The Assassination of United Healthcare’s CEO

A Call to Action for Healthcare Change

The tragic murder of Brian Thompson CEO of United Healthcare has elevated discussion about America’s health system. His death should be a call to action for healthcare reform. Only with reform can all the changes needed to center care at the patient-doctor interaction occur. This essay will explore the needed changes.

OPINION

Recently, Brian Thompson, a top executive at UnitedHealthcare, was tragically shot on a Manhattan sidewalk en route to a meeting. The assassin left behind shell casings marked with "Defer" and "Deny," referencing the health insurance industry's practices. While my recent commentary criticized similar issues , this act of violence and the hatred it sparked are entirely unjustified.

Mr. Thompson was not personally responsible for the denials or delays in care implemented by his company. On the contrary, he was among the few insurance executives working to address the dissatisfaction of UnitedHealthcare subscribers. He consistently advocated for healthcare insurance reform—a system he inherited, not created. He was a victim of a deeply flawed system, not its architect.

The System Behind the Crisis

The U.S. healthcare insurance system operates as designed decades ago by Congress. Post-World War II laws incentivized employers to offer health insurance by making expenses tax-deductible. However, individuals are not afforded the same tax benefits. Over time, the Federal Tax Code’s 72,000 pages have led to complex and counterproductive outcomes.

For instance, hospitals use AI software to inflate bills submitted to insurers, who then deploy their own AI software to reduce payments due to employer complaints about rising costs. Executives like Mr. Thompson work within this framework, akin to highly paid surgeons operating within a flawed healthcare environment.

In this system, doctors and patients have little control. Medicare, introduced 60 years ago, expanded healthcare access for seniors but remains governed by Congressional mandates. Fee-for-service Medicaid does not reimburse providers adequately, especially for complex cases impacted by social determinants of health.

As employers pressured insurers to reduce costs, rationing care became inevitable. Doctors often face limitations in prescribing treatments they believe are best, while patients blame them when care falls short. Executives like Mr. Thompson are unjustly seen as symbols of a system riddled with inefficiencies, misaligned incentives, and Byzantine rules.

Honoring Brian Thompson Through Reform

Mr. Thompson’s death should inspire Congress to address the systemic flaws in U.S. healthcare. Here are actionable reforms that Congress could enact:

1. End Employer Health Insurance Tax Deductibility

Employers should not have tax advantages for providing health insurance that employees cannot claim themselves. Employees should purchase their own coverage with the funds being spent by employers. Health insurance must become mandatory for all, akin to requiring liability insurance to drive a car. Healthcare insurance cannot be optional because no one who breaks their leg could tolerate non-treatment. Those without private coverage would be enrolled in a public plan, funded through their individual Social Security deductions like claiming dependents for Federal Income Tax.

Less coverage for a lower premium should be available. For example, Medicare offers optional plans with limited coverage as Medicare Advantage, but patients unhappy with their options can switch during annual enrollment periods.

2. Pay Doctors for Health, Not Volume of Sick Care

End the fee-for-service payment system for primary care doctors. When patients signed up for health insurance they would register with a primary care doctor for that year. Together they would select secondary coverage for advanced care Primary care doctors, who drive 80% of healthcare decisions (and costs), would assume full care of the patient and receive monthly payments adjusted for their patients’ health complexity.¹ This would shift physician compensation to a model based on patient health outcomes rather than service volume.

Under this model, the doctor and patient would determine whether a test, referral or procedure was worth the cost. At the end of the year, they would split the savings equally. Unnecessary tests or procedures, such as an MRI for a sore knee with no surgical intent, would be minimized. An example is a cash back credit card.

Hospitals that employed doctors would be paid a monthly fee for full coverage of the patient’s health. Health systems would consider cost of care for the benefit of the patients instead of their bottom line.

Doctors ordering unnecessary tests, referring excessive cases to specialists, or sending patients to the emergency room to avoid caring for them would face reduced compensation, while outcomes would be evaluated using patient-reported measures. This transparency would help patients understand healthcare costs, forcing hospitals to finally disclose fees. Doctors and patients would quickly find the best value for care if the cost of tests and treatments were discussed openly on social media. Doctors and patients having “skin in the game” would dramatically change healthcare. Doctors who got patients well faster at a lower cost would earn more, not less as in the present sick care system. Novel care options would proliferate. Technology would transform care delivery.

Patients who were diagnosed with a rare or very expensive condition, like kidney failure requiring dialysis or transplant, would be covered by re-insurance. Coverage happens today only when the patient becomes eligible for Medicare after years long legal battles for disability. Medical bankruptcy often occurs in the interim.

Patients choosing to pay for additional services out-of-pocket could do so through additional separate private insurance plans or choose Concierge Medicine.

3. Outlaw Maximum Allowable Charges (MAC) by Hospitals

Hospitals should charge all patients fairly. The underinsured should be charged the lowest rate accepted from any insurer, not the highest. Hospitals now use the wildly inflated Maximum Allowable Charge (MAC) because of insurers’ contract language. This practice, which leads to exorbitant fees to consumers, such as $50 for a Tylenol tablet or $20 Band-Aid, is a cause of medical bankruptcies. Ending MAC-based pricing would align hospital charges with actual costs, reducing financial burdens on patients.

4. Encourage Collective Bargaining for Employed Physicians

Physicians know the best safety practices for patients, but, as employees, are constantly in conflict with management that emphasizes profits over patients. Physicians employed in health systems work in constant fear of being forced to leave the community as described Case #1 Episode #3 . All health systems employing physicians should facilitate a vote for collective bargaining.

5. Reform Tort Laws to Fix Medical Malpractice

Healthcare-related injuries should be addressed through a no-fault system similar to workers’ compensation. If a medical mistake is acknowledged, the patient’s care would be covered by an injury fund, eliminating the need for lawsuits. The healthcare industry could finally address patient safety as a system property.

Additionally, state medical boards could audit electronic health records to ensure quality, publishing physician ratings akin to restaurant sanitation grades. Open access to anonymized Medicare and insurance data would further enable public scrutiny of provider performance to insure patient safety.

6. Make Pharmaceutical Patent Laws Fair

Pharmaceutical patents should begin when a drug is approved for public use, not when the patent is first issued. Current patent laws leave companies with only 8–10 years of effective exclusivity after lengthy clinical trials, driving up drug prices to recoup all the research and development costs in a short period of time.

By extending the patent period post-approval, drug prices could stabilize and fall, especially for medications treating rare or complex conditions. Physicians, not Pharmacy Benefit Managers, should guide decisions on drug value, ensuring better alignment with patient needs.

A Catalyst for Change

Brian Thompson’s tragic death underscores the urgency of reforming a broken healthcare system. His legacy should be a healthcare system that prioritizes patient outcomes, financial fairness, and transparency—principles he himself championed. Let his death serve as a turning point toward a more equitable and efficient healthcare system. These changes would put patients and their doctors at the center of healthcare instead of being helpless pawns controlled by accountants.

Patient Action

Send a link to this essay to your U.S. House Representative suggesting their staff with a responsibility for healthcare issues consider these proposals.

Preview

In the next series of essays we will:

1. Demonstrate what each step of obtaining healthcare should look like;

2. Examine what challenges exist in the current system to patient-doctor interaction;

3. Suggest options immediately available to patients and doctors.

1. Case Mix Index