It is a curious thing when a nation discovers that its most prolific killer was not a foreign terrorist in a cave, but a man in a suit sitting in a corner office in Minneapolis. Brian Thompson, the late chief executive of UnitedHealthcare, presided over a system that may well have claimed more American lives than Osama bin Laden ever dreamed of taking. The difference, of course, is that Thompson’s victims died not in spectacular fashion on a September morning, but quietly, bureaucratically, one denied claim at a time.
This is not hyperbole, though I suspect many will dismiss it as such. It is the arithmetic of American healthcare, where profit margins are measured against mortality rates with the cold precision of an actuary’s table. Under Thompson’s stewardship, UnitedHealthcare — that leviathan insurer covering 49 million Americans — perfected the art of what Hannah Arendt might have recognized as the “banality of evil.” Not the dramatic evil of the terrorist’s bomb, but the mundane evil of the denied authorization, the rejected claim, the prior approval that never comes.
Consider the mathematics of malice: bin Laden’s September 11 attacks killed 2,977 people in a single day — a horror that rightfully seared itself into the American consciousness. But what of the Americans who die each year because they cannot afford their insulin, their chemotherapy, their cardiac surgery? The Commonwealth Fund and other researchers have estimated that tens of thousands of Americans die annually due to lack of access to healthcare. A Harvard study placed the number at 45,000 per year — more than fifteen September 11ths, every year, year after year.
Thompson’s UnitedHealthcare was not merely a passive participant in this system but an active architect of it. During his tenure, the company’s profits soared from $12 billion in 2021 to $16 billion in 2023, even as — or perhaps because — its denial rates climbed to unconscionable heights. A Senate investigation in October 2024 documented the surge in Medicare Advantage claim denials, revealing a pattern of systematic refusal that would make Kafka weep with recognition.
The company’s methods were sophisticated in their cruelty. Prior authorization requirements that delayed care until delay became denial. Artificial intelligence systems programmed to reject claims with algorithmic indifference. Appeals processes designed not to provide justice but to exhaust the patient’s will to fight. These were not bugs in the system — they were features, carefully calibrated to maximize shareholder value while minimizing human cost.
When Thompson was gunned down on a Manhattan sidewalk in December 2024, the public reaction revealed something uncomfortable about American society. Yes, there was the obligatory condemnation of violence, the proper expressions of sympathy for his family. But there was also something else — a current of satisfaction, of karmic justice served, that ran beneath the surface of public discourse. Graffiti appeared on walls from New York to Paris: “DENY DEFEND DEPOSE.” Social media filled with commentary that would have been unthinkable in response to almost any other murder.
This reaction was not, as some suggested, a sign of American moral decay. It was a sign of American moral awakening — a recognition that Thompson’s death was being mourned less than the deaths his policies had caused. The man who pulled the trigger may have been Luigi Mangione, but the weapon was a system that had already claimed thousands of victims.
One might object that Thompson was merely following the logic of capitalism, that he was duty-bound to maximize profits for shareholders. This is the defense of the functionary, the plea of the man who was merely following orders. But there is a moral difference between selling widgets and selling access to life-saving care. When your product is human survival, your responsibilities transcend the bottom line.
The comparison to bin Laden is not meant to equate their methods but to illuminate their impact. Bin Laden sought to terrorize Americans into submission through spectacular violence. Thompson achieved something perhaps more insidious — he normalized the quiet violence of systematic denial, making the rationing of healthcare seem like a natural law rather than a policy choice.
In death, Thompson has become a symbol of American healthcare’s moral bankruptcy. His assassination was wrong, but his assassination was also inevitable in a system that treats human life as a commodity to be parsed by algorithms and priced by actuaries. When you build a machine designed to profit from human suffering, you should not be surprised when that machine eventually consumes its operators.
The real tragedy is not Thompson’s death — it is that his replacement will likely continue the same policies, pursue the same profits, and claim the same victims. The system that produced Brian Thompson remains intact, ready to produce another Brian Thompson, and another, and another.
Until we reckon with the structural violence of American healthcare — until we acknowledge that some CEOs have blood on their hands even if they never personally pulled a trigger — we will continue to produce both the Brian Thompsons and the Luigi Mangiones of this world. The former because we reward them for their cruelty, the latter because we provide no other outlet for our rage.
This is the America we have built: a country where healthcare is a privilege, not a right; where insurance companies are rewarded for denying care; where a CEO can kill more Americans than a terrorist and receive not condemnation but compensation. Thompson’s gravestone might as well read: “Here lies a man who discovered that the most efficient way to commit mass murder in America is to get a medical degree and an MBA.”
The only question now is whether we will learn from his example — or continue to produce more like him.
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