The morning of December 4, 2024, wasn't supposed to be historic. It was just a chilly Wednesday in Midtown Manhattan. Brian Thompson, the 50-year-old CEO of UnitedHealthcare, was walking toward the New York Hilton Midtown for an investor conference. He was alone. No security. Just a man in a suit heading to work. Then, at 6:44 a.m., the silence of West 54th Street was shattered by a suppressed 9mm pistol.
Thompson was shot in the back and the leg. He died shortly after at Mount Sinai West.
People immediately started asking the same question: why was Brian Thompson targeted? It wasn't a robbery. The shooter didn't take a wallet or a watch. It was a cold, calculated execution. For days, the world watched a grainy CCTV feed of a masked man in a beige jacket, wondering if this was a personal vendetta or something much darker. When the suspect, 26-year-old Luigi Mangione, was finally caught at a McDonald’s in Pennsylvania, the pieces started falling into place. But the answer isn't just about one angry man. It's about a massive, systemic rage that had been simmering for years.
The Words on the Bullets: Delay, Deny, Depose
If you want to understand the motive, you have to look at the brass. Police found shell casings at the scene that weren't just empty metal. They had words etched into them: "DELAY," "DENY," and "DEPOSE." Honestly, anyone who has ever fought with an insurance company felt a chill reading those words. They aren't random. They are widely recognized as the "three Ds" of the insurance industry—a cynical shorthand for how companies supposedly avoid paying out claims.
- Delay the processing of the claim.
- Deny the coverage entirely.
- Defend the decision in court (or "Depose" the claimant).
There is even a well-known book by Jay Feinman titled Delay, Deny, Defend. By carving these words into the ammunition, the shooter transformed a murder into a manifesto. It was a message. This wasn't just an attack on Brian Thompson the person; it was an attack on Brian Thompson the symbol. He was the face of a $281 billion machine that many Americans feel is "parasitic."
Was it Personal? The Back Pain Connection
For a while, everyone thought the shooter must have been a disgruntled patient. Maybe UnitedHealthcare denied him a life-saving surgery?
The truth is a bit more complex. Luigi Mangione, an Ivy League graduate and high school valedictorian, didn't actually have a UnitedHealthcare plan, according to investigators. But he did have a history of chronic, debilitating back pain.
He had undergone a major spinal surgery that apparently didn't fix the problem. On social media and sites like Goodreads, Mangione had documented his "life-changing" injury and his growing frustration with the medical system. He wasn't just a "crazy person" in the traditional sense; he was a highly intelligent individual who became radicalized by his own physical suffering and what he perceived as a corrupt corporate society.
He didn't need to be a UnitedHealthcare customer to hate what Thompson represented. To Mangione, Thompson was the "apex predator" of a system that profits off of people being sick. In a three-page handwritten letter found on him at the time of his arrest, Mangione reportedly took credit for the "symbolic takedown." He viewed the killing as a way to "incite national debates."
The Industry Giant as a Target
UnitedHealthcare is the largest private health insurer in the United States. They cover about 49 million people. When you are that big, you are the natural target for collective frustration.
During Thompson’s tenure, the company faced heavy scrutiny. Just a few months before the shooting, a Senate subcommittee report highlighted a surge in "prior authorization" denials—basically, the company saying "no" to doctors who said their patients needed care.
- The Algorithm Scandal: UnitedHealth was sued for using an AI algorithm (NaviHealth) to predict how much care patients needed. The catch? The algorithm reportedly had a 90% error rate and was used to cut off elderly patients from rehab stays.
- The Profit Gap: While many Americans struggle with medical debt, UnitedHealthcare’s profits grew from $12 billion in 2021 to $16 billion in 2023. Thompson himself made over $10 million a year.
- The Death Threats: Thompson’s widow later told investigators that Brian had been receiving threats for a long time. They weren't always specific, but they almost always centered around "lack of insurance coverage."
When you combine massive profits with a system that feels designed to say "no," you get a powder keg. Thompson was the one holding the match, even if he didn't realize it.
The Unabomber Influence
This is where things get really weird. When police searched Mangione’s digital footprint, they found he had given a four-star review to Ted Kaczynski’s (the Unabomber) manifesto on Goodreads.
He wrote that it was too easy to dismiss Kaczynski as a "lunatic" and argued that he was more of an "extreme political revolutionary."
This suggests that why Brian Thompson was targeted wasn't just about healthcare. It was about a broader, "luddite-adjacent" hatred of modern corporate structures. Mangione used a 3D-printed "ghost gun" to commit the crime—a high-tech way to commit a low-tech assassination. He lived in a hostel, moved by bus, and used fake IDs. He was trying to exist outside the system while simultaneously striking at the very heart of it.
The Public's Unsettling Reaction
Perhaps the most shocking part of this whole story isn't the murder itself, but how the public reacted.
Usually, when a CEO is murdered in cold blood, there is a wave of national mourning. This time? Not so much. The internet was flooded with memes, jokes, and "I don't condone it, but I understand it" type of posts.
A survey by NORC at the University of Chicago found that 69% of US adults blamed health insurers' coverage denials for the environment that led to the attack. Basically, people are so fed up with the healthcare system that they found it hard to muster sympathy for its top executive. This "structural violence"—the idea that the system itself harms people every day—created a vacuum where a figure like Mangione could be seen by some as a folk hero rather than a villain.
👉 See also: Video of Brian Thompson: What Most People Get Wrong
What This Means for the Future
The killing of Brian Thompson changed the security landscape for executives overnight. You won't see many Fortune 500 CEOs walking to conferences alone anymore. But the bigger issue is the "national debate" Mangione wanted to start.
While the act was a horrific crime, it forced a conversation about "deny, delay, and defend" that the industry has tried to avoid for decades. Legislators are now under more pressure than ever to look into how prior authorizations and AI algorithms are used to deny care.
Actionable Insights from the Tragedy:
- For Patients: If you are facing a medical denial, don't just accept "no." The legal and medical consensus is that you should always appeal. Statistics show that a significant percentage of denials are overturned on the first or second appeal.
- For the Industry: The "black box" of insurance decision-making is no longer sustainable. Transparency isn't just a PR move anymore; it's a matter of safety and public trust.
- For the Public: This event highlights the desperate need for mental health support and a more empathetic approach to chronic pain management. Radicalization often starts in the gap where the medical system fails to provide relief.
Ultimately, Brian Thompson was targeted because he was the human face of a system that millions of people feel is designed to hurt them. Whether that's fair to him as an individual is a different question, but in the eyes of his killer—and a surprisingly large segment of the public—he was the embodiment of a "parasitic" industry that had finally been called to account.