I thought immediately of what Hilary Mantel said in 2009 after winning theBooker for Wolf Hall: "Henry VIII was in chronic pain. I know what that does to degrade the personality, to detract from rationality". That kind of primal reaction is made far more likely by a context of systemic failure - the crazily high cost, low results US healthcare system which even at luxe level (my personal experience with no refusal of care or other serious battles), is still stressful, $$$$$ and pettily dehumanising (eg. unexpected "out of networks" eg for an anaesthetist in emergency care for my child, not allowingszid child even into emergency room until I had found my insurance card). Pain-wracked, isolated, feeling a cog in a terrible anti-human system: a horribly predicable risk equation for such a terrible act.
Henry VIII; also George III, more familiar to Americans, who suffered a maddeningly painful disease (porphyria) which eventually led to his being treated as, you know, mad. And subject to the usual extremely painful so-called treatments of the time,
A couple of thoughts after reading this well argued post on Luigi Mangione (and of course Ian is right in his final judgment that "the adulation of Luigi Mangione is a sickness.") First, to say that "the response of many Americans to this cold-blooded murder has been breathtakingly amoral" gets at something fundamental about a very troubled country and its fading civic society. And second, nothing is more emblematic of this sickness than the American health care system, which has a business model built upon denying care and forcing patients to fight for what they're clearly entitled to, knowing most of them won't. My daughter was recently in a serious accident that required trauma surgery, but her insurance company denied everything at first because it was "out of network." A two-year battle ensued, in which the company ultimately paid everything—thousands and thousands of hugely inflated costs for the hospital, doctors, ambulance fees, etc. etc.—and, in the end, essentially acknowledged that all of its profit-maximizing denials were completely improper and unlawful. This is an incredibly sick system that's become accepted by everyone in America simply as the way things are. Maybe this helps explain why so many want to see Luigi Mangione as the hero he's clearly not.
I still think he had a psychotic break. He's the right age for onset of schizophrenia or bipolar disorder. I realize we don't know yet. But I think we'll find out. I'm sure his lawyer will insist on a battery of psychological tests. I just don't believe this heretofore sensitive, intelligent, mild-mannered guy suddenly became a cold-blooded murderer unless he was suffering from some extreme form of mental illness.
As someone who deals with acute psych admissions every day I tend to agree. Of course, his apparent level of organization in planning the crime is difficult to align with that theory — but then there’s also the fact that when he was caught, he still had the weapon on him etc., which seems very odd that he didn’t think to discard it. If this is the case I hope he gets the help he needs. It’s very sad to see photos of his bright smile, looking happy and healthy, and hear from all the people saying what a lovely person he was.
I live in Baltimore, where he's from, and as you can imagine, it has dominated the news here. So many people know this family and know Luigi Mangione personally and simply cannot square his actions with the guy they knew. It is incomprehensible to them.
Of course Ian is right that no one should be glorifying this murder. I certainly haven't, and nobody in my circle has, either. But we do understand the rage, the absolute fury, that has exploded all over the country due to the vile health-so-called-care system we have in the U.S. Everyone -- and I do mean everyone -- we know has a horror story about trying to get their insurance to cover medical costs.
The murder of Brian Thompson obviously won't make a difference in the long run -- these execs will simply harden their defenses, hire more security, further insulate themselves from us peons -- although I will say that the obscene, unconscionable policy that Anthem was just about to put in place to not cover the cost of anesthesia for the full length of surgeries was IMMEDIATELY rescinded. That happened the day after the murder. There's no way they would've done that had Thompson not been killed.
As is clear from my post I really don’t like these ‘but’ statements . ‘Murder is wrong BUT’... Nothing, absolutely nothing Brian Thompson did invited or deserved this. And we shouldn’t *want* this killing to “make a difference”. That would just incentivise more killings.
Of course murder is wrong. I completely agree with you. And the atrocious health insurance industry in this country is also wrong. Both things can be true.
Maybe (I’m not clear why it’s insurance specifically that is meant to be at fault rather than the structural incentives of the industry) but by using this murder as a trigger to talk about it people are taking the murderer’s bait and incentivising others to use this gruesome method of getting publicity for their pet cause.
Oh wow yes it must be whole other level being in Baltimore. His poor family.
I remember reading about that anesthesia policy in the days before the murder. Absolutely despicable. I’m in Canada and work in healthcare; my heart hurts (and my brain bubbles over with rage) whenever I hear about what people in the US go through with the private system. It’s inhumane.
Healthcare in the United States is obscenely expensive and like other businesses has been co-opted by business oriented models to supplant clinical decisions by managers who drive their practitioners to maximize efficiency and minimize costs. Healthcare corporations seem to be in a reciprocal death dance with insurance companies to see who can squeeze consumers the hardest. Medical debt is one of the biggest drivers of personal bankruptcy. Mr Thompson’s company had denial rates that are almost double of their rivals, which resulted in massive corporate profits. Thus he was probably not randomly chosen by Mr Luigi. Murder is never an acceptable response to such business practices. The unseemly online response must be seen as the bottled up rage of a populace who feels completely powerless in the face of such faceless corporate power.
Re the statement, "While there are obviously problems with the system, most Americans are happy with their insurer," I offer a reader's comment from a different Substack essay. Quote:
GD Morris
Dec 13
I do not believe the stat that 81% of people in the US are happy with their health care. Why? It is easy for questions to be designed that yield the outcome you seek. Simple questions that should be asked are "has your health insurance company denied a claim in the last year?". Follow that one up with "Has your medication been denied or changed without your approval in the last year?". Here's one I'd sneak in "What's the average wait time for any medical appointment you've tried to make?". Finally ask "Are you getting your moneys worth for the premiums you're paying?".
If you just ask "Are you happy with your health insurance" people are going to think "I guess". or "Yeah, whatever". That's not getting to the heart of our failing health care "system".
I wouldn't underestimate the fact that many find Mangione highly attractive for the nature of the public reaction. I bet this it's more "ooh look at this sexy guy, I'm sure he's an angel at heart" not a detailed contemplation of the morality of health insurance.
I thought immediately of what Hilary Mantel said in 2009 after winning theBooker for Wolf Hall: "Henry VIII was in chronic pain. I know what that does to degrade the personality, to detract from rationality". That kind of primal reaction is made far more likely by a context of systemic failure - the crazily high cost, low results US healthcare system which even at luxe level (my personal experience with no refusal of care or other serious battles), is still stressful, $$$$$ and pettily dehumanising (eg. unexpected "out of networks" eg for an anaesthetist in emergency care for my child, not allowingszid child even into emergency room until I had found my insurance card). Pain-wracked, isolated, feeling a cog in a terrible anti-human system: a horribly predicable risk equation for such a terrible act.
Great quote and yes I can quite see that could drive a person mad.
Henry VIII; also George III, more familiar to Americans, who suffered a maddeningly painful disease (porphyria) which eventually led to his being treated as, you know, mad. And subject to the usual extremely painful so-called treatments of the time,
Well, that theory, that King George III suffered from porphyria, is highly contested and not established as fact:
https://www.pbs.org/newshour/health/what-illness-did-king-george-iii-have
A couple of thoughts after reading this well argued post on Luigi Mangione (and of course Ian is right in his final judgment that "the adulation of Luigi Mangione is a sickness.") First, to say that "the response of many Americans to this cold-blooded murder has been breathtakingly amoral" gets at something fundamental about a very troubled country and its fading civic society. And second, nothing is more emblematic of this sickness than the American health care system, which has a business model built upon denying care and forcing patients to fight for what they're clearly entitled to, knowing most of them won't. My daughter was recently in a serious accident that required trauma surgery, but her insurance company denied everything at first because it was "out of network." A two-year battle ensued, in which the company ultimately paid everything—thousands and thousands of hugely inflated costs for the hospital, doctors, ambulance fees, etc. etc.—and, in the end, essentially acknowledged that all of its profit-maximizing denials were completely improper and unlawful. This is an incredibly sick system that's become accepted by everyone in America simply as the way things are. Maybe this helps explain why so many want to see Luigi Mangione as the hero he's clearly not.
I still think he had a psychotic break. He's the right age for onset of schizophrenia or bipolar disorder. I realize we don't know yet. But I think we'll find out. I'm sure his lawyer will insist on a battery of psychological tests. I just don't believe this heretofore sensitive, intelligent, mild-mannered guy suddenly became a cold-blooded murderer unless he was suffering from some extreme form of mental illness.
As someone who deals with acute psych admissions every day I tend to agree. Of course, his apparent level of organization in planning the crime is difficult to align with that theory — but then there’s also the fact that when he was caught, he still had the weapon on him etc., which seems very odd that he didn’t think to discard it. If this is the case I hope he gets the help he needs. It’s very sad to see photos of his bright smile, looking happy and healthy, and hear from all the people saying what a lovely person he was.
Exactly.
I live in Baltimore, where he's from, and as you can imagine, it has dominated the news here. So many people know this family and know Luigi Mangione personally and simply cannot square his actions with the guy they knew. It is incomprehensible to them.
Of course Ian is right that no one should be glorifying this murder. I certainly haven't, and nobody in my circle has, either. But we do understand the rage, the absolute fury, that has exploded all over the country due to the vile health-so-called-care system we have in the U.S. Everyone -- and I do mean everyone -- we know has a horror story about trying to get their insurance to cover medical costs.
The murder of Brian Thompson obviously won't make a difference in the long run -- these execs will simply harden their defenses, hire more security, further insulate themselves from us peons -- although I will say that the obscene, unconscionable policy that Anthem was just about to put in place to not cover the cost of anesthesia for the full length of surgeries was IMMEDIATELY rescinded. That happened the day after the murder. There's no way they would've done that had Thompson not been killed.
Here's background on this grotesque policy:
https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures
As is clear from my post I really don’t like these ‘but’ statements . ‘Murder is wrong BUT’... Nothing, absolutely nothing Brian Thompson did invited or deserved this. And we shouldn’t *want* this killing to “make a difference”. That would just incentivise more killings.
Of course murder is wrong. I completely agree with you. And the atrocious health insurance industry in this country is also wrong. Both things can be true.
Maybe (I’m not clear why it’s insurance specifically that is meant to be at fault rather than the structural incentives of the industry) but by using this murder as a trigger to talk about it people are taking the murderer’s bait and incentivising others to use this gruesome method of getting publicity for their pet cause.
Oh wow yes it must be whole other level being in Baltimore. His poor family.
I remember reading about that anesthesia policy in the days before the murder. Absolutely despicable. I’m in Canada and work in healthcare; my heart hurts (and my brain bubbles over with rage) whenever I hear about what people in the US go through with the private system. It’s inhumane.
I believe that is highly likely.
Healthcare in the United States is obscenely expensive and like other businesses has been co-opted by business oriented models to supplant clinical decisions by managers who drive their practitioners to maximize efficiency and minimize costs. Healthcare corporations seem to be in a reciprocal death dance with insurance companies to see who can squeeze consumers the hardest. Medical debt is one of the biggest drivers of personal bankruptcy. Mr Thompson’s company had denial rates that are almost double of their rivals, which resulted in massive corporate profits. Thus he was probably not randomly chosen by Mr Luigi. Murder is never an acceptable response to such business practices. The unseemly online response must be seen as the bottled up rage of a populace who feels completely powerless in the face of such faceless corporate power.
Re the statement, "While there are obviously problems with the system, most Americans are happy with their insurer," I offer a reader's comment from a different Substack essay. Quote:
GD Morris
Dec 13
I do not believe the stat that 81% of people in the US are happy with their health care. Why? It is easy for questions to be designed that yield the outcome you seek. Simple questions that should be asked are "has your health insurance company denied a claim in the last year?". Follow that one up with "Has your medication been denied or changed without your approval in the last year?". Here's one I'd sneak in "What's the average wait time for any medical appointment you've tried to make?". Finally ask "Are you getting your moneys worth for the premiums you're paying?".
If you just ask "Are you happy with your health insurance" people are going to think "I guess". or "Yeah, whatever". That's not getting to the heart of our failing health care "system".
https://yourlocalepidemiologist.substack.com/p/the-dose-december-13/comment/81334788
I wouldn't underestimate the fact that many find Mangione highly attractive for the nature of the public reaction. I bet this it's more "ooh look at this sexy guy, I'm sure he's an angel at heart" not a detailed contemplation of the morality of health insurance.
Very well presented, and thought provoking article.
It would have been a clean, big 👍🏼but I’ve stopped myself at Trump[…] is right.
As a follow-up to my earlier comment, I offer this: https://blog.ayjay.org/five-true-things/?utm_source=substack&utm_medium=email
Is Luigi Mangione the Alexander (Sasha) Berkman of our age?
I doubt that. I think he's just, sadly, a mentally ill young man.