To Be “Unalive”—or Not to Be
It’s thrilling when a new word enters the language, as distinct from an old word acquiring a new meaning. Dope, for instance, went from meaning both “jerk” and “marijuana” (“Don’t be a dope and smoke dope in church.”) to “seriously great” (“That song is dope.”). By contrast, “unalive,” meaning death by suicide or homicide, has few antecedents—and perhaps a promising future. It first came to my attention some weeks ago on a social media site called Threads, in the aftermath of the murder of United Healthcare CEO Brian Thompson on December 4, 2024. The crime occurred at 6:46am on the sidewalk outside the Hilton Hotel on 54th Street and 6th Avenue.
Beyond the basic facts (a term which has also acquired new meanings in recent years), the case of Brian Thompson’s murder is swaddled in conflict of all sorts, the primary one being whether the murder could be in any way morally justified by the fact that he ran a company that routinely makes life and death decisions on behalf of their 49 million customers—and that the decisions to deny covering treatments are often in opposition to doctor’s orders. Put another way, is it fair that the CEO of a company should be a stand-in for the company’s policies and its industry to the extent of murdering him as an act of protest or civil disobedience? Put yet another way, do people really mean it when they say that Brian Thompson deserved to die or is “deserved to die” more a colorful throwaway arising from helpless rage at corporate decisions that, by the way, may cause others to die? Is there any way in which we might construe the murder as either self-defense at a group level or just desserts?
It’s hard to quantify the amount of electronic ink that’s been spilled since we began obsessively watching the video of the hoodied guy who came out of nowhere, gunned Thompson down and disappeared on a bicycle. Once the murderer took off, the story only grew more puzzling, fascinating, and morally fraught. Occurring nearly a month after the 2024 election, the incident and its aftermath were strangely appropriate to our polarized time and place: In learning that the alleged assassin was from a wealthy family and was a recent graduate, with two degrees, from an Ivy League university, we were asked to believe six more impossible things every day before breakfast.
Within hours of the news that the victim was the CEO of United Healthcare, who, by the way, made a cool $10 million a year, between salary and benefits, the battle lines were drawn. “He deserved it,” was one end of the spectrum. “Murder is wrong, no matter who or why,” was on the other. It would be quite a few more days, and maybe weeks, before these positions would be aligned with left and right, blue and red. But even before that, the intensity of the feelings, especially on the “he deserved it” side, opened floodgates of horror stories, many involving denials of coverage by United Healthcare itself, one seemingly more hard-hearted than the next, along with accusations that insurance companies use algorithms to review cases and that reviewers are rewarded for denying claims. One denial that quickly made social media rounds was a putative letter from a doctor protesting the denial of coverage for anti-nausea medication for a child undergoing chemo. A Snopes investigation as to its veracity found that it first circulated online in January 2022, with all identifying information, including the file ID, blacked out. It reads:
“Dear buttheads at the insurance company,
“I can’t believe it has come to this. I have to take time away from my patients to inform you that you are idiots. This whole experience makes me want to vomit. But of course I wouldn’t dare throw up without the approval of my insurance company.
“Which brings me to my point: Apparently, you have decided that a child receiving chemotherapy has no reason to be nauseated. I didn’t think I was unnecessarily writing prescriptions for anti-emetics for [redacted]. Obviously you would know better about the side effects of chemotherapy than me, my peers, and the entire scientific community going all the way back to Dr. Sidney Farber. I suppose my alternative to Zofran and Scopolamine is to let [redacted] know that the nausea is all in his head. However, I don’t imagine you would cover any psychology consultation either.
“So I’ll just tell [redacted] to stop throwing up. Thank you for that simple solution. You have saved your greedy, blood sucking corporation shareholders a great deal of money I’m sure. Of course, that would be the bottom line. Feel free to contact me if you need further information about how much you guys suck.”
Snopes has still not verified the letter, but it’s not necessary to make the point. The sentiment and the rage are familiar and belong to us collectively. We would hope that faced with such a situation, our doctor would be similarly forthright in appealing the denial. If it was true, I wonder: Did it work? Did the company change its corporate mind? It hardly matters—and probably not. Many more stories of insurance company denials continue to populate social media sites with historic and ongoing cases. One I’m following on Threads is a woman whose doctors have ordered two types of chemo for her breast cancer. Regence Blue Cross Blue Shield of Utah has denied the second drug, alleging that it’s “investigative” rather than standard. According to the woman’s husband, the drug has “full FDA approval for this exact use and is endorsed by every major clinical guideline for the most comprehensive care and best health outcomes.”
The husband posts every day about their efforts to appeal the decision, contact the media, enlist their representatives, and petition the maker of the drug for help. The drug in the US has a list price of $20,000 per infusion, an insurance company price of $11,000, and a patient-paying price of $14,000—and the woman needs eight of them. “That explains it,” you are probably saying to yourself. “I wouldn’t pay it either!” But in Canada, Australia, and the UK, the list price is $2000 to $3000, and in some, if not all, of these countries, patients pay nothing to anyone. These few sentences speak to what’s wrong with our for-profit healthcare system, where the lines from Billie Holiday’s song, “God Bless the Child,” are the guiding principle: “Them that’s got shall get, them that’s not shall lose.” But even Americans with insurance and money can be easily bankrupted by healthcare costs—and driven crazy by what appear to be capricious denials and delays. In the time spent appealing denials, resending forms that were “lost,” waiting on hold, and waiting for answers that don’t come, sick people—aka “customers”—could read and reread the harrowing tale of Joseph K. in Kafka’s The Trial.
While medical debtors lose their houses, savings, and retirement funds, health insurance company CEO’s make eight figures a year in salaries, stocks, and benefits. Why, you might wonder, is the CEO’s “salary” only $1 million while his stock benefits are $8 million? Because he doesn’t need to pay taxes on the stock until he sells it, and that tax rate can be lower than income tax, depending on when he unloads it. Last year, the top six health insurance CEO’s pulled in a combined total of $121 million, with Brian Thompson’s boss, Andrew Witty, CEO of United Healthcare Group, dwarfing Thompson’s piddling $10 million with his own $23 million (his salary a mere $1.5 million). Thompson was only the CEO of United Healthcare—no “Group” after his title. UHC Group, says its website, “is a health care and well-being company made up of a diverse team around the world dedicated to making health care work better through two distinct and complementary businesses: Optum and United Healthcare.” Which is to say that before Thompson was unalived, the company was paying two of its three CEO’s a total of $33 million a year. This was, though, small change for the world’s largest “healthcare firm,” now a Fortune 5 company, bringing in $22 billion in earnings in 2022. The salaries and profits are staggering—and the labyrinthian healthcare system they control is an unspeakable, inefficient, unjust mess.
Which brings me back to the unaliving of Brian Thompson—and what the word has to do with his case and the way we live now. In a Threads discussion about him, the word was used, and someone asked what it meant. I figured it was just a cutesy way of saying “dead” and didn’t think to ask. “It’s a way to talk about murder or suicide that does not kick in the algorithm, flag your post, and get you put in Threads jail,” was the answer. Translation: Discussing murder, dying, and suicide sets off electronic bells in the social media sphere and can result in a poster being kicked off for several days—or even permanently. Depending on the content, it may involve law enforcement. People are now “writing posts to the algorithm,” the way health insurance companies review claims using algorithms.
I get it. I have been kicked off Instagram and Threads several times, for making perfectly innocent comments on posts like, “Congratulations!” when a friend had good news, which the algorithm believed meant that I was “looking for likes.” The one time I so much as hinted at unaliving in a completely humorous way, my post was taken down, and I received emails with information about suicide hotlines. It was a week before the 2024 election, and I posted a 1950s-style housewife image of a crazed woman holding up an iron. The message, printed on the image, read: “I’d rather burn my fucking face off than vote for Trump.” The post was taken down within minutes, and I was put in Instagram jail for four days. Or maybe that was another time I danced too close to the edge of seeking likes, promoting a product, flirting with suicide, or considering homicide. The bottom line was that I was not adhering to “community guidelines.”
We are living in perilous times. The battle lines of the Thompson murder were quickly drawn even in my own household, but my spouse and I did our disagreeing in the dubious safety of our Threads accounts. I would scroll through my feed and see comments from the person I had vowed to love in sickness and in health, for richer and for poorer.
I did not object vehemently to my husband’s positions, either on Threads or in the living room, where we barely discussed the issue, though I kidded him about his vituperative posts, and about his having to live with someone for whose “ethical position” he has “no words.” (Though I wonder: why wasn’t he thrown in Threads jail for using words that often trigger the algorithm? How unfair is that?) The hyperbolic verbiage of his posts sounds nothing like the real person, who, IRL, is on the chill side and quite lovely to live with. He holds forth on Threads so he doesn’t have to in the apartment. He knows that I don’t think Brian Thompson “deserved it,” but I do think that his unaliving is and should be an occasion to discuss our “supposed rage” at the private healthcare insurance industry. It is more than “supposed rage,” even if, as the 2023 survey claims, 81 percent of people with insurance are satisfied—and even if United Healthcare claims on its website that it pays “about 90 percent of medical claims upon submission.” UHC insures 49 million Americans, which means that not paying 10 percent of the claims amounts to many millions of claims that are denied and delayed every year, often with devastating results, medically, financially, and emotionally. If 81 percent of people are satisfied, the 20 percent who are not comes to ten million people. On Threads and at home, we have agreed to disagree. I know that he too would have burned his face off before voting for Trump, and in these polarized times, that’s all that matters. The union, for now, is secure.
The rest of the land, not so much. What with our new oligarchy, it’s not bloody likely that the unaliving of Brian Thompson will do much to improve the health insurance system for consumers, though its CEOs will wear body armor and travel with teams of security, when they venture outside at all. For the rest of us, we’ll always have our shared rage, our horror stories, and our algorithms to contend with. And every once and a while, a delightful new word will come along that will make us feel that we’re beating the system, we’re outsmarting the ruthless, money-grubbing motherfuckers, and that we’ve got this under control, if only for a moment.
