After the CEO shooting: what anger at health insurers and middlemen revealed

The Short Version

When the chief executive of UnitedHealthcare was shot and killed, the reaction surprised the people who cover the news. A large number of Americans did not mourn. Some cheered. Joe Rogan came back to that reaction in three separate conversations, with the comedians Brian Simpson, Joe DeRosa and Duncan Trussell, and each time the talk moved quickly from the crime to the system behind it [1][2][3].

None of the three conversations argues that the killing was right. Rogan says the killer should go to jail and that anyone who thinks murdering a stranger is justified is probably mentally ill [2]. Trussell says plainly that he is not advocating violence [3]. What they try to explain is why the anger was there to begin with: people pay for insurance for years as a promise of care, and many feel the promise is broken at the moment they need it [2].

Three other guests never mention the shooting at all, and two of them spoke before it happened. They matter because they describe the machinery the comedians are angry at. Brigham Buhler explains how pharmacy benefit managers and insurers steer patients toward what pays the system best [4]. Mark Cuban shows, with prices, how those middlemen keep cheaper drugs away from patients [5]. Bernie Sanders makes the case that the whole design should be replaced with Medicare for All [7]. Put together, the six conversations show a pattern. The resentment was not created by one event. It had been building for years in denied claims, hidden prices and bills nobody could explain, and the cheering exposed how deep it ran [1][3][5][7].

Table of contents

What They Said

Brian Simpson and Joe Rogan: the one issue that crosses party lines. In a conversation recorded soon after the shooting, Rogan and Simpson agree that healthcare may be the one subject that unites Americans across politics, which is why the killing drew so little sympathy from left or right [1]. Simpson describes what he saw on television: the cable channels first treated the cheering as one political side behaving badly, then realized that anger at insurers does not depend on who a person voted for [1]. In his words, "Healthcare might be the one thing that we can come to a bipartisan agreement on" [1].

Rogan's explanation is about what an insurance company is for. He describes the industry as a set of games inside a game: "Healthcare is the arena in which they're playing their game," while the real game is making the most money [1]. Inside the company, he says, thousands of employees are each playing their own game, climbing the ladder and earning promotions by making the company more money [1]. He recalls a video of a former insurance worker who says she was rewarded for denying care to a man who later died [1]. During the conversation they look up reports that UnitedHealth faces class action lawsuits over the algorithm it uses to process claims, and a California law that bans insurers from using artificial intelligence to deny coverage, which Rogan thinks the whole country should adopt [1]. Their complaint is that the technology is being used to cut costs and refuse treatment, not to make coverage fairer [6].

Rogan's alternative is the fire department. Everyone pays in, and nobody's house is left to burn because the owner cannot pay. He asks listeners to imagine firefighters checking a homeowner's coverage before turning on the hose [1]. He calls himself socialist on some things for that reason, and Simpson puts the principle bluntly: some things cannot be run for profit if the goal is the best outcome [1]. Rogan also raises the other side. Top surgeons need to be motivated, and one of the two mentions a friend in Canada who waited about a year for knee surgery [1].

On the killing itself, the two do not land in the same place. Rogan says the cheering was a troubling thing to watch and, according to the episode summary, condemns celebrating violence, saying progressives who cheered a murder revealed a lot of hypocrisy [1]. What disturbed him most was that people were not outraged: "They didn't treat it like a regular assassination." [1] Simpson is more candid about his own reaction. He admits he felt about the same as he did when Osama bin Laden was killed [1]. That is not a defense of the act as a policy, but it is an honest report of how cold the public mood was.

Joe DeRosa and Joe Rogan: understandable anger, unjustified act. DeRosa raises the case later, after Luigi Mangione had been charged. He says the debate about justified violence that followed the killing was nonsense, and asks Rogan a specific question. If Mangione is now pursuing an insanity plea, as DeRosa describes it, does that undercut the people who cheered him as a crusader [2]?

Rogan says no. Mangione, he says, is simply trying to stay out of prison: "He's trying to not go to jail." [2] Then he draws the line that runs through all three comedy conversations. Anyone who believes he should go and murder a stranger because of the man's job is probably mentally ill, and the killer should be in jail [2]. But the people who celebrated were reacting to something real. Rogan's explanation for the young people who agreed with the act is "Because everyone knows that the system is rigged and no one is doing anything to change it." [2]

He makes the grievance concrete. A person pays premiums for years. Then a spouse needs a major surgery, the claim is denied, the family is bankrupted and she dies. The rage that follows makes sense to him, because the payments were never a gift: "You give them the money because it's supposed to be an agreement." [2] DeRosa agrees with that completely. He says he has no quarrel with the idea of hating a health care chief executive, only with the violence and the hero worship [2]. DeRosa knows the problem from his own budget. Each year he has to decide whether $600 a month for insurance is worth it [2].

Rogan then widens the complaint beyond insurance. Public companies, he argues, are pushed by shareholders to earn more every quarter, which rewards ruthlessness. His examples are small and familiar: underfilled bags, cheapened ingredients, good brands bought out and degraded [2]. He still thinks capitalism is far better than the alternatives and that some regulation is needed. His point is that once a business is successful, its owners can choose to run it for quality instead of the last dollar [2].

Duncan Trussell: a sign of lost trust. Trussell places the shooting inside a larger picture. He describes society as a factory, and says the reaction to the killing is what happens when the factory is out of balance: when people cannot buy a home or get medical care, desperation grows [3]. He is careful about what he is and is not saying. "Now again, I'm not advocating violence." [3] And he adds, "I think that if we keep doing violence, we're going to keep getting violence." [3]

His own example is a bill. He has excellent insurance through his work, and a recent colonoscopy cost him $100. His insurer was charged $9,000 [3]. He contrasts his luck with what he reads about: people denied important medication and procedures and sent stacks of paper explaining why the company will not pay [3]. Rogan answers that healthcare is a giant money machine and tells Trussell he should talk to Brigham Buhler, who understands it from top to bottom [3].

Trussell ties the insurance anger to a general collapse of confidence in institutions. In the same stretch of conversation he and Rogan discuss officials who could not explain drones over New Jersey and a president who appeared to them to have been incapacitated for a long time. The combined effect, Trussell argues, has not merely corroded trust in government but "potentially annihilated it." [3]

Brigham Buhler: how the incentives block alternatives. Buhler, who runs a clinic and co-founded a pharmacy, spoke with Rogan after testifying at a Senate roundtable on chronic disease, and his conversation does not discuss the shooting [4]. What he supplies is the mechanism. Pharmacy benefit managers, he explains, were created in the 1970s and 1980s to lower drug costs. Today they are owned by insurers such as Cigna, Aetna and CVS Health. They negotiate rebates that are kept off the public books, he says, and they profit from keeping people on drugs. The lists of covered drugs are often shaped by rebates and not by which drug works best [4].

His clearest example is the opioid crisis. Non-addictive pain creams existed, he says, but insurers stopped covering them within about a year because they cost hundreds of dollars, against roughly $10 a month for opioids. At the same time, reimbursement for drug screening at pain clinics was cut, which removed a safety net [4]. He also describes insurance rules that delay care, such as requiring two fasted testosterone readings below a threshold before treatment is covered, a process he says can take six months to a year [4].

Buhler is careful about motive. He does not think anyone is intentionally poisoning Americans. He describes a system so divided into silos, and so focused on quarterly earnings, that each part protects its own revenue [4]. He points to a revolving door as well, saying 13 of the last 15 FDA commissioners went on to work for industry [4].

Mark Cuban: exposing the middlemen with a price list. Cuban's conversation with Lex Fridman also makes no mention of the shooting. His diagnosis of what is broken in healthcare is three words: "There's no transparency." [5] And the consequence is the same thing Trussell describes from the other end: "when you can't trust the healthcare system, other than maybe your doctor, that's a broken system." [5]

His company, Cost Plus Drugs, answers with a posted formula. For each of about 2,500 medications it shows what the company paid, a 15 percent markup, a pharmacy fee and shipping [5]. He names the three big pharmacy benefit managers, CVS Caremark, Cigna's Express Scripts and UnitedHealth's OptumRx, and says they put profit first and hide behind non-disclosure contracts [5]. His example is Humira. Its price before rebates is about $8,000 a month, and $3,000 to $6,000 after rebates. A biosimilar that Cost Plus carries costs $594. Cuban says the big three keep it off their lists because they collect no rebate on it [5].

When Fridman reads a CVS Caremark statement describing the company as a leading agent of transparency, Cuban's reply is, "That's a whole lot of nothing," [5]. He found the same opacity as an employer. Generic drugs the Dallas Mavericks bought through a big benefit manager for $169,000 would have cost $19,000 from Cost Plus. His companies were paying consultants $30 per employee per month while being steered toward whoever paid the consultants the largest commissions [5]. He also objects to step therapy, the rule that makes a patient try other drugs before the one the doctor chose: "I want my employees to get the medication that the doctors say is best." [5]

Bernie Sanders: change the design. Sanders, also speaking with Fridman and not about the shooting, gives the most sweeping answer. He says roughly 85 to 90 percent of people agree that health care should be a human right, and that it is guaranteed in every major country except the United States [7]. His plan is to strengthen Medicare, remove deductibles, add dental, hearing and vision coverage, and then lower the eligibility age step by step, from 65 to 55, 45 and 35, until everyone is covered within four or five years [7].

The human costs are what drive him. He says about 60,000 Americans die each year because they cannot afford to see a doctor, that one in four cannot afford their prescriptions, and that one in four cancer patients goes bankrupt or drains the family's resources [7]. On that last figure he asks, "How insane and cruel is that?" [7] His verdict on the whole arrangement is, "It is a disgusting system. It is an inhumane system." [7]

Where They Agree, and Where They Don't

They agree the anger is real and not partisan. Simpson says insurers have wronged people regardless of how they vote [1]. Sanders, from the opposite end of the fame spectrum, says nearly the same thing: "I think healthcare is what unites us all." [7] Buhler told the Senate that chronic disease is not a left or right issue but a human one [4]. Rogan repeats the point with all three comedians [1][2][3].

They agree on the core grievance: the incentive runs against the patient. Rogan says the insurer's real game is to make the most money, and that denying claims is how it is played [1][2]. Buhler says drug lists follow rebates [4]. Cuban shows a case where the cheaper drug is excluded for exactly that reason [5]. Sanders says the system is designed to make huge profits for drug and insurance companies and not to provide care to everyone [7]. Four different vantage points, one description.

They agree that hidden prices feed distrust. Trussell's $100 colonoscopy billed at $9,000, Cuban's $594 drug next to an $8,000 one, and Fridman's story of a friend's son whose basic emergency visit cost $6,000 are the same observation: nobody can see what anything costs or why [3][5][7]. Cuban says outright that the lack of transparency leads to lack of trust [5].

They disagree about the remedy. This is the widest gap. Sanders wants a single public program and argues that removing insurer and drug company profits would cover everyone for no more than the country spends now [7]. Rogan leans the same way on this one subject, with his fire department comparison, and the transcript has him saying health care should be something the government pays for [1]. Cuban's answer is a market one: publish prices, let employers see what they pay, and let competition punish the middlemen [5]. Buhler's answer is preventive, personalized care focused on diet, lifestyle and testing, so that fewer people need the system in the first place [4]. Rogan makes that argument too, telling Simpson that a healthier country would need far less healthcare [1].

They disagree, quietly, about whether profit itself is the problem. Simpson says some things cannot be for profit [1]. Sanders agrees [7]. Rogan tells DeRosa that capitalism remains better than the alternatives and that the flaw is human nature plus shareholder pressure [2]. Cuban runs a for-profit pharmacy with a fixed markup and treats that as the fix [5]. So the critics of the insurers do not share a view of markets. They share a view of this market.

They are not uniform on the killing. Rogan and DeRosa both reject the idea that it was justified [2]. Trussell rejects violence as a path [3]. Simpson's bin Laden comparison stands apart as a statement of feeling and not an argument [1]. Buhler, Cuban and Sanders say nothing about it in these conversations, and nothing in them should be read as a comment on it [4][5][7].

Why It Works

Why would a killing produce cheers? The conversations suggest four reasons, and each one is about the system and not about the victim [1][2][3][7].

First, insurance is a promise, and a broken promise produces a particular kind of anger. Rogan's point to DeRosa is that people do not hand over money every month out of affection. They are buying the assurance that if something goes wrong they are covered [2]. A denial at the worst moment of a family's life feels like betrayal, and Simpson describes the version where a patient is prepared for surgery and only then told the procedure is not covered [1].

Second, the harm has no visible author. Rogan describes thousands of employees each doing a reasonable-looking job inside a company whose overall purpose is to maximize profit [1]. Buhler describes silos, each defending its revenue, with nobody intending harm [4]. A patient who is denied never meets the person responsible, and now may be dealing with software instead of a person [1]. When there is no one to hold accountable, anger collects and looks for a face. That does not make the target a fair one. Rogan himself admits he does not know what that particular executive had done [2].

Third, the ordinary channels look closed. Sanders describes about 1,800 drug industry lobbyists in Washington for 535 members of Congress, and donors who become a politician's real base [7]. He has noticed a rule: "the more important the issue, the less discussion there is." [7] He adds that the country spends twice as much per person as any other nation while 85 million people are uninsured or underinsured, and that this is barely discussed [7]. Rogan's phrase for the same feeling is that no one is doing anything to change it [2]. People who believe the legal routes are blocked are more likely to feel grim satisfaction when something breaks through, even something terrible.

Fourth, the insurance grievance sits on top of wider economic pressure. Trussell connects it to a shrinking middle class and the difficulty of buying a house [3]. DeRosa's line from his act about the youngest adults is "you'll never own land." [2] Sanders talks about decades in which productivity soared while workers' real earnings barely moved [7]. Health costs are one bill among several that feel rigged, and the one where the stakes are life and death.

The same reasoning explains why Trussell's warning deserves weight. If violence comes from imbalance, more violence does not restore the balance. It produces more of itself [3].

Where It Applies, and Where It Doesn't

Explaining is not excusing. The pattern here accounts for a public mood. It does not justify a killing, and the speakers who address the killing say so [2][3]. The victim was a person, and Rogan concedes on air that he does not know the details of that man's decisions [2].

Three of the six voices were not talking about the shooting. Buhler, Cuban and Sanders describe the system. Linking their critiques to the reaction is the comedians' move and this article's, not theirs. Rogan makes the connection himself when he tells Trussell that Buhler is the person who can explain what is going on [3].

Much of the evidence is anecdote and recollection. A video of a former insurance worker, a friend's wait in Canada, a guest's own medical bill: these are stories told in conversation [1][3]. The lawsuit and the California law were read from search results during the recording [1]. Sanders's figures and Cuban's prices are their own statements [5][7]. Cuban himself warns elsewhere in his conversation that anecdotes often carry more noise than signal [5].

The critics have interests. Cuban owns the company he presents as the solution [5]. Buhler owns a clinic and a compounding pharmacy that compete with the system he criticizes [4]. Sanders has campaigned on Medicare for All for years [7]. None of that makes them wrong, but a reader should know it.

The public alternative has costs the speakers acknowledge. Rogan raises the year-long wait for surgery in Canada and the question of how to keep the best surgeons motivated [1]. Sanders says openly that taxes would rise, and argues families would still come out ahead once premiums and deductibles disappear [7]. Fridman points out that making it happen would mean turning the political system upside down [7].

Insurers are not the whole cost problem. Rogan and Buhler both argue that diet, exercise and metabolic health drive a large share of what the country spends [1][4]. Rogan also notes that doctors carry heavy malpractice insurance bills that push them to move patients through quickly [1]. Fixing claim denials would not touch those.

A legal plea is not a verdict on the cause. DeRosa's question about the insanity plea rests on his own account of the case. Rogan's reply is the sensible limit: a defendant's legal strategy says nothing about whether millions of people have a legitimate complaint about their coverage [2].

What To Do With It

1. Keep the two judgments separate. It is possible to say the killing was wrong and the anger is legitimate. Rogan holds both positions at once, and so does Trussell [2][3]. Refusing to separate them leads either to excusing a murder or to dismissing a real grievance.

2. Ask what a company is paid to do. Rogan's test is to look at the game being played. If a business earns more by denying than by paying, expect denials [1]. Buhler's version is to ask whether a covered drug is on the list because it works best or because of a rebate [4].

3. Ask for the price, and compare it. Cuban's whole method is to show cost, markup and fees [5]. Before filling an expensive prescription, check whether a transparent-price pharmacy or a biosimilar is available and ask the doctor whether it is suitable. His Humira example shows the gap can be thousands of dollars a month [5].

4. Treat a denial as the start of a process. The guidance Rogan and Simpson read aloud is practical: keep records, document every exchange with the insurer including denial letters, learn your rights, and challenge the decision, with a lawyer's help if the denial looks like bad faith [1]. They also note how hard this is for someone who works all day, which is part of the grievance [1].

5. If you run a company, learn where the health money goes. Cuban argues healthcare is usually the second-largest expense after payroll and that any company with more than about 500 employees should have a dedicated healthcare executive. He found large overpayments only when he looked [5].

6. Lower your own exposure where you can. Rogan and Buhler both argue that fitness and diet reduce how much a person depends on the system at all [1][4]. It will not prevent an accident or a tumor, as Simpson points out, but it shrinks the part of the risk a person controls [1].

7. Put the pressure where the rules are made. Sanders says Medicare for All will arrive only when millions of people make clear that they want it, and that change starts at the grassroots [7]. Rogan thinks California's ban on using AI to deny coverage should be adopted nationally [1]. Whatever remedy a person prefers, both examples point to legislatures and not to individuals.

8. Do not answer imbalance with more of it. Trussell's sentence is the one to keep: more violence produces more violence [3]. The conversations that followed the shooting did more to explain denied claims and hidden prices than the act itself ever could, and those explanations are where any repair begins [1][5].

This article describes a public debate and is not medical, legal or insurance advice. For decisions about your own treatment or coverage, talk to a qualified professional.

Sources

1. Joe Rogan and Brian Simpson on Health Insurance, Conspiracies, Gaza and the Best Vampire Movie Ever · The Joe Rogan Experience
2. Joe DeRosa on Coffee, Comedy Scenes, Getting Fit, the Mothership and Why Greed Ruins Everything · The Joe Rogan Experience
3. 2247 - Duncan Trussell on The Joe Rogan Experience · The Joe Rogan Experience
4. Brigham Buhler on His Senate Testimony, Chronic Disease and Healthcare's Hidden Incentives (JRE #2208) · The Joe Rogan Experience
5. Mark Cuban: Shark Tank, DEI, Wokeism Debate, Elon Musk, Politics, Drugs · Lex Fridman Podcast
6. Brian Simpson · The Joe Rogan Experience
7. Bernie Sanders Interview · Lex Fridman Podcast