It's Time to Let Go Of Luigi Mangione
a response to a web of madness
Let’s begin by setting aside the facts of the case.
(1) It does not matter what Brian Thompson did or did not do. His murder was wrong.
The Twin Towers, which were struck during the September 11, 2001, attacks, housed offices for 430 companies, the majority of which were financial institutions. Many have faced accusations of engaging in predatory lending practices.
At Ariana Grande’s Manchester concert, 22 people were killed in a suicide bombing. The average ticket price for her concerts is around $200.
During the 2008 Mumbai Attacks, a group of terrorists from a Pakistan-based militant group killed over 170 people. They targeted two luxury hotels and a popular café.
Each of these incidents is widely recognized as an act of terrorism. Endorsing any of them would result in your estrangement. But what makes them different from the assassination of the United Healthcare CEO? These attacks were undoubtedly on a larger scale, but they were still targeted. Maybe the victims were not earning multi-million-dollar paychecks. But they were still richer-than-average. Maybe the difference is just that these were orchestrated by brown men tied to terrorist organizations.
The world’s response tells you that the lives of these victims are not disposable, regardless of their status. What if Luigi had looked just like the Saudi man who slammed his car into a holiday market in Germany, injuring hundreds? I’d bet the response would have been more like the AfD’s anti-immigrant rally rather than the molding of Mangione into an online sex symbol.
There is a difference between large-scale terrorism and a targeted attack. Now consider these hypotheticals:
A hospital hires a company to help alleviate severe staff shortages and operate its emergency room. The new company increases bills for patients with the highest-level billing code to over $1,000. The chief executive of the hospital is killed.
A boy is bullied by a child of wealthy parents in school. He responds by bringing a gun to school to take care of it.
A progressive pro-choicer firebombs the home of a well-known pro-life activist.
Like the murder of Thompson, endorsing any of the above sets a dangerous precedent— one that erodes the value of life and makes it easier to shrug off violence as justifiable under certain circumstances. As much as everyone likes to image themselves as heroes, we are the perpetrators of someone else’s injustice. We buy from companies that pollute others’ rivers. We hold political views that disenfranchise others. We are educated and employed at institutions with troubled pasts and presents. To varying extents, we are all guilty.
These scenarios are not true hypotheticals. In fact, upon becoming aware of the price hikes, the chief executive of Newport Hospital and Health Services terminated its agreement with EmCare and expressed regret that patients had to endure price increases. Thankfully, the executive was alive to do so. Many school shooters have been bullied by their peers in the past. And the third example is flipped — Dr. George Tiller was an abortion provider whose clinic was firebombed. He was eventually shot by a pro-life fundamentalist while sitting in his car.
(2) People like Brian Thompson are not the problem.
At best, Luigi chose the wrong guy.
From a piece by Bret Stephens, an Opinion Columnist at the New York Times:
Thompson joined UnitedHealth Group in 2004 and climbed through the ranks over the next 20 years. He was well-liked and motivated by a desire to make healthcare more accessible for people. However, like any CEO, Thompson’s responsibility lay with his company. He could not wave a magic wand and fix the healthcare system.
Despite all the criticism directed at the wealthy, finding someone who doesn't aspire to career success is rare. Thompson was no exception. He aimed to leverage his business acumen at UnitedHealth. He inherited a flawed system but did not create it.
And on the celebration of Mangione? It couldn’t be more ironic that the so-called movement martyr was a product of a multi-millionaire family leading a life of privilege.
(3) Healthcare is deeply flawed, but celebrating a CEO’s murder does little to spark change.
UnitedHealth is, first, a business. Consumers select an insurance plan (like HMO, PPO, or EPO) and pay a premium to maintain coverage. You pay out-of-pocket until you meet your deductible; from this point, you pay coinsurance, a set % rate for additional expenses. For some services, you’ll pay a fixed out-of-pocket fee (e.g., $40 for a doctor’s visit) called a copay. Then, there’s an out-of-pocket maximum, where the insurance company will cover 100% of expenses after a certain threshold is met.
But there are stipulations around what your insurance will cover. Your insurance will not pay for your Ozempic for weight loss. Your insurance will not cover your retinal camera photos — stick to the dilating drops. And I wouldn’t recommend testing your insurance with expensive out-of-network visits.
I’d also challenge the notion that healthcare companies are the proper villain to cast in this story. Noah Smith does a nice job of explaining why healthcare isn’t truly to blame for an unaffordable medical system. UnitedHealth Group's profit margin, 6.11%, is about half the average profit margin of companies in the S&P 500. Profit is less for other prominent insurance players in the U.S. The important takeaway is that America’s private insurers are paying more to cover healthcare than healthcare systems abroad, which are doing much better for their patients.
This suggests a cost problem — our insurance covers more, but the hospital's bill should never have been so high. The excessive charges could be due to inflated pricing, carelessness (such as unnecessary MRIs), or other factors, perhaps including the growing influence of private equity firms in the hospital system.
This is not to say that insurance companies are not without fault. We hear too many stories like that of Gail Lawson, who, after a complicated procedure to repair tissue following her heart surgery, was saddled with a $100,000 bill — her insurance, UnitedHealth, promised to cover only about $5,000. Through partnerships with data analytic firms like MultiPlan, insurance companies look to slash reimbursement costs while intermediary firms make money by recommending lower refunds.
Patients like Lawson deserve justice. No one ought to come out of an arduous procedure with debt hanging over their head or have family members seeking emergency care for their loved ones while worrying about what it will cost them.
We are making slow progress, but progress nonetheless. Just read the testimony from Dr. Mary Reinbold Jerome, diagnosed with advanced-stage ovarian cancer; Jerome sought the best care for her condition at Memorial Sloan Kettering Cancer Center. She paid for an out-of-network plan yet was burdened with overwhelming bills that came nowhere near her coverage expectations. She worked with then-Attorney General Cuomo to reform the out-of-network reimbursement system. It is people with missions like hers we ought to be celebrating.
How does Brian Thompson’s murder contribute to this discourse? You would be correct to judge that it has done nothing. It has reduced what is a need for nuanced, complex policy reform into a cry for the blood of the elite who “perpetuate capitalism,” in an endorsement of terrorism. It has rejoiced at the destruction of a family and community, instilled fear and horror, and raised hundreds of thousands of dollars in legal fees for the embodiment of structurally advantaged — money that could be going to alleviate medical debt.
Looking closer, we see that the bipartisan fight against surprise healthcare costs has been ongoing for years. The 2010 Affordable Care Act made health insurance affordable to more people, expanded the Medicaid program, and supported other measures to lower healthcare costs. The No Surprises Act passed in 2020, ensures that out-of-network emergency care patients pay in-network prices and prevents out-of-network providers at in-network hospitals from issuing surprise bills. Before the assassination, a Senate committee investigation found that UnitedHealthcare, Humana, and CVS were denying expensive stroke rehabilitation care to boost profits, prompting measures to hold these companies accountable.
There is still a tremendous amount of work to be done. While airing grievances is important, it must not be at the cost of welcoming anarchy. There are far healthier and more productive ways to address these issues. Let’s start by letting go of Luigi and focusing on what matters.
Thanks to Andrés and Rebecca for the interesting discussions in the lead-up to this piece. Happy holidays!