Luigi Mangione: hero? Or Villain?

An essay on the perils of "progress"

Dear H,

I refuse to say that Luigi Mangione is a hero for shooting Brian Thompson in the back; but when The New York Times said he was hauled into court and yelled “It’s completely out of touch and an insult to the intelligence of the American people and the lived experience!” they said they didn’t know what he was talking about. And now I know they're playing stupid.

He could have been referring to the time my wife gave birth, was offered ibuprofen in the hospital, and then got a $300 bill for it later. Or the time my kid hit his head and we thought he was going to die, so we took him to the ER. The ER had us wait for hours, a lone doctor showed up eventually, told us he had no clue, and referred us to another doctor somewhere else. After insurance, that cost me a third of a paycheck. Without insurance, it would have cost me a whole one.

Or maybe he meant when a man told me his kid got hurt, and he wondered whether to take his kid to see if it was serious, but he hesitated because he wondered what it would cost. Or the women whose hormones are failing them but they can't get coverage for it, but crazy people with gender dysphoria have money and hormones just thrown at them. Or the toddler who got a snake bite and almost died and his parents got a bill for $300,000. Or the fact that junkies and illegal immigrants don't have to pay anything at all.

I'm not saying our medical system is the worst in the world. What I’m saying is that we have serious systemic issues and they aren’t being addressed. And when somebody doesn’t get the medical care they need because they don’t have good insurance, or maybe because they have bad insurance, somebody — maybe a bereaved husband, maybe a bereaved mother — is going to get angry. As such I don't think Brian Thompson, ex-CEO of UnitedHealthcare, the biggest health insurance company in the US, was the enemy. And I don't think Luigi Mangione is a hero for shooting him. I’m saying that at some point somebody was going to take the blame for all this. And it was going to happen outside the judicial system. Whether on the streets of Manhattan or in the court of public opinion, somebody was going to swing from a lamp post. Even if it wasn’t really his fault.

In the case of Brian Thompson it kinda was. He was the head of a company notorious for denying insurance claims. Around 30% of them, actually — well beyond industry standards. They started using AI in 2019, before Brian even ran things, and the algorithm denied so many claims for old people that when the elderly took it to court, 90% of the denials were overturned. I don't know exactly what this means, whether they didn’t get the care they needed on time, or at all, or whether they were saddled with debt they couldn't pay until somebody else owned their homes and they ended up on the streets. It could have meant one of these or all of these; but it certainly meant some of these. And you could blame a computer or a clerk or a faceless system if you wanted to. Or you could blame the rich guy in charge of it.

But as a layman I think the problem is even bigger than the fat cats on top. I believed, as recently as two weeks ago, that if American medical care was top-notch and affordable in the 80’s, that maybe we could just do a reset. Just pull up the old files, find out what we added since then, and erase it all. Whatever laws we passed, whatever rules we made, just throw them in the garbage bin and give us what our parents had. But this ignores one glaring fact, and it’s that we have more things than our parents had. And things cost money. We can stop the flow of bureaucracy and paperwork, but we can’t — actually, we won’t — undo the flow of physical wealth and technology.

What's happened since the 80’s is we’ve gotten spoiled. We have new drugs and machines and procedures nobody had ever dreamed of back then. We have facilities that are bigger and more specialized and more centralized too. And you can complain that the bills are bigger and crazier. But so is walking into a hospital where they have a better chance at saving your kid's life. Somebody has to pay for it, eventually; and that person, should you choose to use it, even if they can't actually save your family, is you.

The extreme expense of this historical luxury — which nobody refuses in an actual emergency — can’t be funded by an atomized mass of clerks and construction workers and burger flippers. So we came up with an idea. Why not pool our money together, and then get better care when we really need it? The machinery and the capital it requires were unattainable, so somebody invented medical insurance: a middleman capable of making our worst nightmares disappear, assuming he decided the cause was worth it.

Thus an army of bureaucrats appeared between us and our doctors: a handing of authority to people who aren't medical experts, but bean-counters and moneymen and lawyers. Thus responsibility for our lives was shifted to a distant, faceless machine; and when this god-in-the-sky gave the word, we and our children were saved. And when he said no, we drowned in debt, or were denied care, or were held back waiting until it was too late. Thus was born delay, deny, defend — the words etched on Luigi Mangione’s bullet casings.

The big question is, what choice do the insurance companies have? And where do we draw the line and say a company denies too much? Simply put, there is no medical system in the world, no company in the world, no everyday family budget in the world that allows for all the medical care you’ll want all the time. At some point — especially when you get old, and your whole body begins to give up — medical care becomes too expensive, too pointless, too silly. And people who are desperate feel the opposite way. There is no expense too big to save a wife, or a mom, or a kid.

But when you’re paying for yourself, the responsibility is on you. You decide whether to mire yourself in debt and go bankrupt. When somebody else is paying for you, it’s their choice; and if you were expecting more — something nebulous, many times impossible for a layman to gauge — the fault is on them. Thus every claim they deny — every claim they have to deny — to keep insurance afloat, to make sure the rank-and-file members get basic care from gigantic, overgrown facilities — means a new grudge. No matter how good the defense.

It seems to me — a layman, I remind you, with no insider knowledge about the insurance industry — that we’ve entered an age when medical care is too good to be personal. It has to be managed by giant corporations or governments or global church denominations. It requires a pooling of capital so huge that in order to ditch the capital we would have to ditch the best hospitals: to reduce ourselves to clinics so small, and to a standard of care so regressive, as to risk the lives of our parents and children. And we would have to regress on purpose.

We know we can do better. And we all want to afford it. But sickness and death are inevitable and expensive and living is eventually impossible. And we hang on to our lives and our loved ones as if they're worth everything we have. And they are. So we raised the standard of living too high. And we were not wrong to do it. But we were also not right. And somebody, somewhere, has the unenviable job of telling us no. And when he does too many times, we find him shot on the streets of Manhattan, and T-shirts and mugs being sold all over the internet with three little words on them.

Delay. Deny. Defend.

Yours,

-J

P.S. Luigi isn’t a hero to me because I’m not so sure Brian Thompson was the villain. And I don't like the idea of randos just shooting CEOs and public figures in the back. But it's clear to all of us at this point that he's a hero to large sections of the public — a people squeezed by inflation, mired in debt, kept out of starter homes, denied access to good medical care, and angry at the upper class. This is a generation raised on true stories of public robbery and golden parachutes; of socialism for the capitalists and capitalism for the working man; of mandatory medical experiments and legal immunity against vaccine injuries; the Epstein files buried and the Sackler family — after turning thousands of medical patients into zombies, fiends, and fertilizer — running totally free, coffers still loaded. We have seen good men locked out of work for being "inessential” and Nancy Pelosi get away, publicly, with insider trading. Proud Boys locked up and Hunter Biden bailed out. We have seen everything under the sun but justice against the upper classes. The United States is a pressure cooker, and steam needs to be let off or the whole place will get blown to bits.

What is a hero, anyway? Is it anyone who signs up to push papers for the Air Force? Is it — as the leftists say — a man in the public eye who tries to turn into a woman? Is it somebody who shoots a robber baron in the back?

Emerson, speaking of heroism, says

Life is a festival only to the wise. Seen from the nook and chimney-side of prudence, it wears a ragged and dangerous front. [...] Our culture therefore must not omit the arming of the man. Let him hear in season that he is born into the state of war, and that the commonwealth and his own well-being require that he should not go dancing in the weeds of peace, but warned, self-collected and neither defying nor dreading the thunder, let him take both reputation and life in his hand, and, with perfect urbanity dare the gibbet and the mob by the absolute truth of his speech and the rectitude of his behavior.

To this military attitude of the soul we give the name of Heroism. Its rudest form is the contempt for safety and ease, which makes the attractiveness of war. It is a self-trust which slights the restraints of prudence, in the plenitude of its energy and power to repair the harms it may suffer. The hero is a mind of such balance that no disturbances can shake his will, but pleasantly and as it were merrily he advances to his own music, alike in frightful alarms and in the tipsy mirth of universal dissoluteness.

The heroic soul does not sell its justice and its nobleness. It does not ask to dine nicely and to sleep warm. The essence of greatness is the perception that virtue is enough. Poverty is its ornament. It does not need plenty, and can very well abide its loss.

Self-trust is the essence of heroism. It is the state of the soul at war, and its ultimate objects are the last defiance of falsehood and wrong, and the power to bear all that can be inflicted by evil agents. It speaks the truth and it is just, generous, hospitable, temperate, scornful of petty calculations and scornful of being scorned. It persists; it is of an undaunted boldness and of a fortitude not to be wearied out. Its jest is the littleness of common life.

That false prudence which dotes on health and wealth is the butt and merriment of heroism. Heroism, like Plotinus, is almost ashamed of its body. What shall it say then to the sugar-plums and cats’-cradles, to the toilet, compliments, quarrels, cards and custard, which rack the wit of all society? What joys has kind nature provided for us dear creatures! There seems to be no interval between greatness and meanness. When the spirit is not master of the world, then it is its dupe. Yet the little man takes the great hoax so innocently, works in it so headlong and believing, is born red, and dies gray, arranging his toilet, attending on his own health, laying traps for sweet food and strong wine, setting his heart on a horse or a rifle, made happy with a little gossip or a little praise, that the great soul cannot choose but laugh at such earnest nonsense.

and he finishes, most succinctly, I think,

every heroic act measures itself by its contempt of some external good.

But Emerson is missing two things.

The first is that that spirit of heroism is a spice of life — certainly not the substance of it; and a nation of heroes, butting heads over slights they can't forget and putting their lives on the line for every truth, however small, would put us in a state of constant war. We live in peace and harmony most of the time by putting our pride aside, clicking our heels, smoothing over insults, and (let's be honest) spouting and swallowing lies.

But second, he forgets that all this reckless gusto is only good if in the end it isn’t for something evil, or retarded. And beyond this, unless you're saving a baby from drowning, or pushing a lady out of oncoming traffic, one man’s hero is usually another man's villain. He saves one person, one people, one religion, by killing off another. If he's successful, he gets enshrined in history like Moses, Joshua, and Caleb. If he fails to finish the job, he remains in a state of eternal controversy — a Muhammad, for instance, or an Oliver Cromwell.

P.S. Jesse Welles wrote a song that perfectly encapsulates the working-class attitude towards the bean-counters and money-men who run the health insurance industry. Whether right or wrong, he sings well, and to the point.

There's an office in a building and a person in a chair
And you paid for it all, though you may be unaware
You paid for the paper, you paid for the phone
You paid for everything they need to deny you what you're owed

[Chorus]
There ain't no "You" in UnitedHealth
There ain't no "Me" in the company
There ain't no "Us" in the private trust
There's hardly humans in humanity

Now, the procedure that you're needing ain't the cost effective route
And only two-percent of peoplе end up winning a dispute
So, if you get sick, pray to God for hеlp
'Cause your doctor's gotta pray to UnitedHealth

[Verse 3]
Way back in
Seventy-and-seven, Mister Richard T. Burke
Started buying HMO's, putting federal grants to work
Made fifty-billion buckaroos last year
The Warren Buffet of Health, the Jeff Bezos of fear

[Verse 4]
Now, CEO's come and go, and one just went
The ingredients you got, bake the cake you get
But, if you get sick, cross your fingers for luck
'Cause old Richard T. Burke ain't giving a fuck

[Verse 5]
Commoditized health, monopolized fraud
"Here's the doctors we own, and the research we bought"
They own the pharmacies, and a lot of the meds
They should start buying graves to sell us when we're all dead

There ain't no "You" in UnitedHealth
There ain't no "Me" in the company
There ain't no "Us" in the private trust
There's hardly humans in humanity