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12 hours ago
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At this very moment Luigi Mangione, who is accused of shooting UnitedHealthcare’s CEO last month, is sitting in a federal jail cell in Brooklyn. He’s got a barrage of court appearances scheduled and, once he has wound his way through the criminal justice system, he could be behind bars for the rest of his life.
Which, of course, is as it should be. While there are a lot of reasons that many people find the 26-year-old alleged assassin sympathetic, you can’t just gun a CEO down outside a hotel in Manhattan and face no consequences for it. And Mangione, who is, by all accounts, an extremely smart guy with an Ivy League education, should really have known better. He should have known that if he wanted to murder someone – and get away with it – there were far more socially acceptable ways of doing so.
Mangione could, for example, have got a well-paid job as a management consultant and helped supercharge the country’s opioid epidemic; chances are he would have faced little more than a slap on the wrist. He could have gone to Gaza and shot some Palestinian children in the head – in which case, not only would he probably face no consequences whatsoever, US lawmakers would probably go out of their way to shield him from accountability. And, of course, Mangione could have gone into the health insurance industry himself, and routinely denied life-saving care to desperate people in order to boost profits. That type of violence is perfectly fine.
Mangione is now a household name around the globe: there’s pro-Luigi graffiti everywhere from Chicago to London to Rome. According to one recent poll, 48% of college students in the US say they view the killing of the UnitedHealthcare CEO, Brian Thompson, as totally or somewhat justified. In a more functional world, the outpouring of support for Mangione would have given the folk at UnitedHealthcare (part of UnitedHealth Group and the US’s largest private health insurer based on revenue) pause for thought. On another timeline the endless horror stories shared on social media about how health insurance companies had denied coverage and ruined people’s lives might have pushed the industry to change their business practices. But we live in hell, so none of that happened, did it?
Instead, lawmakers (who get extremely good health insurance thanks to US taxpayers) have made it clear to their corporate overlords that their No 1 priority is ensuring the safety of their donor base. Mangione hasn’t just been charged with murder; he’s been charged with terrorism. Last month New York’s Governor Kathy Hochul made headlines for reportedly considering a special hotline for CEOs to report safety threats. Are you an obscenely rich CEO worried the proletariat may rise against you? Just call 1-800-SAVEOURCEOS and we’ll dispatch 24-hour-security! We’ve de-funded the libraries to pay for it.
Meanwhile, insurers seem to have gone into full-on villain mode; just when you think you can’t hear anything worse about the insurance industry, a new horror story comes out. There’s been an uptick in stories about insurers limiting coverage of prosthetic limbs and questioning their medical necessity, for example. Mr Beast, an influencer with 343 million subscribers on YouTube, recently railed against the healthcare industry in a new video where he helped 2,000 amputees walk again. “Many lived in America and it feels so disgusting that in a country with this much wealth, a fucken YouTuber is their only option to get a prosthetic leg,” he tweeted. “We need to fix this.”
And last week a plastic surgeon called Dr Elisabeth Potter – a specialist in reconstructive surgery for breast cancer patients who have had mastectomies – went viral on TikTok for claiming she had to pause an operation because a health insurance representative demanded proof it was necessary. According to Potter, her patient was under anesthesia when she got an urgent phone call from UnitedHealthcare while in the operating room.
“So I scrubbed out of my case and I called UnitedHealthcare, and the gentleman said he needed some information about her,” said Potter. “Wanted to know her diagnosis and whether her inpatient stay should be justified.”
Potter reportedly explained to the insurance representative that her patient had breast cancer – something he apparently didn’t know because someone else in a “different department” had that information. This is why health insurance executives get paid so much money, you see. They structure their companies in complicated ways that mean you have to go through at least 50 different people in different departments to try and sort out a claim; in the end, a certain percentage of people just give up because the process is so laborious. That said, actually going through real life customer service representatives is becoming less common. UnitedHealth Group has been under the spotlight for how it uses AI to aggressively deny claims. A lawsuit filed last November claims UnitedHealth illegally denied “elderly patients care owed to them under Medicare advantage plans” by deploying an AI model known by the company to have a 90% error rate.
To be clear: it is difficult to completely validate Potter’s story because of laws that protect patients’ health information. UnitedHealthcare, for their part, seem to reject the doctor’s account of events and have insinuated that Potter was being unprofessional. A spokesperson from the company told me: “There are no insurance-related circumstances that would require a physician to step out of surgery … We did not ask, nor would ever expect, a physician to interrupt patient care to answer a call and we will be following up with the provider and hospital to understand why these unorthodox actions were taken.”
Nevertheless, the virality of the story is yet another reminder of just how frustrated everyone – from doctors to patients – is with the profit-driven health insurance industry in the US. Yet, despite this palpable anger there seems to be no appetite by those at the top to change the system. Indeed, it looks likely that Donald Trump’s administration will shrink Medicaid (a government system which helps low-income people access healthcare at a reduced cost or for free) and insurance companies will up their use of AI to deny coverage. Mangione should absolutely be facing consequences for what he is alleged to have done – but there should also be more legal consequences for those pushing predatory health insurance practices. Killing people with paperwork instead of a gun doesn’t make you any less of a murderer.
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Arwa Mahdawi is a Guardian US columnist
