Murder Amid American Medical Malice

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Luigi Mangione and Brian Thompson

After Brian Thompson was shot and killed in New York City this month, millions of Americans from all parts of the ideological spectrum flooded social media to express little sympathy for him. That’s because he was the CEO of UnitedHealthcare, the massive company known for denying a huge number of legitimate medical-insurance claims in order to maximize its profits.

The result of those denials? Anguish for millions of patients and death for thousands of patients who (either individually or via employer plans) pay large monthly premiums for medical coverage — even as residents of every other developed country enjoy some form of much-more-humane national health insurance. And doctors with years of medical training and experience get their requests for needed tests and treatment for their patients denied by insurance bureaucrats with little or no medical expertise.

Meanwhile, Thompson — who was specifically targeted for assassination (the arrested suspect is Luigi Mangione) — raked in yearly compensation of $10.2 million.

Obviously, murder shouldn’t be celebrated, and this was an awful tragedy for Thompson and his family. But he and other execs at UnitedHealthcare and other private insurance providers are guilty of indirectly/continually causing tragic deaths — only their method is shooting down claims rather than shooting a gun.

As with many other situations, I was reminded of certain books I’ve read. There have been numerous nonfiction titles covering the cruel, pricey, unequal, inefficient U.S. medical system — which only works very well for the wealthy — but I’m a literature blogger and will thus focus on fiction in the remainder of this post. To me, the novel I’ve read that best expresses the fury “inspired” by the U.S. medical system is Lionel Shriver’s So Much for That. I highly recommend her 2010 book, despite much of it being a painful read. Somehow, Shriver manages to often make things entertaining, too.

And I thought of novels that have strong elements of vigilantism, which of course involves seeking justice by “illegal” means when such justice might not be achieved through “legal” channels. In the U.S., there have been various efforts by Senator Bernie Sanders and others urging “Medicare for All” to give Americans the type of health-insurance system every other “first world” nation has. But those efforts have been thwarted by a political class (virtually every Republican and most Democrats) as well as a mainstream media mostly bought off by campaign contributions and ad dollars from the profit-swollen companies (also including “Big Pharma”) benefiting from a privatized medical system. So, what are beleaguered citizens to do?

Among the novels with characters who take the law into their own hands for the “right” reasons (not necessarily medical-related reasons) are Louis Sachar’s Holes, John Steinbeck’s The Grapes of Wrath, Alexandre Dumas’ The Count of Monte Cristo, Lee Child’s Jack Reacher books, and Johnston McCulley’s The Curse of Capistrano featuring the protagonist who would also become the title character in Isabel Allende’s later Zorro. For those who haven’t read those novels, I’ll refrain from giving specifics in order not to spoil things.

As we know, there are also strains of vigilantism in many western novels (like Owen Wister’s The Virginian) and in comic books starring superheroes such as Batman.

Your thoughts about, and examples of, this topic?

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81 thoughts on “Murder Amid American Medical Malice”

    • Thank you for the comment, Munaeem Jamal. I agree — the response to the murder was very revealing about the U.S. healthcare system and what MANY people think about it. Change is indeed sorely needed to prevent as much future heartbreak as possible.

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  3. All in all a sad situation. One wrong doesn’t right another wrong.

    (One argument against capital punishment)

    Even a good person has a breaking point. I mean often the killer gets more notoriety than the victim(s). Like In Cold Blood. Rapists getting away with it. The legal system seems ineffective. Society is helpless.

    Vigilantism – I never read the the book, Death Wish (1972) by Brian Garfield, but I’ve seen all the movies in the franchise. A killer becomes a hero, because he took care of what the law couldn’t/wasn’t. His heroics empower others to take back their streets.

    Do you remember NYC’s The Gaurdian Angels? 1979 – ?. They called themselves a crime prevention organization. Some called them vigilantes.

    I was surprised to see Curtis Sliwa had run for mayor against Eric Adams.

    Well, my thoughts!

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  5. The US has the most expensive healthcare system in the world with the lowest percentage of coverage and efficiency. The only segment of the healthcare system that is functioning relatively well is run by the government and serves politicians, military personal, and civil servants.

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    • Thank you for the comment, Shaharee. Yes, the U.S. has the priciest healthcare system with often the worst results. And a TERRIFIC point that politicians and military personnel have government healthcare — very good government healthcare. Why can’t everyone have the same? Expanding Medicare into “Medicare for All” would be one way to go about it.

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      • The good solution is not by taking the lives of those corporate scoundrels but by taking away their money. Big time some lawyer starts a class action to compensate the relatives of those who lost their lives because of this delay, deny, defend policies. In fact I’m astonished it didn’t happen already. I expected it to happen after Sicko by Michael Moore (2007), but the only thing that happened after that was Obamacare that was watered down till it didn’t include a public option, which was removed after the independent US senator for Connecticut Joe Lieberman (heavily sponsored by insurance companies) threatened with a filibuster.

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        • Great idea! Would love to see that type of lawsuit. Of course, given the problematic “justice” system in the U.S. and all the money the privatized health-insurance system would throw at defending such a suit to protect their obscene profits, it would be a tough road. And, yes, the right-wing Joe Lieberman was the Joe Manchin of his day — a VERY conservative, corporate-bought Democrat. (While the admirable Michael Moore is a principled, exceptional filmmaker and political activist.)

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  6. To protect the Veiled Lady from a blackmailer, even Poirot turns to crime.

    Sherlock Holmes shields a thief from prosecution. ‘Send him to jail now, you make him a jailbird for life. Besides, it is the season of forgiveness. ‘ The Blue Carbuncle

    Alan Breck ? Supposedly, every kind of villainy, including murder, could be arrested as a traitor/Jacobite, saves David Balfour’s life.

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  7. Law breakers for justice ? To protect the veiled lady from a blackmailer, even Poirot can turn criminal –

    Blue carbuncle ? At Christmas, Sherlock Holmes allows a thief to escape justice, ‘ Send him to jail now, you make him a jailbird for life. Besides, it is the season of forgiveness.

    Alan Breck ? One of my favourtite antiheroes. Without Breck, would Daviedc Balfour have survived. Traitor – by being a Jacobite ? Murderer too ?

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  8. Hi Dave,

    I read Lionel Shriver’s “So Much for That” when my friend here in Australia was going through his cancer battle. It made me curious and I asked John-Michael about his out of pocket expenses to beat cancer. He said quite bluntly that if he’d been diagnosed in the United States, he’d be dead. Sadly, the side effects of bone marrow transplants eventually became too much to overcome, but only because our medical world had done all they could, not because there was no more money.

    I guess because of that I can’t really imagine the anger towards something like United Healthcare. And as an atheist, there’s probably a lot that I’d disagree with Tony about, but like him, I just can’t condone the murder of the CEO, or imagine any kind of outcome where it will help. I also agree with Kim and am more than a little disturbed at some of the reactions to this violence. Though unlike Kim, I cheered the ending of “Crawdads”. I loved that the protagonist got away with her brand of justice. But for me, that’s what fiction is all about. Enjoying things that you wouldn’t enjoy or even understand in the real world.

    Susan

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    • Thank you for the comment, Sue. Well said!

      Sobering to think that a non-rich person with a serious illness in a non-U.S. country has a better chance of survival than a non-rich person with a serious illness in the U.S. — even though there’s of course no guarantee anywhere. Very sorry about your friend. 😦

      And I understand your feelings about murder, even when that murder is of someone with the proverbial “blood on their hands.”

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  9. This murder was heartbreaking on several levels. The CEO didn’t deserve to die, true. Yet none of the individuals who died because of the horrors of the United Healthcare System deserved to either.

    I remember on my grandfather’s death bed, he confessed he killed a man who was trying to rob him. This was 1920s, and he kept the secret until his death 1970s. So *sigh* Its a slippery slope.

    With that said, my only contribution bookwise is Scrooge, and though there was no vigilante on the horizon, had a great many individuals he cheated or treated cruelly who would have liked to off him. It is not for me to judge what a man does although I may vehemently detest it. What Marley told Scrooge is the best to be said re how a man should conduct his life esp. in business matters:

    “Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence, were all my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!”

    God bless us everyone.

    A sad theme Dave, but I’m glad you addressed it. Many thanks, Susi

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    • Thank you for the comment, Susi. Your first paragraph says a LOT. I agree!

      That is quite an intense memory your grandfather held inside for a half-century.

      Scrooge is a very apt example of a rich and powerful person who “done wrong.” I wish his willingness to redeem himself would be an example to American CEOs, though I’m not holding my breath.

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      • Thanks Dave. I once heard this about very wealthy pipl, that they get everything they want, but one thing they can’t get is how it feels to make that last car and/or mortgage payment. So there’s that. Perhaps if they had more joyous events in their life, they would be less greedy esp. at the expense of others. But mostly, no matter how you slice it, they are a real piece of work.

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        • Love that, Susi! (…wealthy people “get everything they want, but one thing they can’t get is how it feels to make that last car and/or mortgage payment”). Yes, they can never know certain satisfactions. And I agree that greed can stem from unhappiness, though of course in number of cases it stems from…greed.

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  11. Several years ago I read a book by Jodi Picoult, I think it was called My Sister’s Keeper about one siblings donating bone marrow as I remember.

    Not sure how the troubled man with apparant mental health concerns Luigi Mangione has many people on his side, Brian Thompson did not deserve to die. Too much more to discuss but it’s truly devastating and troubling how someone can take another life and flee to a PA Mc Donalds,eat a hash brown in attempt to go on with his life as if he did nothing wrong. Alot more to learn on this sad story and the reality of countless people with mental health concerns are not getting help.

    Michele

    E &P way back

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    • Thank you for the comment, Michele. I’ve read “My Sister’s Keeper” — which definitely had a significant medical theme. I thought it was an excellent novel until what I felt was a less-than-satisfactory ending.

      It’s true that the shooting suspect might have some mental issues. I also think a medical-insurer CEO who made $10.2 million a year, in part through denying medical care to thousands and thousands of premium-paying patients, had some psychological issues as well. Or maybe it was just blatant greed. 😦

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  12. Dave – your posts are always spot on. You prompted me to considered why many of us are drawn to the Robin Hood story due to its themes of justice, rebellion against tyranny, and the fight for the underprivileged. The character of Robin Hood embodies the ideal of a hero, with pure motives, who defies authority to protect the oppressed, resonating with readers’ desires for fairness and equality. The Robin Hood archetype is repeated generation to generation and has moved from books to comics, to movies. In comic books, “Green Arrow” fights against social injustice and corruption. Movies such as “Robin Hood: Prince of Thieves” and “The Hunger Games”, both based on novels, also reflect this motif, showcasing protagonists who challenge oppressive systems and seek to aid the disadvantaged. I think that Walter Scott says it best of all:

    “The name of Robin Hood, if duly conjured with, should raise a spirit as soon as that of Rob Roy; and the patriots of England deserve no less their renown in our modern circles, than the Bruces and Wallaces of Caledonia.” Walter Scott, Ivanhoe

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  14. It’s horrible to read that many people on social media had little sympathy for the murdered CEO. Despite what you feel about his company, he didn’t deserve to be murdered.

    Dave, you raise an interesting question in your post (again!) about vigilantes in literature. Your mention of Batman jumped out at me, as he’s one of my favorite superheroes. I’d add The Punisher as an example of a vigilante. He’s an ex-Marine who pursues revenge on the people who murdered his wife. I think he broadens that mission to punish other villains, too. I confess to running a Google search about vigilantes in popular culture, as I was curious about others. Lisbeth Salander popped up. I read the original trilogy that starts with “The Girl with the Dragon Tattoo” several years ago, and I still remember the intensity of her pursuit for revenge.

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    • Thank you for the comment, Dave. You’re absolutely right that Brian Thompson (or anyone else) doesn’t deserve to be murdered. But the reaction does say something about how millions of citizens are furious at being taken advantage of by powerful people and corporations.

      Yes, various “cartoon” superheroes have meted out vigilante justice — as did Lisbeth Salander. I’ve also read Stieg Larsson’s riveting trilogy, and Lisbeth is a tremendous character creation. She had a LOT to feel vengeful about.

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  15. The only novel I can think of is Stephen King’s The Wheel of Fortune in which the main character has acquired psychic abilities after recovering from a coma. He knows that a presidential candidate will do bad things if elected (!) and reluctantly decides to shoot him at a campaign event. It’s a highly dramatic scene with a twist ending. I say no more in case you haven’t read the book.

    You’re right about vigilantism being part of the American way. And further to Luisa’s comments about the health system in Italy, Canada’s isn’t doing well either. Not enough doctors, long wait times, etc. Ironically, those who can afford it go to the US.

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    • Thank you for the comment, Audrey. Is “The Wheel of Fortune” Stephen King’s “The Dead Zone” under a different title? The plots sound similar. Either way, a terrific example!

      You’re right that countries with national health insurance are not problem-free with their systems. But those systems are still better than the U.S. one, especially for the non-rich. And, yes, given that the privatized American healthcare system is great for the rich, I can see why some wealthy people from other countries would use it — including to bypass longer waiting times.

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  16. Hi Dave, and thanks once again for another thought-provoking post. I’m glad you mentioned that particular Lionel Shriver book, she’s one of my current favourite authors. I’m almost at the end of ‘The New Republic’ just now, and will make ‘So Much for That’ my next. I can’t help but agree with you on this. Murder is murder, but when the general response is such a huge lack of sympathy for the victim it’s a sign that something is very wrong. I can’t think of any particular ‘vigilante’-style protagonists at present, apart from the general trend in Jacobean Revenge Tragedy, where the protagonist is looking for revenge for a real or imagined injury against somebody high in society and difficult to reach, like a king or emperor. ‘Hamlet’ is probably the best example of this, with various plays by Webster, Kyd and Marston following behind. The revenging character usually has to die by convention in these, given that it’s a bad example to have somebody kill a king or higher-upper and get away with it. If I recall any more I’ll be back, but I suspect that’s me done for this week. Have a good one, catch you next time. 🙂

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  17. It seems the American health system is one of the more unequal systems one can find. l would be pretty scared to get sick or have an accident in the U.S. And it seems almost impossible to make any real changes to it. Such a sad story, all of it. I have an American friend, who moved to Germany and who says she’ll never move back to the U.S. now she knows what it’s like to not get ruined just because you need surgery. The frustration is very understandable, but as already stated here, murder is never justified, or an answer to anything.

    When hearing about the murder I came to think about the movie “Falling down” with Michael Douglas – which was also quite thought-ewoking. Thanks for an interesting post, as always!

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    • Thank you for the comment, Thérèse. Yes, the U.S. medical system deservedly looks cruel and awful when viewed from other countries. So many Americans have become sicker than they had to be, lost their life savings, and more because of that system. I can totally understand the feelings of your American friend now in Germany.

      I’ve heard about the “Falling Down” movie but have never seen it.

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  18. This is a difficult post, Dave. As a friend of mine shared the other day on LinkedIn, “It’s OK to be angry at the executives who run the health insurance industry in the US AND to object to murder.” I did suffer due to the practice of delay and denial by an insurance company but all I did was complain. It was a minor issue, but one that was important to me. My complaint fell on deaf ears, but I didn’t consider more drastic action.

    As for fiction, I was going to suggest Coma by Michael Crichton, but I discovered that Crichton directed the movie based on a novel by Robin Cook. Interestingly, Crichton said it was easier for him to adapt someone else’s novel than his own. Also, Coma is more of a sleuth-solves-a-mystery by taking on a corrupt medical industry than a vigilante goes gunning for evil.

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    • Thank you for the comment, Dan. You’re absolutely right that a person can feel two things simultaneously — be furious at the medical-insurance industry and be against murder. Brian Thompson shares responsibility for thousands more deaths than Luigi Mangione, but Thompson’s “murders” (via denial of claims) were indirect and done wearing a suit in an executive suite while his bank account soared. 😦

      Sorry about your delay and denial experience (not the only one, I’m sure) — a real rite of passage for most Americans. 😦

      Interesting “Coma”/Crichton/Cook paragraph!

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  19. As a Christian I cannot condone the murder of the CEO of United Healthcare, our society would be even more dangerous than it already is if too many people engaged in vigilante justice. The suspect in this case reminds me uncomfortably of Raskolnikov, the antihero in Dostoevsky’s “Crime and Punishment”. However the author did not approve of the actions of his fictional protagonist.

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    • Thank you for the comment, Tony. Christianity in its best sense is indeed against all murder, so I hear where you’re coming from. Hopefully, good Christians are also against medical-insurance-company greed that leads to thousands of other kinds of deaths every year.

      And that’s an interesting comparison to Raskolnikov! I think Luigi Mangione’s motives were somewhat “better,” but I can definitely see the connection.

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  20. Thanks for addressing this issue and event, Dave. I’ve just finished reading Bernie Sanders’ “It’s OK to be Angry about Capitalism” (USA, 2023) in which he devotes a chapter to “Ending Greed in the Health Care System.” When it comes to fiction, I believe that the superhero genre serves to empower/defend/protect the vulnerable members of our society against the powerful and greedy.

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    • Thank you for the comment, Rosaliene. Bernie Sanders is always worth reading; I have that book, too! And you make a GREAT point that superheroes serve as wish-fulfillment vehicles, among other things. They do what we wish we could do — including obtaining justice in a world where there is too little justice.

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  21. I had hoped that the situation of your health insurance had improved with president Obama, but I am shoked reading of the real situation in your country, Dave! “To Kill a Mocking Bird”, where Atius Finsh, a white lawyer had the courage to defend the black inocent Tom Robinson and showed to his comunity in behaving so that sympathy and understanding are worth much more than hatred, prejudice and maybe money came to my mind! Many thanks for your insightful post:)

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  23. i too was appalled by some of the reactions to this murder. As someone with a chronic illness I’ve had lots of unpleasant experiences with the insurance industry and reform is needed, but murder is still murder. Not the way to change things!

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    • Thank you for the comment, Leah. I totally hear what you’re saying. I don’t think the murder will change much of anything (although one insurance company did pull back on a plan to not fully pay anesthesia claims if the surgery ran long). Still, one can understand the fury of many people.

      Very sorry about your experiences with insurance as someone with chronic illness. 😦 I, like most others, have had many rotten experiences myself.

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  24. I am very much against vigilante justice under any circumstances, and I am appalled by the nation’s gleeful response to Thompson’s murder, as if the killing of one man will cause the government (under Trump? What a joke!) to solve the cumulative problems of the US health care system, a convoluted mess has been decades in the making and is not the fault of one or even one hundred people.

    Unlike most people I know, I despised the end of WHERE THE CRAWDADS SING, which celebrated murder as a heroic solution to a problem that could have been dealt with sanely. This glorification of murder as justice is a US sickness that goes back to our love of the idea of cowboys staging shoot-outs in the middle of town, and, as you say, Dave, leads directly to the success of Jack Reacher novels. If all this vigilantism stayed in the realm of fantasy, I suppose that would be just entertainment, but the American way of life and death shows that too many people like to translate this cowboy ethic into reality, including many US police officers. How can we condemn the actions of so many policemen and then condone the same behavior in Mangione?

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    • Thank you for the comment, Kim. I hear you. Murder is indeed horrible, and, yes, a single killing will probably not change the U.S. medical-insurance system. But, in an ideal world, it would be great if the private system became more humane (denying many fewer claims) or if a public single-payer system were established. Instead, there’ll be tons of money spent on security for insurance CEOs, and a crackdown on free speech criticizing the industry. 😦

      It would also be great if CEOs whose enormous compensation depends on hurting the public wouldn’t be considered “admired businesspeople” by people in the power structure.

      You’re right — there’s a real strain of vigilantism in American history and American society.

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    • Thank you for the comment, Maggie. I was also kind of shocked at first with the reaction to the murder, but I guess it really wasn’t too surprising. Reading many of the angry and/or heartfelt social-media comments was quite an education, in addition to the “education” Americans get from personal negative experiences with the U.S. medical insurance system.

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  26. Thanks for listing various literary characters who take the law into their own hands for the “right” reasons.

    Unfortunately you are right, the US medical system is cruel and unfair. But even in Italy the public health system is getting worse and worse. To use its services we pay many taxes that are withheld from employees and pensioners at the base, without the possibility of evading them as artisans, professionals and entrepreneurs often do. It used to be very efficient, but now health care works very well only for the rich who can afford expensive visits and treatments privately, without having to wait even over a year for an appointment

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