Stefan Jeremiah/AP Photo
Members of the New York Police crime scene unit investigate the scene outside the Hilton Hotel in Midtown Manhattan where Brian Thompson, the CEO of UnitedHealthcare, was fatally shot, December 4, 2024, in New York.
“It wasn’t me. I didn’t kill him,” said Rita Baker, 88, when I told her I was calling about the Wednesday morning murder of Brian Thompson, the 50-year-old chief executive of American health care juggernaut UnitedHealthcare, by a masked assassin who shot the millionaire Minnesotan three times across the street from his Manhattan hotel, then escaped down an alley and disappeared into Central Park on a Citigroup-branded e-bike. Added Baker, “I mean, I can’t even ride a bicycle.”
I was calling Baker, who asked me to use her confirmation name in lieu of her given one due to her being “terrified” of the half-trillion-dollar insurance giant, because she’d contacted me earlier in the year to rant about the Medicare Advantage plan in which her late husband’s employer had coaxed her into enrolling, reluctantly, a year earlier. Thompson had spent most of his 20 years at UnitedHealth running its Medicare business, the cash cow around which much of the far-flung health care colossus essentially revolves. In recent weeks, his wife told NBC News, he’d received “threats” from unidentified foes who perhaps suffered from “I don’t know, a lack of coverage?”
Baker’s story was nothing approaching the most nightmarish “lack of coverage” stories I’d heard from UnitedHealth customers, many of which definitionally end in death via claim denial. In September, I detailed some of those stories collected in a class action lawsuit against the company’s nursing home “algorithm” NaviHealth, which a few years back UnitedHealth acquired and tweaked to automatically kick Medicare Advantage patients recovering from surgery out of their rehab centers after a maximum of two weeks, even if they could not move.
But I was struck by Baker’s aggravation, because she is the kind of relatively healthy patient the conventional wisdom consistently maintains is well served by Medicare Advantage: lucid and mobile, no serious medical conditions or recent hospitalizations, frail but fit, affluent. But she has medical needs, and UnitedHealth doesn’t seem to want to cover most of them. None of the five physicians she sees regularly accept any forms of the company’s insurance, much less MA. She never received reimbursement for the teeth cleanings and physical therapy appointments the company’s friendly sales representative promised would be covered in full. The Xarelto she takes for a mild heart condition still costs hundreds of dollars a month out of pocket. The “free” transportation service advertised in one of the glossy brochures came with a sign-up fee of $400.
UnitedHealth has been a particular trailblazer in the art of managing “risk” by simply denying claims for treatments and procedures it unilaterally deems unnecessary.
The one thing UnitedHealth had sent her free of charge was a cardiac monitor, to help her cope with the heart arrhythmia she blames on dealing with her insurance company. But when it went off in the middle of the night and she dialed the number on the packaging, no one answered. So she called UnitedHealth in the morning and stayed on hold until her call was dropped because it was a Saturday. The only other “benefit” she receives is a $24 “use it or lose it” gift card every three months. Last month, she used it to buy toothpaste at Walgreens, only to get painfully thwacked by a malfunctioning door on her way out of the store. In the future, Baker says, she’ll just stick with Amazon, since she can’t risk a fall knowing she barely has health insurance; her now-retired adult son, who lives with her, spent close to a year in a coma and decades in physical therapy after a gruesome boat accident he suffered working as a medic in his early twenties, back when the family had Blue Cross Blue Shield. “He got his degree while he was still in therapy and ended up having a long government career, all thanks to Blue Cross,” she said. “I think UnitedHealth would have cut us off. They are a nickel-and-dime operation to the point of insanity,” she said yesterday of the world’s largest health insurer.
But when she hired a consultant to help her switch to a new insurance policy, she realized she’d been trapped. She needed $10,000 up front, then again every three months, to enroll, which would have been a lot easier to swing if she hadn’t been paying all her medical bills out of pocket. After waiting on hold for hours while she cooked dinner for her son and cleaned the kitchen, she discussed her options with a friendly UnitedHealth customer service representative named Michelle, who told her she would regret switching; she knew that was a lie. But she let the enrollment deadline pass. “I’m just too exhausted to do it, and $10,000 is so much money.” I didn’t have the heart to tell Rita that she might consider herself lucky: New York is one of just four states that prohibit Medigap insurers from turning down applications from seniors with pre-existing conditions like her cardiac issues.
SOME 33 MILLION AMERICANS, more than half of the nation’s seniors, have done what Rita Baker did, forfeiting their Medicare cards in favor of enrollment in a privatized health insurance program that receives a flat monthly fee from the Centers for Medicare & Medicaid Services in exchange for assuming the “risk” that a patient’s health care needs might turn out to be costlier than the revenue they bring in. UnitedHealth, which insures close to a third of the nation’s MA patients, is to a great extent the architect of this vast privatization project, which has in recent years become the undisputed profit center of both the insurance giant and the American health care industry generally.
Medicare Advantage’s outlandish profitability is a product of government rules that allow insurers to artificially maximize the flat fees they collect for each patient (by claiming the patients—whose medical records CMS does not require the insurers to supply—are far sicker than they are), while minimizing their obligations to treat said patients’ reality-based maladies. A 2017 whistleblower lawsuit details Thompson’s personal efforts to convince CMS officials to issue statements assuring the company’s lawyers they won’t enforce a rule requiring insurers to repay fees collected from fraudulent diagnosis codes until a later date. Last year, the government spent more than $460 billion, or about $14,100 per patient, paying Medicare Advantage insurers; critics of the program estimate that overpayments comprise as much as $127 billion of that haul.
And what do seniors like Rita Baker get for all those tax dollars? Increasingly, not much. A Senate report published in October shows that denial rates at the big three corporate Medicare Advantage insurers for big-ticket expenditures like nursing home care have all risen dramatically over the past five years, as UnitedHealth and its peers outsourced those decisions to algorithms that have an easier time than humans denying vital care to patients in need. UnitedHealth has been a particular trailblazer in the art of managing “risk” by simply denying claims for treatments and procedures it unilaterally deems unnecessary. Last spring, even as the company was embroiled in a scandal surrounding revelations that NaviHealth kicked frail seniors out of rehab facilities after two weeks, the company appealed a decision that affirmed a lower-court determination that it had “arbitrarily and capriciously” denied coverage of a 2014 psychiatric hospital stay to a suicidal middle schooler who had subsequently killed herself. While the Supreme Court ultimately declined to take the case, the sense of self-righteousness the company maintains around its constitutional right to decline a hospital bed to a suffering patient shows up again and again in the company’s rap sheet.
There is virtually no consequence for unilaterally denying care, in large part because the entire Medicare Advantage ecosystem is itself ensconced in fraud. Seniors generally sign up for the program unwittingly and under duress, either from providers who receive kickbacks for switching their patients, sales agents who use deliberately misleading language to convince them that the program is a supplement to—rather than a substitution for—Medicare itself, or celebrity pitchmen who do a combination of both.
Once enrolled, patients are largely shut out of traditional Medicare via a little-known and predatory loophole in Obamacare that exempts Medigap insurance policies from the federal prohibition on denying coverage to patients with pre-existing conditions, the one Rita Baker could have sidestepped thanks to living in New York. Even seniors who take pains to conduct due diligence on their health care choices are systematically duped by misleading information, like the CMS-issued “quality scores” that reflect little beyond the awesome power the major health insurers wield in Washington, where regulators were forced in October to reverse their extremely minor downgrade of a UnitedHealth MA plan after the company sued CMS in Texas, arguing that it was being unfairly penalized for a call center misunderstanding.
SOCIAL MEDIA GREETED THE NEWS of Thompson’s gruesome death with a startlingly rich array of prior authorization jokes, followed by the inevitable sentiments of shock and horror that humans on social media apps could be so crass, followed by an array of angry threads detailing various UnitedHealth customers’ attempts to force the company to reimburse them for lifesaving chemotherapy, mental health treatment, nursing home care, etc. Many posters seemed legitimately inspired by the notion that the assassin had been motivated to avenge the death of a loved one kicked out of their psychiatric hospital or postoperative rehabilitation facility by the insurer’s tyrannical deprivation algorithms; apparently the shell casings at the scene had the words “deny,” “defend,” and “depose” written on them. Many others wondered how it was that a populace so universally contemptuous of its reigning health care monopoly had been too preoccupied throughout the fall bickering over immigration and pronouns to even notice the provision of Project 2025 that would make Medicare Advantage the default option for seniors newly enrolling in Medicare.
Still others pointed out that UnitedHealth had spent much of the past year negotiating with various members of the feuding ransomware gang who earlier this year purloined many terabytes of sensitive data on some 100 million American patients, and that the surgical assassination of its executive was far likelier to be linked to its encounters with bona fide international gangsters than its dejected and demoralized patient population. Or maybe the killer was on the losing side of Thompson’s $15 million share sale earlier this year, which an insider trading lawsuit recently filed by a firefighters pension fund notes was suspiciously timed during the window between the company’s learning it was the target of an active Justice Department antitrust lawsuit and the public disclosure of the probe that sent the stock spiraling downward.
The point being, it would be harder to find someone who wasn’t a suspect at this point.
