Last week, The Wall Street Journal published an article titled “The Complicated Mourning of Brian Thompson.” The piece is heartbreaking, detailing not only the mourning of his family but also the grief experienced by those who knew Mr. Thompson. As we can imagine, his loved ones are struggling with his loss, compounded by the fact that many are “cheering for the man accused of killing him.” As we’ve said before, this assassination was and should never be justified. The circumstances surrounding his death make it even more tragic, and it’s a historic moment in time. Mr. Thompson left behind a widow and two teenage sons, as well as a network of family and friends who will be forever impacted.
Even Saturday Night Live has weighed in on the tragic irony, with Chris Rock commenting on the “condolences,” but also noting that “sometimes drug dealers get shot.” In my home state of Florida, a woman was recently criminally charged for threatening her insurer after using the words “delay,” “deny,” and “dispose” during a recorded call.
Many of my conversations in the business, technology, and social sectors are with people who have good insurance, are well-educated, and are generally healthy. I am often surprised at how few of these individuals understand the frustration felt by much of the broader society. Personally, I’ve experienced periods without insurance and have dealt with numerous claim denials in my family. For years, I had access to top-tier insurance with low deductibles, which I am sure allowed me better access to care. Yet, I still encountered denials.
A Political Point of Order
America will not have “single-payer” healthcare in our lifetime, not because the majority of middle-class consumers don’t want it (Medicare and Medicaid don’t really count here), nor because the right-wing powers don’t want it, or even because unions don’t want it. It’s because the biggest companies, particularly those in the S&P 500, don’t want it. I’ve been in these discussions. Both the most eco-friendly and the most carbon-intensive companies in America share one thing in common: they leverage their “Cadillac” insurance benefits to attract top talent.
It’s not that these companies aren’t frustrated with the ever-growing cost of care—remember that Medicare and Medicaid set fixed rates that insurance companies cannot alter. But in the commercial market, they can raise prices. The reality is that most of America’s health system would collapse overnight if Medicare rates were used in a single-payer system. I suspect that Medicare or single-payer rates would need to be increased by 200% to 300% to healthcare providers to keep the system functioning, as they are currently dependent on significantly higher commercial rates. I may explore the math behind this in a future post.
Back to the Current Revolution
While many in the protected healthcare class remain unaware, The Wall Street Journal reported on a striking statistic: An Emerson College poll of 1,000 registered voters found that while 68% of people deemed Brian Thompson’s assassination unacceptable, 41% of those aged 18-29 considered the shooting somewhat or completely acceptable. Furthermore, 19% of voters in this age group were “neutral.” This result stunned one of Thompson’s former colleagues, who remarked, “I’m just disappointed that anybody feels that a shooting is appropriate, especially this type of shooting. That’s just crazy. My perspective is that Brian worked all his life to make healthcare better.”
What Can the Industry Do?
The problems facing healthcare are enormous, and the system would require a dramatic overhaul, not just more regulations. This feels like the worst outrage since Health Maintenance Organizations (HMOs) hit the mainstream in the early 90s. Back then, much of the frustration came from the medical profession, which had to change how it treated patients. Today, the outrage is consumer-driven, as people feel the industry is broken, prioritizing profits over their health. The rising costs and the increasing number of claims denials, some of which are life-threatening, have left consumers feeling helpless.
The issue is that consumers can’t just downgrade their coverage because that only worsens the problem. With less coverage, benefits shrink, and access to care becomes even more limited. Though the alleged assassin in this case was highly educated, graduated from an Ivy League school, and worked in technology, the insurance industry’s issues disproportionately affect lower-income individuals, people of color, and residents of certain low-income regions.
The Role of AI in Healthcare
Increasingly, insurers are relying on technology, including AI, which can result in improper denials or, surprisingly, improper payouts. Some may be surprised to hear that AI could also be used to manipulate claims on the other side. Healthcare providers, legally, may explore these edges. I can tell you that we did in the past. If we were doing it manually in the 90s, AI can now accelerate and improve these tactics.
The Patient Advocate
The power to deny a referral, treatment, or medication is a heavy burden for any doctor. In some organizations, these decisions are made not by doctors or nurses, but by other professionals, who are supervised by clinicians. This system scared me when I was an administrator, and as a CEO, I was concerned about the reputational harm a mistake could cause to our business, especially as a publicly listed company.
So, we did something different. Our Medical Director made the final decisions, but we also created a department of patient advocacy. This team, consisting of two passionate nurses, advocated for any denial before it was finalized. If a change wasn’t made, the issue was appealed to our Chief Medical Officer for a final determination. This team saved lives—literally. They helped my father in a separate hospital case, and they also advocated for patients when any of our 12 insurance contracts denied a referral for one of our members. We had an enviable denial rate of just 3%, and in every case, our care team made alternative arrangements for the patient.
AI in the Hands of the Consumer in 2025
As we’ve said before, today’s patient must become their own advocate. This means controlling their health data, not just storing it in an app but actively searching for potential issues and even supporting themselves in fighting insurance companies. Doctors today rely on referral teams who are tasked with getting approvals and managing claims. What used to be a small issue is now a full-time job, likely requiring one referral person for every two doctors. This is a lot of work. We want to improve this for consumers and be their advocate—that’s where AI comes in, supporting the consumer’s side.
-Noel J. Guillama, Chairman
https://www.wsj.com/us-news/the-complicated-mourning-of-brian-thompson-d6af8d96
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