On Monday night, Luigi Mangione, 26, was charged with murder in New York in the death of UnitedHealthcare CEO Brian Thompson. Authorities have not confirmed his precise motivations, though Mangione was in possession of a note criticizing UnitedHealthcare and the U.S. health care industry more broadly. But from the moment Thompson was shot on Wednesday, his killing was widely interpreted online as political in some way. Police officers found shell casings at the scene that had “deny,” “defend” and “depose” written on them — seeming references to health insurers’ practices. The reaction online to the murder has shown little sympathy for the victim, and sometimes celebrated the crime.
Vigilante justice is no different from mob justice: It is an immoral and anti-democratic way to try to solve a problem or effect social change. At the same time, it would be imprudent for politicians and pundits to ignore what underlies that online anger. People are furious about our health insurance system, and there’s a real appetite for sweeping change. As the left takes stock of the way forward under another Trump term, extreme frustration with the health care status quo is a neon sign illuminating the path to real populism.
Most people know it doesn’t need to be this way.
Polling shows that Americans are deeply dissatisfied with health care and insurance. Based on surveys conducted in November before the shooting, Gallup found that Americans’ positive rating of health care quality in the U.S. is at a 24-year low; that just 28% of Americans say coverage in this country is excellent or good; and that almost 80% are dissatisfied with the cost of health care. According to surveys conducted in 2022, KFF, a health policy research nonprofit, found that “about half” of American adults say it’s difficult to afford health care costs, and that 1 in 4 said they skipped or postponed costly care in the 12 months before the survey. The KFF polling found that 48% of insured adults worry about affording their monthly premium, and 41% report having debt due to medical or dental bills.
These grim numbers reflect a broken system. America’s employer-based insurance system remains a global anomaly. It’s been nearly 15 years since Obamacare, the only major modern effort to reform American health care, was signed into law. Over 25 million people remain uninsured. Costs have come down, but not enough to prevent tens of millions of Americans from avoiding care or going into hundreds of billions of dollars worth of medical debt. Figuring out insurance coverage is still a byzantine mess. Even for those with high quality insurance, anxiety about surprise medical bills is the norm.
Most people know it doesn’t need to be this way. The U.S. is the wealthiest country in the world. It has extremely high quality doctors, cutting-edge medical research and is unrivaled as a pharmaceutical innovator. But because of the way our insurance system is set up, the U.S. spends far more money per capita than peer nations, yet it’s the only one that lacks universal coverage and it delivers worse health outcomes.
Amid this mess there are vocal communities ready to exploit tragedy to express their anger toward profit-maximizing private insurance companies that literally hold lives in their hands and yet so often treat them as disposable. The solution is not to revel in schadenfreude online, but lies in political organizing for a radical change to the health care system. Sen. Bernie Sanders’ 2016 run for president brought renewed attention to a Medicare-for-all proposal. It gained even broader support in the 2020 primary, with multiple Democratic candidates pushing their own versions of universal health care. During the Biden era that policy demand ebbed. President Joe Biden reneged on his promise to pursue a public option, and the Democratic establishment appears content to tinker with small reforms. Meanwhile Trump is capitalizing on discontent with the system with faux-solutions by continuing to peddle “concepts of a plan” for degrading or potentially eliminating Obamacare. But a new Gallup poll shows a big upswing in the belief that the government should ensure universal health care coverage. It’s time for people to rally behind Medicare-for-all again, or some equivalent proposal that puts an end to the patch-work, private insurer dominated status quo.
Zeeshan Aleem is a writer and editor for MS NOW. Previously, he worked at Vox, HuffPost and Politico, and he has also been published in, among other places, The New York Times, The Atlantic, The Nation, and The Intercept. You can sign up for his free politics newsletter by clicking the link at the top of this bio. 
