Why the Murder of the United Healthcare CEO Feels So Much Like a Movie

The man’s wife had gone to the hospital in agony, suffering from unspecified neurological issues, but she had received only disdain and disregard from medical personnel. As a result, murder was on the mind of Paddy Chayefsky. “Writer Herb Gardner and Chayefsky were walking along a New York street one evening when Paddy turned to him and asked if he knew of a good way to kill off nurses,” author Shaun Considine wrote in Mad as Hell, his 1994 biography of the screenwriter.

That was January of 1970 and the Oscar-winning Chayefsky was not actually planning to solve his problems with homicide. He had a movie idea that would hit back at the medical industry instead. Then best known for 1955’s warm-hearted Marty, and later for 1976’s blistering TV critique Network, Chayefsky was devising a dark satire called The Hospital, in which a series of vengeful killings of hospital staff would underscore the kind of miseries experienced by patients like his wife, Susan. “Susie had been in the hospital, and Paddy was not happy with what went on there,’” Gardner, the playwright of A Thousand Clowns, said in the book. “Nothing got him going like anger. Paddy was always best writing when he was pissed off about something.”

More than a half century later, it appears that rage about the failures of the American medical establishment may have led to a killing that has transfixed the country. Last week, United Healthcare CEO Brian Thompson was shot in the back on an early morning New York City street in what investigators believe was a targeted slaying over the company’s well-documented reputation for denying claims and treatment.

“It felt like something literally out of a movie,” says producer Adrian Askarieh, who has spent years thinking about how killers operate. The film and TV veteran has made two movies based on the assassin video game series Hitman: Agent 47 and is currently developing a TV series based on the character for 20th Century Television. He was at his office, scrolling through social media when he saw footage on Wednesday. “It really resonated with me with regards to real life imitating art and vice versa,” Askarieh says.

He may have been troubled by it, but much of the reaction to the killing has been celebratory, as though a make-believe villain had received comeuppance. The murder became an instant meme on social media—with one popular joke being to mock his fatal bullet wounds as a condition not covered by his insurance.

In the widely circulated surveillance video, a gunman raises a pistol with both hands in a tactical shooting stance, and as he opens fire, the victim collapses against the side of a building. A stunned bystander at a nearby ATM glances around in alarm, then scurries away. The killer does not attempt to stop or harm that individual and barely seems to register this eyewitness to the brazen killing.

The unflappable behavior looked familiar to the Hitman producer. As the victim lies dying on the sidewalk, the shooter casually steps between two parked cars and walks across the street—vanishing from sight. “That [shooter] had just one target, he had one mission, and he very slowly walks up,” Askarieh says. “I found it to be very chilling.”

The footage of the killing called to mind other stories of precision-minded killers, usually fictitious. NBC’s new The Day of the Jackal, with Eddie Redmayne, follows a gun-for-hire who is known for flawless execution. It’s based on a 1971 Frederick Forsyth novel and 1973 movie adaptation that established the archetype of the exquisitely calm and meticulous assassin—think 1994’s Léon: The Professional, or last year’s sardonic David Fincher drama The Killer, with Michael Fassbender as the nonchalant triggerman. Video games also came to mind, since in addition to the calculated calmness of Agent 47, the killer’s tan hooded coat resembles the costume worn in the Assassin’s Creed games.

Despite being nauseatingly real, the slaying of the United Healthcare CEO had the cadence of those fantasies, right down to the unexpected mercy shown to the innocent onlooker who was in the wrong place at the wrong time. No one has blamed assassin escapism for inspiring this attack, but the similarity may explain why so many have responded as if it’s something to be applauded.

On Monday investigators said they were questioning someone in Altoona, Pennsylvania, and had taken a 26-year-old named Luigi Mangione into custody. Investigators said the motive was likely vengeance over Thompson’s role at United Healthcare. “It does seem he has some ill will toward corporate America,” New York chief of detectives Joseph Kenny said at a press conference. That was clear even before the arrest. The company reportedly rejects more medical claims than other American insurers, and the killer left behind shell casings marked with the words “delay” and “deny,” which mirror terms the industry uses to avoid paying for medical procedures. After the shooting, Jay M. Feinman’s 2010 book Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It sold out on Amazon and vaulted to the top of its Kindle bestseller lists.

Askarieh felt uneasy seeing it play out. He has recently been trying to ensure that the new TV series scripts add a degree of humanity by underscoring how its antihero has lost his own. “It’s a character that’s looking for redemption, looking to be saved in a way, and I think that component is very helpful in balancing out what he does for a living,” Askarieh said. What the producer saw in the real-life shooting was someone indulging that darkness instead of resisting it. “I want to make sure I’m being very clear, I’m not condoning what happened in New York. I think it was horrific,” Askarieh says. “For a producer like me who works on these things, you kind of feel like you’re desensitized to it but when you see it in real life, it really has an impact. It makes you feel a great sense of responsibility in handling the storytelling the right way so you’re not glamorizing it.”

Having spent years making movies about these kinds of characters, Askarieh also has some insight into why the public seems so titillated by this apparent act of street justice, with some even posting flirtatiously thirsty responses after security footage believed to be the killer revealed him flashing an endearing smile. “One of the reasons the idea of an assassin has been so fascinating, going back to movies like Le Samouraï with Alain Delon, is that there is a catharsis that comes with the assassins doing what we can’t see ourselves doing,” he says. “I think it’s more of a vicarious experience. A lot of human beings feel helpless and want to vicariously live through those characters.”

In the aftermath of Wednesday’s shooting, some health insurers took down public bios about their executives. Many posters who did not directly praise Thompson’s killing instead used the moment to share excruciating stories about insurance-industry denials of lifesaving and vital treatments.

Those who expressed misgivings about the cheerful reactions to Thompson’s murder drew scorn. Journalist Nancy Rommelmann wrote a Substack post that collected some of the hostile reactions she received, concluding with a warning about the distorting effect of such behavior. “The idea of it is apparently enthralling, to imagine yourself the one with the power, a person who would make the right and humane decisions every time, just as soon as you cut off a few people’s heads,” she wrote.

Rage against health care bureaucrats has simmered for decades. Although targeted violence against such corporations or their employees remains rare, it occasionally erupted into the zeitgeist in the form of Hollywood revenge fantasies.

The recent true-life scandal tales Dopesick and Pain Hustlers, about how pharmaceutical greed led to the opioid epidemic, dramatized moral failings in the industry and the legal comeuppance that resulted. The horror series The Fall of the House of Usher used gothic fantasy to inflict Edgar Allan Poe–style condemnation on a fictional medical industry family that exploited the ailing.

Thompson’s shooting has also called to mind a 2002 episode of Law & Order, titled “Undercovered,” in which a father kills an insurance executive who denied a lifesaving treatment to his ailing daughter. In a rare twist for that show, the jury was split on the verdict and the district attorney, played by Dianne Wiest, drops plans for a retrial, saying she doubts any jury would unanimously convict him. The killer ultimately goes free.

That same year, a denied medical claim was at the center of the feature film John Q, in which a father played by Denzel Washington held an emergency room at gunpoint after his child was denied a lifesaving transplant by insurers. This was loosely inspired by a real-life incident from 1999, in which a father in Toronto held a gun to the head of a doctor to force emergency room workers to help his infant child, who was experiencing an asthma attack. The man was shot and killed by police, who then discovered his weapon was only a pellet gun.

Nick Cassavetes, the director of John Q, did not respond to a request for comment, but when the movie debuted, he said he saw it as a warning about the US health system’s failures. “You’ve got to get people talking about it,” Cassavetes told Southam News Services. “What will happen in my opinion is that the problem will get wider and wider and more and more people will not be able to afford it, and we will have horror stories like this one.”

John Q had one of its villains, a hospital administrator played by Anne Heche, warn police not to give in to the hostage-taker, so they don’t risk copycat incidents. When Ray Liotta’s police chief questions why she didn’t just treat the man’s s son, she replies: “The fact is there are 50 million people in this country without medical insurance. If you don’t like it, you should call your congressman.”

According to the US Census, the actual number of uninsured people in 2002 was closer to 43.6 million. At the time, Cassavetes was pessimistic about things changing. “The government of the United States has decided that HMOs have a right to make money and that they can conduct their business any way they want. Is that right or wrong? Morally, it’s wrong, but we’re a capitalist country and we’re not going to change that,” Cassavetes said. “Are we going to have a socialized system of medicine in this country? No. The chances of that are absolutely none.”

Since former president Barack Obama signed the Affordable Care Act into law, the number of uninsured has fallen to 25.6 million. Those are better results, but Cassavetes’s prediction was nonetheless true. The country is still no closer to a solution for all.

In the Chayefsky-scripted film, 1971’s The Hospital, a deranged patient resorts to murder due to his anger over the medical center’s dysfunction. Chayefsky, who died in 1981, told The New York Times that The Hospital was framed around one question: “How do you behave in a collapsing society?” At one point in the film, the embattled doctor, played by George C. Scott, melts down and rages about the incompetence of the health care bureaucracy: “We have established the most enormous medical entity ever conceived and people are sicker than ever! We cure nothing! We heal nothing! The whole goddamn wretched world is strangulating in front of our eyes.” A handful of years later, Scott wrote a famous, and similar, jeremiad for a mentally-broken news anchor in Network: “I’m mad as hell—and I’m not going to take it anymore!”

Like Cassavetes a generation later, Chayefsky saw his work as a warning. His biography notes that he paraphrased T.S. Eliot when talking about the messages in his films: “When the moral fiber of a community erodes, it is the poets who have to stand up and establish some kind of a moral contact.”

The poets had their say. A murderer just had his.