Yes, Killing Healthcare CEOs is Bad.
But if you're going to do political violence, at least do it the right way.
On December 4, United Healthcare CEO Brian Thompson was shot to death outside of his hotel in Midtown Manhattan. The story quickly made front page news and it was suspected by many that the killer was someone with a claim denied by United Healthcare or a close relative, with bullet casings found saying “DELAY” and “DENY” engraved into them.
Until we found out who the killer was 26 year old Luigi Mangione, who as it turns out, had no insurance claim denied by United Healthcare, and who hailed from one of the wealthiest families in the state of Maryland, having been a valedictorian at a $40,000 a year prep school and a computer science alum of the University of Pennsylvania. We don’t quite know what made him snap. His family and classmates described him as a completely normal, sociable, and ambitious young man with no traumatic childhood, until about 6 months ago when he cut ties with his friends and family. He was struggling from chronic back pain, which can be excruciating and in many cases personality altering, or maybe he’s an undiagnosed schizophrenic. He praised the unabomber’s manifesto, and tweeted a lot about self-improvement. We’re so used to having mass shooters kill themselves and losing access to the thoughts not left in the manifesto, and so it’ll be interesting to see what the lawyers and psychologists say about him, especially since he’s pleading not guilty.
There has been an eruption of glee and support over the killing on the internet, notably among leftwing opponents of the death penalty. But even Ben Shapiro’s conservative audience dunked on him pretty hard for condemning the killing, with many citing their own horror stories in the comment sections of his video. This seemed to be a unique story of division between the poor and lower middle class against the upper middle class and rich, rather than a simple right-left divide, despite Brian Thompson being the son of a small Iowan farmer who worked his way through state school, while Luigi Mangione was born on third base.
According to an Emerson Poll, 40% of Americans aged 18-29 think that the assassination of Thompson was completely or somewhat acceptable, with 19% on the fence about it, to only 10% of Americans 70+. Keep this in mind as older people are more likely to see doctors and deal with health insurance industries. 22% of democrats and 12% of republicans think that what Mangione did was acceptable.
I think much of the support for what Mangione did is rooted in some serious misconceptions about healthcare in America, and the means we should use to change it.
Not even the problem
Much of the outrage over American healthcare is simply anti-middleman bias. Insurance companies are just one part of the healthcare system that also includes pharmaceutical companies, hospitals, and government regulators, all of whom add substantially to the cost of healthcare. As Noah Smith points out, the average S&P 500 company has a profit margin of about 12.1%, while UnitedHealthcare only has a profit margin of 6.11%, making health insurance not a very profitable industry.
The company itself only profits about $23.1 billion dollars, while medical and operational costs amount to $241.9 billion and $54.6 billion respectively. Brian Thompson earns about a $10 million dollar salary, and the reason he became CEO was because of his crucial role in delivering $135 billion in relief money from congress to hospitals through the United Health fund during the early days of the pandemic when no one thought it was possible.
Many hospitals have smooth and amicable service with doctors, nurses, and receptionists, but at the end of the day, you interact with the insurance companies for the billing. When people are surprised that the hospital they went to is out of the insurance company’s network, it’s because the receptionist at the hospital didn’t bother to tell them. When people are surprised that their prescriptions cost hundreds and sometimes thousands of dollars a month, it’s because the doctor who wrote the prescription didn’t bother to tell them. Hospitals and doctors just provide their service and while they may have a ballpark idea of what their services are truly costing, it’s not really their professional concern, and so why even tell the patients? And for this reason, they escape the blame.
Definitely Not the Solution
I don’t see so many people cheering on Luigi rather than doing some whataboutism in the form of “Yeah, this CEO was murdered? Well what about the 40,000 people every year who are murdered by United Healthcare?” and hoping that you don’t notice the rhetorical sleight of hand at play here. As stated earlier, health insurance companies are only a small part of the problem. But even if they were entirely the problem, it still would be a terrible idea to kill these people.
Society functions because we have explicit bright line norms against certain types of behavior. They’re called laws, and if they are broken, the punishment must be severe in order to deter anti-social behavior. These range from the arbitrary and tyrannical, such as restrictive zoning laws and the current drug schedule classification, to the bare minimum required to maintain civilization, such as don’t steal and don’t kill.
But what about certain behaviors that indirectly harm vast numbers of people over time? Such as fossil fuel companies accelerating climate change or social media companies trying to hook children on their platforms for life? Why is it that some people can become wealthy by denying healthcare to thousands of people who pay for insurance, but it’s when the people fight back, the powers of the state finally punish such behavior?
One reason is simple: In order to have any civilization whatsoever, you have to punish the most explicitly violent behavior, no matter how small the scale, even if there are other people committing longer term and more indirect harm. There is some hypocrisy to the idea of the government having a monopoly on violence (as opposed to regular citizens), but on net, it’s far better than allowing radicalized Ivy League graduates to assassinate those who they deem to be public enemies based on what they read on Twitter.
Large scale problems like healthcare, climate change, and social media require institutions to fix. If we didn’t punish murder and theft, and violent drug crimes as harshly as we did, then we would cease to have functioning institutions. We’d be like Mexico, Russia in the 1990s, or Gotham City in Batman Begins. How do societies like those then go on to fix climate change, healthcare, and regulate social media?
Imagine you want to decriminalize drugs (bad idea by the way, look at Oregon!) and imagine you think the criminal justice system is so irredeemably corrupt and racist that the only way to do this is to “give people in power a taste of their own medicine” by executing cops, prosecutors, and judges. These people are simply going to be too busy fighting off these domestic terror attacks to even contemplate these larger scale reforms.
Not Even a Revolution
Peter Thiel did an interview with Piers Morgan in which he hilariously stuttered through the entire thing and took an entire minute to articulate if shooting the healthcare CEO was wrong, but there was one thing he said that was very insightful but completely ignored:
Thiel: “There are ways in the 2020s in the U.S. resembles Weimar Germany in the 1920s, a lot of the conventional ideas had failed and we need to look outside of the the overton window on this, but one of the ways we’re very different from the early 20th century is that fascism and communism at the end of the day were youth movements, movements of violent young men and there was probably a lot wrong with those youth movements, but if we look at the 2020s, I don’t think that our fundamental problems is that we’re going to have communism or fascism. Even with this dramatic healthcare killer, and he should not have killed the CEO, I don’t think this is actually mainstream. The risk in our society is that we are a gerontocracy with an inverted demographic pyramid, in which the values are set not by loser twenty-something high testosterone men, but driven by seventy-something grandmothers who don’t want to take any risks whatsoever.”
I came across this photo of Luigi Mangione that reminded me of young Stalin. Not Stalin the dictator who killed millions, but young Stalin, the handsome revolutionary. It’s tempting to look at Luigi the same way, but as Thiel articulated, we simply don’t live in a world where revolution is possible in the most advanced countries. The American Body Politic is not a young society with burning revolutionary fervor for change before it was completely captured and stifled by the managerial revolution and bureaucracy. And even if we did, Tiktok, Netflix, and Pornhub are all too irresistible of distractions.
In Luigi’s own words to the police, he said “To save you a lengthy investigation, I state plainly that I wasn't working with anyone.” He wasn’t trying to start some revolution or really even fundamentally change anything. He just had an itch to scratch; his anger over the for-profit health insurance industry. No call to action, no nothing. He hasn’t even inspired an army of followers to attack the headquarters of United Healthcare and wipe the medical debt records from their servers or anything like that. Similar to how if you come for the king, you best not miss, if you’re going to murder people in the name of a political ideology, you best not stop until you’ve achieved your aims. And it doesn’t seem like Mangione was aiming for anything other than life in prison while the whole world watches with excitement, but then quickly forgets that the whole thing happened and moves on.