On The Daily Show on Monday evening, host Jon Stewart brought up the capture of Luigi Mangione, the 26-year-old Ivy League graduate who had been arrested that day in connection with the killing of a health-insurance executive.
"They did appear to catch that guy today at a McDonald's," Stewart told his audience, eliciting a mix of boos and applause. "Look, I'm sorry guys." The host then joked about the person who turned Mangione in to police, noting that "snitches get stitches, but obviously without pre-approval there's really..." as guffaws filled the studio.
It's that kind of cavalier reaction, devoid of sympathy for Brian Thompson, the 50-year-old husband and father of two who was gunned down on the streets of Midtown Manhattan last week, that is unsettling workers in the industry.
Conversations with employees in various roles revealed shock at the callous treatment of the UnitedHealth Group Inc. insurance chief on the day of his private funeral "- and the evident sympathy in some corners for the man charged with murder. Social media was full of praise, often from anonymous or unverified accounts, for Mangione and even many people who condemned the violence used the killing as an occasion to criticize the industry's practices.
Frustration with health insurers is nothing new - long before Thompson died, there was widespread condemnation of a profit-driven system that makes difficult-to-understand decisions about what medical treatments to cover.
But the degree of vitriol in the wake of the killing has taken even industry veterans by surprise.
"There is a very strong concern that we're going to see copycat events," said Scott Stewart, a vice president at security firm TorchStone Global.
Police in New York were investigating threatening "WANTED" posters spotted in Manhattan that depicted company executives and echoed the language found on the bullets in Thompson's killing, a New York Police Department spokesperson said.
Companies say they are prioritizing their workers' safety and sense of wellbeing, even as some believe the reaction to the killing online has unfairly amplified attacks on the industry writ-large, according to one industry official who asked not to be identified discussing a sensitive topic.
Some health insurers have scrubbed information about their executives from their websites and are weighing closing public access to offices. Companies are also tracking call-center activity and making sure consumer complaints are taken seriously, according to another person in the industry who asked not to be identified.
The NYPD is on alert for "a risk that a wide range of extremists may view Mangione as a martyr and an example to follow," according to a law enforcement document reviewed by Bloomberg News. "Rhetoric may signal an elevated threat facing executives in the near-term."
For now, it's unclear if the fury unleashed against health insurers after the murder of one of the industry's top executives will lead to any self-recrimination or broader changes to how coverage decisions are made.
"This has been very much with us and under the surface of US health care for a long time," said Warris Bokhari, a former executive at Elevance Health Inc. who now runs a company called Claimable that helps people appeal insurance denials. "At the bottom of it is people are frustrated and they want something better."
Insurance surveys
Industry officials point out that the current backlash isn't broadly representative of Americans' experience with their health plans. About 65 per cent of people in a November Gallup survey rated their own coverage as excellent or good.
Still, denials of care are widespread, and there is no shortage of heart-wrenching stories. In an August study from nonprofit Commonwealth Fund, 17 per cent of respondents said an insurer had denied coverage for care that had been recommended by a doctor. Nearly 60 per cent of those who experienced a denial said care was delayed as a result.
Health insurers are weighing ways to improve how they communicate with members about coverage, benefits and hurdles like prior authorization and claims denials. The health-care industry will have to redouble its efforts to help explain the role of insurance, another person in the sector said, noting that there's widespread misunderstanding. That will be a longer-term effort.
But there's a recognition by insurers that the issue isn't simply a communications problem "- companies need to examine the policies that provoke so much ire, two industry officials said. Those discussions were underway before Thompson's murder, but have taken on new urgency.
Public anger
Even some doctors who pledge to "first, do no harm" expressed conflicted feelings about the killing. James Young, a family physician from Eau Claire, Wisconsin, wrote in the trade publication MedPage Today that he "shed no tears for Thompson" who he said profited "off the suffering of others."
He said physicians are "the profession that has the moral high ground" against insurers, and called on doctors to "condemn the actions of Thompson and UnitedHealthcare as vehemently as we condemn the actions of his assassin."
Some in the industry praised remarks from Pennsylvania Governor Josh Shapiro, who after the suspect's capture said: "He is no hero."
Complex web
Insurance companies frequently face public anger since they're in the position to set limits on care, but the medical industry is full of complex relationships among employers that pay for benefits, hospitals and doctor groups that provide care, and drug and device companies that sell medical products. All segments of the industry include large, for-profit entities, and they frequently blame each other when patients get upset.
Going forward, health insurers will likely make a greater effort to publicize how they help customers, like flagging gaps in care or reminding someone they need a cancer screening, said Michael Sherman, a former health-insurance executive who worked at Humana Inc. and Point32Health, a nonprofit insurer based in Massachusetts.
But simply loosening policies in response to public anger can hurt their business.
"If a health plan has less restrictive policies, that leads to higher costs and some employers may be less likely to choose them as their carrier," Sherman said. "A failure to be competitive leads to lost business, even if a payer wants to do the right thing."
Thompson's murder has forced a very sudden reckoning, but the insurance industry has long faced accusations that it puts profits above patients.
Wendell Potter, a former communications executive at Cigna Group, was familiar with anger from people who had been denied life-altering or life-saving care. Then, in 2007, Potter began to feel that anger himself, when a 17-year-old girl was denied a needed liver transplant by Cigna.
An outcry ensued, and the insurer eventually caved and approved the care. But it was too late, and the girl died a short time later.
"It was the first time it became abundantly clear to me that there was problem," he said. "I just saw too much."
Potter left his job at Cigna and became one of the most prominent critics of the industry, writing books, testifying before Congress, and advocating for patients directly.
"This happens day in and day out, and people are suffering," he says. Insurers are "denying what they know is medically necessary care, and they do it because they don't think people will fight it."
