Three words—delay, deny, and defend—are a testimony to the ever-unaffordable American healthcare system. Although violence cannot be condoned, it is increasingly evident that insurers undervaluing or outright repudiating claims and then refusing to accept responsibility in litigation may just be justification for public outrage. On December 4th, 2024, in an act intended to send a message to the insurance industry about its priorities, a gunman–allegedly identified as twenty-six-year-old Luigi Mangione–fatally wounded UnitedHealthcare chief executive Brian Thompson. Mr. Thompson’s untimely death has brought the topic of corporate greed to the forefront of public discourse and has set a precedent that corporate leaders are struggling to address.

The current timeline established by authorities is as follows. On November 18, Mangione’s mother filed a missing person report with the San Francisco police department, requesting information on the whereabouts of her son, Luigi Mangione. Unbeknownst to her, by November 24, Mangione had already entered New York City at Port Authority by bus where he checked in and out of the HI New York City Hostel on the Upper West Side using a forged New Jersey ID under the name Mark Rosario. The suspect extended his stay in the hostel several times, but on the morning of December 4th, Mangione left the hostel for good and traveled to Midtown by e-bike. Between 5:52 a.m. and 6:45 a.m., Mangione scouted the premises of the Hilton Hotel, briefly detouring at 6:15 a.m. to purchase a bottle of water and granola bars from Starbucks at 1290 6th Avenue. For approximately six crucial minutes, Mangione, masked and armed with a 9-millimeter 3D-printed ghost gun fitted with a silencer, waited for his target across from the New York Hilton Midtown. Upon locating Mr. Brian Thompson, Mangione crossed the street to the Hilton and proceeded to approach Mr. Thompson from behind just in front of the north entrance to the hotel. Mangione opened fire, and Mr. Thompson was shot once in the back and once in the leg. Thereafter, Mangione fled northeast on foot and took an e-bike uptown, where he flagged down a taxi and is believed to have left the state from Penn Station to Philadelphia by train. On December 8th, FBI agents and NYPD detectives, now informed of the missing person report filed days earlier, corresponded with Mangione’s mother. Mangione’s photo and fingerprints seemed to be a match for those of the gunman. Consequently, Mangione was identified as a primary suspect and detained at a McDonald’s in Altoona, Pennsylvania, on December 9th. 

Mangione’s actions represent the culmination of years of growing frustration with the U.S. health insurance industry. Three words were found etched into Mangione’s ammunition: “DENY" and “DEPOSE” were found on two of the shell casings, and “DELAY” was found on a bullet. All of these pieces were recovered at the scene of the shooting. The engravings, along with Mangione’s handwritten two-and-a-half-page manifesto, directed investigators to the gunman’s possible motive. In his manifesto, Mangione clearly expresses his antagonism towards the healthcare industry, writing that the “parasites had it coming.” Mangione argued that many healthcare companies, including UnitedHealthcare, prioritize making a profit over the safety of patients. Furthermore, though there is a switch from “defend” to “depose,” and it is undisclosed why the change was made, Mangione's engravings are still a direct reference to three powerful, recurring words: “Delay,” “Deny,” “Defend.” For context, “Delay, Deny, Defend” is both the title of author Jay Feinman’s book detailing insurance injustice and a common phrase used to describe the mercenary practices of numerous insurance companies. That is to say, insurance companies often delay the processing of patients’ insurance claims in order to push patients into abandoning care or accepting suboptimal solutions. Moreover, insurers will outright deny claims, and patients consequently lose coverage for necessary treatments under pretexts like technical errors, outdated policies, or misinterpretations of medical necessity. Insurance companies also defend against claims by engaging in aggressive legal tactics. By out-lawyering patients and forcing them into lengthy, expensive legal battles, insurance companies leave many patients with no choice but to give up on their claims. This often results in patients facing financial ruin, suffering severe health complications, or even losing their lives. 

As a result, many Americans agreed with and even supported Mangione's actions, viewing his violent defiance as a reflection of their own frustrations with the healthcare system. Following the murder of Thompson, there was an outpour of support for Mangione. Countless individuals shared their grievances about the U.S. healthcare system, ranging from delayed treatments to outright denial of coverage for life-saving care. Protests and online campaigns emerged, demanding systemic reform for holding insurance companies accountable for practices perceived as prioritizing profits over patient well-being. Mangione’s actions not only ignited widespread public discourse but also placed healthcare companies under intense scrutiny. UnitedHealthcare, in particular, has faced intense criticism for numerous scandals, including the use of an AI detection system with a 90% error rate, which was employed to automatically deny patients' insurance claims. Despite some public support, Mangione still faces harsh criticism from many news outlets. Many news outlets characterize his actions as an act of terrorism, arguing that there is no justification for murder. 

Mangione faces numerous charges from the Manhattan district attorney, including first-degree murder in the interest of terrorism. New York pressed two counts of second-degree murder, one of which is charged as murder in furtherance of terrorism; two counts of criminal possession of a weapon in the second degree; four counts of criminal possession of a weapon in the third degree; one count of criminal possession of a weapon in the fourth degree; and one count of criminal possession of a forged instrument in the second degree. Currently, he has pleaded not guilty to all charges and appears to be pushing for a mistrial by arguing that the extensive news coverage of his case renders it impossible to have an unbiased jury.

Since Mr. Thompson’s assassination, corporate greed has taken center stage as a central issue in the American zeitgeist. Mangione’s violent action sparked widespread protests against the harmful and dangerous practices of many healthcare companies. The death of Brian Thompson reflects a larger issue with US healthcare practices and exposes a system that many claim prioritizes profits over people. For many Americans, it is a clear sign that it's time for an overhaul of the American healthcare industry.

Information retrieved from Fox 5 New York, CBS News, Deshaw Law, Harvard Business Review, Northeastern Global News, and ABC News.