Mene Mene Tekel Upharsin

An accounting of the victims of Brian Robert Thompson

In the time since the killing of UHC CEO Brian Robert Thompson, much ink has been spilled on the practices of United Healthcare and the other private health insurance companies. From United's industry-leading claim denial rates to Thompson’s abominable abominable use of AI algorithms to auto-deny claims, others far more qualified than I have documented the character of Brian Robert Thompson’s sins against his victims and against common decency. What I have yet to see, however, is a cold calculation, an honest attempt to numerically document the total magnitude of the crimes of Brian Robert Thompson. I will attempt to produce such an estimate here. This is not intended to be a perfect accounting of every individual that died as a result of Brian Robert Thompson’s actions, but merely a decent first-order estimate of the magnitude of his crimes.

Methodology and Moral Culpability

Brian Robert Thompson was never convicted in a court of law for his inequities. He was accused of insider trading. But no court ever indicted him for the deaths that he caused. In our legal system, the actions he committed were largely legal. When I refer to the crimes of Brian Robert Thompson, I do not accuse him of the violation of any specific legal statute. Instead, I refer to his moral crimes, violations of common decency and common humanity. I hold that a killing committed with a gun or bomb is no more or less evil than a killing committed with a pen. Taking a life by deliberately denying someone life-saving medical care, that by contract should be provided, is as damning as doing it with your own two hands. The law may not recognize it as such, but common decency and basic human dignity demands it. Thus, when I refer to the killings or murders of Brian Robert Thompson, this is to what I refer, not the violations of any explicit legal statute, but a violation of the natural law of all humankind.

Corporate Structure and Moral Responsibility

In this analysis, I will place full moral responsibility for those killed by United Healthcare during his tenure as CEO entirely on the head of Brian Robert Thompson. Some may think this unfair. But a moral failing of our existing corporate system is how it is designed to produce an utter lack of moral accountability. Observe the excuses for moral culpability. A front-line worker will say, “I am not responsible for the deaths resulting from the claims I deny. I am merely obeying my manager.” The manager will say, “I am not responsible for the deaths resulting from the orders I give to my subordinates, I merely follow the commands of the executives.” The executives say, “I am not responsible, for I am merely maximizing shareholder value.” The shareholders say, “how can I be held responsible? All I did was buy a share of an index fund in my 401k. I’m just trying to save for retirement!”

It is difficult to find any locus of moral responsibility within our corporate structures. Still, if moral culpability is to be assigned, it is reasonable to place it on the head of a company’s chief executive officer. Under Thompson’s tenure, United Healthcare’s profits soared to record highs. On the morning of his death, Brian Robert Thompson was on the way to a shareholder conference, where he intended to gleefully celebrate the record profits produced as a result of UHC’s soaring and industry-leading claim denial rates. For these profits earned in blood, he was lavishly rewarded with an obscene pay package of over $10 million per year.

Brian Robert Thompson willingly and proudly took full credit for the profits that resulted from the deaths of United Healthcare’s numerous victims. As such, it is entirely reasonable to place full moral responsibility for those deaths on his head. I place moral culpability for UHC’s actions on him, because he willingly accepted that responsibility.

Counting the Dead

Estimating the total number of individuals killed as a direct result of claim denials is impossible to determine at present. Private health insurance companies do not publish detailed data on claim denials and resulting morbidity. Instead, the best that can be done is to estimate the number killed as a result of the private health insurance system in general. Studies have attempted to do this, controlling for numerous factors such as income and health.  They contrast countries with universal healthcare to the US system, countries that cover everyone and lack the usurious deductibles and co-pays found in the US medical system. Estimates are that moving to a single-payer system would save approximately 68,000 lives in the US each year. This includes deaths both from lack of health insurance entirely, and from those who have health insurance but are killed when their health insurance company wrongfully denies coverage of life-saving medical treatment. This is admittedly a rough number, but it is the best available. As private health insurance companies are the main political driving force preventing the transition to Medicare for All, it is also not unreasonable to assign moral culpability for the deaths of the uninsured on their heads as well. Imperfect though it may be, the 68,000 figure will be used going forward.

Market Share of the Deceased

United Healthcare is the largest private health insurer in the country, controlling approximately 16% of the private health insurance market. If we assume that the deaths caused by private health insurance are proportional to market share, then UHC is responsible for 10,880 American deaths per year, or approximately 30 per day.

Brian Robert Thompson became CEO of United Healthcare in April 2021 and remained so until his death in December 2024. He was CEO for 3 years and 8 months. As such, UHC, and in turn Brian Robert Thompson, were responsible for the deaths of 39,900 innocent Americans during his tenure. This a reasonable first order estimate of the number of people killed as a result of Brian Robert Thompson’s actions.

Limitations and Conclusion

This is obviously a limited first-order estimate; it is meant only to illustrate the approximate magnitude of the number of people killed by Brian Robert Thompson. However, it is likely a conservative estimate. United Healthcare leads the industry in rates of claim denials. It is not impossible that the real figure is much higher, potentially 100,000 or more. And while this 39,900 figure is based on those killed by the existence of private health insurance in general, a figure specifically related to denials of claims would be similarly high. If even 10% of this figure can be attributed directly to denials of valid medically necessary claims, than Brian Robert Thompson would have a body count in excess of many of the greatest mass murderers in American history. For example, 10% of this figure would still make him responsible for the deaths of more Americans than Osama Bin Ladin.

The usual caveats here apply. Obviously, no one has the right to take a human life. Brian Robert Thompson was responsible for the deaths of approximately 40,000 innocent human beings. Each one had a family. Each one was a mother, brother, sister, father, child, friend, or lover. Each one left grieving loved ones behind. Yet still, no one has the right to kill another. Brian Robert Thompson did not have the right to take the 40,000 lives that he did. And Luigi Mangione did not have the right to take the one life that he did. No one has the right to make themselves a one-man judge, jury, and executioner. Luigi Mangione did not have that right any more than Brian Robert Thompson did.

Luigi Mangione will face justice for his crime. And in a just world, Brian Robert Thompson would have faced justice in a court of law as well. At the very least, he should have been held criminally responsible for the deaths that resulted from his improper and morally reprehensible denial of valid life-saving claims. In a just world, he would have been indicted and convicted on thousands of counts of manslaughter and received a life sentence for his crimes. Even by a conservative estimate, he was responsible for more deaths than the 9/11 terrorist attacks. And this figure includes only deaths, not the injuries, pain, suffering, and bankruptcies that resulted from his actions. When these are included, his victims likely number over a million.

Brian Robert Thompson unfortunately never faced legal justice for his crimes, and he never will. And what was done to him in response was not an act of justice. Even the worst monster deserves a fair day in court. In the same way as Osama Bin Ladin, he was gunned down without trial, never able to mount a defense or face his accuser in an open court of law. And we should mourn that injustice to the same magnitude that we mourn each of Brian Robert Thompson’s thousands of victims.

Still, though he never faced legal justice for his sins, it is important not to ignore or minimize the magnitude of his crimes. His killing was an act of injustice, but that does not absolve him of his sins. From a traditional religious perspective, he died proudly unrepentant for his killings. And through such a lens, his final fate is grim indeed. On the morning of his death, he was on his way to a conference, a conference where he was to openly and proudly celebrate the profits of his crimes. If that is not enough to secure the eternal Damnation of a soul, I do not know what is. While I cannot know for certain the will of the Divine, according to all available evidence, his eternal Damnation appears secured. It is likely that when he fell and struck the pavement, he did not stop falling. He fell, and fell, and fell, right into the open maw of the Pit of Hell itself. If there is a Hell beyond this mortal realm, his soul is almost assuredly burning there right now. And there he awaits his reunion with one Luigi Mangione.  

Though shall not kill. One or forty thousand. High or low. Rich or poor.

Though. Shall. Not. Kill.