US thought leaders are struggling to deal with the fallout of the killing of Brian Thompson, CEO of the insurer United Healthcare. The suspect, Luigi Mangione 26, who has millions of page views as a hooded assassin, and now as a protesting detainee in an orange jumpsuit, has become a cult hero on social media. Some see him as a Robin Hood out to teach the mean insurance companies a lesson; and legions of girls are swooning over his smiles and six-packs.
Even as the police collect evidence in what seems to be a watertight case of premediated murder, donations have poured in from online supporters. So far, $50,000 has been collected through the GiveSendGo fundraiser.
A post on Redditt said: “It’s not going to get better any time soon. As long as corporations are considered people, and money is considered free speech, we are stuck in this dystopian hell we call healthcare.”
Josh Shapiro, Governor of Pennsylvania, where Mangione was arrested, said the support for the killer was “deeply disturbing”. Police officers working on the case have described him as a ‘stone-cold killer’.
A crime is a crime; but from the emerging public evidence, it seems Luigi Mangione was sending a message. The bullet casings left behind on the Manhattan sidewalk where the United Health CEO was shot had ‘Deny’, ‘Defend’ and ‘ Depose’ inscribed on them.
Investigators say it is a reference to the 2010 book ‘Delay, Deny, Defend: Why insurance companies don’t pay claims and what you can do about it’. Documents found on Mangione indicate he wanted to get even with the ‘corporate greed’.
The message seems to be gaining traction. Reuters has reported “Wanted” posters with the faces of CEOs have appeared on walls in New York. Websites are selling Mangione merchandise, including hats with “CEO Hunter” printed across a bullseye.
One week after the murder, Jay Feinman’s 14-year-old book ‘Delay, Deny, Defend’ had shot to the top of Amazon’s insurance law category. US companies meanwhile are scrambling to ramp up security for their top brass; and healthcare insurers have gone in to a huddle on how to clean up.
Insurers play dirty
Healthcare in the US, possibly the most expensive in the world, is intertwined with a web of complex insurance schemes promoted by the private sector. There’s certainly no welfarism here; it is a for-profit insurance industry. The unabashed push to keep profits booming leads to the three-stage system – to first delay claims, then to deny them, and then finally defend the denial. No wonder there is so much resentment and hatred towards the insurance industry.
In a first response on Friday, UnitedHealth Group CEO Andrew Witty admitted the US health is “not perfect”. In a guest article in the New York Times, Witty said: No one would design a system like the one we have. And no one did. It’s a patchwork built over decades.”
Politico Magazine reported the United States spends one sixth of its GDP on health care, yet 8% of its citizens are uninsured, and about 23% are underinsured. In a recent survey by the Commonwealth Fund, 17% of respondents said their insurer denied coverage for a procedure recommended by a doctor within the last year.
Political scientist Miranda Yaver of the University of Pittsburgh, quoted by Politico, said: “in 2022, over 1 in 4 Americans reported delaying or foregoing medical care, prescription drugs, mental health care, or dental care due to cost, with 17% of insulin users reporting in 2021 that they ration their insulin. It is little wonder a November 2023 Gallup poll found that just 31 percent of Americans trust the U.S. health care system.”
Social banditry
The Politico article by Joshua Zeitz relies on a 1959 analysis of Marxist scholar Eric Hobsbawm who introduced the concept of ‘social banditry’ in the lexicon of sociology. ‘Social bandits’ at different points in history emerge – sometimes real, sometimes fictional – and they are revered for the instant justice they mete out in an unequal world. Jesse James or Billy the Kid, in the post-civil war era, though extremely violent, were looked upon as Robin Hoods and glorified for attempting to correct inequality.
What Hobsbawm said was when the state loses its ability to address people’s concerns, the people sometimes look to outlaws, when they attack and try and bring down the establishment.
That a 2010 book should comeback as a bestseller – described by Amazon as an “expose of insurance injustice and a plan for consumers and lawmakers to fight back” – shows the problem has not gone away.
In India, we are hobbled by both poor healthcare infrastructure, as well as well as low insurance cover. According to the National Health Profile, India has only 0.9 beds per 1000 population, of which only 30 percent are in rural areas.
Healthcare insurance too has low penetration, with only 14 percent of the people in rural areas and 18% in urban areas having access to any sort of health insurance. What we have is starkly unequal. Healthcare policies largely cover only the rich and the educated elite.
India’s insurance sector is mainly run by for-profit, private insurers while the public health insurance schemes – the Rashtriya Swasthya Bima Yojna (RSBY) and the PM Jan Arogya Yojna (PM-JAY) – have limited reach. Though clunky and inefficient, in the long run public, government-funded schemes – even if they offer a maximum cover of Rs 3 lakh – will serve the people better. There is still time. We need not go down the pure ‘capitalist’ model like the US.
