The Killing of Brian Thompson and the Human Cost of Healthcare with Jia Tolentino

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3:15It's Morgan, the EP of the show, filling in for Nicole this week while she's on mat leave. Today, we're going to talk about health insurance. We're talking about this today because on December 4th, Brian Thompson was murdered in Midtown Manhattan at 6.44 a.m. He was 50 years old. He played golf and Wordle. He had two sons. He was also the CEO of UnitedHealthcare, the health insurance company with the highest rate of claim denials in the industry. So Gia, at what point did you think to yourself, I have to write about this? That's a good question. that's Gia Tolentino Gia is a staff writer at the New Yorker and the New York Times bestselling author of a collection of essays titled Trick Mirror in an interview on the podcast we can do hard things with Glennon Doyle Doyle said that if the news is ever dark or complicated she asks herself her own version of what would Jesus do which is what will Gia write about this and I find myself doing the same thing in moments like this Gia wrote a piece in the New Yorker about what Brian Thompson's death means to America.

4:20It's an amazing piece, and I linked it in the show notes so you can read it if you haven't already. Here she is on why she wrote it. I think this has been an incredibly interesting story in part because I don't know if you have felt this within your own sort of group chats versus professional networks, but there's a big difference in the way people are talking about this in private and the way that they're talking about it in public. And that always strikes me as the ripe situation for someone to try to step in and merge them. I mean, I remember I was covering sexual assault like the couple of years pre-Me Too and afterwards because that felt like, you know, another thing where there was this large social understanding of something being the way that it is.

5:00And then with the sort of public discourse lagging behind it, and then an explosive event that tried to merge the two. And I was interested in that, you know, the mainstream media of which I am a part and politicians, everyone was giving these very sort of performatively somber and reverent sort of like, this is an appalling, inexplicable, devastating loss of human life. And then, you know, social media is just full of, you know, the United Healthcare had to close comments on Facebook. And there were thousands and thousands of like, ha ha, cry laugh emoji. It just struck me as really interesting that the reaction was so was so sharp.

5:44Were there any of the sort of memes or comments that people were posting before the Facebook was shut down that are like burned into your mind? I would say the most common joke, you know, and it's, it's, you know, even talking to you about this, it's, it's nuts that we're having this conversation. Like, oh, well the, the most common joke that was being made about this man that was murdered in Midtown at 6 45 AM or whatever. Like it's, it's wild. We're living in wild, wild times, but an incredibly common joke and comment that was everywhere. And I was checking, like I was checking conservative media outlets, comments.

6:17I was checking sort of like a down the road CNN. I was checking the New York post. I was checking the times. I was checking Tik TOK. I was really trying to make sure that I was not locked in my own bubble of maybe like disaffected DSA Brooklyn or, you know, people and, um, and, and everywhere people were using the cold language that the private health insurance industry uses to deny people medication and life-saving procedures, like thoughts and prayers were not prior authorized and denied. And it was a real reminder that of the way most of us have experienced these companies as cold and uninterested in not only our quality of life, but, you know, if we haven't experienced it ourselves, probably most of us know someone whose entire existence medically, if not their existence financially, and certainly their existence spiritually, egg freezing, whatever it is, right?

7:16IVF, endometriosis, you know, whatever it may be. The vast majority of Americans have experienced health insurance as more or less cold-blooded merchants of violence in some way. And the way that that was just instantly flipped back onto this news story was so striking. Thompson's death, his murder, is a difficult topic to cover. It's difficult because there are two truths that feel mutually exclusive. Brian Thompson should not have been killed, and the healthcare system in the United States is broken. If you acknowledge that second truth, some say it's disrespectful to Thompson's family or it validates this really violent act, and I do understand that criticism.

8:00but I think that reaction comes from an assumption. The assumption is this, anyone who is talking about the flaws in the healthcare system right now is arguing that the ends justify the means, that in this case the ends, people looking critically at the broken healthcare system in the United States, is justifying the murder of Brian Thompson. I want to be clear, that's not what I'm doing today. I'm going to be talking about the healthcare industry, what the stakes are, and how we can have a better system. But I'm not debating whether the ends justify the means. I'll tell you personally, I think Thompson's death is terrible and tragic.

8:38But what I'm trying to do, and I hope you'll do with me, is separate the ends of the means to acknowledge that killing is always wrong, but also to look at how we got here, how we might be able to fix what is clearly very broken in the healthcare system. You don't have to have any sort of ideology at all to think like, why is this happening? To get a bill from urgent care and say like, why, why, why, why? Why do I pay thousands and thousands and thousands of dollars for private healthcare? Why do I determine my entire employment life around how to get healthcare for myself and my family? And I'm getting billed$700 for taking a child with 105 degree fever to the ER.

9:23You know, like, why is my bill before insurance discounted at$150 ,000 for, you know, an entirely normal labor and delivery, right? So let's rewind. Let's talk about what we know about UnitedHealthcare. It is notorious, even within the sort of notoriously awful American healthcare system. It is kind of known as the most rapacious. And it has gotten these profits, these record profits. It has grown to this size, not in spite of the fact that it denies so much care to so many people, but because of that fact. UnitedHealthcare is part of the health insurance conglomerate UnitedHealth Group, which is the fifth largest company in the United States by revenue and the largest insurance company in the United States.

10:08It's also the largest provider of Medicare Advantage, which is the type of health insurance you might get if you're over 65. United Health Group is a public company and their stock is up 63 % compared to its price five years ago. In Gia's piece, she notes that UnitedHealthcare has the highest claim denial rate of any private insurance company. It denies 32 % of claims. Claim denial is a profitability driver for healthcare companies. When Thompson was killed, he was actually headed into an investor conference. In that conference, claim denial rate was likely going to be a topic of discussion. In fact, according to Vox, the most watched number on every earnings call for an insurance company is the, quote, medical loss ratio, which is the percentage of premiums that are spent on paying out claims.

10:57Shareholders want to see that number low, but patients, of course, would want to see that number high. If the number is higher than expected, the share price of the stock can suffer. Gia also points out that one driver of UnitedHealth's high claim denials is a software they use called NaviHealth, which is an algorithm that provides care recommendations for patients, including when care is no longer necessary after a surgery or illness. In 2023, a class action lawsuit alleges that NaviHealth has a known error rate of 90%. This means that many people have had to face the choice of either going without care that they, by statistic likelihood, actually need, or pay out of pocket.

11:39In the class action lawsuit, there are many stories of people going without the care they need and dying shortly thereafter. Today, the parent company UnitedHealth Group is valued at$560 billion. UnitedHealth Care made$281 billion in revenue in 2023. The outstanding amount of medical debt in the United States is$220 billion. Medical debt is, in fact, the leading cause of bankruptcy in the United States. The American Journal of Public Health found that 66 % of bankruptcies in the United States were due to medical problems. I should note here that we do have resources for anyone struggling with medical debt, and I've linked those in the show notes.

12:23The fact that claim denials are so common makes this a blatant socioeconomic inequality issue. If it costs more money to heal, to get care, to live, wealthier Americans can live longer, healthier lives than poor Americans. So one of the things that I was writing about in this New Yorker piece is that when we think about violence and when we sort of decry violence, it's a very particular kind of violence. It's direct physical violence caused by a person with an intention to harm. But there are a lot of other ways that people's lives are taken prematurely. There's a lot of ways that people's lives are taken away from them.

12:59And structural violence, you could also call that social injustice, but structural violence, like the denial of health care and denial of safe housing. It's like these are a lot of ways that people's lives are taken away from them. I think those of us who are not subject to it on a daily basis still kind of understand the major things through which people's quality of life or life itself is given, like health, housing, school, the environment. All of these things are structured by deeply unjust systems that spare some people and treat almost everyone like very, very, very badly. And yeah, and I do think people are talking about that more now.

13:34Yeah. Yeah. I thought one of the really interesting things that you said about that, but also how people are seeing it the same way from both sides of the aisle is everyone's pointing at this and saying social decay. But the origin, they're sort of pointing at different places. Like some people are pointing at the killing itself. Some people are pointing at all of the comments online that seemed heartless. And some people are pointing upstream and talking more about the structural violence that has happened long before. you know obviously it's clear which side i fall on right it's like why wouldn't you look upstream and and you're right it's like even where people are like the the sort of heartlessness right what heartlessness are we appalled by yeah you know and even in the case of the you know there's a strange parallel daniel penny just got acquitted for strangling jordan neely on the subway right and that ideologically lines up with my prior is like i am appalled that this man strangled like someone in the middle of a crisis and, you know, instantly became a folk hero among some conservatives.

14:35And I think this was something that like the protests in 2020, like they tried really hard to redirect us. Like, yes, this sort of murder that occurred in public is, you know, it's egregious, committed by one man, one police officer, one vigilante ex-marine, whatever it is. But the real problem, you know, like the real problem is upstream. The real thing to be outraged about is the system, you know, which is not just like the New York City mental health care system, but it's part of it that makes it possible for people to be so unsafe and feel so unsafe and thus then make other people feel unsafe.

15:09You know, I do understand the tendency to fixate at the end point, but it doesn't make sense if you think about it for any longer than that. Acknowledging this head on pushes the conversation back into the feedback loop of criticism. But again, I think it's perfectly acceptable in this complicated time we're living in to feel the weight of Brian Johnson's death and the weight of the harm people have endured through not having access to affordable health care. It kind of reminds me of the Sacco and Vanzetti case. Like there were these two young men that were part of this violent, overtly violent Italian anarchist sort of collective group in New York in the 20s.

15:47And they were wrongfully convicted for an armed robbery and all these things. But they became these sort of folk heroes and they became this sort of famous cause. I just think it's interesting whenever there's a clear reason to talk about something like the healthcare system where we all know, like, this doesn't make sense. This doesn't happen in places other than America. It's like school shootings, right? It's like these things that we know are so profoundly hideous and so profoundly American. and we feel kind of powerless to do anything about it. And like, it'll never, ever change. And maybe it will never, ever change.

16:23But these moments where everyone suddenly is talking about the morality of private health insurance and the immorality of it, you know, it would be a lot better if someone hadn't had to be murdered to make this happen. But, you know, and of course, like this is exactly what presumably, I mean, you know, who knows what the shooter wanted. And you hate to sort of think like, Like, oh, like I'm happy about the thing happening that he wanted to happen aside from the murder. But I do think we ought to be talking about all these things more. And this energy belongs in other places other than group texts where we're, you know, like literally two of my friends being like, oh, yeah, I'm having endosurgery and my insurance won't cover it.

17:05And like, oh, I can't freeze my eggs until 2025 because the preapproval has to come in three days before my period. And I was one day too early. You know, like it's when we're like, oh, you know, these assholes like, oh, my prescription just went up to 500. You know, the people I'm talking to are all people like we'll be fine. It's not going to drive us into bankruptcy. And the way a lot of people cope with this is just to not get the medical care or start a GoFundMe. And I I hope that the conversation about this is is alive for for longer. So that's what people are feeling right now. And it's notably been across the aisle.

17:37I think there are many sort of populist economic issues that are presented as leftist when they're not. I read this book last year called Limitarianism, and it talks about this study from 2011 where researchers asked people to choose between three different models for wealth distribution in the country. and the first choice was perfect equality that every quintile had 20 % of the wealth. The second choice was each quintile receiving successively like the top 20 % has 36 % of the wealth. Next has 21%, next has 18%, next has 15%, next has 11%. And the last option was the actual wealth distribution of America in 2005, which meant that the first quintile, the top 20 % had 84 % of the wealth.

18:20The second quintile had 11 % of the wealth. The third quintile had four, and the last two had basically nothing. And 92 % of respondents chose the second option. And we are so far from it. And so I'm always like, there is so much populist economic energy that is not being harnessed by any person that I can see. Again, it's presented as this sort of leftist plank, but the energy exists everywhere. Anyway, I think economically, it makes no sense for there to be a class of people making tens of billion dollars a year off of the backs of people who are struggling. And in this case, very, very directly, and in a case where the company is itself causing the struggling or failing to address it in the way that they could.

19:09There There is money out there to give everybody health care. We have the wealth in this country. We have the technology. We have the ability. There's no reason. There's no reason why people should be dying for because they can't pay for insulin. There's no reason that that should happen in this country. And I think most people agree that, you know, the situation we're in is unjust. Yeah. Yeah. During COVID, I watched TV shows that got really hyped up that I had missed, like Game of Thrones. And I watched Breaking Bad. I had sort of missed the train on that by many years, but I had heard of it and I knew so many people were big fans.

19:44And what was so shocking to me at first was that people just sort of accepted the premise that somebody got a terminal illness and had to cook meth in order to provide for his own health care costs. It's crazy. If the show were to take place in Canada, it would have been a very boring show. It would have been one episode and he would have got chemo and it would have been fine. So because this outrage does seem to be across the aisle, can we expect a solution from the government to fix the broken health care system? I think now would be a really wonderful time if this country's political process functioned enough that we could have sort of like a nationwide referendum on single payer health care.

20:19I do think the numbers might be quite different right now than they were two weeks ago. And I do think that the Democrats in general would be profoundly foolish to not push public universal health care as a primary plank in 2028. I don't think they will. But I think that's I mean, what does this show us if not that that that's a layup, you know? And lastly, can we expect a solution from the health care industry and UnitedHealthcare itself? I'll leave you with an excerpt from Gia's piece. Of course, the solution in the end can't be indifference. Not indifference to the death of the CEO and not the celebration of it either.

20:59But who's going to drop their indifference first? At this point, it's not going to be the people who have a lifetime of evidence that health insurance CEOs do not care about their well-being. Can the CEO class drop its indifference to the suffering and death of ordinary people? Is it possible to do so while achieving record quarterly profits for your stakeholders in perpetuity?

21:27money rehab is a production of money news network i'm your host nicole lapin money rehab's executive producer is morgan lavoy our researcher is emily holmes do you need some money rehab and let's be honest we all do so email us your money questions money rehab at money news network.com to potentially have your questions answered on the show or even have a one-on-one intervention with me and follow us on Instagram at Money News and TikTok at Money News Network for exclusive video content. And lastly, thank you. No, seriously, thank you. Thank you for listening and for investing in yourself, which is the most important investment you can make.