Like you, I have been following the news stories of Brian Thompson and Luigi Mangione. I can’t remember another time when an alleged killer received more understanding and sympathy than the victim. (Although it has probably happened.)
Based on what is known now, the murder was connected to one man’s occupation, healthcare insurance executive, and the other man’s grievance, healthcare cost and delivery. I am sharing this post from Minnesota Reformer, slightly edited to focus on the healthcare issue, not the crime.
This story won’t be going away anytime soon, and shouldn’t. I hope this tragedy prompts a serious review and changes in how we provide and fund healthcare in the United States.
I also believe whoever is proven to be Mr. Thompson’s killer should be brought to justice. And I want Mr Mangione to receive attention to and treatment for his obviously significant medical issues.
(photos for illustration only)
The original title of this article is
A man radicalized by statistics
by Christopher Ingraham, Minnesota Reformer
December 12, 2024
In a note he was carrying when he was arrested, Luigi Mangione paints himself as a man radicalized by statistics.
“The US has the #1 most expensive health care system in the world, yet we rank roughly #42 in life expectancy,” wrote the alleged killer of Brian Thompson, the late CEO of Eden-Prairie-based UnitedHealthcare.
“United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but [h]as our life expectancy?”
Mangione is a scion of a rich, connected Maryland real estate family who recently withdrew from friends and family following severe medical issues. The numbers he cites are, in broad strokes, accurate.
Healthcare by the dollars
On life expectancy, the U.S. ranks somewhere in the 60s among the world’s countries, according to data from the United Nations, falling in between Panama and Estonia. Among the wealthy subset of countries that are part of the Organization for Economic Cooperation and Development, we rate 32nd out of 38.
The U.S. also spends far more on health care than any other country in the world: around $12,000 per person each year, thousands of dollars more than the next-highest spenders.
The discrepancy between the staggering amount of health care spending and our relatively short lives has been perennial fodder for commentary and political debate: Where is all that money going?
The answer, to a significant degree, is that it’s being skimmed off by the private health insurance industry.
“The largest component of higher U.S. medical spending is the cost of health care administration,” according to an analysis by Harvard health economist David Cutler. “About one-third of health care dollars spent in the United States pays for administration.”
Peer countries, even those that have similar systems with multiple private insurers, pay just a fraction as much.
“Whole occupations exist in U.S. medical care that are found nowhere else in the world, from medical-record coding to claim-submission specialists,” Cutler writes.
That excess spending adds up to something like half a trillion dollars each year, according to a recent analysis of Congressional Budget Office data by Matt Bruenig of the People’s Policy Project. For every $100 spent on health care, $16 goes directly to private insurance companies and another $16 goes to hospitals to cover the cost of administering care.
Only about $68 goes toward actually paying for medical services.
Under a single-payer system, on the other hand, the CBO estimates that the public insurer would need just $1.60 of that hundred bucks to cover its costs, while the hospitals would only need $11.80 to cover administration, because they no longer have to deal with the hassle of multiple private health insurers.
Under that system, $86.60 would go toward paying for care.
UnitedHealth Group
As the nation’s top health insurer and the fourth-largest company by revenue, UnitedHealth Group — the parent company of UnitedHealthcare — is also the chief beneficiary of all those billions in essentially wasted spending. In 2023 the company socked away $22 billion in profits on $371 billion in total revenue, adding up to a return for investors of $25 per share.
Think of it this way: A person who owned a single $500 share of UnitedHealth Group stock at the start of the year would get rewarded, at the year’s end, with $25 of America’s health care spending, despite contributing precisely nothing to American health care.
Those profits, it should be noted, don’t simply generate themselves. UnitedHealthcare has developed a reputation for being especially ruthless in its pursuit of shareholder value. The company “relentlessly fought to reduce spending on care, even as its profits rose to record levels,” ProPublica reported last year.
A U.S. Senate committee concluded UnitedHealthcare, along with other insurers, intentionally denied critical nursing care to stroke patients in order to increase profits. The company has been accused of using rigid algorithms to determine when to cut off payments, regardless of whether or not patients still needed care.
Thompson had been accused of dumping stock before the company alerted shareholders that UnitedHealth Group was being targeted by a federal antitrust investigation.
What happens to patients?
Virtually every American has their own horror story to tell of the Kafka-esque indignities of fighting with insurers over billing codes, prior authorizations, pre-approvals, in-network providers, and the like. This likely explains the organic outpouring of condemnation launched at the health insurance industry in the wake of Thompson’s killing, which spanned the political spectrum, even as elites of both parties scolded the vigilante apologists.
Doctors say the delays caused by those barriers between patients and their care, which are set up largely to protect insurance company profits, can make patients sicker and in some cases kill them.
In his manifesto, Mangione lamented that so little has been done to solve the profit-driven dysfunction of the health insurance system. “Many have illuminated the corruption and greed (e.g.: [Elisabeth] Rosenthal, [Michael] Moore), decades ago and the problems simply remain,” he wrote. “It is not an issue of awareness at this point.”
The note makes no mention of any personal struggles with the insurance system, despite evidence that Mangione suffered from chronic back pain and underwent major surgery for it.
But at some point — whether driven primarily by personal experience, systemic frustration, or the sheer force of a mental breakdown — Mangione decided to take things into his own hands.
republished under Creative Commons license from
Minnesota Reformer -part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.
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While I agree that private insurance companies (and hospitals) have driven the cost of healthcare up so far that many can’t afford it, I cannot agree with the taking of another’s life. I get where the people who seem to be set on making Mangione a martyr for the cause are coming from, but it’s still murder.
I am frequently amazed when we get our bills after doctor visits and hospitalizations. Our provider is able to get tens of thousands knocked off that bill. Either someone is paying more heavily for their care, or something else is happening. My guess is prices are inflated, knowing they will be reduced by provider agreements with institutions. For those who are uninsured or under-insured, I cannot imagine what they are doing.
At our various doctors, there seem to be so many people behind the desks. I wouldn’t want them to lose their jobs, but I do remember my family doctor (and our family doctor until he retired) had one person who took care of booking appointments as well as billing…all without a computer. Decades ago, but one has to wonder has medicine changed that much? It’s more the insurance part of it. I did have to fight with my insurance company over something years ago re: a diagnostic code. I was the middle man…calling my doctor’s office and explaining the situation…trying to get them to resubmit the bill with the right code (as far as the insurance company was concerned) even when they said they’d submitted the right code for why I was there. These days, I’ve not had to have any precertifications done as the doctor offices have taken care of that.
I think, as the article you’ve referenced pointed out, this is known yet nothing is done about it. I think our government is too concerned about pointing fingers rather than, perhaps, doing something about it. I recently heard many aren’t entering the medical field any more because it doesn’t pay like it use to do.
Thanks, Aletha, for once again giving me something to really think about when it comes to medicine. We seem to be caught between a rock and a hard place here in the US (though I have Canadian friends who have had to wait years for knee replacements).
https://marshainthemiddle.com/
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Thanks Marsha, your comment could be another blog post. Thank you for calling the attack what it is, a murder. And in cold blood, with no chance for Mr. Thompson to defend himself. That is cowardly, not heroic.
No matter how physicians and hospitals price their services, they will only get what the insurance “allows”, that is part of the disconnect you notice. And insurances do negotiate with hospital systems over what they pay. In other words, it’s complicated and not transparent.
You ask, has medicine changed that much? The answer-YES. When I entered practice in 1982, most physicians in my area had their own private practices. Insurance was mainly for hospital admissions and tests, and patients filed their own. And we used paper charts. Some doctors knew their patients so well, they only wrote a short note for a visit.
Fast forward to now, most physicians are employees of hospitals or health corporations. They use an electronic medical record and every encounter creates a long note, not matter how simple the visit. And instead of fewer employees, often to deal with insurance.
This may be the tipping point that will start some chance, but the insurance industry is powerful.
I so appreciate your interest in this, it’s not as fun as food and fashion blogs, but I believe is important.
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I think that was the point I was trying to make…the biggest change in medicine is the medical practices themselves. Our family doctor, up until my late 30s, delivered me as well as my first two children. His was an independent practice. And, he was one of those doctors you could call in the middle of the night, and he’d answer on the first ring…and never charged for those calls. We’d often see him at the mall, and he knew us at first glance. My mom absolutely adored the man, and I almost think the feeling was mutual. His son, who took over his practice, may have been smarter and educated at a better school, but he lacked the empathy and true caring his dad had. Our GP now is the same kind of doctor though he is part of a practice owned by a large hospital group. I think, if he truly had a choice, he would be independent. But, I’m sure, with joining a hospital group, all those nightmares like insurance, precertification, and such are taken care of by them. He does take notes on paper, and I often wonder what the transcriptionists think of his chicken scratches. We actually drive 2.5 hours to see him. Luckily, we can also do virtual visits with him. When Mike was scheduled for his hip replacement, Dr. Berube called him to talk with him (on his own time). He also called a few weeks after just to check in on him. We jokingly tell him when he retires (he’s a few years younger than me), he has a room here at our house! The nurses all tell me they’re sure they’ll wheel him out of the office/hospital on a gurney. Here, I just wrote another blog post for you!
https://marshainthemiddle.com/
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