“Deny. Defend. Depose.” These words were found written on three bullets at the murder scene of UnitedHealthcare CEO Brian Thompson. The echoes of these bullets spread across the internet and captured public attention in December, leaving discussions about the role of insurance in the American healthcare system in their wake.
Following the killing of Thompson, dialogue criticizing the exploitative nature of medical insurance surged on social media and in public discourse as stances critical of Thompson’s role in the healthcare industry have garnered widespread support. While Thompson’s death should not be celebrated, the long-due conversations criticizing the healthcare industry that Thompson’s death has served as a catalyst for is necessary.
The shooting took place on Dec. 4, 2024, in midtown Manhattan, beginning a 6-day-long investigation that prompted media coverage and public attention. Immediately afterward, many reacted with little sympathy toward Thompson due to his role as CEO of UnitedHealthcare. Discussion on social media shifted to criticism of the insurance industry, reflecting the broader anger Americans feel toward those involved in handling healthcare insurance claims. While these discussions have been happening for decades, the broader public’s approach to this extreme action on behalf of this issue should serve as a wake-up call to those in power and those who are able to begin making change.
“I understand that Thompson is being mourned by his family, but I’d rather acknowledge the many other families who have been impacted by his actions,” senior Kelly Chu said. “While I do not support capital punishment under any circumstances and therefore do not condone the killing of Thompson, I find it difficult to sympathize with him.”
This attitude was illustrated across party lines on social media. When UnitedHealth Group, the parent company of UnitedHealthcare, posted on Facebook the day of Thompson’s death to remember his legacy, within two days, over 70,000 users reacted to the post with a laughing emoji. While Thompson’s death is not a laughing matter, this reaction suggests that many Americans reacted without much sympathy for those sustaining an industry worth $4.3 trillion that makes its profit by denying average citizens sympathy.
“Platforms like TikTok shed light on a lot of normal people sharing their stories, where they’re forced to appeal decisions or pay exorbitant out-of-pocket costs while their health is at risk,” Chu said. “It’s increased class consciousness, and most students are thinking critically about the system that we’ve inherited.”
Over the course of the New York Police Department’s investigation, several details left at the scene gained public attention. One of these details is three bullets: each with words written in Sharpie from the phrase “Deny. Defend. Depose.” The phrase was likely inspired by Jay Feinman’s “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It,” a book that explores the tactics insurance companies use to exploit consumers. The phrase details three steps insurance companies use to increase profit at the expense of those filing claims, a fundamentally abusive practice that takes advantage of people at their lowest, shoehorning claimants into medical debt, which as of 2021 significantly affected 15 percent of US households according to the US Census Bureau.
“Delay” refers to the practice of insurance companies delaying the processing of claims intending to frustrate the claimant until they give up or can no longer pursue the claim. Companies are known to do this, especially for long-term illnesses or injuries, by creating procedural blocks. This means adding additional forms to the process or claiming that forms were not filled out in order to complicate the claimant’s ability to receive a payout. This approach takes advantage of those in physical, mental and often financial distress; a 2022 study documented a connection between chronic and long-lasting conditions, such as cancer, brain trauma or physical disabilities, with increasingly high debt.
“Deny” references the method of denying claims with the expectation that claimants often do not have the resources or knowledge to legally challenge the denial. The medical insurance industry does not disclose the majority of its data, however, an analysis of numbers released under the Affordable Care Act revealed that, while numbers vary significantly throughout the industry, an average of 1 in 5 claims are denied. Out of the reasons cited by insurers, only six percent of these are denied based on lack of medical necessity, meaning the majority of denials occur when a patient is seeking necessary medical care. However, fewer than one percent of denied claims are appealed, leaving those who may not have access to resources to challenge denials having to undergo significant medical charges or forgo medical care altogether.
“We can certainly say that the system we have now is not cost-effective unless you’re one of the very small fraction of people that can afford really comprehensive health care,”Master of Public Health Program Director at San Jose State Kevin Roe said. “The insurance companies interject themselves in between the doctor and the patient as the arbiter of, ‘we’re going to pay for that or not’, regardless of whether or not it’s medically appropriate or necessary.”
A large percentage of claims are denied, yet several companies have found ways to further distance medical claim processing from the empathetic human eye, reportedly streamlining the denial process with AI and predictive algorithms. Three of the largest insurers: Humana , Cigna and UnitedHealth, are facing lawsuits alleging they knowingly put to use an AI model denying claims with a 90 percent error rate.
When all else fails against the one percent of people who appeal their claims, insurance companies with access to vast resources and legal teams will “defend” insurance claims in court, aiming to exhaust the claimant into a low settlement.
“They have the capacity to delay people, to tire people out,” Roe said. “What may be someone’s life being taken over, to them it is just one more. That is power. They have the power of time, they have the power of money.”
In the aftermath of the shooting, many have connected the phrase “Delay, Deny, Defend” with violent ideation and plans to repeat Mangione’s alleged actions, which downplays the righteous anger many feel at the actions of insurance companies when referencing the phrase. Others believe Mangione’s large-scale support is a result of his conventionally attractive appearance.Comments on social media platforms — often insensitive to the grim context of Mangione’s fame — reflect an aspect of Mangione’s support that appears more superficial, and should not represent the entirety of the critique against Thompson’s and the insurance industry’s actions. It serves as a sign for necessary reform to a system that has hurt so many.
“Sometimes it seems like we can no longer stop the system because we’ve created so much infrastructure around it, but the infrastructure can be shifted into a national healthcare payer system,” Roe said. “It’s a challenge because the healthcare industry has a stranglehold on us, they’re not going to willingly give up their profit, the system is based on a profit motive. Until we take the profit out of healthcare, I don’t see how it’s going to get any better.