Yelling at the Clouds

Luigi Mangione, a 26-year-old man, just shot and killed a prominent healthcare companies’ CEO in cold blooded murder. After he shot the CEO – using bullets with the words ‘Delay’, ‘Deny’, and ‘Depose’ inscribed on them – Mangione, in Midtown Manhattan, found a bicycle and rode off, evading law enforcement for 5 days until he was caught – at a McDonalds in Altoona, Pennsylvania. Mangione was a man who had a lot going for him. He was educated at UPenn, studied computer science, and was working remotely as a software engineer from Hawaii. He appears to come from a privileged background with a loving family and a good upbringing. Mangione also almost certainly had health insurance.

Despite this, he became enraged by the healthcare industry. So enraged that he performed one of best demonstrations of violent protest I have ever seen.

Violent protests are not usually successful, but they sometimes can be the most impactful. There are some examples of successful violent protests, like the assassination of the former Prime Minister of Japan, Shinzo Abe. Abe was the member of a cult – the Unification Church. He was assassinated by a Japanese citizen whose mother was a member of that same church – the cult bankrupted her through her 30-year membership, like it has done to so many of its members. Since his killing, the church has been fined by the Japanese government for refusing to answer questions about their organization. The government is now looking to dissolve the church through the court systems. Other potential examples include the rise of the Black Panthers during the Civil Rights Movement or the self-immolation of Monks in Tibet.

And so, as we all react to this story, some really expect us to believe that Brian Thompson, the shot CEO, is the real victim here. That UnitedHealthcare’s goal was to get people the treatment that they needed, and that they were doing their best to make a broken system work. “No one would design a [healthcare] system like the one we have…” wrote Andrew Witty, the current CEO of UnitedHealth Group, “Our mission is to help make it better”.  

These companies are either in an intense state of delusion, or this this is just corporate PR bullshit to make us feel better. UnitedHealthcare has one of the highest rates of denial of care of any health insurance company in the US. They have been accused of using artificial intelligence to wrongfully deny patients, relying on a confused and uneducated public that appeals denials at a <1% rate. “As a reminder: The US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy,” writes Mangione. These companies “simply have gotten too powerful, and they continue to abuse our country for immense profit”. And profited they have – UnitedHealthcare has profited $15-23 billion each year since 2020, profits only increasing as their denial tactics continue to improve.

Violent, this protest certainly was. If it was successful remains to be seen. The mere fact that I and so many others are thinking about this event might be success enough. The system is the way it is because “the American public has allwed them to get away with it,” wrote Mangione in his handwritten manifesto. Just like so many of the large, challenging problems our society is facing, this problem too is perpetuated by a population that feels indifferent to or immune from the negative externalities of the US healthcare industry. We want profits and growth but can never picture ourselves on the other side of a denied $200,000 medical bill.

Until it gets us – like it got Mangione. And it bankrupts us. Or kills us.

“Health care is both intensely personal and very complicated,” wrote Witty as he fished for pity in his New York Times Opinion piece. I agree, it is intensely personal, and very complicated. Would you like to hear a story I have to share?

A few years ago, I got shoulder surgery to fix my chronically dislocating shoulder. The surgery went smoothly and I lived happily with the results for a year. Well after I was finished with physical therapy and done talking to my doctor, I got a notification in the mail; my bills were denied by insurance, and I was expected to come up with $200,000 for my care.

My parents and I were confused. At the time I was on their health insurance and went through the necessary steps to get authorization for the surgery. After a few calls with the insurance company and closely scrutinizing the legal word soup of my denial, I noticed there was an error on one of the forms. I was being auto denied because of a clerical issue on the insurance companies’ side, resulting in my authorization not being considered. I called the insurance company and they agreed with the error. They said they would fix it immediately and it should go through.

A few weeks later, I got a new letter in the mail. Denied. I looked to see if that error was still in the form, and there it was. I received the same, uncorrected form in the mail. This repeated 5 more times. Each time I wasted almost an hour bringing the poor soul on the other end of the line up to speed on the issue. Each time I got confirmation that this indeed was an issue and that they would fix it. I even went and formally appealed this decision. Each time I was denied.

Can you imagine being in this position? 26 with your whole life in front of you and $200,000 of debt gets dumped on you, all because of a clerical error? These devastating stories you hear about the healthcare industry are real and should frighten all of us. It really can happen to anyone; even someone with a job, good health insurance and who tries their best to navigate the system correctly.

In my case, the insurance company never bothered to fix this error and continued to deny me. Luckily, I was on my parents’ insurance at the time, and my dad had a high up position at his company. He spoke with his benefits team about this issue who then threatened to drop the insurance company entirely if they did not fix the issue. Within a week it was solved, and my debt was cleared.

I know this is not most people’s story. I got lucky. I empathize with Mangione deeply because I know just how easily I could have had my life derailed to get the care I thought I needed. That I earned by being a productive member of society. Profits and the wellbeing of people clearly do not mix. We spend, go broke, and die at a far higher rate than the rest of the world. It is in the health insurance companies’ best interest to make sure we don’t get the care we deserve.  

The current system is outrageous and deserves furious anger. If it takes three bullets in Manhattan for us to all see it, so be it.