Let them eat cake

“Let them eat cake” (actually the strict translation is ‘Let them eat brioche’) is a quote attributed to Marie-Antoinette, the queen of France during the French Revolution and wife of the last king of France, Louis XVI. As the story goes, it was the queen’s response upon being told that her starving subjects had no bread. Because cake (and brioche), is more expensive than bread, the anecdote has been cited as an example of Marie-Antoinette’s obliviousness to the conditions and daily lives of ordinary people.

However, there is absolutely no record of Marie-Antoinette actually saying this¹.

This sort of attitude by the extremely wealthy was clearly one of the factors that eventually led to the French Revolution after which many of the aristocrats lost their heads to Madame Guillotine.

Jump forward some 235 years to December 4^th this year and 50-year-old Brian Thompson, the CEO of UnitedHealthcare, was shot dead outside the New York Hilton Midtown in Manhattan, where the company was hosting an ‘investor day’. Thompson had been CEO of UnitedHealthcare, since April 2021 and was responsible for “leading growth across the company’s global, employer, individual, specialty and government benefits businesses”, according to a 2021 company statement announcing his appointment².

Consumer Affairs in the US provides reviews of assorted health insurance companies and UnitedHealthCare is one of these. The reviews range from 5 stars to 1 star, and at the time of writing there are 102 5-star ratings, and 1,993 1-star ratings. Some of these 1-star ratings are accompanied by comments. These include: 

“United Health has a long history of denying care to those who need it, simply to boost their bottom line”; 

“We recently switched to United Healthcare and have been incredibly disappointed with their lack of care and support. My wife, who has been on Entresto [heart failure medication] for four years, had her coverage denied after the switch. Despite the doctor’s efforts, including virtual appointments and additional paperwork, the claim was still rejected. Furthermore, a necessary medical procedure, a mammogram, was also denied coverage”; 

“I made a switch, they started not covering life saving meds I needed etc, basically in the end they don’t care. I will never again go through this company.”

“Had this insurance [company] for a while when I was young and they didn’t pay for anything. Denied hospitalization claim even though it was medically necessary and ended up paying out of pocket and went into debt’.

“I suffer from several autoimmune diseases and require over 10 medications. I have went [sic] from paying less than $200/month for my meds to over $500/month with UHC. They consistently pay less for all of my medical claims and for the first time in years I’ve been receiving medical bills. I also have Medicare and with Aetna I never received a bill. UHC is clearly only money motivated and have zero concern for their clients”³.

Of all the predatory firms that comprise the multitrillion-dollar US healthcare industry, UnitedHealthcare has a particularly appalling reputation for charging huge premiums while consistently denying claims. The Associated Press news agency reported that UnitedHealthcare raked in $281bn in 2023, while Thompson himself enjoyed a $10.2m annual pay package⁴.

At the scene of Thompson’s murder were three bullet casings, with these words written on them in permanent marker: depose, deny, delay. These allude to the manoeuvres by health insurance companies to avoid paying for the things they are supposed to pay for.

A commemorative Facebook post by UnitedHealth Group – the parent company of UnitedHealthcare – had racked up more than 77,000 laughing emoji reactions. Other social media users scattered witty counter-condolences across various online platforms, such as “My empathy is out of network” and “I’m sorry, prior authorization is required for thoughts and prayers” – a reference to another common tactic employed by UnitedHealthcare and similar firms to decline coverage and increase profit margins⁴.

Thompson was emblematic of the lethal inequality that underpins US corporatocracy, where the health insurance racket does its part to keep people so sick and debt-ridden that they can’t pose a challenge to the system. And that, at the end of the day, is why the alleged gunman is being “venerated as something approaching a folk hero”⁴.

Although data is scarce about how the denial of claims could cause injury or death, one example is perhaps instructive: Intensive care physician, Deirdre O’Reilly’s university aged son, suffered a life-threatening anaphylactic allergic reaction, and was saved by epinephrine injections and steroids administered intravenously in a hospital emergency room. However, the family’s medical insurer, stated that the treatment was “not medically necessary”⁵. Without that treatment, he would have died.

The parallels between members of the CEO class and the French aristocracy of 1789 are clear, and from what I have seen, this has led to an extraordinary increase in the number of people on social media referring to guillotines, or posting images of them.

Very few of the ultra-wealthy seems to be aware of this similarity between them and the French aristocracy. One who does is Nick Hanauer, a self-described plutocrat; a decade ago, he warned that the rising economic inequality will lead to people with pitchforks coming for the rich⁶.

The killer of Thompson has been charged with terrorism as well as murder⁷. It is perhaps instructive that Dylann Roof, the white supremacist who killed nine black people in a church in South Carolina in 2015, all in the hope of starting a race war, was simply charged with multiple counts of murder⁸. Poor black people don’t rate as much as a white CEO

If you are wealthy you can effectively kill poor people for profit; that is simply ‘business’, but if you are poor and kill someone who is wealthy, that is ‘murder’ or ‘terrorism’. One law for the wealthy, and another for the poor. Thompson, as the CEO of United Healthcare, has most likely presided over the deaths of people because of the company’s policies of denial and delay. The only real difference between him and his alleged killer, is that the latter used a gun.

Sources

1. https://www.britannica.com/story/did-marie-antoinette-really-say-let-them-eat-cake
2. https://www.cbsnews.com/newyork/news/midtown-manhattan-shooting-hilton-hotel/
3. https://www.consumeraffairs.com/insurance/united_health_care.html?page=2#scroll_to_reviews=true
4. https://www.aljazeera.com/opinions/2024/12/9/no-surprise-americans-are-rooting-for-the-unitedhealthcare-ceos-killer
5. https://www.pbs.org/newshour/health/analysis-health-insurance-claim-denials-are-on-the-rise-to-the-detriment-of-patients
6. https://www.ted.com/talks/nick_hanauer_beware_fellow_plutocrats_the_pitchforks_are_coming?subtitle=en
7. https://apnews.com/article/unitedhealthcare-ceo-killing-luigi-mangione-terrorism-law-7fcb28dcc0106c980b6ecf4aa9cf682f
8. https://www.npr.org/2015/06/19/415809511/dylann-roof-said-he-wanted-to-start-a-race-war-friends-say