When Brian Thompson, the CEO of UnitedHealthcare, was shot to death on his way to an investors’ meeting in midtown Manhattan on December 4, politicians, law-enforcement officials, and members of the media were taken aback at the public outpouring of anger—directed not, for the most part, at the fugitive killer, but at the private health-insurance industry. Social-media platforms were swamped with testimonials from people who had been denied coverage for life-saving medical treatments. Of course they did not condone murder, but…there was almost always a “but.” In addition to all the expressions of raw anguish and resentment at the system Thompson represented, there was also a striking eruption of gallows humor: “Prior authorization needed before thoughts and prayers,” read one online comment. When authorities arrested the twenty-six-year-old Luigi Mangione as a suspect in the case, he was immediately celebrated as a folk hero, with admirers selling “Free Luigi” t-shirts and showing off tattoos of the words Mangione allegedly wrote on shell casings found at the crime scene: “Deny,” “Defend,” and “Depose.”
Many commentators have registered alarm and disgust at these reactions. Glorification of political violence, they warn, is a sure sign that America’s civic fabric has been frayed to tatters. Some historians have compared Mangione to Theodore Kaczynski, who has his own cult following among members of a generation too young to remember the real terror people felt when the Unabomber was at large. Like Kaczynski, Mangione had a “manifesto,” in which he noted that “the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy.” The problem was with the practical conclusion Mangione drew from these statistics. In a notebook he was carrying at the time of his arrest, he is reported to have written, “What do you do? You wack [sic] the C.E.O. at the annual parasitic bean-counter convention. It’s targeted, precise, and doesn’t risk innocents.” This combination of cold-blooded hatred and selective moral scruple made Mangione all the more fascinating to the public.
In a guest essay in the New York Times, the bioethicist Travis N. Rieder argued that one must be able to understand the anger that seems to have motivated Thompson’s killer while also condemning his crime: “I get the rage…. But not everything understandable is justifiable. This tragic situation should motivate us to change the institutions and structures that have failed so many people. But not to give murder a pass, and especially not to glorify it.” Amen to that.
Still, it isn’t enough to understand the rage that Mangione and his admirers feel. We also need to understand the desperation that would lead a troubled young man to conclude that assassinating an insurance executive was the best or only adequate expression of his anger. One person, acting alone, can assassinate a symbolic figure, but one person can’t change the health-care system. For that, you need politics. Sadly, political gridlock has left many Americans feeling that there is no point in trying to act collectively on this or any other issue, that the courts and the corporations will always have more political power than any mass movement, however popular, and that politicians can always be bought off. This situation leads predictably to a certain amount of despair and, yes, violence. We call it “political violence” when it’s related to a public issue, but it’s really a kind of anti-political violence, and it appeals only to those who have given up on real political solutions to their problems. The increasing sense of futility about politics is as big a threat to democracy in America as any would-be autocrat. Indeed, the two threats often go together: tyranny battens on resignation.
That our broken health-care system is now one of the country’s most pressing problems should be clear to everyone, and yet it received little attention in the 2024 election season. The Harris campaign proposed a few modest tweaks to Medicare coverage. Trump falsely claimed to have saved the Affordable Care Act but also promised to replace it with…something. In lieu of a plan, he had “concepts of a plan.” No one from the incoming administration seems to know what the concepts are.
Meanwhile, a growing number of Americans face bankruptcy because of medical debt, while others forgo medical treatment because of high insurance deductibles, even as their premiums continue to rise. A 2020 report from the Congressional Budget Office found that only about 68 percent of the money from insurance premiums goes to health care; the rest is pocketed by insurance companies or spent—by them and health-care providers—on administrative overhead. Matt Bruenig of the People’s Policy Project calculates that the United States pays over half a trillion dollars more in administrative expenses than it would under a single-payer system. That’s more money than the country spends on its entire public-college system.
In short, Americans are suffering too much, dying too soon, and going broke in order to prop up a completely unnecessary but very profitable industry. The time has come for us to begin phasing it out. The only questions should be how fast to do so and by what means: we could add a public option to Obamacare’s individual insurance market; we could gradually lower the eligibility age for Medicare or allow people to buy into Medicaid. But until we change direction, the problem will just get worse, leading to more despair and to more acts of rage. It is right and necessary to condemn such acts, but we no longer have a right to be surprised by them.
