Eat The Rich?
Blue shell or not: You missed
Well, I woke up this morning
On the wrong side of the bed
And how I got to thinkin'
About all those things you said
About ordinary people
And how they make you sick
And if callin' names kicks back on you
Then I hope this does the trick
-Aerosmith
A lot of people want to canonize Saint Luigi. As ever, a lot of people are dumb. Let me see if I can persuade you that he did nothing that will help anything.
NEWS ARTICLE:
assassin takes out pharma insurance megacorp CEO and escapes on rented ebikeME:
… are we sure this isn’t a deleted plot line from Cyberpunk 2077?
If you missed the media circus, here’s roughly what went down.
On December 4, 2024, health insurance CEO Brian Thompson was shot and killed outside the New York Hilton Midtown in Manhattan, where he was attending UnitedHealth Group's annual investors' meeting. The mystery assailant escaped into Central Park on an electric bike, and a huge manhunt ensued: the news trumpeted the latest updates like the discovery of his backpack… filled with Monopoly money?
This complete clown show ended five days and a few hundred miles away with the arrest of Luigi Mangione in a McDonalds in Altoona, Pennsylvania, after being recognized by an employee from surveillance images circulated by the police and blasted over every media channel possible. He was in possession of various incriminating items including a ghost gun, a silencer, fake IDs, and a manifesto expressing his grievances against the healthcare system; he hadn’t bothered to dispose of literally any of this incriminating evidence.
The image caught on camera used to identify the culprit:
Incidentally, if you want to make a fashion statement, Macy’s had a huge run on this particular jacket amongst those who for some reason found it very fashionable; as I write this, it’s on end of season clearance.
I can’t claim to understand entirely what went through the man’s head. According to various reports, Mangione had a personal grudge against the medical insurance community due to how it treated a sick relative and his own health issues, particularly chronic back pain from spondylolisthesis. He also held anti-capitalist views (despite being a trust-fund baby from one of his hometown’s wealthiest families) and was influenced by figures like Ted Kaczynski. His writings indicated a disdain for corporate America, specifically targeting UnitedHealthcare because of its size and influence in the healthcare industry. Various conspiracy theories have circulated about whether Mangione was “one-shotted by ayahusca” or otherwise chemically not in his right mind; I have no idea whether to give them any credence, but it’s a little odd for someone who got his masters degree in computer science to get radicalized by the technology-rejecting Unabomber manifesto. (The Washington Post has the Unabomber’s manifesto online, which I find hilarious, and I’m sure he’d hate them for that.)
There’s been reference made that Mangione chose his silenced gun rather than a bomb in order to not endanger others. In any case, it clearly sufficed, and all other things being equal I’m glad to not have bombs on the streets on Manhattan.
Mangione has been charged with first-degree murder, second-degree murder, and various weapon and forgery charges. Federal charges were later added, including stalking, use of a firearm with a silencer, and murder, making him potentially eligible for the death penalty. (I mean really? Stalking? Somehow that seems like “…and one moving violation.” )
He was extradited to New York for trial; the mayor decided to make his perp walk a photo op which seems to have hilariously backfired and stirred up yet more public support for the man.
It is unclear how quickly this will go to trial, and though it will undoubtedly be a media circus to rival the OJ Simpson case of the late 1990s, it does not seem to me like Mangione has a good basis for any sort of defense other than the court of public opinion. Mind you, there is enormous public sentiment against the current state of affairs as to how health care is handled in the United States and in particular how health insurance companies are seen as denying critical care when doctors prescribe medically necessary services, so the public discontent / rage with the situation is pretty commonplace. And certainly it’s no great leap from there to the thought that the health insurance companies are profiteering by gouging their clients for insurance premiums on one hand and denying them lifesaving care on the other, right? This line of thought might depict Luigi Mangione as Robin Hood.
And it’s not even a little unreasonable to think “Well, UnitedHealth Group is the 8th largest company in the world by revenue: bigger than Microsoft, Sony, Samsung, JP Morgan Chase, Exxon, only $2 billion behind Apple - $389 billion last year, that’s an astronomical amount of money. You could almost pay my bar tab.”
UnitedHealth also denies 32% of its claims, highest among the major health insurers, and is innovative in having set up an AI system to automatically process (and largely, automatically reject) patient claims “in order to keep costs down” as they put it. But rejecting patient claims will mean either “medical procedures aren’t approved in the first place” or “reimbursements aren’t made” or “aren’t made at the level the insured person was expecting” all of which amounts to people who are unwell being in a position where medical care is not available or not affordable to them.
Why do we have this strange awful business? Is it huge profiteering? Yes, to a point, but the amount of profiteering that can exist is federally limited by the same laws that have basically enabled the consolidation of this industry. You’d not be surprised to learn that this is the Affordable Care Act aka Obamacare, which both mandates that Everyone Must Buy Insurance or they will be fined, that insurance companies can only make a certain level of profit off those fees (capped by law at 8%), and the combination of those two incentives has led to consolidation and mergers in the space to give us Giant Uncaring Insurance Companies. But critically, what it did not give us was insurance companies that were actually interested in lowering the cost of health care! Because, you see, these guys make a percentage of the overall cost structure - so if they managed to reduce the cost of health care overall, that would save you the consumer money, thereby reducing their commission. And it’s worked out for them, UnitedHealth stock is up 800% since Obamacare became the law of the land.
I’ll write more later on how to actually fix health care and how we ended up with this particular broken mess. It’s not a small/short process, but the Affordable Care Act wasn’t exactly it. And spoilers - socialized medicine is not it either.
However, even if you mandated that UnitedHealth and all the other health insurance companies literally couldn’t make a dime - that they all had to run as non-profits, or you socialized them outright, you’d still have the problem that congressmen at the time of the Obamacare debates demonized as “death panels” but which are more commonly called “triage” or “care rationing” - briefly summarized, there is a nearly-infinite demand for health care and a limited amount of medicine and doctors to go around, so not everything gets treated optimally. If you took all the insurance company profit out of the equation (and no efficiency was lost, highly questionable) it’d go about eight percent further, which… is something. You might get a little further if you turned the screws on compensation for executives at Big Insurance Companies, eg if Brian Thompson had been making $450,000 a year instead of $10,200,000 a year, but that’s still kind of a rounding error against an overall top line of $389 billion a year.
But there’s another point about insurance and its role in health care that everybody knows and that we don’t often talk about in these discussions.
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
That's how it goes
Everybody knows
-Leonard Cohen
In this country, health insurance doesn’t do just what you’d traditionally use insurance for - which is catastrophic risk mitigation; the premise being if everyone pays a little, nobody has to pay a lot in the case of the black-swan events like getting hit by a car or getting cancer or something else that is catastrophically expensive to deal with. But the system has gotten to the point that - especially with health insurance - it's also effectively a collectivist group buying plan for bulk discounts on medicine and medical services due to co-op discount buying power. And insurance companies, eager to reduce the likelihood of enormous payouts, are willing to see to it that various small payments are made (e.g. your free flu shot, because the cost of that to the insurance firm is less than the actuarial cost of treating you multiplied by the probability of you getting sick.) It’s also why you pay only $2 for penicillin when you go to Walgreens, and probably another $3 for the bottled water to wash it down with.
That may sound contradictory to what I said a minute ago, so let me pre-emptively clarify. Doctors and hospitals have a great deal of interest in keeping prices for their services relatively high; likewise, major pharmaceutical companies invest heavily in new medicines and then look to charge a great deal over the lifespan of the patents to derive value from their investment. But there are products that do have free-market competition and for which you tend to get very affordable solutions, such as generic medicine that is no longer subject to patent-restricted single-vendor production. There is no one trying to “keep up the price” of these older medicines (conversely, there is no one trying to advocate these medicines for new conditions, so in some cases doctors have to prescribe them “off-label” to treat diseases for which no one is willing to pay for the full cycle of FDA testing as they will not recoup those costs.) Noah Smith wrote a good bit about the economics of all this, and though there’s points with which I subtly disagree, I think he’s sufficiently on topic that I recommend reading it if you have the time.
But all that being said. Luigi threw his life away for an empty gesture that will change nothing.
It won’t drive health care reform; the US won’t move to socialized single-payer medicine nor make any consequential changes in how the insurance companies interact with hospitals and doctors. There isn’t sufficient support for expanding Medicare into the proposed Medicare For All single-payer solution for Americans (in fact, many hospitals and doctors have stopped accepting Medicare patients because Medicare doesn’t reimburse enough, and so correspondingly, Medicare patients tend to get short shrift.)
Our other and possibly better primary example of single payer medicine, the Veterans Administration hospitals, exist to serve the veterans, service members, and their families - for those who have served active duty in the military and in combat zones. The VA also covers funeral/cemetery services, but let’s not get off topic. One of the unspoken reasons that you are unlikely to see better general purpose health care is that it devalues Veterans Administration healthcare (and thus makes it less attractive to enlist). Though I will say basically everyone I know who does get their healthcare through the VA is less than thrilled with it - definitely a mixed bag.
Of course things are worse off for the family of Brian Thompson - though he was already separated (though not technically divorced). And a few other less than glorious things have come out about him as the spotlight fell on him: a drunk driving plea bargain and rehab treatment, a rather expensive bit of insider trading. But definitely an unhappy spouse. It’s almost as if there’d be other candidates with a motive to have done this! Beyond, say, 52 million UnitedHealth customers and 440,000 employees and 17 million health care workers in the US who are potentially not getting paid if United Health decides that their procedures aren’t reimbursement worthy. Barely any suspects at all. There’ll probably be some attempt to cast doubt that they caught the right guy, but I doubt that will go anywhere.
No question things are worse off for Luigi Mangione himself too. Whatever his master plan may have been, this wasn’t any sort of glorious martyrdom or clever skip-the-country sort of Roman Polanski maneuver. Getting picked up in, of all things, a freaking McDonalds?
There’s little hope that any sort of social outcry or groundswell of grassroots support is going to bring Mangione any sort of relief; the governing class is too firmly aligned with his victim and will be all too glad to make an example of him.
And as I’ve written elsewhere: a couple days after this happened, before we knew who Luigi was, an fierce and indignant sympathizer was trying to tell me that This Would Change Everything and that Actions Have Consequences. I told her I doubted it could change anything much except for who was the man in the CEO's office, but that it did indeed have an unintended consequence: United Health (and many other companies) would now spend even less on customer health care because they would be spending more on executive protection; nobody wins except maybe the Pinkertons. And once legislators get to it, we’ll probably get even more of a surveillance state.
And that is not an outcome any of us wanted; it is objectively worse than back in November.
Mario Kart Wii is one of my most played games but man do I hate the social justice shell.
The point of Luigi isn't that the murder will actually change anything. Its just that a thing happened