Dehumanized First: The Vocabulary Is the Violence

This piece is the longer version of the receipt.

December 4, 2024

A man was shot outside the New York Hilton Midtown shortly before seven in the morning. The man was Brian Thompson, CEO of UnitedHealthcare, the largest private health insurer in the United States. He was in town for an investor day. The shooter walked up to him, fired three rounds, and disappeared into Central Park.

On the shell casings investigators recovered at the scene were three words: DENY. DEFEND. DEPOSE. The phrase is a near-quotation from a 2010 book by attorney Jay Feinman about how insurance companies handle claims. Delay, deny, defend is the version the literature usually uses. The shooter shortened it and substituted depose.

Five days later, Luigi Mangione was arrested at a McDonald's in Altoona, Pennsylvania, after a customer recognized him. He was twenty-six. His manifesto, found in his backpack, identified the American health insurance industry as the target of the act. He was charged with murder and terrorism in New York and federal charges followed.

The op-ed cycle

Within twenty-four hours, a particular kind of op-ed began appearing across every major US opinion page. The titles varied. The argument did not. We should not celebrate murder. We should not dehumanize executives. The polarization has reached a dangerous point. The cheerleading is a moral collapse.

These op-eds were not wrong about the first sentence. Murder is not celebrated by serious people. The first sentence is the throat-clearing. The second sentence is where the move happens. We should not dehumanize executives arrived as if it were a new commandment — as if dehumanization were a thing that had been done to executives, recently, and now needed to be defended against. The columnists used the exact word. Multiple times. Across publications. The phrase became a template.

The template had a problem. The columnists worked at outlets that had spent forty years describing the systematic stripping of humanity from workers and patients with a vocabulary so precise it could be transcribed into payroll software. The same outlets called the executives' actions right-sizing. They called the dead patients adverse outcomes. They called the denied claims medical loss ratio. When the language did the dehumanizing, the columnists wrote the business section. When a bullet did it, they wrote the opinion section.

The asymmetry is the project. The shirt is the receipt for the asymmetry.

The vocabulary inventory

Below is a partial inventory of the language American business journalism has normalized over the past four decades. Each phrase is a small move. Each move makes the bigger move possible.

• Right-sizing. Used to describe a layoff. A layoff is the firing of people who did not do anything wrong, because the people who own the company need a different quarterly number. Right-sizing converts that fact into a janitorial verb. The wrong size becomes the worker's problem, not the owner's choice.
• Restructuring. Same operation, different syllables. The corporate structure is restructured. The workers are restructured into unemployment. The verb is intransitive in a way the world is not.
• Headcount. Workers as a unit of measurement, like livestock. The plural form has no singular: there is no a headcount. The word exists only to make the people invisible at the population level where the cuts get made.
• Covered lives. What health insurers call their customers in actuarial filings. The lives are covered by the policy, not by the care.
• Medical loss ratio. What insurers call the share of premiums that gets spent on actual medical care. The loss in the phrase is the company's loss, not the patient's loss. Care delivered is loss; care denied is gain. This is not a metaphor. This is literal accounting practice.
• Prior authorization. The process by which the insurer requires the doctor to ask the insurer for permission before delivering the care the doctor has already recommended. The denial of prior authorization is described in the financial press as care management, not as care denial.
• Denied. The verb the insurer's claim-processing software prints on the letter to the patient. The denial is described, when the financial press notices it at all, as part of the company's underwriting discipline.
• Adverse outcome. What an HMO calls the death of a patient whose treatment it refused to authorize. The patient is the outcome. The death is the adverb.
• Eviction. The only word in the list that has not been euphemized, because no euphemism is needed. The eviction industry is so insulated from consequence that it uses the legal term directly. It does, however, get described in shareholder reports as managed turnover.

This is the vocabulary the shirt names. The ticker on the back — $RENT ▲ $WAGES ▼ $MERGE ▲ $AUTOMATE ▲ $FLEX ▼ $GROWTH ▲ $EVICT ▲ — is the same vocabulary set to a stock-page rhythm. $EVICT is in Wake Orange because that is the line where the metaphor stops being a metaphor.

The numbers underneath

The numbers underneath the vocabulary are not in dispute. UnitedHealthcare denied roughly one in three Medicare Advantage prior authorization requests at one point in the early 2020s. The Senate Permanent Subcommittee on Investigations published a 2024 report — bipartisan, signed by Senators Blumenthal and Johnson — documenting that the major Medicare Advantage insurers, with UnitedHealthcare named first, had built denial systems designed to refuse coverage for post-acute care at scales orders of magnitude higher than what traditional Medicare did for equivalent patient cohorts. The Kaiser Family Foundation tracked claim denial rates in the ACA marketplace and found insurer denial rates ranging from 1% to 80% across plans, with median denials approaching 17% and only a vanishingly small fraction of denials ever appealed.

The phrase used in the financial press for this performance was strong underwriting. The phrase used by the actual patients was they let my husband die.

The inversion

The argument the op-eds wanted to make was that violence against an individual executive is a moral collapse separate from the violence the system performs at population scale. The argument did not survive contact with the inventory. If dehumanization is the word for what was done to a CEO by a gun, then dehumanization is also the word for what was done to a million working people by a denial letter. The columnists could not use the same word in both directions and they knew it. So the columnists chose a direction. They chose the direction that protected the building they worked in.

The shirt does not undo the choice. The shirt names it. The front quote is the line the columnists used. The follow-up is what the workers already knew. The ticker on the back is the receipt that the dehumanization was not invented in December 2024. It was the business plan.

Why the shirt is not glorification

The shirt is not about the shooter. The shooter is not the subject. The shirt is about the response to the shooter — the way the press class discovered grammar the instant a bullet pointed up the income distribution. The phrase they dehumanized us first is not a defense of the bullet. It is a refusal of the rhetorical move that converts decades of routine death into background noise so that one death by gun can be foregrounded as the singular tragedy.

Routine death is also death. The ticker on the back is what routine death looks like when you charts it. $EVICT in Wake Orange is the small alarm that goes off when the eviction stops being an abstraction and becomes the family at the courthouse with the trash bags.

Wear it

In the lobby. At the all-hands. In the doctor's office where the prior auth got denied. In the hallway outside the HR meeting. Anywhere the language is the violence and someone is about to use the language to make the violence easier to schedule.

They dehumanized us first.

The receipt is the inventory. The inventory is the indictment.