Who Is To Blame For The UnitedHealthcare Killing? A Question of One Shooter or a Broken System
On December 4, 2024, Brian Thompson, the 50-year-old CEO of UnitedHealthcare, was gunned down outside the New York Hilton Midtown as he arrived for his company’s annual investor conference. The shooting was captured on surveillance video. The masked gunman fled on a bicycle. Five days later, 26-year-old Luigi Mangione was arrested at a McDonald’s in Altoona, Pennsylvania, with a ghost gun, a silencer, and a handwritten “manifesto” [citation:1][citation:10].
The killing shocked America—but not in the way one might expect. As Mangione became a folk hero to millions, the public’s reaction exposed a deep, festering rage at a healthcare system that millions believe is designed to profit from sickness rather than promote health [citation:2]. So who is to blame? The answer is far more complex than a simple “murderer vs. martyr” narrative.
The Alleged Shooter: Luigi Mangione’s Manifesto and Motive
Prosecutors allege that Mangione meticulously planned the assassination for months. According to court filings, a handwritten journal entry from October 2024 described UnitedHealthcare’s investor conference as “a true windfall” and said it “embodies everything wrong with our health system” [citation:1][citation:3].
In the diary, Mangione allegedly wrote that he wanted to “whack the CEO at the annual parasitic bean-counter convention” because it was “targeted, precise and doesn’t risk innocents” [citation:1]. He described UnitedHealthcare as a company that “literally extracts human life force for money.”
A three-page document found in his possession included the language: “I do apologize for any strife or traumas but it had to be done. Frankly, these parasites simply had it coming.” Another passage read: “To the feds, it had to be done” [citation:1][citation:10].
Notably, UnitedHealthcare has stated that Mangione was never a client of the company. According to NYPD Chief of Detectives Joseph Kenny, “We have no indication that he was ever a client of UnitedHealthcare, but he does make mention that it is the fifth largest corporation in America, which would make it the largest healthcare organization in America. So that’s possibly why he targeted that company” [citation:7].
The ammunition used in the killing had the words “delay,” “deny,” and “depose” scrawled on them—a phrase commonly used to describe how insurers avoid paying claims [citation:1][citation:8].
The Jury’s Role: What Evidence Will They See?
In a significant ruling on May 17, 2026, Judge Gregory Carro determined that Mangione’s alleged manifesto and the 9mm ghost gun will be admissible as evidence at trial, while other items found during his arrest, such as a cellphone and wallet, were excluded due to an “improper, warrantless search” at the McDonald’s [citation:3][citation:4].
Judge Carro found that once Mangione was taken to the police station, officers conducted a “valid inventory search,” meaning the gun, silencer, and notebook discovered there will be presented to the jury [citation:3].
Mangione, who turned 28 in May 2026, has pleaded not guilty to murder in the second degree, weapons charges, and possession of a forged instrument. His state trial is scheduled for September 2026, with a federal trial set for January 2027 [citation:3][citation:4].
The federal case recently saw a significant development: U.S. District Judge Margaret M. Garnett dismissed four of the federal counts, including murder through the use of a firearm, meaning Mangione is no longer eligible for the death penalty [citation:3]. He still faces two counts of interstate stalking, carrying a maximum sentence of life in prison without parole.
How Americans Poll: Blaming the Killer and the System
While prosecutors argue that Mangione alone is responsible for Thompson’s death, polling data reveals that the American public sees a far more complicated picture.
According to a NORC at the University of Chicago poll conducted in December 2024, about 8 in 10 U.S. adults said the person who committed the killing has “a great deal” or “a moderate amount” of responsibility. However, about 7 in 10 adults also said that denials for health care coverage by insurance companies or the profits made by health insurance companies bear at least “a moderate amount” of responsibility for Thompson’s death [citation:8].
Younger Americans are particularly likely to see the murder as the result of a confluence of forces rather than just one person’s action. About 7 in 10 adults between 18 and 29 say “a great deal” or “a moderate amount” of responsibility falls on both insurance company profits and the killer. Only about 4 in 10 young people say “a great deal” of responsibility falls on the shooter, compared with about 6 in 10 between 30 and 59 and roughly 8 in 10 adults over 60 [citation:8].
About half of Americans believe that at least “a moderate amount” of blame is rooted in wealth or income inequality [citation:8].
The poll also found that roughly 3 in 10 Americans say they have had a problem getting coverage from their health insurer in the last year—whether problems finding a suitable provider in-network, a claim getting denied, or issues getting prior authorization [citation:8].
The Health Insurance Industry’s Role: Profits Over Patients?
UnitedHealthcare made more than $16 billion in profit before interest and taxes on $281 billion in revenue in 2024 [citation:8]. The company has said it pays about 90% of medical claims when they are submitted, though it has not provided details about how many claims that involves [citation:8].
Critics argue that even a 10% denial rate represents millions of people being denied care. The Physicians for a National Health Program (PNHP) argues that the health insurance industry profits from denying care, and that “there are no unsolvable problems” if Americans unite to demand a national health program that puts patients before profits [citation:6].
Dr. Carol Paris, a healthcare activist and vice president of PNHP, wrote: “In their anger, have some people overstepped the bounds of moral decency? Yes. That’s something people do when they are chronically anxious about going into medical debt, and always vulnerable to the whims of a health insurance industry that profits from denying them care” [citation:6].
Academy of Management scholar Tim Pollock said that people’s reactions to Thompson’s killing point to the “infamy”—a bad reputation associated with people’s negative emotional reactions—that the U.S. health insurance industry has with the general public [citation:2].
“Almost anyone in the U.S. you talk to about health insurance has complaints,” Pollock said. “It happens to everybody in the U.S., and in some cases it can be pretty devastating, resulting in bankruptcy and losing all your assets when you have to absorb the costs when coverage is denied for a medical emergency or an expensive medical treatment” [citation:2].
Insurers frequently note that most of the revenue they bring in goes back out the door to pay for care. UnitedHealthcare says prior authorizations help eliminate waste and let people know whether care will be covered before it is delivered. The company says less than 2% of its customers experience a denial of care from prior authorizations annually [citation:8].
The Public’s Reaction: A Folk Hero Emerges
Perhaps the most telling evidence of widespread anger at the healthcare system is the public’s reaction to Mangione. Supporters have flocked to his court appearances, flooded him with mail (up to 115 letters per day), and worn green clothing as a symbol of support [citation:3][citation:5].
Outside the courthouse, one supporter told reporters: “No one should be killed. That’s a very bad thing. But if we had a healthcare system that started from the patient’s perspective rather than making profits, he would probably still be alive today” [citation:5].
Another supporter, whose mother has a traumatic brain injury, said: “I feel that UnitedHealthcare and the entire healthcare system are delaying her care. The current healthcare system is designed to make profits—that’s murder, causing far more deaths and crimes than the person currently being prosecuted” [citation:5].
Social media posts following the killing mocked Thompson’s death with messages like “Request for thoughts and prayers denied” and “You failed to get prior approval for having an object removed from your chest, so therefore, it will not be covered” [citation:2].
The Broader Context: A System in Crisis
The UnitedHealthcare killing did not occur in a vacuum. For years, Americans have faced rising premiums, rising deductibles, and rising denial rates. According to KFF, the average annual premium for employer-sponsored health insurance in 2025 was $9,325 for single coverage and $26,993 for family coverage—nearly double what other wealthy nations spend per capita [citation:8].
The U.S. spends nearly twice as much per person on healthcare as other wealthy nations yet has lower life expectancy, higher rates of chronic disease, and worse access to primary care. Administrative costs consume nearly 25% of every healthcare dollar in the U.S.—more than double Canada’s 12% and nearly triple Germany’s 9%.
According to KFF, insurance companies deny an average of 17% of in-network claims, with some carriers denying more than 30%. A ProPublica investigation found that UnitedHealthcare used an automated system to deny post-acute care claims at rates significantly higher than its competitors, often overriding the recommendations of physicians.
The Road Ahead: Trials, Accountability, and Reform
Mangione’s state trial is scheduled for September 2026. He faces life imprisonment without parole if convicted. The federal trial is set for January 2027, where he faces two counts of interstate stalking, also carrying life without parole [citation:3][citation:4].
Regardless of the trial’s outcome, the killing has already changed the conversation about healthcare in America. Whether that change will translate into meaningful reform remains to be seen.
Dr. Carol Paris warned that “this outpouring of rage at the health insurance industry will have no practical impact no matter how loudly or persistently we cry because members of Congress are not listening to us. They listen to the threat of losing campaign contributions if they fail to do as their corporate donors demand” [citation:6].
She called for reformers and activists to unite across causes: “Maybe all the people who have been harmed by the health insurance industry would join their voices with the voices of health reform activists, campaign finance reform activists, climate activists, reproductive justice activists, racial justice activists, fair wage activists, affordable housing activists, food security activists and more. Just think of the power of all our voices, together, demanding a multitude of social justice reforms” [citation:6].
What Employers Can Learn
For employers who sponsor health plans, the public anger exposed by this case offers important lessons. Employees are frustrated with rising costs, confusing benefits, and denied claims. Employers who ignore these frustrations do so at their own risk.
Conduct a benefits audit to understand where your healthcare dollars are going. Add navigation and advocacy services to help employees challenge unfair claim denials. Review PBM contracts to ensure transparency. Consider self-funding to access claims data that reveals waste.
For a quick assessment of your benefits strategy, take this free 5-question mental health check.
Conclusion: One Shooter, But a System on Trial
Luigi Mangione alone pulled the trigger. But the public’s reaction—and the polling data—suggests that millions of Americans believe the healthcare system itself bears significant responsibility for creating the conditions that led to Thompson’s death.
The question of who is to blame for the UnitedHealthcare killing has no simple answer. There is the alleged shooter, who meticulously planned an assassination. There is the health insurance industry, whose profit-driven practices have left millions feeling desperate and abandoned. There is a political system that has failed to reform healthcare despite decades of public outcry.
As one supporter outside the courthouse put it: “We talk about this violent incident without talking about its context. Denying people access to education and healthcare is also a form of violence that America refuses to acknowledge” [citation:5].
Whether the killing will lead to systemic change—or simply fade into the next news cycle—is a question only Americans can answer.
Please note: This blog is for informational purposes only and is not a substitute for professional legal advice. All defendants are presumed innocent until proven guilty in a court of law.
Key Takeaways
- Luigi Mangione, 28, is accused of fatally shooting UnitedHealthcare CEO Brian Thompson on December 4, 2024, and has pleaded not guilty
- Mangione’s alleged manifesto described UnitedHealthcare as a company that “extracts human life force for money” and said killing the CEO “had to be done”
- About 8 in 10 Americans hold the shooter responsible, but 7 in 10 also blame insurance company profits and coverage denials, according to a NORC poll
- Young Americans (18-29) are equally likely to blame the shooter, insurance profits, and coverage denials for Thompson’s death
- UnitedHealthcare made $16 billion in profit in 2024 on $281 billion in revenue
- Roughly 3 in 10 Americans have had a problem getting coverage from their health insurer in the last year
- Mangione’s state trial is scheduled for September 2026; his federal trial is set for January 2027
- A judge ruled that his alleged manifesto and the ghost gun can be used as evidence, while other items from a warrantless search were excluded
- The death penalty is no longer on the table in the federal case after four counts were dismissed
- Crisis support: Call or text 988 (Suicide and Crisis Lifeline)
- Resources: KFF, PNHP, ProPublica
This comprehensive guide was published on May 21, 2026. Sources include Associated Press, NORC at the University of Chicago, Academy of Management, Physicians for a National Health Program, Daily Mail, RTL Today, Radio-Canada, Chief Healthcare Executive, and Newsweek.
