertical integration made many feel that the company had a monopoly on their health. If UnitedHealth decides you don't need a certain medication, and they also own the company that delivers that medication, where are you supposed to turn?
The insider trading allegations
Adding fuel to the fire, Thompson was named in a lawsuit in May 2024. The claim? That he and other executives engaged in insider trading. The lawsuit alleged they sold off millions in stock right before the public found out about a Department of Justice antitrust investigation into the company.
Whether or not he was legally guilty, the optics were terrible. To the public, it looked like the guys at the top were cashing out while everyone else was struggling to get a claim approved for a basic MRI.
The shift in public perception
After the shooting, the "brand health" of UnitedHealthcare plummeted to its lowest point ever recorded by YouGov BrandIndex. But it wasn't just the company. The event forced a national conversation about why we have a system where "prior authorization" has become a dirty word.
Fortune once described the surge in Medicare Advantage denials under Thompson as a "stain" on his legacy. It’s a harsh phrase, but it reflects the reality of how his tenure was viewed by consumer advocates and even some members of Congress. A Senate subcommittee report in late 2024 showed that denial rates for post-hospital care more than doubled in just two years.
Moving forward: What this means for you
The dislike for Brian Thompson was a symptom of a much larger disease in American healthcare. It’s not just about one CEO; it’s about a culture that prioritizes shareholder value over patient outcomes. If you’re dealing with the same "deny and delay" tactics that fueled this fire, here is what you actually need to do:
- Always appeal a denial. Remember that 90% figure? The system counts on you giving up. If your claim is denied, file the first, second, and third appeal.
- Request the "clinical peer review." Ask for the name and credentials of the person who denied your claim. Often, it wasn't even a doctor in your specialty.
- Involve your state’s insurance commissioner. Insurance companies hate it when regulators start poking around. A formal complaint can sometimes magically resolve a "glitch" in the denial process.
- Document everything. Keep a log of every phone call, the name of every representative you speak to, and every document they send you.
The tragedy of Brian Thompson's death hasn't fixed the system, but it has dragged its darkest corners into the light. Transparency is starting to become a requirement rather than a suggestion, as lawmakers feel the heat from a very angry public. Whether the industry actually changes remains to be seen, but the conversation is no longer happening behind closed doors.