52
votes
Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO
https://apnews.com/article/luigi-mangione-plea-unitedhealthcare-ceo-3b8a5bb41589c9f5f4775dba2beea66f
This topic is locked. New comments can not be posted.
Never understood why people idolize him. Regardless of who or why you killed someone, it's still murder.
It's probably not wise to normalize killing the people you view as your opponent. An eye for an eye, as they say.
Edit: DefinitelyNotAFae helped me understand why this is a contentious issue, I encourage others to read it.
If the system denies people a way to meet their needs, not all will sit legally with their needs unmet, some will seek it outside the system. That applies to the need for justice as much as it does hunger. Luigi felt grievously wronged by a corporate entity in a way that millions of people related to. A kind of wrong that is legal but can still kill and ruin lives. As they say, it's cheaper to run a fair system than to enforce an unjust one.
Not an endorsement, but, man I get why people are angry. If I had my body screwed up by some suit with the stroke of a pen and the law told me tough shit, who knows how I would cope with that.
A lot of things make me think of Discworld, but I've been thinking about this exchange from Going Postal a lot since the health insurance CEO was shot:
(edit: I should've scrolled farther before responding)
I work adjacent to healthcare and have friends who are doctors and nurses. Heath Insurance companies have killed millions of people and made the lives of millions more, worse. Everyone that's worked in healthcare has dozens of stories that are all worse than the last. The one I keep remembering was a man who was a prime candidate for a treatment that would have restored the use of his legs who was denied coverage by an adjuster on a phone who never saw him.
I don't condone murder. But every, single, person involved in that industry should indicted on manslaughter charges. It's extremely disturbing how banal they are about ending lives, metaphorically or otherwise.
Why not charge the doctors and nurses too while you're at it?
Not providing good enough healthcare is not the same thing.
Because they didn't deny the care. They don't have the ability to offer the care, because they have to order those supplies and they won't be approved to do so without insurance approval.
There are plenty of occurrences of poor care from practitioners. But it feels like a tangential distraction to the topic rather than a useful broadening of the discussion.
Denying care is different in a matter of category.
Since doctors make medical decisions, I'm doubtful about the idea that they don't sometimes deny care?
Edit: but actually, I'm not into finding people to blame. I think this would be better thought of as a systemic problem. Finding scapegoats doesn't fix systems.
There is a difference in denial of care by insurance providers and a doctor making a clinical judgement, even a poor one. I've experienced poor medical practice, there's a distinct difference and they're different topics.
You do realize that the people denying care at the health insurance company are also doctors right?
I think in terms of denying care it doesn't matter who does it, an insurance company declining to pay, and a doctor declining to treat without being paid. If you believe that healthcare systems and providers aren't also profit seeking then you have a very misunderstood idea of how broken US healthcare is and who the bad actors are (it's not really anyone tbh, it's just perverse incentives the whole way down)
If it gives any clarity, I can provide a very specific example of the absurdity of UHC's claim denials. The cartilage in my hip joints was destroyed by undiagnosed aggressive RA over the space of about 6 months. Under Humana insurance, the first hip replacement was approved immediately (like eye surgery, orthopedists don't do both legs at once even if they're in the same condition).
Under UHR, I was forced to "fail" physical therapy - painful, useless (according to the therapist - he used the time to work on my hands and shoulders instead), and expensive. My orthopedic surgeon had to attend two hours-long insurer board reviews to establish that the x-rays plainly showed no cartilage, and bone erosion with no treatment other than joint replacement, the exact same justification that resulted in approval of the first replacement. "Deny, delay", indeed.
While I waited for the surgery, the ongoing release of inflammatory joint debris was making the overall autoimmune disease worse. I had to remain on prednisone while working through UHR's required DMARD drug list before starting biologics. What should have been a six month DMARD drug trial process per the standard of care stretched out to two and a half years. That process had its own health consequences (weight gain, hypertension, bone density loss, joint damage, partial tendon detachment, other drug side effects and reactions) that are taking more years to recover from. Un- or inadequately treated RA is a life-shortening disease. I don't have any idea of what the ultimate cost of UHR's delays might be, but the rheumatologist is furious on my behalf because there's permanent joint damage that could have been avoided. The bitter joke is on UHR, because they'll be paying for more joint replacements.
As angry as I am at my own situation and that of others, I still don't believe that Luigi Mangione's action was justifiable morally, ethically, or practically (there is evidence that assassination is marginally effective in international relations, if you ignore the long-term instability it causes).
However, as others here have indicated, it's predictable that we'd get to the point of CEO murder given the frustration and powerlessness of ordinary citizens faced with this systemic behemoth of greedy gamesmanship with people's lives.
Yeah typically doctors very much not specialized in the care being requested, working as direct employees of the insurance companies. That wasn't what the other poster was referring to by "doctors and nurses."
I do not believe I misunderstand the situation. I have a lot of experience with the healthcare system, including that I will be returning to the hospital to visit my partner today.
We disagree about whether there are bad actors
How it typically works is there are criteria for anything not automatically approved, and then beyond that a doctor is tasked with being the final adjudicator of claims approval, and beyond that there is still appeals and grievances. But IME it doesn't take much to meet the threshold for medical necessity. All the doctors have access to the same information on what treatments are effective or not. It isn't so cut and dry that one avenue is better than another.
In the same vein that one doctor is paid by the insurance the other doctor is paid by the hospital, he has exactly the same perverse incentive to get that MRI approved as the medical director does to deny it, per your own admission
I am very aware of how it works. I have had to be aware to ensure that my partner, who is on Medicare and Medicaid and receive a HCBS via the waivers which are managed by a bureau I used to work for in grad school, doesn't lose coverage and die. And while providers can have "perverse incentives" in my experience they mostly want to treat their patients, not do bonus MRIs. I've had plenty of bad provider experiences personally and with my partner, I've had to spend the night at his bedside so the nurse would treat him like a human
But I don't think bad provider experiences are relevant to the conversation of culpability of the insurance companies. And while the system at large needs reform, I find the previous poster's comment to deflect from the topic of conversation by broadening it to meaninglessness. It's like pointing out also the roads have potholes that need fixed. They do, but that's not what we were talking about. I decided not to even engage with him after he demonstrated a lack of understanding about why ACA premium costs were skyrocketing. Because without an awareness of the political actions that caused that bump, there's no point in discussing it.
I'm just limiting the scope of my conversation. I haven't even expressed an opinion here on Thompson's killing other than explaining why some people feel catharsis about it even if they intellectually oppose vigilantism.
And you in one breath tell me you don't want to "hound" me and in another tell me to "seriously consider educating [myself] on the details before spouting nonsense." Consider me "hounded."
I was perhaps needlessly hostile, in retrospect. Believe me when I say that I am always malding about healthcare, it's my hobby horse everywhere.
Providers love that they can push all the blame to insurers, especially to patients, but they could just as easily lower costs or increase care if they wanted to. I understand that if you've been interacting with the healthcare system, especially for someone who is dual, and if it's not strict Medicare but MA, and not sure the Medicaid situation, but yes, it can be astronomically annoying when you just want to receive care, but providers made this bed. At no point in their finance meetings are they thinking "how can we treat more patients more cheaply" and I've seen what I would describe as hostile negotiations where they'll threaten not to treat Medicaid or indigent population to get better rates from the state.
Sorry I got heated, I have enough rage for everyone involved XD
You're right, I think it's an important note to call out that large healthcare providers like Sutter or Stanford also benefit from this system. We're in a predatory cycle of insurance and health providers squeezing us on both ends.
I just want to thank you for consistently advocating on behalf of disabled people like me, in threads like this.
/noise
There are also things like doctors not taking insurance at all, or not taking Medicare, or only working with certain kinds of insurance. These are business decisions, not medical decisions.
I think it's less problematic because it happens up front, but it's technically denying care.
Lots of things are denying care. I have denied care. You said "why not charge the doctors and nurses too while you're at it?" Because they're different.
I'd like to know what you actually think instead of random questions. Because the question implies a stance but doesn't take one and it would be more helpful to just state your opinion than asking something that deflects the topic and then dying on the hill of talking about how doctors take insurance. "Technically" lots of people and roles deny care.
So yes they do, but do you think they're the same and thus should be held as liable as people want insurance companies held? Or do you think it's ridiculous and that's a silly idea? Just say it!
I edited a post but you might have missed it: I think that finding scapegoats is a bad way to solve systemic problems, so I'm against it. I don't really know how to fix it, but I think that's not it.
The comparison to blaming doctors is just a way of getting at why it's problematic.
I don't think insurance companies are scapegoats I think they're the active problem. They're a huge part of the system and therefore the systemic issues can't be resolved without them. Doctors and nurses are often relatively powerless in the face of hospital execs and insurance companies.
But fundamentally calling them both "denying care" becomes an operationalization of terms issue.
I don't want to hound you, so tell me if you'd rather just not have further discussion about it. But insurance companies exist to manage risk, and to collectively bargain. That is the service they provide, and health insurance provides more and takes less profit than basically every other type of insurance in existence. Your bills are lower because the health insurance negotiates for you. You can afford to have a catastrophic medical event because the insurance spreads your costs over a greater risk pool. Your premiums pay for someone else's catastrophic event, so on and so forth.
Whether you believe this should be the government's job or not has no bearing on the application or value add of insurance. Also both Medicare and Medicaid are often managed by insurance companies as a health plan, and have to make the exact kinds of decisions about coverage, utilization management, etc in order to maintain profitability. That means denying care, it also means giving only certain members additional care. I worked for a Medicaid health plan in New York, when the budget bill passed, we had to reduce membership because NY was losing federal dollars and had no way to compensate. You either deny care to maintain profitability or you no longer cover unprofitable members. The dollars truly are zero sum. Health plans can only lobby, they otherwise have no bearing on the funding situation or laws at a federal level. I absolutely assure you that nobody wants patients to be sicker, everyone wants them to get high quality care, but it's a difficult problem to solve. Recently I evaluated a vendor we were paying for the sole purpose of helping patients get into their PCP, they got an extra community based healthcare worker to get them in, remove barriers, facilitate transportation, plenty of extra care and cost because getting them in and then being healthier would reduce costs. And it had zero ROI over three years of program!
Until the government gets off their ass, which they seem uninterested in doing, insurers are unfortunately a solution rather than a problem. We could also get the AMA to stop fucking restricting residency slots and reduce education requirements so we could have enough doctors to service our population, too!
I'm just tired of misinformed opinions on this. I've worked in healthcare for 17 years, I've worked at hospitals, doctor's offices, pharmacies, insurance plans, health service providers, it is insanely stupid and reductive to think you can point to any one actor as "the problem" and I would seriously consider educating yourself on the details before spouting nonsense. For the record, the CEO of UHC was not the CEO of UHG who dictated many of the overall policies around increased usage of AI in prior auth, or increase in denials without using actual clinicians, things I very much disagree with. I just think Thompson's murder..... accomplishes nothing, it changes nothing. I think it was better that CEOs take the subway or walk the streets instead of taking an armored van or flying only by helicopter anywhere, I don't think whatever this was in service of actually improved anyone's life, and I was just as incensed about the response here when it happened as I (apparently) am right now. And I never met the guy or anything, I have no personal stake in it
To your point, there are systemic issues with U.S. healthcare, and I agree that Brian Thompson's murder accomplished no enduring change in that system.
UHG absolutely has culpability for creating the equivalent of a medical zaibatsu, with insurance, billing, pharmacy benefit management, clinician groups, IT services, and other entities vertically integrated, and market control greater than 50% in some of those octopus arms.
Pharmaceutical companies, hospitals, outpatient surgical practices, regulators, medical products vendors, specialist practitioners, assisted living facilities, home health companies, etc. all need a share of the blame for costs that deplete insurance funds.
Just as personal for-instance, I'm once again fighting through a UHC prior authorization requirement for a generic version of Humira (adalimumab), the wonder biologic drug that makes my life possible. I need roughly $2,000 USD/month of that medication at current prices. It's such an amazing improvement for so many people that it represents half of all pharmaceutical spending in most developed nations, whether their health systems are public or private.
You'll hear that "biologic drugs are expensive to make" by comparison with small-molecule drugs. That's true in a relative sense, but the pharmaceutical price is 140x the cost of monoclonal antibody manufacture. That's taking my prescription as an example - 160 mg/month, scaled cost of adalimumab at $91/gram for manufacturing to filled vials. With the note that commercial scale may be much cheaper.
I understand that there are research and regulatory costs for bringing a drug to market, including the amortized cost of all the failures. There are regular pharma complaints about the est. $2 billion costs of proper U.S. drug trials. However, adalimumab has had over $200 billion in sales since its introduction. U.S. pricing for this drug is 400+% higher than the global average. Due to the regulations for biosimilar drugs and pharmacy benefit management, the generic competition hasn't dropped prices as much as or as quickly as expected.
I understand why insurers will put roadblocks up for an expense of this magnitude. But the conflicting profit incentives for UHG in particular through its OptumRx subsidiary have contributed to keeping generic biosimilar prices high.
I suspect you know this, but for others who were as confused as I am, it's biologics as a class that make up this large portion of pharmaceutical spending, and biologics (biopharmaceuticals) are
Humira's biosimilars (the biologic version of generics) have cut its price significantly since they first became available in 2023 and are far cheaper than Humira, and yet the price p_l quoted was still $2000/mo, so there's still a long way to go for how effective the drugs are.
Thank you for the corrections/definitions, and my apologies to all for the sloppy post and any confusion it may have caused.
Also, India launched a national program in 2014 to make adalimumab more available and affordable for its citizens through local manufacture of Humira biosimilars. As a result, the cost of a prefilled autoinjector pen with the usual 40 mg dose in India is $49 USD, around 10% of the US price.
And as a semi-offtopic aside, I'd like an option to get non-emergency medications dispensed in vials, without the autoinjector pen, if this significantly reduces costs. Immediate-use packaging makes perfect sense for an EpiPen. Users of insulin and other drugs have been safely filling their own non-automatic syringes for a very long time. Patents on proprietary autoinjectors are just another pharma money extraction scheme.
One more correction/clarification - my employer stopped using UHG/OptumRx due to the excessive pricing. OptumRx did not require prior authorization for adalimumab, presumably because they profited from easy prescribing. I'm fighting my fight because the new pharmacy benefit manager, TrueScripts, does require prior authorization for every prescription. This is complicated by the fact that my rheumatologist's practice was absorbed by a hospital system that's horrible at overloading practitioners and managing its communication systems.
As both /u/rosco and /u/DefinitelyNotAFae's stories indicated, the system is broken and has pervasively perverse incentives.
There's often a lot of uncomfortable tradeoffs we have to make. You could also say that most civil engineers kill millions of people every year. They design things knowing that they will kill people. The Department of Transportation has an exact figure at which to value a human life - $14.2 million dollars. Civil engineers every day make things where the economic value produced is higher than 14.2 million times the number of people that will die.
As much as we'd like to believe that life is priceless, in practice it cannot be. It applies as much to healthcare as anything else.
Okay, assuming that we can - and should - put a price on life so as to better be able to calculate the... I'm going to say efficacy, instead of profitability, because I might be able to see my self believing that, I'm not convinced that the tradeoffs made in the US medical system, specifically focusing on health insurance, are some anyone has to make.
I don't live in the US. I'm priviliged, my healthcare is funded and run by my government. There are also tradeoffs in our healthcare, not all of them I agree with, but they seem drastically fairer, and more efficient, than those made in the US insurance based system.
I'm not saying I'm right, just that I'm unconvinced that you are :)
There’s a difference between whether the exact trade offs we make are overall the best we can do, vs something someone has to do. I don’t think that the current healthcare system is perfect by any means, but denying claims is something all healthcare systems do.
No matter the insurance system, someone will deny a proportion of claims, and that will lead to some amount of deaths. It do be what it do be. Society’s priority is not purely maximizing the number of alive humans.
In the US system, insurers and healthcare providers are two counterbalancing forces, where insurers want to pay the minimum cost and healthcare providers want insurers to pay the maximal cost, with the intention of creating a equilibrium that pays healthcare providers a fair cost while not being too high such that no care is given.
Does it necessarily produce the best results in the US? Not necessarily, but I don’t begrudge insurance CEOs anymore than defense attorneys who represent heinous criminals. They’re doing their role in the system we set up. If change is to be had, it’s in the hands of the elected government.
No? At least not necessarily in that way? In our health system a doctor cannot deny you care. They define what help you need, which they might be more or less competent at, and you might end up on a waiting list if your treatment needs specil equipment or rare expert staff (which, yes, might have fatal or dbilitating consequences). But they can't deny you care, if they know you need it. They are not allowed to.
It is not an insurance system, just statefunded healthcare. Private clinics, paid by the state, public hospitals.
We do have a seperate health insurance company (one, singular) and private hospitals, but the insurance company is at best a necessary evil and at worst a scam and the private hospitals are for the wealthy.
I'll timidly concede to the first sentence, but I think the second is wildly irresponsible. I admire the principle, the belief in the system and society as a whole, choosing to work within it, the collaborative spirit of it. But I don't think it's realistic. Governments can and do go bad. Democratic processes implode. Power goes corrupt. At some point you can't elect a government that is willing to make the change necessary for the betterment of the people.
It do be what it do be, but it damn well doesn't have to keep do being what it do... or something.
What’s the difference between being denied care and being placed on a waitlist so long you’ll die before you get care? They’re both symptoms of the same root cause, a root cause we will probably never solve: demand being higher than supply.
That’s why the NHS can cover dentistry in the UK but no one can actually get dental care done without paying out of pocket.
Why is it irresponsible? What’s more likely to change the US healthcare system, a CEO of UHS resigning or refusing to take the job, or government action?
Well, yeah, everything in the world can go wrong. It is what it is.
The scope? The motivation? When people start dying, don't get the care they need, are mistreated, we can object to the budget decisions, the management. Because the core motivation isn't profit but national health. Yes, the government has to balance their books, but there is no intrinsic profit incentive, no bleeding of resources to wealth hoarding at first approximation. How people are being treated in the health system can and do become local and natinal agendas, are used in the political processes, become national news, leads to change! Certainly the limiting factor are resources, but nothing so simple as just demand and supply, not just cash flow.
Sure, IF the givernment would take action, THEN they would have more power to chabge things. But we can't rely ob this alone, and a CEO resigning (or, gods willing, trying to CHANGE their company for the better) would still have some effect. It won't change the whole world, but it will be a step.
And then we fix it. Try to change it. Combat it. It only is what it is until it isn't.
It’s two sides of the same coin. In the US system, profit is the incentive for the sides of the healthcare system to keep each other in check, and the market overall exists to allocate resources. Whether they’re allocated by mandate or allocated by market, it is nonetheless a game of resource allocation. It is just supply and demand. We like to treat human lives as priceless, but in practice they always have a price, and it’s usually not that high either.
What effect? Luigi shot someone and the only effect was an increased spending on podcast ads as far as I can see. A CEO is just an employee in the end. They can be fired and hired on a dime. It really makes no difference.
I actually think this is infinitely more irresponsible a message. The reality is that politics can change healthcare both quite rapidly and easily. Obamacare made far more change than any CEO of a single health insurance company can make.
Just a year ago the No Surprises Act was quietly passed by Congress, which outlawed surprised out-of-network bills. That’s a helluve a lot more change than a CEO change.
It’s not even just federal politics. Massachusetts has a heavily state subsidized healthcare scheme. Because people voted for it.
Yep. With politics. Other than that it is what it is.
I do not get this reduction to supply and demand. This belief in the market as an organ for resource allocation. I understand the simplified theory, but I've yet to see concrete proof that it fits reality.
As for both market and mandate allocation being games of resource allocation, I reject the notion that their rules are then fundamentally similar. That the number of players are the same, that the goals for the players are the same. If we are to compare them as games, then I think we ought to actualky cobtrast and compare their rules in earnest.
I don't get that. You don't think CEOs can influence their company? That two different CEOs would lead the company differently? That is not my experience. Yes if one CEO steps down, a new CEO will take their place. Might be that they change the company, might be that they won't. But they have the possibility.
Really glad to hear that, that sounds like good work, good change. Some faith restored. I'm still not convinced that that didn't take some personal action (as in phoning your representative, not car bombs). But maybe you don't agree to that either? This subthread was for me motivated by what I read to be the democratic mindset of "vote, trust the government, mind my own business outside of that". But this and other comments in other threads leads me to believe that you also think it important to engage with your democracy by spreading you opinions, discussing, maybe even activition? Or am I mistaken?
This I think is a core philosophical disagreement. Exploring this here would certainly constitute "noise".
I think we'll have to agree to disagree, so I'll just leave it at this: the rules of the game that the US electorate set up is one where medical resources are allocated by market. In that game, the players should play the game. The game may be bad, but to change it is for the electorate to change the game. If you're playing basketball and think that the rules promote chucking 3s, in the end you still need to chuck 3s. Talking to the officials to change the rules is the path to avoid a game where you chuck 3s.
In that respect, any UHS CEO is doing their part building the equilibrium by being profit-maximizing. I don't think that they are in any way evil. The rules of the game are determined by the electorate. That Trump tried to dismantle the ACA, only to be foiled by a dying McCain, won re-election just shows that the priority isn't there. And that's okay.
I think what Luigi did was quite bad, and thankfully it seems like he will rot in jail for likely the rest if not a significant portion of his life. It do be what it do be.
If these weren't people's lives, maybe. But they are. And irreparable damage will be done in the time it takes to play by the rules of the game.
And it's why I cannot get on board with the idea that sacrificing lives for profit is just no big deal, part of the balance. I'm deeply tired of being at the mercy of "the electorate." And I find this sort of language to be far more callous than talking about Thompson's killing.
(And the idea of "rotting in jail" is another way we dehumanize prisoners too. It's all part of the same dehumanizing worldview)
ETA: there's no way i can remain civil so I'll stop here: Absolutely fuck this attitude towards people's lives and health.
If you don’t play the game, more people die. The game is resource allocation. If you play intentionally badly, then the more mid allocation occurs. Which means more death.
Maybe the game doesn’t produce the best results. Definitely possible. But you have to change it at the root (eg, the government). As long as everyone else is playing the game, it is what it is.
If a billionaire said this we would rightly shit on them. What alternative is there?
If democracy ever broke down in the states, a lot more people could die than have ever died from being denied insurance coverage, and for potentially a worse outcome.
You replied after the edit so I assume you're fine with less civility. I'll keep it on the right side of the line for Tildes.
That is a stupid argument.
Amazingly, two people, even if one is fictional and a billionaire, can say similar things and have entirely different moral stances and life experiences. So shit on me if it makes you feel better but I didn't say "man I wish democracy broke down and people died" I said I'm tired of being at the mercy of the electorate. Treating this like a hypothetical philosophy question ignores the real people being hurt and actually dying now. And at imminent risk of dying in the future.
I lost my rights to control my own body because of "the electorate", my partner may lose the care that keeps him in our home and alive and I have to not write down if my students need healthcare so they can't be targeted by the government for literal persecution.
It feels dehumanizing as fuck to keep hearing "it is what it is" and essentially "could be worse" when it's already bad. I have tried to point out with empathy where people are coming from in this thread because this shit is complicated and morality is rarely simplistic and I was genuinely hoping to improve communication but instead I just get the same stupid what can you do, if you don't like it, you're just like a billionaire and society would collapse!
But instead I'm supposed to not be tired of this? Or not say it? Nah. I'm not coming back to the thread after this, so say whatever you want. But just because you say something dispassionately (nor because I say something emphatically) doesn't make it a better argument. That was not logical, rational or kind.
I’m also tired. Sorry for the trite response but it’s exhausting to see people (not specifically you) hand wave away political violence because assumedly they see it as forwarding their political goals. Political violence is not a continuation of politics, it is the breaking down of the political fabric of society.
And of course you should be mad! I would be mad if I was American. Nobody is saying you should lay down and accept things being the way they are. But what does assassinating a CEO accomplish? There is a new CEO now, and their ilk will now rub elbows even less with the regular world. So why carry water for people who are saying he deserved it or killing him was the lesser evil etc. etc. What does that even accomplish? I get that people are frustrated — that’s no excuse in my opinion.
The way to accomplish what you want is to pursue actual politics. It’s to talk with your neighbours. It’s to organize. That’s what the path to progress looks like. Way too many people on the left are content to latch onto to doomed symbolic actions like justifying the murder of a CEO while not doing anything else except despair and consume more algorithmic despair. I’m tired because it seems like people have doom scrolled their way to defeatism, and instead of achieving (achievable!) goals they are just giving up instead.
Certainly, I think our views are fundamentally different, and that it is impossible for us to reach a consensus within this medium. Nontheless, thank you for the discussion, it was testing - I'll look forward to the next one, if it is to happen.
I agree with 99% of what you're saying here (hello fellow medical professional), but I have to note that UHG is a publicly traded, explicitly for-profit company. Their financials tell you everything you need to know about just how "zero-sum" this particular company is. There's a huge difference between how UHG operates and how medicare or medicaid operate. The government isn't looking to make a profit off health insurance, but UHG most definitely is and some of the deplorable policies you mentioned are a direct cause of that, no matter who you attribute the "blame" to.
...funny, i always ask healthcare providers what my total cost would be without insurance, if i just pay cash, and it's always been substantially cheaper than my out-of-pocket cost with insurance...
That's sort of a bug, not a feature. Basically, hospitals expect that patients without insurance generally cannot pay much at all, so they write down the bill below their own cost in an effort to at least get something. And they have to make up the shortfall by billing insurances more.
I'm not saying don't do it, of course. But it's not like you've discovered that hospitals are secretly marking up by 4000% or whatever -- they lose money on the care when you do this.
(That's assuming you're talking about catastrophic care. For stuff like routine lab tests, yeah, it's usually just cheaper because it's easier and faster for the hospital to get cash from you than go through the billing process, risk nonpayment, etc).
It's called regulatory capture and it's funding from insurance companies that keeps our system this way. The majority of Americans now support medicare for all.
I'm well aware of lobbying, as I stated. The majority supporting something and that thing being politically likely to occur are also, unfortunately, not the same thing at all in the US. I am not even sure what would need to occur to get medicare for all, but it's extremely possible that even if we did, it would be a marketplace situation like MA/ACA/medicaid(in markets like NY). So it's not even a given that the insurance companies would even fundamentally change. Pretty grim, I try to focus myself on improving patient outcomes or at least not spending money wastefully.
I think they're part of the system too. They exist because there isn't unlimited money and somebody has to say "no" sometimes, or health insurance premiums are just going to keep going up. The Obamacare system is already in danger of denying service to more and more people due to higher premiums.
It's easy to find cases where they could do a better job, but that's always going to be unpopular.
From reading books about the old days, doctors were paid directly and had to make their own decisions about what to charge, when to deny care, and when to give free service. Many have effectively outsourced being the bad guy. There are some doctors who don't take insurance, but they only serve rich people. They, too, in their way, are denying care sometimes.
Any doctor could also work sometimes in a free clinic or something like that. They probably have limited time for this.
Maybe one part of the problem is that there aren't enough doctors?
It should also be noted that this happened right as the AI-hate movement started. The initial response was "Rich kid took out a healthcare CEO? Hell yeah." The followup was "Rich kid killed a man that was part of setting up an AI system to coldly deny healthcare benefits for profit? Hell yeah, brother."
You're not just seeing an anti-corpo movement, but a blend of two staunchly heated groups: People without healthcare and people against AI. Both are filled to the brim with hatred for the systems that oppress them, and Luigi fought both of their problems with one shot.
To be fair, plenty of people with healthcare hate the insurance companies and by proxy their CEOs. Possibly we hate them more than uninsured people.
Yeah, I don't know anyone who read this as an AI thing. Everyone was frothing for change to our insurance system.
Idk what this isn't giving me a notification for your comment, but it was right around the time some news about AI software stuff came out iirc. However trust that the hate for the insurance companies and United Healthcare in particular has been longstanding. It was (still is but was too) common to see skits on in short form videos specifically about them sucking.
Agreed, theres just lots to be furious about.
Going on pure utilitarianism, he’s almost certainly saved more lives by acting than by doing nothing. Trolley problem goes here.
The nuance in the utilitarian argument comes down to the question of whether acceptance of his actions does or doesn’t constitute a wider unacceptable risk (justification of vigilantism, normalisation of political violence, etc), because his actions taken in isolation helped more people than they harmed by a pretty significant margin.
It’s vanishingly rare for a genuine good guy with a gun who kills a mass shooter to receive anything other than accolades and adoration. The cause and effect is clear and direct, and people applaud them for it, even though there are plenty of injuries and deaths attributed to mistaken identity or straightforward inaccuracy from people trying to be a good guy with a gun. Even so, the ones who get it right are treated as heroes.
So I don’t think the arguments against Mangione’s alleged actions are really because of the things it could encourage. I think they’re because the widespread killing perpetrated by an insurance CEO choosing to dial in profit margin against patient care is so indirect, so well insulated, it isn’t thought of as “real” killing at all. And in a system where consciously choosing to curtail thousands of person-years of life not only isn’t condemned but is actively rewarded, is it really that hard to empathise with someone who decides to take direct action, even if you ultimately come down on the side of it being unjustifiable?
Wow, this sure does dovetail nicely with another conversation I was just having…
From Discworld
-- Terry Pratchett, Going Postal
GNU Terry Pratchett
This is a pretty specious argument, IMO. The same logic would hold that, in isolation, all people who are subjectively a net negative on society should be killed. The nuance is the important bit.
If you're actually a hardcore utilitarian and do genuinely believe this, we can debate the fundamental legitimacy of utilitarianism. But that's not the general vibe I'm getting from your post.
In any event, the deeper problem with the logic is that nothing actually changed. There is now a new CEO of United healthcare. Their policies have not changed measurably. For the utilitarian argument to hold water, it would actually have had to make things better.
You’re right, I’ve never found a belief system that purist that actually survives contact with messy reality and I was mostly talking it through conceptually, although I do find a fair amount to like in utilitarian philosophy.
But I also think you’re kinda doing what I alluded to at the end and underestimating the many thousands of lifetimes of potentially-lived years the healthcare industry is willingly and knowingly choosing to trade for profit. I would’ve loved to see real reform and I agree that we didn’t, but even the few weeks of “ah shit, just approve anything even remotely borderline” after it happened was already more than enough to put Mangione’s lives saved/lives taken ratio well up there in the double or even triple digits, alongside people widely thought of as heroes.
Did that actually happen? I cannot find any evidence that approvals changed, even temporarily. All I see is articles noting that several insurers promised to review policies, and then retrospectives from around now noting that few or no policies have changed.
Under most frameworks, murdering someone is not justifiable even if it does directly save the lives of others. Most moral frameworks, for instance, (including most versions of utilitarianism) hold that it would be wrong to murder you and use your organs to save the lives of dozens of other people — and that’s a direct cause-and-effect hypothetical, not what actually happened, which is more like “the total number of quality-adjusted life years in the US might have gone up as a result of murdering this guy… maybe.”
I support healthcare reform and think single-payer healthcare would generally be a better system from several points of view. However, this argument falls apart pretty quickly. For example: I assume you’re aware that single-payer healthcare systems also deny claims. Single-payer healthcare systems also knowingly don’t pay for some people to get more lived years. If there’s an experimental treatment that would prolong your life by a year but cost 100MM, you’re not going to get it. I could maybe see that the for-profit aspect of the American system makes things marginally ethically worse, sure. But “some people die as a result of the healthcare system we have” is only a slam-dunk argument if it’s actually possible to construct a healthcare system where we don’t have to prioritize, which, as long as we’re in a society with scarcity, will be impossible. Is it justified to murder the administrator of Medicare because Medicare denies claims? I’d bet, actually, that as the largest provider of health benefits in America (by a huge margin - 29% of all claims in the US), the administrator of Medicare is responsible for more indirect death than Brian Thompson was. Acceptable to murder them?
Hard to say, and I’ll be honest here and admit that I’d been remembering anecdotal evidence as stronger than it was. There are a decent amount of anecdotes, there are some suspiciously timed u-turns, and there’s an industry wide change for the better a year after it happened. But those are circumstantial, it looks to be too early for real statistical research to have been done, and I was probably overconfident on the assertion.
Really? This doesn’t match what I see: I mentioned the “shoot the person who’s shooting others in order to stop them” example for a reason, because from what I see it is widely considered morally acceptable to do so in the real world.
The organ donor example flips the ethical question (killing an ostensibly innocent party to save others, vs killing a guilty one to prevent them enacting further harm on others). Should that distinction flip the ethical view? Personally I think yes, intent matters a lot, but we’re back into classic trolley problem variants again now, and utilitarian purists might disagree with the importance of that nuance.
I’m sorry, but I absolutely, vehemently disagree with you on this. Systems like the NHS specifically and explicitly allocate their fixed budget between priorities with the goal of maximising quality adjusted years of life among their population of patients; they deny some to save others. For-profit companies maximise profit regardless of the impact on human life; they deny some to keep the money. The fact they both sometimes deny care is absolutely in no way an equivalence.
[Edit] And yes, I know, private insurers also prioritise quality adjusted return on treatment cost. Doesn’t change the fact that they deliberately reduce the overall pool of money spent on care in order to pay shareholders.
I really admire your intellectual honesty and I hope I will hold up my half of the conversation.
“Assassinate the CEO to maybe produce a temporary bump in QALYs” is a lot closer to “murder the guy for his organs” than it is to “stop the mass shooter by shooting him.” Brian Thompson didn’t create the American healthcare system. Frankly I would bet that he probably didn’t have all that much input on the actual approvals process. And, as CEO of a publicly-traded company, he had a legal, fiduciary duty to the shareholders of UnitedHealthcare. He could have literally been sued and held personally liable for not prioritizing the company’s best interest. Our legal and ethical systems differentiate between direct harm and indirect/systemic harm for a reason - because they’re not the same.
This isn’t a super controversial position, right? I used “murder” specifically. Clearly yes, most moral frameworks allow you to kill someone to directly save the lives of others, and that’s also reflected in basically all legal systems. But we distinguish between shooting-to-kill-a-mass-shooter (legal killing) and executing-a-CEO-on-the-street (murder) for a reason.
This is reasonable.
I do think the fiduciary duty of the CEO to the shareholders makes things a lot more complicated for your position, but I get where you’re coming from and to really argue against this would be pretty pedantic, I think. Like, re: your edit — yeah, but I wasn’t going to throw that in your face because it’s clear that’s not what your overall point was.
I appreciate the chat, it’s interesting and all too rare to discuss this kind of genuinely principled disagreement in good faith.
I think all I really have to add is that the CEO explicitly chose to take the duties and the enormous monetary rewards of that position, with full knowledge of what it entailed. I try not to blame the subsistence level worker for the job the system imposes upon them under pain of homelessness; I absolutely do blame the multimillionaire CEO for the consequences of the job they freely chose to take on. Whatever your thoughts on what happened to him as a result, I do think he bears the moral weight of choosing that specific way to participate in the capitalist system imposed on us all.
For what it’s worth fiduciary duty is also a little more nuanced than people often think. But to me the stronger case is still his choice to accept the duty, however it was understood.
I get that. Probably unsurprisingly I don’t exactly agree — no issue with your framing or use of moral weight, which I both really liked — but because I think it’s a lot harder than it looks to prove that the American healthcare system is ethically flawed instead of just systemically flawed. But this is one of those things where I think we get and respect where the other is coming from and there’s not a huge value in hashing it all out.
[And yep, totally understood re: fiduciary duty. I’d actually thought about specifying that it was more about long-term interest than ‘number go up’ but figured you already knew : ) ]
I haven't seen any evidence whatsoever that this has influenced the everyday operations of the insurance industry.
There kind of is. UHCs shareholders actually sued them months following this event because they decreased the amount of claims they were denying in the following months (presumably because of the bad PR after this event) and the shareholders weren't seeing the same level of profit. Which is absolutely demented.
I agree that murder is murder.
Historically when a system becomes broken enough, violence is what happens as a result, and sometimes that violence does lead to change.
You can make a reasonable case that health insurance CEOs have killed people for the sake of profit. At what point should they be charged? Not saying you are pro-health insurance CEO but I think this whole situation does raise awareness around this topic.
I think people have a general sense that many of the systems that exist in our culture are harmful and extractive, but they don't see any way to make things better and they may not even understand what is wrong or what it is that they feel (which is why scapegoating groups like immigrants is effective). People are frustrated that corporations are permitted to make decisions that prioritize profit over human life and I think the Mangione case was cathartic for some because of that feeling of powerlessness.
Anyone in a leadership position at any large healthcare company has killed people for profit, (more accurately, let people die for profit). The US has a for-profit healthcare system. Its a requirement of the job.
The key nuance here though is that it doesn't matter how healthcare is doled out, if you're in a leadership position in a place where there's more need for healthcare than resources to give that healthcare (literally everywhere on earth), you will have to make decisions that will result in people dying.
If a 95 year old man needs MRIs to detect tumors on a biweekly basis, and a 20 year old comes in from a car accident and needs an MRI to save his life, and there's only one spot left on the MRI machines schedule, a choice needs to be made. If you only have three trauma doctors on duty and 5 people come in with life threatening injuries, a choice has to be made.
There are a lot of issues with how the US doles out healthcare, but any other system requires that similar choices are made. I don't think it's fair that rich people get better care than poor people in the US, but blaming insurance companies for finding ways to make money is pointless. They exist to make money. That's how the system is set up.
If we had public healthcare, it would be policy boards and administrators making decisions about who gets care. If we had anarcho capitalist city states, it would be the Lord chancellor CEO of the city making those decisions or whoever.
Someone would still have to make them, so the idea that this guy deserved to be murdered for being the guy that did it doesn't really square that well. He might have deserved to be punished for how he made those decisions, but deciding who gets lifesaving care and who doesn't isn't inherently morally wrong. Its necessary for someone to do.
Nobody has to be a health insurance CEO. Someone made that choice. They aren't being forced.
Health insurance arguably adds little or negative value to the experience of getting healthcare. They are middlemen at best.
I don't think the MRI example is fair or even comparable in this situation. We are talking about health insurance, not health care. If you have three trauma doctors and 5 people come into an emergency room health insurance isn't picking who gets treated. They will be treated based on immediate need.
An expert making a medical decision to allocate limited medical resources to the place they will do the most good is in no way comparable to how health insurance works in the US. They aren't middlemen making a decision based on what creates the most "shareholder value".
Health insurance, abstracted, is a mechanism for the allocation of where medical care goes. That mechanism will exist regardless of how healthcare is doled out, because healthcare is extremely resource intensive and demand will always exceed supply. You can argue that the determining factors of who currently gets that healthcare are unjust (primarily, who has the best health insurance plan, and by proxy who has the most money), but you can't really argue that the act of making the determination itself is immoral.
Going back to the trolley problem referenced elsewhere in these comments, this would be akin to calling someone immoral for signing up to be guy who operates the trolley switch. The trolley is going to kill people regardless of what you do. Someone has to pull the switch. The switch right now is pulled by people who make sure the trolley only runs over poor people wherever possible, but even if the system was replaced by something more just, someone would still have to pull the switch. The switch pulling itself isn't the immoral part.
But I think the point is that while pulling the switch might be neutral, signing up to pull the switch in an inherently immoral situation - for profit and harming poor people - is still immoral.
So yes, someone has to pull the lever* - though there's nothing stopping the insurance company CEO from stopping the trains entirely and paying for everyone's coverage except losing his job - but if you choose to do so in an amoral or profit driven fashion you're perhaps engaging in active harm/evil/etc. (idk what model we're using)
Sometimes all you can do is harm reduction, especially when a system is fucked up. I'm having to do that now in higher education given certain threats made by certain politicians. There's a big difference between an engaging and harm reduction and just pulling the lever on whatever makes me the most money, or is the best for PR, or is in anyone's best interest other than patients.
*In our current system. I'm not so sure we need to pull levers nearly as often as we think if we revamped things entirely
The problem is WHY they make the decision, not that decisions are being made. Health insurance companies are shareholder and profit motivated. The determination is immoral due to the motivations and goals. UnitedHealth Group made over $10b in net earnings (after costs!) in 2025. They also paid dividends in 2025 to shareholders.
The switch pulling becomes immoral if the operator of the trolly is deciding to flip the switch based on what will save them the most money or make them the most money.
As a side note it is crazy that health insurance companies are also allowed to own healthcare companies.
In your scenario pulling the lever is akin to distribution of resources. On a micro scale doctors are very familiar with this. It is the core tenet of triage. I'm an emergency situation with more patients then resources you try to put the resources where they will do the most good.
I have focused in on the idea of 'just' distribution. I agree that wealth is a poor stand-in for value. What is though, is a very difficult question. We could let the doctors decide. A purely medical evaluation. Make sure that national resources would be spent to give that maximum amount of quality years of life.
Here is where things get tricky though. I dislike the idea of assigning an individual's life some sort of worth value. The above system would be completely disassociated from societal worth. Some people are harder to replace in a society. From a strictly pragmatic sense doctors, engineers, scientists, etc. have consumed many resources to become trained. Losing the people who understand and run the tools of modern society would be felt by everyone.
Now further. Even if you manage to find the perfect set of variables to perfectly and without prejudice or bias allocate the finite resource of medicine, who will manage this. A system that literally holds the levers of life and death in their hands would need to be definitively free of corruption. Is that even possible?
Would the wealthy even opt into this system? I suspect people with the means to circumvent the system would. Get sick but are given a poor health care worth, travel somewhere where money can buy you better care.
This post was mostly rambling, but thank you for triggering some new thoughts. Appreciate you.
I think there is a lot of miscommunication here between people who are mostly saying that there's a lot of responsibility and culpability for harm caused by decision makers at insurance companies, especially C-Suite, while bringing an understanding how people who feel there's no avenues of redress make drastic moves. (And even acknowledging there could be some moral stance to be made there) And on the other side folks focusing on the idea of whether that person is supporting vigilante justice, or whether an individual "deserved" to be killed.
And I think those are two different trains of thought, especially when people may experience some cognitive dissonance about their overarching beliefs and the reality of a specific situation. Kind of like when people wish they could harm someone who hurt their family, but oppose vigilantism generally. No those two thoughts don't seem like they should fit together but "it's different when it's my people" is a recognized thing in ethics.
There's a difference between saying that someone should have been killed and saying that you understand someone's reasoning for killing them, or are empathetic to their suffering, or think they shouldn't be punished to an extreme for it. Or even to posit a moral philosophy or legal system where people who harm millions in a white collar way are punished more harshly than someone who kills one person. (Think how rampant wage theft and major embezzlement/fraud go far more unpunished than shoplifting or burglary as an example).
/Sorry this was just the most recent post to mention the idea of "deserving" death and I felt like it was worth commenting on the overarching pattern I'm seeing.
I agree, but I think a lot of people aren't just understanding the reasoning behind the killing, or empathetic to Luigi's suffering. The reason why I think that is is because even when they're not cheering for what luigi did (a lot of that is ironic meme fodder, I get it), they're bringing up the reasoning behind it a lot.
When I watch the news about murders, I understand the reason behind most of them, to be honest. If I were a gang member, and my entire income and reputation came from being able to defend my turf, and a rival gang stepped on it, I would be understandability motivated to kill them to make a point. If I walked in on my wife cheating on me with my best friend, I would be understandably motivated to kill him. If I were in a marriage to a rich guy who I no longer loved, and in fact detested, but had no skills of my own with which could support my current lifestyle, I would understandably be motivated to hire someone to kill him.
Like, I get the reasonings behind all of these things. I don't ever bring them up, because I think everyone understands why most people kill other people. Motivation is a big factor in finding a suspect for a crime after all. I don't actually support any of those killings though. I understand them, but don't condone them.
With Luigi, (and this happens a lot with "justified", legally wrong violence), people bring up understanding his motivation over and over. Why the difference between that behavior Luigi and gang violence or passion killings? I think it has a lot to do with people having adopted a rigid ethical framework (murder is wrong) that doesn't actually mirror their own personal morality (murder is actually ok if the person being murdered is a piece of shit). That is, they actually do condone the killing, they just won't outright say that because murder is wrong.
Sure, lots of people make exceptions to "murder is wrong" such as "murder is ok if they're a rapist" or "murder is ok if it's the state, because it's not murder then" or whatever. That's not really what I'm hitting on.
I'm seeing a lot of people talk past each other, and basically just lecture someone that "murder is wrong." So that's maybe it's the case that all you're saying is true - I'm not sure that it is for everyone here - but the response ignores that and just tells them how bad vigilante justice would if society engaged in it writ large, ignoring that the person never advocated for such a thing nor seems to want it. Same for reiterating that the death wasn't deserved or what have you.
I do think people discuss motivations a lot more with more assassination type killings, and that's closer to what this is than a typical murder. I don't actually find that odd, it's also usually where people get about wobblier about what is "right" or not especially as there have been no other practical consequences for the actions of those in power. CEO has just not typically been in that category the way politician has.
Ultimately there's just a lot of talking past each other and that was what I'm addressing, hoping folks would respond to what the person is saying and not just reiterate that it's bad to support vigilantism/murder/etc. on a large scale where even if the person were supporting it in this case, they're not advocating for the Purge.
But like, I'm not the boss of conversations, just pointing out a pattern.
I'm curious if you live the US, as that will likely really flavor your impression of the entire event.
Since I was 24 I've had a number of really impactful insurance claim denials:
2014 - MRI denied for a torn medial meniscus, my out of pocket cost $6,500 (I was told it would be covered and then had a denied when it was billed)
2018 - Denial to see a specialist with a referral from an urgent care doctor. My torn achilles went misdiagnosed for a month while I was able to get an appointment to see an "approved" doctor. The recovery was delayed by 6-8 months.
2024 - dropped coverage of our hospital/OBGYN 3 weeks before my wife's delivery. An insane amount of work by ourselves and with paid advocated to get a continuation waiver.
All of those happened while I was young, healthy, well supported financially, and with relatives who work in the healthcare industry and could help me navigate it. The first two happened with a United Healthcare plan. I'm going in as the low risk, low payout patient from an insurance perspective and still end up managing poor health coverage and outcomes. Imagine being in a high risk category.
I think Luigi ends up representing "street justice" in a system that otherwise prevents everyday people from getting any justice at all. I have no recourse over United Healthcare, I have very little power to even fight the denied claims. And there are very few parts of society that I very with so much contempt and rage than private insurance. They are literally the bean counters of death. So while I agree that murder is bad, it was a glimmering moment for many of us that hoped something might change. That the social contract was broken enough that people we resorting to vigilante justice. It was a signal to the bean counters that there would need to be a re-evaluation of the profit/outcomes equation.
But then we didn't get that. We saw the system double down in a way many of us have never seen. The man hunt, the terrorism charges, the unbelievable expenditure on this case. A quick blip of changes to procedure, but otherwise it was additional security of the top brass and a return to business as usual. So many people, me included, rooted for Luigi.
Yeah, no, there are people in the healthcare industry who profit over the suffering and deaths of many. The normal justice system doesn’t work, so people understandably resort to this.
I don't understand what you mean by "Yeah, no". Are you suggesting we kill everyone we view as immoral? To what end? And who is the arbiter? That is a very dangerous game, and borders along the thinking of eugenics.
And FYI, it's hard to hear your side of the argument when you flat out reject the thing I'm saying.
I don't think it would be great for everyone to start killing anyone they consider immoral.
However I do think it's good for immoral people to occasionally get a reminder that they aren't invincible.
I understand you're not who I replied to, but that still makes no sense to me. Your second sentence cancels out the first one. It's like saying: "I don't condone the action, but I do sometimes."
Again, my issue is with precisely who we consider immoral. It's the same issue as deciding who we deem unfit to breed. That line is impossible to draw. Just look at the history of eugenics and you will quickly understand.
Do you like Batman?
We can agree that in general vigilante justice is a bad idea and we can feel some catharsis when someone we perceive as "bad" gets consequences for their actions. Even if we wouldn't generally support that. Just like we might be ok with the idea of a Batman even if we can recognize a billionaire with PTSD is probably not the ideal law enforcement scenario. How many people have a bottle of champagne in their fridge just in case we have an early presidential transition? How many of those folks would normally celebrate death?
As a staunch advocate against eugenics I think the comparison here doesn't work, because it's too easy to flip it:
If you staunchly oppose eugenics then you must object to people deciding who lives and who dies. So you must strongly object to healthcare CEOs and others denying healthcare to the sick for the sake of profit. Obviously. So you must support any action ending that denial of healthcare, or you basically support eugenics.
Neither is a necessary or logical conclusion. Supporting lifetime incarceration for Mangione or the death penalty would also be deciding if he should be allowed to reproduce. So if you support his conviction you must support eugenics.
Again I am one of the louder anti-eugenics voices here. I get your point. I just think you're assuming this is about logic rather than emotion. Humans aren't just one or the other.
I understand a little better now, thank you.
I often struggle to "put myself in their shoes", so it's helpful to know that both "sides" (logical vs emotional) can be correct in their own way.
And people aren't all one thing, or always internally consistent. Assuming we are will lead you astray on why people act or think as they do.
To add on to what @DefinitelyNotAFae said, and because I don't see this being mentioned elsewhere, there's a few additional factors we should consider when we consider morality.
First and foremost, what is considered moral is often a game of weighing pros and cons. Think of the classic killing baby Hitler question - It's a hypothetical in which we know the outcome if baby Hitler lives. You can draw parallels to the Trolley problem and optimizing for minimal harm, but regardless of the reasoning it's clear that to at least some people the "morality" of something is often a form of calculus.
This is further supported by ideas like "we cannot be tolerant of the intolerant." The conditions, also known as the premise, are critically important for both logical and emotional arguments. In the logical state, they are used to reason towards an answer. For the emotional state, they are often what creates the emotion in the first place that someone is reacting to.
On the logical side, whether Luigi did something good or bad is largely a function of the premise itself. If we start from a premise that "society is functioning correctly and law and order are good things which allow society to function" it might be easy to reach the conclusion that the killing is immoral on the grounds of disrupting this system. However, if we start from the premise of "society is not functioning correctly and law and order are sometimes used by evil people to corrupt society" it might be equally easy to reach the conclusion that killing people indiscriminately is not a good thing but this particular killing might be justified on some grounds because it has removed someone who is corrupting/damaging society.
On the emotional side, the premise is more a function of the people involved. Lets take an extreme and start from the premise of someone who is a billionaire - they are in control of society, benefiting from society the way it is set up, and the killing of someone of their class represents an existential threat to their way of life. It would be easy to see how emotionally they would be strongly against this killing. On the other end, we may have individuals who have personally been effected by the system - perhaps having been crippled by medical negligence that was a direct effect of policies that this CEO put in place. It would be trivial to imagine a situation in which they are strongly in favor of this killing. I suspect most people fall somewhere between these two extremes, either critical or in support of the existing status quo, primarily a function of how much the status quo privileges them.
One other thing to note here is that for most people, morality is not universalist in the way you are suggesting here. Besides the broader societal/structural premises weighing heavily into the calculus of whether a specific action is moral rather than the universalist position of the action itself being moral, most humans also weigh their own personal gain as well as their audience into functions of morality. There was a fascinating study on morality where they compared neurotypical to autistic individuals where they created a set of "good context" and a "bad context" moral choices, and manipulated the personal premises (personal gain/loss and whether there was an audience) to see whether people would shift their moral compass based on these premises. While autistic people were more likely to take universalist stances on "bad context" moral choices and were less likely to care about whether there was an audience, both groups changed behavior in the "good context" based on personal gain/loss, indicating that personal reputation and the visibility of an action change how people conduct moral calculus and determine whether something is moral or immoral.
Basically I don't think we should drag every billionaire out of their homes to be shot in the street.
But there's people who think they can do whatever they want because their money and connections insulate them from legal consequences. When they're about to take an action that will bring misery and harm to thousands or even millions of people, I think we all benefit if they have to consider the small chance that one of those people will be pissed enough to kill them for it.
So on one hand we have to punish people that go outside the law to enact vigilante justice since we can't just go open season with vigilante justice. But on the other hand, the threat of vigilante justice is really one of the only braking mechanisms we have left to try to check this insane greed and corruption
One of the main issues with this point of view is that it only works for vigilante violence that happens to be aimed in a direction you agree with. Far-right pro-life individuals get very upset about what they perceive as the harm done by abortion clinics, but I assume you would not apply the same argument here.
It's also nearly impossible to fairly define. What constitutes "bringing harm?" or "corruption?" Medicare is the largest provider of health insurance in the US by far. Ergo, the administrator of Medicare is almost certainly responsible for more claim denials than Brian Thompson was. Is it acceptable to murder that person?
As an aside, Brian Thompson was not corrupt. Greedy, sure. But corruption is a specific thing.
I'm not sure your analogy works. The crux of the matter is that very wealthy people are much more able to avoid legal consequences when they do others harm. Seeing as we want especially them to behave well in our society, as they have a much greater influence on than most people, we need other ways to motivate them to act responsibly. Other ways to stop them. Vigilante justice is not a nice solution, not a good solution, but it might still be just. And regardless, for the people that need some external motivation to behave - and who happen to be rich - the fear of retributive violence is better than no fear at all.
I also disagree that "bringing harm" and "corruption" are nearly possible to faily define. If I cut off your arm, I've brought you harm, and you yourself say that corruption is a specific thing. If I truly believed that abortion was as horrible as profiteering off of denying people lifesaving treatments, if it was just as harmful, then I would also find it just and maybe necessary that violence found a very rich person that actively worked for increasing access to abortion. Again, the core problem is that a rich person lacks the checks that apply to the common people, not that they are necessarily less moral and therefore more deserving of violence.
I don't personally think that anyone deserves violence. I don't want a society where we solve our differences with destruction of the other, no matter how mild. And I don't know if Brian Thompson was someone who hurt the world drastically more than he helped it. Deferring a judgement that I cannot reasonably make, I choose instead to mourn the loss of Brian Thompson and Luigi Mangione. But I think that it is possible that such violence as was done against Brian Thompson can be just and necessary given the failures of our current society, if nothing else, then as a deterrence.
By this logic, any sufficiently zealous person would be just in murdering the target of their ire, as long as that target was rich.
You're touching on a reasonable point about how the ultra-wealthy generally face fewer consequences. But there are about 20 steps between that and "therefore murder as deterrence," and we've skipped right over them.
That is fair, I think my general despondency got the better of me, we certainly should search for a better deterrence than violence in the face of the very rich avoiding the deterrence of law.
I suppose my personal problem is that I don't know what that is. I don't see a lever for the common person to combat this problem. It is power against power, which within the law means money against money.
How does the common person compete in that game? Truly, I'd like your opinion, what is the moral action faced with such opposition?
Well the core question is what actual crime you think Brian Thompson (or other healthcare CEOs) is getting away with? What behavior is the law failing to deter?
I'm being fully serious. That's a very key point that often gets glossed into "rich people bad." And that's what I was getting at earlier with my distinction between criminal behavior and stuff we just don't like -- the former could reasonably impel action, whereas the latter is just... Life.
And here we disagree. I don't think only criminal behaviour should impel action. I believe its important to take personal action when one believes there is an injustice. Tempered, proportional, legal. Profiteering off of the denying people healthcare seems absolutely heinous even if it is legal and therefore I'd like to change that. A healthcare CEO is someone who runs that system. They have some measure of power over that system, and as such holds some measure of responsibility for perpetuating it. I'd like to make such a system illegal, and to get there I must act to forward that agenda. I don't think the murder of CEOs (or murder in general) is the solution, but action must be taken, and we need some way combat this behaviour outside of the money we don't have.
I don't think all rich people are bad. But they are powerful, the very rich tremendously so, and that power is unchecked. What do we do when they use that power for selfish but legal reasons to the severe detriment of most others? Must we accept that just because they would be found innocent in the court of law?
(I'm also generally sceptical of the means necessary to achieve the end of great wealth. To me it seems lees like something one is given because it is deserved and more sonething that is taken because it was possible, with all the exploitation that this entails. This mainly targeted tiwrds those that are not just single digit millionaires, but in the doubles and above. I'm certain that it is possible, but I'm doubtful that it is the norm.)
No man. Go do politics, I think that's great. Just don't go murder.
Fair.
Are all legal actions moral? Are all illegal actions immoral? Just because it's legal to deny care, delay treatment, and fight lawsuits to ensure maximum profits for shareholders doesn't mean everyone should just suck it up and accept it.
Again, the context is that we're talking about murder as deterrence.
More broadly, I'm not saying "suck it up and accept it," I'm pointing out that it's hugely important whether something is illegal, immoral, or just distasteful. It is a good thing to fight immoral (but not criminal) actions by voting, protesting, doing politics in general, etc. It's much harder to justify carrying out crimes (to say nothing of murder) to fight those immoral actions.
I specifically asked about what crime disco thought Thompson committed because disco's entire frame was that the rich are not held accountable by the law. That frame doesn't make sense if Thompson hasn't actually committed a crime.
But there's a stage further than the rich not being punished for violating laws that the poor are punished for, and that's when the immoral things the rich do are never even made illegal to begin with. I believe Thompson engaged in actions that were entirely legal. But saying that he didn't break the law and so that's the end of the story is missing the point.
As I said explicitly:
People are hurting, desperate, downtrodden, hopeless, strained past breaking, stressed, and beyond the point of empathy.
They are past the point of caring about those perpetuating and facilitating a broken system that is actively preying on them.
A couple of things:
First, the world is a pretty big place. Any famous murderer who is at least a 4 is going to have fans. I'm not sure how serious the science behind this is, but they do have a word for it.
Second, I think the memeification of Luigi is a little bit murkier than plainly idolizing him or the propaganda of the deed or whatever. Taylor Lorenz, who has been reporting on Internet and social media culture for a long time, made a video essay about the 'Somebody needs to do it' memes last year and I think it touches on your question. It's worth a watch, but the TL;DR/TMVF;DW is: frustration, despair, catharsis.
FYI your YouTube link includes your account in it. You might want to fix that.
Oh damn, I didn't know that they did that! Thanks for the heads up.
I had no idea there was a word for that. Thank you for sharing!
Same reason people idolise the French revolutionaries, I suppose. Or any revolution. All violent revolutions involve, well, violence.
Ideally society comes back from the brink where an increasing number of people feel that the nobility has left them no way out.
Mildly irrelevant but I still find it funny people idolize the french revolution when it not only involved things like executing 16 nuns from Compiegne because they refused to renounce their religious vows, it didn't even result in a democracy or republic - the continuation was a military dictatorship by Napoleon later crowned Emperor, ruling an Empire.
I think it's because it's one of the first cracks in the class foundation of Europe, and it inspired quite a lot of stuff we value today.
Like you said, a lot of innocent people died. I find it odd when people praise revolutions, but not the ones that were bad. All revolutions are a failure of the system. Sometimes they're necessary, but if your system has gotten to the point where the masses are picking up pitchforks, those masses are furious, and innocent people are going to suffer and die. The nobles, the servants in the palace, and innocent bystanders. We would ideally avoid that by not creating the conditions that allow for revolutions to form, (e.g. make sure people can afford to go to a hospital).
That's the whole point of liberal democracy - it's supposed to enable a political response to intolerable conditions before people start picking up pitchforks and bringing back the guillotine. I don't think there's any question the United States has been trending towards plutocracy for a while now.
Agreed although I feel like we would be the minority opinion here and that's ok.
I perfectly understand why he did it and all his motivations but I think this is a dangerous precedent to set. If you don't like the system, just go after the CEO.
I would also like to point that out all of us have been in toxic corporate or startup environments. I've seen a few threads here about it. Those can easily do a number to your mental health as you're dealing with that toxicity on a daily basis, 8 hours a day, 5 days a week and drain you. This is just a common example of the average person feeling gravely wronged by the system. I am sure there are millions of examples. Would be complete chaos if everyone tried the same way to seek justice.
I agree. Murder is wrong. I think the deal penalty should be outlawed. I think it’s absolute fucking bullshit that conscientious objector status in the US requires a religious affiliation. Why can’t I just be morally opposed to killing? Why do I have to have a specific religion?
That all being said, I also feel like company executives need to face consequences from the decisions that their companies make. Both civil and criminal consequences. And Luigi successfully made a CEO face consequences. Were they the right ones? No. Do I agree with what he did? No. But it is refreshing to see an executive face consequences for what feels like the first time in my entire life.
I can't find my previous post on this, but I quoted someone from Bluesky saying some like... When there are no other consequences, no justice, no legal defeats or public shaming, people will celebrate the only ones that they get, like their death or even murder. Because there's no other hope for a change.
Outside of precedent and morals, I’m not sure it accomplished much either. I remember that some insurance companies were going to be timing anesthesia and after the murder they backtracked. But, it’s not like there was widespread change with insurance companies.
Admittedly I did not investigate further so the below is just from broad knowledge and my uneducated guess.
To change a system is incredibly hard. Most systems are exploited for personal gain. It's unfortunately just how it is. There are and always will be people who are trying anything they can to exploit a system. So taking out execs or anybody will just have the next wave come in place. The only way to prevent this is by designing a system to maximize incentive across each party so that they act exactly as the system intends.
Here's how how the US medical system is designed today, an extremely dumbed down version: Employers wants to minimize paying for healthcare plans, insurance companies thus wants to both have cheaper plans yet appearing wide coverage so that employers buy them. Hospitals therefore want to charge insane amounts for specialized services because insurance are the payors not employees and insurance buys en-masse not by particular procedure. All this means as regular humans you have no choice but to participate into this game employers / hospitals / insurance play. You have limited choice or really almost 0 flexibility in decision making in the meta. Now it is not all bad. Having insurance means that for the average person, they can afford a life threatening or extremely expensive care without having to pay out of pocket. That part still works as intended albeit obviously not ideal for every type of care or treatment. Generally though it does work and many countries you do need to have $$$ or else you're basically toast.
Here’s a fun point of discussion: I believe that it is fundamentally unethical and perhaps even immoral to be a CEO of an S&P 500. The average salary in that position is over $22,000,000. To put that into scale, it is not only more money that I have made so far in my life, it is more money than I am likely to make in my lifetime. They are a wealth extractor that takes away from the budget which could be just as easily be used to pay more to the people who are actually doing the labor that runs the business which generates its income. They are thieves who run organizations which are themselves extractive, with anticompetitive practices which at best prevent their competition from having some of their business and at worst literally lead to people dying such as these insurance companies do. They are, effectively, mob bosses.
I believe in the concept of a “moral vacuum”. If enough people are incensed about something happening, the relative moral good of other actions increases. This works particularly well on an individual level. Why do people murder? “I had to. They were asking for it. They deserved it.” Someone was wronged so they thought the only way to correct it was to murder the person who wronged them.
You can say that this kind of thinking is wrong, that we have to be above it. And socially you are right, but this is a fundamentally human way of thinking. Everyone has a breaking point in which they get violent.
I don’t want people to die, but clearly our society has problems that the people in charge are uninterested in fixing. Murder may be indefensible in almost every ethical framework, but what do you do if you have no options to remediate the crimes done against not only you, but your family, everyone you care about, and everyone else in your nation?
You are right that things would be chaos if everyone would murder the people heading organizations that wronged them, but we do have examples of this happening: wars for independence and political revolutions. Do they always turn out well? Certainly not. But there are also examples where the people’s goals were achieved. Much like you, I’d much prefer to live in a world where leadership were flexible enough to preclude the assumed need for such things to happen.
Crimes is doing a lot of work here. I recognize that you believe it's immoral to be a CEO, but there's a huge difference between that and a crime. Particularly one that would justify murder.
To show why it's important to differentiate between subjective "immorality" and objective, legal criminal behavior, take this line of thought and flip it so that it's originating from a far-right individual who believes that Pres. Obama committed crimes against the nation, etc. I assume you would not condone the assassination of Pres. Obama simply because someone felt he had wronged not only them, but their family, everyone they cared about, and everyone else in the nation.
What is this objectivtiy you're speaking of? What makes criminality objective? There are laws, but they were written based on subjective morals. There are judges, but they are affected by their subjective morals. There are police officers, but they apprehend based on their subjective morals.
We've codified some of our morality as laws, defined some immoral behaviour as crimes. That does make it different from the uncodfiied cultural morality, but that doesn't make it objective. We still very much can - and do - disagree on what a crime is, on what us legal. Between countries, between states, between judges, between lawyers, between people.
Do you disagree?
Look, nobody serious disputes that the law is a social construct. My point wasn't "the law is completely perfect and impartial," my point was that there's a crucial difference between "defined as criminal according to our mutually-agreed upon framework" and "I, personally, think it's bad."
I don't really need to append "as per the legal code of the United States, as interpreted and executed by the US criminal justice system" to my earlier comment, right?
I agree that there is a difference, I don't agree that it is crucial in this case, and I think that even though you don't believe the law to be actually Objective, you are still presenting it as a much more objective thing than it is. "[T]he legal code of the United States, as interpreted and executed by the US criminal justice system" is not a self-consistent thing. Within the justice system, judges wil disagree. Present then with the same facts and they will give you different verdicts. The text of the law itself is interpreted by the judges. Their verdicts become precedent for future verdicts. But even this can and does get overturned, explicitly, implicitly. This is especially the case when the cases are rare - common theft not so much. But while a judge might pass quick verdict and define the crime of shoplifting, the actual enforcement of it's illegality (the crimes practical definition, if not it's theoretical definition) is dependent on the police officer or shopowner, both of which might be more lenient or strict based on personal convictions.
While our system of law is a mutually-agreed upon fiction, the definitions of the criminal are not. We delegate this to a system and it then defines this, essentially on a case by case basis. Certainly some things would never hold in (or go to) court, and some things are nearly consensually criminal. But many things lie in the inbetween, their criminality and severity being determined by the whims (well informed, but none the less) of those that man the posts of justice.
Say, you accuse your former president of crimes. But are they crimes until he has been convicted of them? Can you, according to your justice system, call him a criminal yet? You might think that he is, and others might agree, but he has not yet been convicted, and what actions he's done have not yet been judged. Unless his actions have very very clear precesence as illegal, the criminality of his actions would be up to the justice system.
The morality of people outside the law, is, conversely, also not as disparate as "I, persobally, think it's bad". Much of that morality is social, cultural, shared. Would youbkick a puppy? Would you help a friend in need?
Again, I think you are overstating the consistency of the justice system, and understating the consistency of social norms.
We're going pretty far afield. Even if I grant every single point you've made above, that doesn't really mean much of anything for my core assertion that personal outrage is not a legitimate basis for vigilante violence.
You argued that there was a great difference between crime and personal belief, I thought that you overstated the difference. In this thread (I realise that by now we have several) I contest this point primarily. Your assertion on vigilante violence was not explicitly mentioned in this thread, and I've only belatedly realised that you argued it elsewhere. I myself am unsure if violence is justified, in this case as in most others, but I do hope that my point serves to put vigilante violence closer to lawful violence, personal conviction closer to common law, if not on even footing.
I'm not sure where legitimacy comes in when discussing vigilante violence. The basis for vigilante violence is situations where the government, who normally maintains a monopoly on violence, is perceived to be incapable or uninterested in resolving the fundamental concerns of the populace. Note I'm not defending it, just talking about the situations in which it is likely to emerge. Within that framework, what other basis is there for vigilantism but outrage so severe that someone who feels there's no other way to resolve their issue and is moved to violence? As such, trying to frame some vigilante action as legitimate or illegitimate is entirely missing the point.
Please note: I'm not saying it's right or good. Only that it's a reaction to situations where it's believed that there are no other options for redress.
Why not? The US government is doing something reprehensible somewhere in the world at all times and is literally directly murdering people. As a counterpoint why not have Trump or Bush murdered? Both of them were objectively criminal and continue to get away scuff free.
The law is irrelevant. Law is a measure of organization. It is the force of government on the people. It is very different from morality or ethics, and is in many cases adversarial to them. That is the very problem we are addressing; the laws exist to uphold and empower a small class of people at the expense of the masses, and that is something that should not be tolerated.
In any case I am not saying that I think we should all go out and murder people, I’m saying when all avenues for change are closed it is the best possible option. Like it or not, that is the world we are living in. Our elections are becoming increasingly restricted and our politicians are so dedicated to the status quo we are only now starting to get some of them who are willing to admit to basic things like the Palestinian genocide. The majority of politicians in office right now are fairly dedicated to the cause of letting the ultra-wealthy extract even more from the masses. We are in a very bad place.
You keep jumping to people that you personally don't like -- Bush, trump-- and my point is that by the standard of "murder is justified if they did something I think warrants murder," everybody ever is a valid target.
Biden and Harris provided arms to Israel. Why are they not a valid murder target, in your framework?
The danish government is separating greenlanders from their children. Why is it not valid to murder the Danish PM?
The Medicare administrator is responsible for more denials than anyone else. Why are they not a valid target?
The people in power already have power. They don't need the law. The law protects the weak, and the fact that it doesn't always work or can be subverted doesn't change that. If the US government wants to come take your house, they have to use the courts to do it. They can't just show up with a gun - and if they did, you could use the law for recourse.
These sentences together literally suggest that we "all go out and murder people" as the "best possible option" in the world we are living in. I'm not accusing you of directly advocating for murder, I get that we're just talking, but the literal meaning of the words is that.
I already said every us president is subject to this. As the heads of government, with impeachment proving to be completely ineffective, assassination is literally the only punishment a president will ever receive for their actions in office.
Laws exist to protect the government. The rights they grant are the bones they throw to the people to prevent them from uprising. Restraining their power is merely a means to reinforce the illusion of justice and legitimacy. If the government wants to do something that is illegal it will and then it will simply come up with a framework to make that action legal. See, for instance, what the US did to racially Japanese citizens around WWII.
If you genuinely believe that it would be justifiable to murder any US president (and at least some CEOs) because you fundamentally believe that the legitimacy of the law is an illusion, our views are far enough apart that we're not going to find any common ground on this.
For any others -- among the many problems with the "laws are just an illusion to control the masses" as a belief is that it's completely unfalsifiable. By definition under that theory, any restraint on the government is actually just another layer of the illusion, and so it never stops being okay to assassinate people. It's also a theory that completely ignores the millenia-long development of the entire concept of law and, indeed, citizenship. And finally any theory that treats "the government" as a unitary body (especially when we're talking about a flawed democracy) should be treated with at least a little caution. Trump and AOC and your local mayor are all "the government." The DA and the public defender are also "the government." Asserting that "the government" can just do whatever it wants ignores that in modern republics systems are set in opposition by design.
The issue is you’re defining these units of Wrongness and accompanying Unaccountability that can justify murder. But anyone can do that, for almost any reason. You don’t have any issues about what the end state of that world looks like?
I don’t want anyone to be murdered. But I also don’t want people to be unaccountable for their actions. But as long as we live in an unequal society we will continue to see assasination attempts.
We see assassination attempts for all sorts of reasons though, all probably rationalized to some degree by the perpetrators. MLK was assassinated by a white supremacist and I'm sure the assassin thought it was the best option available to him.
So when you say
I think that's both defeatist and actually a much worse vision of the world than the one we're actually living in right now, precisely because most people still believe in the law and all avenues for change are not in fact closed.
Without the actual law, you just get the law of the jungle or might makes right, and that is not going to lead to a fairer or more just world. Is it possible whatever emerges on the other side is fairer? Maybe? But it's also possible that it's much worse.
Frankly I agree with you. But I also believe that while positive change isn’t impossible, it’s been made monumentally difficult and the deck has been stacked in favor of those with power, with the trend further entrenching power further and further away from the people. If, on the other hand, enough people thought things were hopeless and discontented, Mangione could have sparked a revolution, for better or worse (and in the short term, absolutely worse).
Maybe I am being defeatist. But civil rights are being defeated constantly in recent years. We recently saw rights to abortion get clawed back, and we are watching trans rights getting trampled in real time. Americans are supposed to be promised life, liberty, and the pursuit of happiness, but it certainly doesn’t seem like society is set to achieve that for everyone.
We all deserve a fairer society with better opportunities and a general baseline of welfare. I would vastly prefer to achieve that through nonviolent means. And frankly given the rise of fascism I don’t think that a revolution would actually achieve this without the country going through another civil war.
It would be better to take to the streets and announce immediate general strike and that you will occupy key public institutions and imprison given set of people (typically lawmakers, elected officials and billionaires) unless wealth cap of $10M is implemented by the next tuesday and any attempts to prevent that by civilians, police or military will be met with deadly force as a necessary self defense.
Leave the first shot to them.
One can dream. At least vote for Bernie's friends, please.
Probably better to be in a federal prison rather than a state prison. Especially given the many problems surrounding the New York state prison system.
Also better to be sentenced for stalking than first degree murder. Not sure what the sentencing range is in federal stalking charges or if there's aggravating factors.
Well I'm confused how admitting "I shot him" while pleading guilty to stalking helps with the not guilty plea for murder.
It's basically a gamble on double jeopardy. New York has stronger double jeopardy laws than many other states. Since he's now been convicted in this case, the argument is that he can't be tried in NY. And the state was worried about a federal plea deal tanking their case.
But how does that tie to the state murder charge? Doesn't it just potentially preclude the state stalking charge, which I imagine is the least of his concerns.
Because it's for the same conduct. The same overall action.
New York laws are more protective of defendants than you're thinking. It's not charge for charge, he's being convicted of stalking in the action of the murder.
Does Mangione's guilty plea in federal case jeopardize his state murder trial? - CBS News
Which is probably why his plea included the statement, because it makes it clear that it's all one successive action.
It's no guarantee, but it's probably his best shot.
Also, I learned all this from articles like the one I linked. If this still isn't making sense to you, I probably won't be able to explain it to your satisfaction so arguing with me or questioning me about it won't be useful.
It’s not just stalking. It’s stalking with the result of death. The maximum sentence is life, which is what the federal prosecutors are going for as well.
It’s not like what obsessed gf/bf’s get slapped with.
I'm not deeply aware of how the US healthcare system works, so a few questions that might be ignorant follow.
Isn't it so that a vast majority (80% or more) of insurance claims are accepted and paid normally? Are the denials done according to a contract that both parties agreed to?
Given how the healthcare resource is not infinite, doesn't there always have to be some kind of rationing? Why is the rationing made by an insurance company that individuals are free to choose worse than rationing made by some central committee?
How is the limited healthcare resource improved by forcing the insurance companies to top up their senior management's security?
Depends on how critical the denial is, doesn't it? As /u/rosco, /u/DefintelyNotAFae, and I mentioned, some of those 20% private insurance denials are disabling (physically and financially) at best, life-threatening at worst. The denials often go against medical standards of care with little if any long-term cost savings, and are completely opaque to the people receiving them.
The majority of working people in the U.S. have health insurance through contracts their employer agreed to. The quality and coverage of these contracts varies wildly - you must take whatever the job provides, and lose it if you lose employment. There are insurance marketplaces for people whose jobs don't provide any coverage (also self-employed, intermittently employed, etc.), but again, the policies are very costly and often unaffordable (moreso since the suspension of subsidies, causing millions of people to drop coverage) or insufficient.
An insurance denial doesn't actually block care except to the extent that the insuree can't pay for it. Which is nearly always, given the astronomical non-negotiated prices outside of insurance coverage, and low wages. Employers often explicitly justify relatively low wages due to the cost of health benefits... In any case, there's not much incentive to align the insuree's interests and the insurers, other than long term healthcare costs. And long term costs are buffered by the government insurance program, Medicare, which workers age into.
Policies in countries with public insurance usually include a transparent process to evaluate the cost/benefit ratio of treatments, as well as the ethics of denial. It's not great emotionally if it's your grandmother who didn't get the $2 million dollar chemo that might extend her life by 6 months, but I'd personally take that denial if it means 1,000 kids get care they wouldn't otherwise.
I do not argue that threatening the lives of insurance CEOs will improve anything - I'll let someone else make that case.
Edit: I've left out a lot of nuances that make U.S. health insurance even more complicated to explain, like preferred provider networks and denial of coverage outside them. Even Medicare isn't really a "single payer" program, since there are coverage exclusions and private insurance for those.
I wonder how this'll impact the state trial since he more-or-less admitted to Brian Thompson's killing and have basically given prosecutors enough ammunition to land him behind bars for life without parole.
Federal stalking offences carry a max sentence of five years, and since we're talking about a plea deal...
The maximum sentence for federal stalking resulting in death is life imprisonment without parole.