The killing of CEO Brian Thompson exposes the growing anger at the US health care system.

The “brazen and targeted killing” of health insurance executive Brian Thompson, CEO of UnitedHealthcare, outside a New York hotel this week shocked America. The response to the crime also exposed growing anger against the trillion-dollar industry.

“Prior authorization” doesn’t sound like a phrase that would inspire much emotion.

But on a hot day this past July, more than 100 people gathered outside UnitedHealthcare’s Minnesota headquarters to protest the insurance firm’s policies and denials of patient claims.

“Prior authorization” allows companies to review recommended treatments before paying for them.

Eleven people were arrested for blocking the road during the protest.

Police records show they came from across the country, including Maine, New York, Texas and West Virginia, to attend a rally organized by the People’s Action Institute.

Anai Montes-Erosti, director of media strategy for the Chicago-based advocacy group, said the protesters had personal experience with denied claims and other problems with the health care system.

“They are denied care, then they have to go through an appeals process which is incredibly difficult to win,” he told the BBC.

After Thompson’s targeted killing in New York City, the anger felt by many Americans at the health care system—a smorgasbord of for-profit and nonprofit companies, insurance companies, and providers for government programs. Saif – came out in the open. on Wednesday.

Thompson was the CEO of UnitedHealthcare, the insurance unit of the health services provider UnitedHealth Group. The company is the largest insurer in the United States.

Police are still searching for the suspected killer, whose motive remains unknown, but authorities have revealed messages written on shell casings found at the scene.

The words “deny,” “defend” and “deposed” were discovered on the casings, which investigators believe may refer to tactics that critics say insurance companies use to avoid payments and increase profits. used for

A scroll through Thompson’s LinkedIn history shows that many people were outraged by the denial claims.

A woman responded to a post in which the executive boasted about her firm’s work on making drugs more affordable.

“I have stage 4 metastatic lung cancer,” she wrote. “We just left. [UnitedHealthcare] Because of all the refusal of my meds. Every month there is a different reason for denial.”

Thompson’s wife told NBC that she had received threatening messages before.

“There were some threats,” said Paulette Thompson. “Basically, I don’t know, lack of.” [medical] Coverage? I don’t know the details.”

“All I know is that he said there were some people who were threatening him.”

Frustration over high prices in a range of industries inevitably leads to threats against corporate leaders, a security expert says.

Philip Klein, who runs the Texas-based Klein Investigations, which protected Thompson when he gave speeches in the early 2000s, says he’s surprised the executive didn’t have security for the trip to New York City. was

“There is a lot of anger in the United States of America right now,” Mr. Klein said.

“Companies need to wake up and realize that their executives can be victimized anywhere.”

Mr Klein says he has been in the dark since Thomson’s death. Top American companies typically spend millions of dollars on personal security for top-level executives.

In the wake of the shooting, several politicians and industry officials expressed shock and sympathy.

Michael Tiffin, president of the insurance industry organization AHP, said he was “heartbroken and horrified by the loss of my friend Brian Thompson”.

“He was a devoted father, a good friend to many and a refreshing companion and leader.”

In a statement, UnitedHealth Group said it had received many messages of support from “patients, consumers, healthcare professionals, associations, government officials and other caregivers”.

But many people online, including UnitedHealthcare customers and customers of other insurance services, reacted differently.

These reactions ranged from UnitedHealthcare jokes (a common one was “thoughts and prior authorizations”), to “thoughts and prayers” to comment on the number of insurance claims denied by UnitedHealthcare and other firms. (a play on the phrase).

At the extreme end, critics of the industry made it clear that they felt no pity for Thompson. Some even celebrated his death.

Online outrage seems to bridge the political divide.

Hostility was expressed from socialists to right-wing activists suspicious of the so-called “deep state” and corporate power. It has also come from ordinary people sharing stories about insurance firms denying their claims for medical treatment.

Mr Montes-Irueste of People’s Action said he was shocked by the news of the murder.

He said his group campaigned in a “non-violent, democratic” way – but added he understood the bitterness online.

“We have a broken and broken health care system, which is why there are so many strong emotions being expressed right now by people who experience this broken system in different ways,” he said. are doing.”

Mr. Tiffin, head of the Health Insurance Trade Association, condemned any threats against his colleagues, calling them “mission-driven professionals working to make coverage and care as affordable as possible.” described as

The posts underscored the deep frustration many Americans feel toward health insurers and the system in general.

“The system is incredibly complex,” said Sarah Collins, a senior scholar at the Commonwealth Fund, a healthcare research foundation.

“Just navigating and understanding how you’re covered can be challenging for people,” he said. “And everything can seem fine until you get sick and need your plan.”

Recent Commonwealth Fund research found that 45 percent of insured working-age adults were charged for something they thought should be free or covered by insurance, and billing Less than half of those who reported suspected errors challenged them. And 17% of respondents said their insurer denied coverage for care their doctor recommended.

Not only is the U.S. health care system complex, it’s expensive, and huge costs can often fall directly on individuals.

Prices are fixed between providers and insurers, Ms. Collins says, meaning that what patients or insurance companies are charged often bears little resemblance to the actual costs of providing medical services.

“We find high rates of people who say their health care costs are unaffordable, across all insurance types, even (government-funded) Medicaid and Medicare,” he said. He said.

“People accumulate medical debt because they can’t pay their bills. This is unique to the United States. We really have a medical debt crisis.”

A survey by researchers at the health policy foundation KFF found that nearly two-thirds of Americans said insurance companies deserve “a great deal” of the blame for high health care costs. Most insured adults, 81%, still rated their health insurance as “excellent” or “good.”

Christine Ebner, a senior economist at the nonprofit think tank RAND Corporation, said that in recent years insurers have increasingly been issuing denials of treatment coverage and using prior authorizations to reduce coverage.

It said premiums are around $25,000 (£19,600) per family.

“On top of that, people face out-of-pocket costs, which can easily be in the thousands of dollars,” he said.

UnitedHealthcare and other insurance providers have faced lawsuits, media investigations and government investigations over their practices.

Last year, UnitedHealthcare settled a lawsuit brought by a chronically ill college student whose story was covered by the news site ProPublica, alleging that when his doctor prescribed The medication was denied, leaving him with $800,000 in medical bills.

The company is currently fighting a class action lawsuit Claims that this treatment uses artificial intelligence to eliminate skin.

The BBC has contacted United Health Group for comment.

With reporting by Tom Bateman