How to Talk About a Broken Health Care System After an Unjustifiable Murder

Ever since footage emerged of the assassination of Brian Thompson, the CEO of UnitedHealthcare, his killer has been held up as a folk hero in a disturbing online trend. After Luigi Mangione was identified, arrested, and charged with Thompson’s murder, his lionization has only increased, with people raising money for his defense and unabashedly declaring him justified in what they view as vigilante justice on behalf of people angry about their health care coverage. Adding grist to their mill, at the time of his arrest, Mangione had a 300-word manifesto on him which claimed, among other things, “it had to be done. Frankly, these parasites simply had it coming,” the result of the “corruption and greed” of the health care system.
The glorification of Luigi Mangione is unconscionable. The killing of another human being in cold blood is brutal, savage, and utterly unjustifiable. But it is no defense of Mangione to insist that our health care system desperately needs a non-violent intervention. The admiration for Mangione is unforgivable—but the rage millions of Americans feel at the health care system is something we must understand.
As a doctor who has practiced neurology and pain management for 50 years, I can attest firsthand to the fact that we are long overdue for this conversation. Mangione must be tried for the act of murder. But we also require an urgent debate as to the inequality of health care access in the wealthiest country in the world. The industry, along with Big Pharma and hospital conglomerates, must come under the microscope they have long evaded about how, as the gatekeepers of health, they deny urgent care to millions of Americans.
Frustration with insurers has reached a peak, and it’s no wonder. According to a survey conducted last year by the Kaiser Family Foundation, 18 percent of Americans were refused care they thought would be covered the preceding year, while 27 percent had insurers pay less than expected, and 40 percent of Americans went without health care because of insurance limitations. Even those who have insurance are struggling. Fifty percent don’t know what’s covered, or what needs prior authorization.
Meanwhile, the rate at which claims are being denied has been on the rise in recent years, with insurance companies using artificial intelligence to ensure they pay out even fewer claims. And there’s no transparency when it comes to rates.
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As a doctor, I am distraught at how difficult it is for my patients to get the care they need. This is especially true for lower-income patients. Studies have found what I have experienced firsthand: Lower-income households spend a higher percentage of their income on health care. And contrary to what you might expect, it’s not the very poor who struggle the most. In my experience, Medicare and Medicaid are less likely to reject claims. It’s the lower-middle class and working class who get stuck with the bills they can’t afford and the most difficulty covering what should be essential health care.
Something is fundamentally wrong with a system in which the burden of costs is falling upon the lower-income, blue-collar worker. Forty percent of Americans have medical debt. That’s 100 million Americans, according to Kaiser. Two-thirds of bankruptcies are the result of medical bills.
In rural Indiana, where I have practiced since 2002, I see the struggle it is for some of my patients to afford to see me. Those on public aid (which is under threat in the coming administration) were still able to take a Medicaid cab to see me. But blue-collar workers now have higher deductibles and huge copays, making every therapeutic decision we make together dependent upon finding generic alternatives, as well as difficult choices as to how the family spending will be allocated anticipating procedures.
Of course, none of this applies to Luigi Mangione, who comes from a wealthy background. But that should make it all the easier to untangle the condemnation of his alleged actions from the discussion around health care.
Mangione’s personal experience with health care seems to have come in the form of chronic back pain, possibly from a surfing injury. He posted an X-ray online that showed a spine that with a three-level fusion with screws. But UnitedHealthcare has no records of Mangione having been insured by the company, and another account claimed Mangione was pain free after the surgery. It is both the case that doctors are too quick to rush to unnecessary lumbar spine surgeries, the result of a profit-driven business model, and the case that there is no amount of mismanaged care that would have justified the murder of Brian Thompson.
As the trial gets underway, the ability to condemn both Mangione and the health care system is going to prove difficult for many. Some will lionize the killer, while others succumb to the temptation to defend the insurance companies. Neither of these is the way forward.
We are long overdue a conversation about a predatory health care system that puts profits before patients. Let’s have that conversation—while unequivocally condemning the acts of an alleged murderer.
Julian Ungar is a neurologist practicing in Indiana. He is the father of Newsweek opinion editor Batya Ungar-Sargon.