In the early morning hours of Dec. 4, 2024, 26-year-old Luigi Mangione walked along the sidewalk in front of the New York Hilton in Midtown Manhattan, raised his pistol, and shot 50-year-old Brian Thompson dead. The brazen killing, caught on CCTV, sent shock waves around the country.
A father of two was killed by what appeared to be a complete stranger, all while heading to a meeting. But it didn’t take long for more details to come out about the victim. He was the CEO of UnitedHealthcare, the nation’s largest insurer. As a result, Thompson was declared to have deserved his death by an uncomfortably vocal swath of mostly younger Americans.
With anger at health insurance driving the rage, Mangione was turned into a sort of folk hero. Mangione’s youthful good looks added to the mystique surrounding him. In far too many minds, Thompson was the sole representation of an evil industry that preys upon the sick and poor. Mangione, a sort of Generation Z martyr, sacrificed his future and freedom to make a viral, supposedly necessary statement. Less than two weeks after the killing, an Emerson College poll showed 41% of voters aged 18-29 found Mangione’s murderous actions “completely acceptable” or “somewhat acceptable.” This age group carries the most pity not for the victim but for his killer. An early January poll by Generation Lab shows sentiments haven’t changed since the killing. Of the college students polled, “81% of the students … said they have an extremely or somewhat negative view of Thompson, the victim.” And where do sympathies lie? According to the data, “45% of respondents chose suspect Luigi Mangione, 17% chose Thompson, and 37% said neither.”
Turning a killer into a generational celebrity is usually reserved for a small minority of the population. But the overwhelming, social media-driven support for Mangione is as broad as it is disturbing. It doesn’t bode well for the future as this emerging generation is on the cusp of or having newly entered adulthood. It reveals a deep societal sickness whereby violence is endorsed if the victim, even while personally unknown to most, is disliked. It points to wide-ranging ignorance concerning the healthcare industry. It also points to a larger picture that includes the false notion that more healthcare services somehow translate to better health.
It is more than accurate to say the healthcare system in the United States is broken. But that reality does not mean an insurance CEO, or anyone related to the healthcare industry, deserves death. This goes without saying: The healthcare landscape is not made better by the killing of Brian Thompson. According to Mangione’s manifesto, a system in which life expectancy is low and cost is high means “these parasites simply had it coming.” Mangione’s addled mind concluded a high-profile killing would start a revolution. Not only was he wrong about the results of his egregious actions, but he was wrong about the root causes in the first place.
Health insurers are necessary because high-quality, low-cost healthcare in an advanced nation like America is hard to come by. And providers, pricing, dishonest practices, and lack of transparency are largely to blame.
Medical bills are one of the main reasons people file for bankruptcy. In a report by the Consumer Financial Protection Bureau, “Medical bills accounted for 58% of debt collection on consumers’ credit records.” Healthcare costs continue to rise. Both health insurers and medical providers make billions in profit, but the latter easily outpaces the former by a rather substantial margin. As reported by USA Today in mid-December, “Health insurance companies took in $25 billion in profit last year, while hospitals collected an eye-popping $90 billion.” Americans have the highest medical costs of any country, but does this translate to better care and health? Given that the 2024 estimate for life expectancy places the United States 49th on the list, at 80.9 years, the answer to both would be “no.”
To look at health insurance as the main problem is to ignore the reason for its existence in the first place. People open their medical bills, and anger is largely directed at the health insurance companies for failing to cover a greater portion of the final cost. The list of causes behind skyrocketing healthcare charges is long, varied, and growing at an alarming rate.
One of the key components behind the problem is administrative costs. In a piece at Harvard Magazine and again in speaking to USA Today, David Cutler, professor of applied economics at Harvard University, pointed to that as a major problem. According to Cutler, “About one-third of healthcare dollars spent in the United States pays for administration.” This is largely due to the fact that there are multiple steps required to take a doctor’s treatment from plan to implementation. Add to that the difficulty in transmitting and obtaining patient medical records, and the headaches, and costs, increase.
Health insurers often require doctors and hospitals to get authorization before performing procedures or operations. Or they mandate “step therapy,” which makes patients try comparable lower-cost prescription drugs before coverage for a doctor-recommended drug kicks in.
These mandates trigger a flurry of communication and tasks for both health insurers and doctors, Cutler said.
Although medical records are computerized, too often, medical computer systems don’t communicate with outside organizations such as health insurers, Cutler said. That results in extra administrative tasks when doctors attempt to get authorization from an insurer on behalf of a patient.
A more efficient system would not only help patients in terms of medical care but also financially benefit them, as the costs are eventually passed along to them and their insurers.
When it comes to pricing prescriptions, tests, procedures, or other services, patients are often left in the dark. And since a patient’s medical needs are a result of necessity and not want, the costs matter. Unfortunately, a lack of provider transparency means patients are either stuck with a higher-than-expected bill, even after insurance kicks in, or they put off services entirely to save money. And what one doctor or hospital charges for a procedure can and does vary greatly across the U.S. This results in confusion and anger for patients and their families. It also opens the door for dishonest billing practices.
One such example involves an elderly woman named Kyunghee Lee. For years, Lee received steroid injections for debilitating arthritic pain in the fingers on her right hand. And during this time, the treatment cost she was billed, after insurance, was roughly $30 per visit. The next time Lee went to her doctor’s office for treatment, the office had moved up one floor in the same building, but nothing else had changed. When the bill came, her portion, after insurance, was now $354.68. The reason? The total bill was “$1,394, including a $1,262 facility fee listed as ‘operating room services.'” And what was the reason for the massive additional cost? The clinic was now a part of the University Hospitals system in Ohio. According to NPR, which reported Lee’s struggle with billing, “that slight location change allowed the hospital system to bill what’s called a ‘facility fee,’ laid out on Lee’s bill as ‘operating room services.’ The increasingly controversial charge — basically a room rental fee — comes without warning, as hospitals are not required to inform patients of it ahead of time.” Lee, an elderly woman on a fixed income, finally told her daughter about the higher bill after trying to get the problem straightened out herself. Lee’s daughter paid the bill.
A similar thing happened to Caren Blanzy. For years, Blanzy received treatment for cervical dystonia, which causes constant pain and movement in her neck. As reported, her treatment had been fully covered for five years until the clinic she went to became part of a large system in Michigan. Blanzy was charged outpatient fees as though she were receiving outpatient hospital services. The result? Blanzy’s bill went from $0 to more than $1,100 overnight.
Lee and Blanzy are just two patients whose stories of bloated and unexpected billing have been shared, but this kind of thing is a common occurrence across the country. Personally, my own family has experienced receiving unexpected charges that were not discussed ahead of time. But once a procedure is performed and payment is due, patients have little recourse. It is a terrible thing to feel helpless when it comes to your own healthcare. And again, the culprit behind these increases is often the provider’s shifting definitions of what care looked like or where it was obtained, not the treatment itself. The lack of transparency in the healthcare industry is a major problem.
Under a law that passed Congress during President Donald Trump’s first term and was enacted under the Biden administration, hospitals must disclose cash prices and rates negotiated with health insurers for a broad list of procedures in a computer-readable format so the information can be analyzed. The rule also mandated hospitals post estimates for at least 300 services so consumers can compare prices.
According to an organization called Patient Rights Advocate, most hospitals still do not comply with the hospital price transparency rule. As of November 2024, a review of 2,000 hospitals revealed only 21.1% are in compliance. This is actually down from February 2024, when 34.5% of hospitals reviewed were in compliance. The numbers are abysmal. In the end, it is patients who are left with the burden. The small voices of those seeking care are easily drowned out by the much more powerful voices in corporate health systems.
Another aspect of the flawed system is the fact that providers are paid by service, not for outcome. And outcomes of improved patient health should be the No. 1 priority for providers. This past summer, a House Ways and Means subcommittee hearing focused on discussing the importance of value-based care: “The current fee-for-service model, which reimburses providers for delivering services rather than improving health outcomes, has led to higher Medicare spending, failed to produce better patient health, and contributed to physician burnout. Value-based payment systems, which pay medical providers for patient outcomes, is a promising concept that could improve patient health, promote coordinated care delivery, and rein in Medicare spending.” If the focus of providers is making sure patients undergo more testing and procedures, those providers will be handsomely rewarded in the current system of service over outcomes. If patient health is prioritized, efficiency increases and costs are lowered.
Healthcare reform is a monumental task as the network of hospitals, clinics, providers, and patients is vast and ever-changing. The real, underlying flaws in the massive and complex U.S. healthcare system will take time and a realistic, albeit concerted, effort on the part of all involved. There is no quick solution, there is not only one reason, and there is certainly not one person to blame for the complicated mess.
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Luigi Mangione’s brutal killing of Brian Thompson, an innocent man, did nothing but cause pain and destroy lives. Those without a functioning moral compass view his crime as a sort of catalyst for much-needed change. It was nothing of the sort. In his manifesto, Mangione even admitted ignorance: “Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument.” He is the complete opposite of a hero. His legacy will be nothing more than a fool drunk on premeditated savagery.
In addition to the brutality he perpetrated, Mangione infected youthful, already delusional minds with the idea that violence, if it’s supported by enough rage, is good. But health insurance companies do not even earn the majority of the blame. And even those who are perhaps more responsible for the current state of healthcare in the U.S. do not deserve to be killed as Thompson was on that morning. There are no excuses. This rationale is so basic it should not need repeating. But given the immediate reactions to Thompson’s killing and the simmering attitudes still in play in society and the discourse as a whole, it is required.
Kimberly Ross (@SouthernKeeks) is a contributor to the Washington Examiner’s Beltway Confidential blog and a contributing freelance columnist at the Freemen News-Letter. She is a mother of two and lives in the Southern United States.