The Extrajudicial Murder of Health Insurance CEOs is Bad, Actually

I was going to write something light-hearted, as a break from writing about research misconduct, but needs must as the devil drives. That's not a headline I thought I'd ever have to use.

I'm seeing several demographics crash into each other at the same time, and while I’ve got a second, I’ll try, TRY, to clear some of it up.

Also, I will briefly make the point that murdering CEOs is a bad thing.

Health Insurance In America

Healthcare in America is like everything else: if you have money, it's excellent; if you don't, it's godawful. I do not need to re-tell the tales of just how many people are cut off, marginalized, abandoned, killed. It is a collective disgrace which needs little summary.

It fits into the broader pattern of the financialization of everything else, and regardless of what you think of how well that has worked in your own industry and circumstances, it has made a lot of people's lives a lot worse.

The people who chat the most shit about insurance companies are, however, not the people they have directly harmed. They have their grievances, but they are singular and private. My father, his cancer, those claim denials, our grief.

But the people who you can find in an airport bar who are happy to go on a rant, replete with Australian language uncommon from non-Australian people, about the rapacity of the business and how it is full of filthy parasites, are doctors.

Doctors hate American health insurance with the same impotent fury people usually reserve for incompetent governments. The average doctor spends 13.5 hours a week on healthcare administration. Insurance companies tell them how to do their jobs, question their decisions, and take their money.

In a small and bitter irony, the entire dynamic is monstrously unhealthy.

The Participants Today

Our cast of characters today is just a few of the many involved, but the dynamics between them are important. They are:

(1) regular people who work in or around health insurance, they are horrified. We’ll call them the Stooges.

(2) the gigantic hordes people who have white-hot anger at the astonishingly dysfunctional US health insurance system, they have an touchstone for their (often justified) feelings. We’ll call them the Fallen.

(3) worm-brained terminally-online edgelords, they have a day or two of gleeful savagery and Discourse right now.

These are groups who don't typically interact. The Stooges actively avoid the Fallen and their stories, because they make them deeply uncomfortable.

There is a great article in the Financial Times today, where you can see the kind of milquetoast acknowledgement typical of the sector, the kind of ‘actually we know it is hard to put food on your family’ moment that is instead a massive indictment on just how little they know:

SOMETIMES IT CAN BE FRUSTRATING.

People crying on the couch, dying in the bathtub, lying hopeless on a bed after failing to find an in-network surgeon, people standing hollow by graves, limping to the store with a bone-on-bone hip, treating open sores with supermarket disinfectant, deteriorating slowly or fast enough to scare those around them or appallingly quickly, people waking up from anesthesia to be presented with a bill more than the equity in their house that they incurred while unconscious, somewhere in between being mashed into a steering column by an uninsured driver and waking up covered in tubes and debt.

SOMETIMES IT CAN BE FRUSTRATING.

We all have our willful oversights within what we hope are ethical lives. People working in US health insurance companies seem to have more of them than most.

The Fallen feel understood by the titanic levels of disrespect handed out by Edgelords, who have appended several tens of thousands of laughing emojis to the formal Facebook obituary from United Healthcare. They are unaware that they would laugh at their own dead relatives in a second.

The Stooges think Edgelords are mean and bad people, rather than people participating in late-stage capitalist games. They can, of course, be both. Again, the Financial Times piece, which you really should read, has the single most telling quote I have read this year, a glorious north-face-of-the-Eiger summiting of naivety:

Astonishing. Prior authorization. Care denial algorithms. Profit margins stacked on corpses. All behind a computer, all drained of humanity.

Alarmed, now, at cruelty via digital means. Beyond tone deaf, more ‘without ears’.

Astonishing.

Edgelords are of course busy disrespecting everything until they find something else to froth over. Welcome to the Internet.

You Cannot Kill Your Way To Better Healthcare Companies

The day after this happened, I wrote to a friend that this would have absolutely no impact whatsoever on the management and conduct of health insurance companies. There will be no reckoning where they suddenly ‘come to their senses’ and run a different business model, no Road to Damascus. Rather, the opposite. The wagons will be circled, and a new attitude will emerge:

We are guilty of nothing more than trying to do our jobs under difficult circumstances, and now they’re killing us because they don’t understand how complicated it all is.

I said this, and thought ‘oh boy, there I go speculating again’.

And last night, someone posted this to Reddit. I cannot confirm it is real, but if it is, it’s insane.

I see fear, wrapped in corporate nonsense.

But there is no alternative to fear.

A public company with its Commitment To Shareholder Value And Growth cannot suddenly decide to have an entirely different ethos. There is no sea-change here. Companies this large, in sectors this complicated, are absolutely welded to their course of action. Billions of dollars and hundreds of thousands of jobs depend on them acting exactly the same way they act now.

So, there is no broader value in scaring them. They will not change. I think there is an implicit expectation in a lot of the ghoulish delight around this that amounts to:

“You see? That’s what you GET! Now, you change!”

(This is presumably followed by a Hallmark movie moment, where a health insurance executive with a complicated job titles realizes there was always an alternative to being a rapacious bastard, and leads the industry into a new ethos of people over profits.)

This will not happen. I am not sure of much here, except that this will. not. happen.

Let us assume this industry remains predatory, and is now just predatory and scared.

Then what?

The Memetics of Execution

Ten years ago, Nick Hanauer (he’s a billionaire) wrote a piece called The Pitchforks Are Coming, which he framed — literally — as a message to his ‘fellow plutocrats’.

… what do I see in our future now?

I see pitchforks.

At the same time that people like you and me are thriving beyond the dreams of any plutocrats in history, the rest of the country—the 99.99 percent—is lagging far behind. The divide between the haves and have-nots is getting worse really, really fast.

… Our country is rapidly becoming less a capitalist society and more a feudal society. Unless our policies change dramatically, the middle class will disappear, and we will be back to late 18th-century France. Before the revolution.

And so I have a message for my fellow filthy rich, for all of us who live in our gated bubble worlds: Wake up, people. It won’t last.

If we don’t do something to fix the glaring inequities in this economy, the pitchforks are going to come for us.

I did wonder, at the time, if he was right. I don’t know.

I wonder now if the first tine of that pitchfork has appeared. If they have, it is Quite Bad.

Why this feels like it might be the memetic turning point will be hard to explain, as someone who doesn’t write about this much, but here goes.

Growing up in Australia, there was no such thing as a 'school shooting' -- the words existed, and the concept is trivial, but there was no center to the concept. It was something that happened to other people, and in a way, it didn't exist.

Columbine made it real, I think, two weeks after my 17th birthday. Columbine had images, an aesthetic, a feeling to it. I knew what it was, then. It had an identity.

What might happen, what I hope I am being paranoid and bleak about, is that we are on the precipice of doing the same thing to extrajudicial assassination of healthcare executives.

There is a slogan ('deny' etc.), an aesthetic, and there will eventually be a character. They will find a dead body in a hostel, or a live one in a bad motel. And then there will be a post-mortem of his motives, and more cultural artifacts to come.

Deny, Defend, Depose already has a Wiki.

I would be amazed if there isn’t merch already, because Google Autocomplete tells me there is demand for it.

People will be dressing as the killer next Halloween.

America has a long history of shooting important people: Lincoln, Garfield, McKinley, Roosevelt, JFK, RFK, Malcolm X, MLK, Reagan, and Trump — so in a very real sense, there is no cultural barrier in the way of asking:

Is there enough collective dissatisfaction in this country right now for this to tradition to graduate from a single CEO into… more?

This may be a singular event. But if it becomes an enduring cultural artifact, the answer to ‘who gets hurt?’ will be proximally ‘more people like the UHC CEO’ and then distally will be: all of us.

The growth of this as a cultural phenomenon has a very big stick behind its back, one built of state power, martial law, deportations, and mutual vengeance.

That’s why it’s bad. It’s simple. I see the seed of a rotten tree, and we have only seen one leaf of it so far.

Anyway.

I’ll spend the rest of the day hoping this is a flight of paranoia, and listening to black metal.

UPDATE: 8th December

Changed a word I got wrong.

Updates, tho:

https://www.tmz.com/2024/12/07/unitedhealthcare-ceo-shooting-suspect-lookalike-contest-in-nyc/ - it didn’t take until Halloween, it’s happening now.

And the merch is real.