Killing Insurance Executives Who Practice Insurance

American politics today is ugly. But it has been worse. After George Washington retired, the Federalists and Jeffersonians bitterly battled for control. No less antagonistic were the later fights centered around Andrew Jackson’s three runs—two successful—for president. In 1860 the nation broke apart and suffered through a murderous civil war.

Nevertheless, political disputes in the U.S. only rarely turned violent. In some other countries assassinations became almost common. For that reason the 2025 murder of Charlie Kirk was so shocking. More ominous, however, might be the earlier killing of Brian Thompson, CEO of UnitedHealthCare.

Kirk courted controversy. That didn’t justify his assassination, of course, but his activism turned him into a target. Thompson was a businessman who did nothing unusual or nefarious. He simply ran an insurance company. A firm which sold health insurance.

He was murdered by Luigi Mangione, an intermittently employed 26-year-old who pleaded guilty to the crime and will be sentenced in December. He evidently blamed Thompson for the state of American health care. The reason for Mangione’s animus was unclear: after all, he was never insured by UnitedHealthcare, which differs little from other industry participants. Nevertheless, hostility toward insurance firms is widespread.

Mangione immediately attracted fans, who contributed to his defense. Some supported his action as “self-defense.” His plea bargain resulted in disappointment, not repudiation, among his backers. And many still stand by him. For instance, the December 4 Legal Defense Committee, which raised $1.5 million from 42,000 people, is continuing its activities. Sam Beard, the organization’s spokesperson, stated: “We are committed to helping provide Luigi support until he is free.” That’s not all. Added Beard: “In the event that Luigi ends up serving time for what he pled guilty to, we will continue to provide support for Luigi.”

Thankfully, unlike the Committee’s founders and funders, most Americans do not effectively endorse murder. Nevertheless, many Americans believe the insurance industry shares responsibility for Mangione’s action. According to the Associated Press: “About 7 in 10 adults say that denials for health care coverage by insurance companies, or the profits made by health insurance companies, also bear at least ‘a moderate amount’ of responsibility for Thompson’s death. Younger Americans are particularly likely to see the murder as the result of a confluence of forces rather than just one person’s action.”

There is much to criticize about American health care, which is a mishmash of government programs, restrictive statutes and regulations, private providers and insurers, and perverse incentives. For reasons stretching back to wage controls during World War II, the U.S. system is overwhelmingly based on third party payment, that is, roughly 90 percent of medical costs are in the first instance paid by someone else—primarily government and private insurers. Indeed, health insurance has largely become prepayment of common medical expenses, rather than coverage for unexpected and significant expenditures. (Imagine if auto insurance covered oil changes, tire rotation, and gasoline fill-ups.) Which inflates demand, since patients care little about prices, and thus cost. Both public authorities and private firms then use eligibility standards and utilization controls to limit spending.

This leads to complaints about denial of coverage. Sometimes firms abuse that practice. But most times that decision simply reflects what the policy covers. If you buy a cheaper policy, you typically get less coverage. Yet most Americans have come to believe that someone somewhere should pay for everything, irrespective of what the policy says. Unfortunately, the system of employer-provided insurance—an anomaly, since we don’t expect firms to pay for our auto or homeowners’ insurance—means we don’t choose our health insurance, so most of us don’t choose what is covered.

Understandably, then, health care has long been one of Washington’s most important and contentious issues. Advocates of government-provided health care continue to push to expand federal coverage, with “Medicare-for-all” the latest cause. Most governments worldwide play a significant role in providing health care, though their programs differ markedly. However, government-provided care is no panacea. No one has found a way to simultaneously expand coverage and reduce costs. It simply cannot be done.

There is no “Christian” position on health care. A good society should include access to medical attention, with support for those who lack the means to afford some minimal level of care. What that means in practice, however, is a matter of substantial debate. How to provide how much care is not self-evident. Should everything be “free,” meaning paid for by someone else? If so, by whom?

And should everything be free? Am I entitled to every medical test and remedy known to man? How about treatments with a very low likelihood of success? Which may offer only minimal benefits? What of experimental procedures? Moreover, very important, who gets to decide? Me? The president? Congress? Or some obscure committee buried within the federal bureaucracy?

No system can escape the essential reality of scarcity. Someone must make decisions about who gets what. Nationalized systems tend to ration by delaying care, with significant wait times for appointments and treatments, and, even more important, denying care, with sometimes serious deleterious health consequences. In some countries governments make the brutal calculation—rarely acknowledged publicly—that the elderly, with shorter life spans, should not receive more expensive treatments. In a system in which the state largely determines who has access to what, a denial of care is far more devastating than in America, where companies and charities often underwrite treatment, and in which family members, friends, and even interested members of the public can help someone afford otherwise unaffordable remedies.

In confronting America’s complicated, malformed, consequential, and often irrational system, it makes no sense to blame insurance companies and their executives. The system, ultimately formed by a mix of government policies and market forces, has generated insurance companies, rather than the reverse. If you think the current system is broken, imagine making your way without health insurance, in which case you’d have to pay the entire bill for emergency or life-saving care. It is in practice foolish and, indeed, immoral, to blame United Healthcare or any other company for a system others created. Of course, there are errant and even, occasionally, criminal operators, and they should be punished accordingly. But most of the public criticism of insurers is that they insist on fulfilling their basic purpose of providing insurance rather than charity.

Health care in the United States needs reform. However, that process obviously will not be advanced by murdering health insurance executives. Although only a small minority of people see that as an answer, the fact that tens of thousands of people contributed to the defense of an admitted murderer is more than disturbing.

Instead, Americans must realize that there is no “free lunch,” as the saying goes. The more treatment you want, the more you will have to spend. And, ultimately, we all will have to pay the resulting bills. While market economics cannot determine our ultimate objectives, it can help us decide what we want and how to get there. Addressing our health care needs is yet another reason we need to declare a political truce and cooperate collectively to address the many deep policy challenges facing our nation.