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Suppose a company is operating on a business model that demonstrably depends on letting people die through intentional neglect. Is it murder for someone who becomes aware of that crime to take violent action to try to prevent more deaths? Take, for example, a nursing home that decides to save money by leaving elderly inmates with a deadly and contagious disease to share rooms with vulnerable, non-infected but bedridden inmates because there are not enough beds available to put all the infected patients together in a hall separate from the as-yet-uninfected. Would that be criminal and justify violent action if nothing else could prevent the continuation of the deadly practice? Or what if a mining company sent coal miners underground to work knowing that its air monitors for dangerous explosive methane buildup and that safety equipment to allow miners to survive a resulting cave-in was defective and out-of-date?
Say hypothetically that in each of the above cases (both real) one person was aware that the senior manager each of those companies not only knew of the risks but was not acting to correct them (because he or she was getting fat bonuses by the companies’ boards of directors for the savings being made by continuing those deadly policies), and the two individuals who were aware of them could not get anyone to pay attention and take action to prevent disaster?
Would violent action to put a halt of those life-threatening abuses be justified if attacking or slaying the guilty managers finally led to action to end them?
That is the question inevitably raised by the assassination on December 5 of United Healthcare CEO Brian Thompson, 50, gunned down in the early morning in midtown Manhattan as he was heading into an investor gathering where he was to report on the record profits of his company, the largest health insurance and health management company in the US. His alleged assailant, Luigi Mangione, 26-year-old scion of a wealthy Baltimore property tycoon, was captured after a five-day nationwide manhunt. He was spotted sitting in an Altoona McDonald’s restaurant eating a burger on a tip to local police from an employee who recognized him from widely published photos in the media. He was reported to have been captured with the gun used in the slaying — a 3D-printed “ghost gun” —as well as with a three-page manifesto explaining his reasons for the action.
Mangione, described as the “brilliant” valedictorian graduate of a prestigious private high school in Baltimore, who went on to get a BA and MS in Engineering from the University of Pennsylvania, in his statement, described UHC and other so-called “healthcare” companies like it “Mafiosi” which were killing insured patients by denying them treatment for deadly diseases. He wrote that while others had exposed their corruption to no effect, he was “the first to face it with such brutal honesty,” adding, “These parasites had it coming.”
One of the first bits of evidence suggesting the assassination of Thompson might have been a vigilante set against an evil corporation and its top executive were three 9mm shell casings discovered at the scene of the shooting, which had, before being placed in the gun’s magazine, had been etched with the words “Delay,” “Deny” and “Depose.”
The first two of these words are the beginning of the title of an exposé of the health insurance industry’s deadly practices. Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It by J. M. Feinman, published in 2010, was favorably cited by Mangione in his three-page document found on him when he was arrested. The document also included the line: “I apologize for any strife and trauma, but it had to be done.”
As the NYPD Chief of Detectives, Joseph Kenny, told reporters with considerable understatement, “It does seem he has some ill will towards corporate America.”
This fatal attack upon the chief executive of a major US corporation recalls Theodore Kaczynski, a man dubbed the Unabomber, whose attacks, described by him in writings as targeting corrupt capitalism, eluded police capture for 18 years and killed three people, injuring another 12.
Few praised Kaczynski, who died at 81 by suicide while serving serving a life sentence for his actions. But Mangione’s slaying of Thompson seems to have struck a chord with many Americans and has frightened health insurance executives and perhaps executives of other industries perceived as destructive or dismissive of human life.
“Are we going to be killed next?” Health industry and finance industry executives were reportedly asking each other anxiously as they were were heading to attend the same investor meeting at the New York Hilton as Thompson was walking towards when he was gunned down — a meeting which was abruptly cancelled after the shooting.
They may be right to be worried. Right too are the private security execs now rubbing their hands with glee at the prospect of new clients to guard, as they did as leftist groups like the Bader-Meinhof Red Army Faction in Germany and The Red Rossa (Battalion) in Italy were gunning down big capitalists in Europe during the 1970s – 90s.
The anger that has been simmering over the insurance industry profiteering that has increasingly made the US the costliest place in the world for obtaining needed health care, and the richest country with the largest percentage of its citizens who cannot afford to see a doctor or go to a hospital without ending up bankrupt, has suddenly erupted in a volcano of fury following word of this particular gun murder, which is strikingly different from the almost routine street shootings that plague our nation’s cities.
This shooting was not about robbery or a gang grudge or a road rage incident. Nor was it something that was the result of a sudden fit of uncontrolled rage at some perceived insult or a desire to commit “suicide by cop.” This was, by all the evidence reported so far, seemingly a carefully worked out plan for and act of retribution against the leader of a corporation who was seen as directly responsible for the denial of care, treatment or medication for large numbers of people — perhaps some known to the shooter. It was an act allegedly committed by a young man from a wealthy family, but one who, according to published reports by friends, was well acquainted with the healthcare industry because of a congenital spinal deformation that had led to his requiring major back surgery with the implantation of a number of metal pins in his lower back that he complained caused his back and hips to lock up painfully.
In Mangione’s writings, he talks about how UHC has been a leader in the corrupt and often deadly practice of ramping up profits by denying insured people reimbursement for required medical care and procedures and for declining life-saving treatment to people it insures, even when such treatments are recommended by physicians in UHC’s own participating provider groups.
Given the huge spread of such private insurance coverage thanks to the Affordable Care Act, it’s a problem the majority of Americans too old for Medicare — and even many of those who are old enough for Medicare but who instead have switched to private so-called Medicare Advantage Plans — can readily relate to.
According to Census figures, over 200 million Americans are over 18 and under 65. In our country, that means that if they want to have medical insurance, they have to buy it on their own or get it through an employer or through the Affordable Care Act “marketplace.” According to the Commonwealth Fund, in 2024, 44% of that working-age demographic, or some 85 million adults, had either no health insurance (9%), were underinsured, meaning they didn’t have access to needed healthcare with whatever plan they had (23%) or had a gap during the year during which they had no insurance coverage (12%). And remember, these individuals are often parents of children who also likely don’t have health coverage when the parent doesn’t — making the total number of underinsured even higher.
The anger shown in a wave of disgust, rager or mockingly cynical comments about the Thompson shooting following articles on line, many of which get pulled down later. As one cold-hearted wag in a posting in the comment section of a story about the Thompson shooting, noting that the shooter was angry about treatment denials, put it, “That’s 50 million or more potential suspects that police have to consider.” Another comment from a nurse on a Reddit string wrote, “If you would like to appeal the fatal gunshot, please call 1-800-555-1234 with case # 123456789P to initiate a peer-to-peer within 48 hours of the fatal gunshot.”
This one shooting has opened the door to a dark room that America hasn’t really seen the inside of since the Weather Underground and other small armed groups were blowing up banks, science labs, and robbing Brinks trucks in the 1970s or a wave of killings in of corporate executives into the ‘80s and ‘90s.
One might wonder why the American public in this case seems to be responding with such understandable rage, not at the killer, but at the victim and his company. Why not the same kind of targeting of oil and gas industry executives, whom we know have been deliberately pumping out more and more carbon-based fuel and worsening the already dreadful climate change the Earth is experiencing and facing, all the while lying about how “green” their businesses are? Or why not the arms industry execs who are behind and lobby for the trillion-dollar-a-year military monstrosity that is sucking up all the taxes collected from hard-working Americans to go towards fomenting pointless wars, death and chaos around the world?
The answer I think, is that so far, those who suffer from climate change are mostly in remote arid or flood-prone regions like western Africa, Bangladesh, the Caribbean, or superheated regions like parts of the Indian subcontinent and the Middle East, and the threat here in the US won’t become undeniable for at least another decade or maybe longer. Meanwhile, expensive corporate PR campaigns are funded to convince people as long as possible of the lie that the dangers of climate change aren’t real or can be avoided. Similarly, the arms industry is great at appealing to fear and patriotism to make Americans believe that there is a dangerous world out there that only massive arms spending can save us from attack.
When it comes to healthcare, however, the evils of the profit-crazed capitalists running the health insurance scam are identifiable and the impacts are as plain as day in their perfidy. When these companies deny needed cancer medication or treatment to a dad or mom with a third- or fourth-stage malignancy, or rehab therapy to a chronically weakened grandmother living alone, or emergency treatment for a wife with severe bleeding from endometriosis, the resulting damage is personal. When a loved one suffers terribly because of a denial of care by an insurer or even dies, it’s also clear right away who is the guilty party. This kind of abuse is happening all the time So it shouldn’t be surprising that some will react in the way Americans are so prone to act — with violence and particularly with guns or explosives.
United Healthcare, the fifth largest industry on the Fortune 100 List, got there by dint of its obscene if coldly mechanistic algorithms to deny care and it leads the pack with 32 percent of its clients’ claims denied. But it is not alone in its denials. As a chart in an article by Jeffrey St. Clair on Dec. 6 in CounterPunch shows, Medica and Anthem were not too far behind UHC, which boasted 27% and 23% denial rates, respectively. BlueCross/BlueShield, the purported not-for-profit that I personally discovered while trying to help an elderly friend get care covered, subcontracts with one of several for-profit companies to handle its denials and is in the mid-range with a denial rate of 17 percent of claims. (Given the industry denial rate average is 16 percent, so much for the Blues’ claim of being more caring because they are “not-for-profit! Although, in fairness, not-for-profit Kaiser Permanente did show the lowest denial rate at 7% of claims denied (a rate which UHC would define as worst, not best).
The Kaiser Family Foundation, a health research organization, reports that one in five Americans has experienced a denial of care by their insurer within the 12-month period studied. That’s a rate twice as high as with Medicare and Medicaid, which reportedly have a denial rate of 10%. Often those denials leave patients and their families bankrupted if they decide they have to pay themselves for denied but needed care, as often happens. (The leading cause of bankruptcy in the US is unpayable medical bills.) For those who are not as well off financially, denials can in many cases be fatal.
It needs to be noted here that UHC’s rapid growth and profitability under Thompson’s leadership (for which he received hefty bonuses), is also intimately linked to the giant Medicare privatization scheme of government-promoted encouragement of Medicare Advantage plans, the insurance industry replacement of Government Medicare which is deceptively luring elderly people away from government Medicare covered into private insurance products that offer deceptively attractive perks like free gym membership, dental coverage and no deductible. Left unsaid by these plans is that they restrict coverage of serious medical conditions by requiring prior approval authorizations, gateway doctor referrals, and use of doctors within an approved group, making them essentially HMOs. As the Medicare Advantage subscribers age and get less healthy, they discover that if the plan doesn’t have the specialist they need or if no gateway doctor in the plan will authorize a specialist or costly testis needed, they’re out of luck. One of the biggest companies that make those key decisions on a subcontractor basis is UHC, which also handles an enormous amount of the care coverage decisions (denials) for Medicare and Medicaid, getting rewarded for the number of denials it issues.
It’s easy to see how in a country where violent and deadly road rage is epidemic, and there is a tradition of going back to the country’s early days of vigilante justice, health care denials by health insurers could lead to more cases of vigilante “justice.”
Of course, the people who knew Brian Thompson are saying what a “warm and loving person” he was and what a loving father to his two young sons. I’m sure that’s all true. He might even have convinced himself that by denying care to 32% of his company’s insured clients he was aiding society at large by helping to keep medical costs down for the other 68% (until they start getting care denied too). But I’m reminded of a conversation I had with a reporter for the NY Times who had covered the bloody civil war in El Salvador and who remarked to me how Roberto D’Aubuisson, the leader of the right-wing death squads in that country who nightly led his men out to slaughter and butcher hundreds of peasant backers of the guerrillas, and was behind the murder of liberation theology Archbishop Oscar Romero and six priests. He said D’Aubuisson was a neighborhood Cub Scout den leader, a good neighbor, mowed his own lawn and seemed like a “nice suburban guy.”
At this point, reading the comments following reports on the case of the Brian Thompson assassination, it’s looking like suspected assassin Mangione is being increasingly viewed as a potentially sympathetic figure — perhaps a Jesse James-type folk hero — even before it’s fully known what in his life happened that might have driven him to plot and carry out such a violent act of murder. With a single act, this vigilante act has opened Americans’ eyes to the sickness of capitalism in one huge US industry: healthcare. That awakening is not going to fade away. And it may well spread to the rest of corporate America and to the corruptness of the supposedly democratic government in Washington that is actually owned lock, stock and barrel by corporate money and the wealthy.
The government will no doubt try, and will likely succeed in preventing Mangione’s defense from presenting evidence about UHC’S deadly crimes of denial of care as an argument either against guilt or even as a mitigating circumstance in deciding on the penalty in case of conviction. Given his family’s money, he should locate an attorney of the caliber of the late William Kunstler or Leonard Wingless — lawyers who knew how to get jurors to see the politics of an alleged crime and to ignore the skewed instructions of judges in steering them towards supporting the arguments and evidence of the state.
Maybe Mangione or his family should call New York attorney Marty Stolar, who managed to get the Camden 28, a group of mostly Catholic anti-war activists who raided a Camden, NJ draft board in 1971 and destroyed thousands of records of young men classified 1-A (suitable to be drafted) acquitted despite their guilt having been documented by FBI agents who had secretly monitored the whole break-in. In their case the jury, convinced by the testimony of defense witness and leftist activist historian Howard Zinn that their principled act of civil disobedience against an unjust war, and the widespread opposition to that war by that time, merited jury nullification: Jurors, thinking for themselves about the charges and the evidence, decided no crime had been committed.
Because of their unanimous decision, the government couldn’t appeal or retry the case.
