Mangione & Thompson: The Meaning of a Murder

I'm going to risk wading into this, because I have heard a lot, and a lot of what I've heard, I think, misses the mark.

The Assassination of a Money Guy

Brian Thompson's Wikipedia page recounts a career starting in Business and Accounting at University of Iowa, then he went on to work for the vaunted PricewaterhouseCoopers--a firm that keeps track of numbers, like the money of Russian oligarchs hiding their wealth from the economic sanctions imposed by the West in the wake of the Russo-Ukrainian War. He then went to UnitedHealth Group (UHG), where, at the age of 50, he met his untimely end. 

His official picture...he looks like a nice guy. He's the guy who maybe wasn't a bully in high school. Just a good lookin', successful, valedictorian and homecoming king, maybe. I mean, he may have been a bully, but I give him the benefit of the doubt. Maybe he was a just a decent gated-community guy who made sure the numbers came in good at the end of every quarter.

When is a Murder More Than a Murder?

There are a couple of themes running in the press and on some social media. One: This was murder, and it's never ok to murder someone. Of course this overlooks things that don't pass for "murder" because they have some sort of socially acceptable purpose--like the death penalty or military combat. So, that's one theme. 

A second theme is expressed most bluntly over social media: This robber baron had it coming. Think of all the people his company "murdered" through neglect, greed, and attrition. You get the idea.

Another theme: "This is not right, but we need to have a conversation about this. Maybe this is a time for reform...."

I've got news for you. When the pitchforks come out, the time for conversation is coming to an end.

Why This Isn't What Anyone Thinks It Is

Let's return to Thompson. He's a money guy. It's his whole adult life. You can argue about the efficiencies of the private marketplace all day long, it doesn't change the fact that this man, his company, their aim has been to maximize profits within an envelope of tolerance to indifference and certain goverment regulations. Health care is a cash cow, and Thompson's job--no matter what he told himself it was--was to milk that cow for all he's worth.

Are there more odious, less cosmetically sympathetic robber barons out there? Sure, how much time do you have? But that is not what this is about.

The Object of The System is Not to Care For People

What I feel is missing from this conversation is plain talk about a system that is built on status, dreams, and ambition--and much of that pays off in dollars. It really is a no-brainer to see why this system exists in the U.S. We are a people deeply certain that our own effort, our own happiness, is more important than that of others. It isn't anarchy, though, or even libertarianism. It's a fairly stable system in which everyone benefits in some financial or personal way at the expense of someone else. Its stability has been maintained by a carefully interwoven set of prerogatives and justifications.

If you have any sort of IRA, or even many defined benefit retirement plans, the frustration you experience appealing a rejected medical claim is in part compensated by dividends to your own retirement fund's investments for your later benefit--if you live through your health crisis long enough to enjoy that benefit.

If you're a doctor or a nurse or a therapist, your continually rising standard of living stems, in part, from the existing business model. This has been especially true for specialist physicians.

And the college you attended to learn your medical craft, it charges tuition--often higher than in other countries by adjusted rates--part of which it invests in research that benefits...Big Pharma, medical equipment developers, and so on...which in turn benefits the college through patents and licensing.

If you're an insurer, your job is to profit for the good of shareholders (and all those retirees!) by reducing loss ratios, a number by which insurance company success is measured by investors, fund managers, and bankers. 

If you're a hospital administrator, you're job is to maxmize the margin, profits over expenses--and if you think this matters depending on whether the organization under scrutiny is for-profit or not-for-profit you are mistaken. One way or the other, the job is to make money. The smaller, more community-focused the hospital, the more an actual human sense of mission moderates appetites. But those hospitals are dying--or being bought up--all over the country. Many are closed, because they are not efficiently profitable. The others may be converted into profitability centers that emphasize procedures and high-profit health problems. 

It's true even if you're a patient insured by this mostly for-profit system. A 2015 report in the American Journal of Medicine noted that a majority of Americans opposed a single-payor option to the Affordable Care Act because they mistrust the government. This reminds me of an article in our local paper last Sunday, in which a man on disability, worried about his family's financial future, stated that he voted for the "money guy" in the November presidential election. "I don't think he [the President-elect] cares about us...but maybe some of that money..." that will go to the rich, will "trickle down to people like me."

I have another suggestion here, based on my 40+ years in health care: Many people intuitively understand that making health care more affordable for all will, of necessity, negatively impact some people who feel they are advantaged by the present system--even if those people are not "rich" by any conventional metric. The implied compact in our current system is that many people will get somewhat "more" care, that they have access to a bit extra. In a more rational system, their fear is that some services will be rationed. Privatized systems in Switzerland and Japan belie this belief, but it is what many people think, and I know because they have said such things to me. Americans love having the freedom to make less-than-ideal choices at the expense of others. A "wealth mindset" reaches farther down into the "99%" than you think!

You see? Everyone benefits from the current system. New Yorker writer Jia Tolentino, on Amanpour & Co. notes, "This is a system that...neither [political] party is really trying to do anything about." 

The Real Threat

The real threat is not the assassination of a man who happened to lead a company that, according to Tolentino, is arguably responsible for thousands of deaths in the form of denied care. Or is it?

Just imagine for a moment a mythical country, a "land of milk and honey." Closer, more sustained scruitiny of this Elysium would find a perfect equation for violent unrest: a people deeply disaffected by graft and inequity and loss of faith in its institutions + a lot of guns.

What could possibly go wrong?

What's funny is that the same drive for corporate longevity-with-profit that motivates the industrial medical complex, has also motivated the gun industry. A perfect mix for mayhem!

The real threat is that, no matter whose side you're on, people are arming up, and some of them are shooting. There has been escalating political violence in America for a while now (remember Timothy McVeigh?), and that tells me that people are upset, about a lot of things, some of them perhaps justifiable. I won't tackle it all here. I'll stick to health care, but it's just one example of how both anxiety and a deep sense of injustice are combining to form a combustible mix.

Why I Don't Mourn for Adonais

 

Thompson was killed because he was a convenient target for rage that emerged from a society that worships at an alter of materialism, and simultaneously shrugs off the suffering of those in want in this land of wealth. We love our corporate overlords--even as they stamp us into the mud. There are lots of studies in psychology, sociology, and economics that plainly explain this in general human terms, and of Americans specifically. It's a curious cognitive dissonance. I'm not here to bash America, but let's face it, most countries as well off as we are (or less well off) have decided to make health care a social good instead of just a profit center. Someone struck out at The Gods, and took one down.

The overlords seem genuinely baffled about the outcry in support of Thompson's assassination. They should be worried.

Thompson Chose Something. So Did the Killer

I'm sure the guy's family mourns him, I'd guess. I mean, I didn't know the guy. I don't know those people. But that would be a human response. His company mourns him--heck he was probably making them a lot of money--but there's also a deeper reason they would mourn him.

He was on their side. He was a believer. No matter what he may have been thinking otherwise, his actions served a system that aims to make as much money as possible by providing only what their algorithms and the rules say they must. Thompson, nice guy or not, family or not, chose to serve them.

It would then be fair to say that the killer (Luigi Mangione is simply a suspect now) chose too. He chose to strike at someone who he felt was killing people--even if "the rules" allowed for it. (Words to this effect were in writings attributed to him.)

The real issue here is that one person who represented a system built to profit on pain was killed in the street by someone with a "pitchfork." That's not supposed to happen.

But then, it does. 

What this is really about is that a system that idolizes growth and profit may be finally reaching its outer limit. Collapse could follow. Noam Chomsky wrote that the purpose of power is to get more power, to build a world that suits its impulses, and to endure, and to do this, it must persuade people to suffer a bit for stability and modest hopes. Alternatives to the present system--our health care system and unrestrained capitalism--have their problems, but the intentional imposition of suffering to increase money profit for the benefit of a few tends not to be one of them. 

I won't mourn for Adonais. I feel no more sorrow for him than the people who--however unwittingly he misintended--died because of UnitedHealth Group. I think it's all a shame. But Thompson is merely a "casualty." An actuarial notation in a bigger drama.

I do think that more people with such power should meet their justice. I would prefer it in a courtroom. 

But, you know, things don't always work out that way.