Assassinations are despicable. I don’t much care if the targets are politicians or mafia bosses. It’s the method I despise. For those who are old enough to remember the killing of Patrice Lumumba, then JFK, then Malcolm X, then MLK, then RFK, every assassination is (I hate this word) a trigger. Assassinations are destabilizing. The shooting of Archduke Franz Ferdinand set off the first world war. Targeted violence has always been a sign – an augury – that the social order is breaking down. I would have preferred to see Osama bin Laden brought to justice so that we might have understood his methods and motives. I know that trials can be rigged, corrupted, biased, but so far the courtroom is the best place we have in which to decide between guilt and innocence – and to assign an appropriate punishment. Assassination is a death sentence without benefit of judge or jury.

All of which is to say that I was deeply horrified by the assassination of Brian Thompson, the CEO of UnitedHealthcare, in cold blood, in broad daylight, in front of the Hilton hotel, in Manhattan.

As I write this, the gunman remains at large, but his motives were clearly written on the casings of the bullets he used: “deny” and “delay”. Many would argue that those are the two favorite activities, the go-to business practices, the bold-faced words in the scripts, that health insurance employees are instructed to follow. As a consequence, Thompson’s killing has set off a storm of conversations and internet postings about the deep wounds that the medical insurance industry has inflicted on Americans who made the mistake of trusting their carriers to provide adequate coverage.

It’s a pity that Thompson’s murder is being politicized – as the latest eruption of the left’s destructive rage or as the sign that a gun-lover is brandishing his muscle. Brian Thompson’s murder is a criminal response to a criminal situation. The only consolation – the only good that could come of it – would be if his death led to some serious soul-searching, to a concerted attempt to understand why an apparently affable CEO inspired such violence and hatred.

Deny. Delay. Everyone knows what those words signify in reference to medical insurance. Doctors and patients agree that our healthcare system is seriously broken. It hardly needs to be said that medicine, in the United States, reflects and further deepens our profound economic divide. Not long ago, my husband’s longtime doctor left his practice to join a medical concierge service that charges $60,000 per person per year. Soon after, I found myself in the waiting room of an upstate New York urgent care center, watching patients ask the receptionist if they could pay the $35 co-pay in $5 monthly installments.

The critique of the national health services in Canada and in Europe was always that one had to wait months for a medical appointment. But now, in this country, we have discovered that an appointment with a specialist might take months to arrange, and (depending on one’s insurance) will be anything but free, as it would be in countries with state-sponsored systems.

Long before Thompson’s killing, people had been talking about the loved ones who suffered and died because of an insurer’s refusal to pay the cost of a treatment or of long-term care. If the extremity and cruelty of these companies’ cost-cutting measures didn’t so often strip patients of their life savings and their homes, they might almost seem like a joke.

Recently, an insurance company in the north-east decided, and later (after a public outcry) rescinded its decision, to limit the hours of anesthesia for which a surgical patient could get reimbursed. Should the anesthesiologist, midway through a long surgery, turn off the hose and tell the patient to bite the bullet? Or should the patient be billed thousands of dollars for those last few hours? And before we blame the doctors for these high fees, let’s remember that the anesthesiologists are paying fortunes in malpractice insurance … to the companies that are being paid by both the doctor and the patient.

What’s puzzling is why people who have suffered so much because of the current system are so reluctant to try something else. What would be lost if we instituted healthcare for all? Our freedom? Our control? Our ability to choose? The bad news is all that is already gone. The only things that might be diminished would be the annual bonuses and stock options of the insurance company executives.

So let me be clear. I’m sad about Brian Thompson’s death. The mess we’re in wasn’t his fault. Our problems are so much larger than he was. He was an unlucky, visible symbol of everything that’s gone wrong with our healthcare system.

I’m sad about the rage and desperation that caused someone to write “deny” and “delay” on the bullets he aimed at Brian Thompson. But mostly what I’m sad about is the fact that we, as a society, are so willing to accept a status quo that dooms our neighbors to suffer and die without the medical care they need. The writer Lucy Sante has said that we are in the 33rd year of the Reagan administration – an observation that has never seemed more apt. More than three decades have passed since we were told that we were on our own, that the miseries of our neighbors were not our problem, and that we should continue to allow the industries that the unfortunate Brian Thompson represented to profit from our tragic, unrecoverable losses.

• Francine Prose is a former president of PEN American Center and a member of the American Academy of Arts and Letters and the American Academy of Arts and Sciences

• This article was amended on 9 December 2024 to correct Brian Thompson’s first name in the picture caption and in some main text references.