The Roots of the Rage Against the Healthcare Machine
Most of us, sad to say, realized last week that we can comprehend the anger that drove 26-year-old Luigi Mangione—a privileged Penn grad and tech whiz—to allegedly murder Brian Thompson, the CEO of UnitedHealthcare, as the executive walked alone to an annual investors meeting in Manhattan.UnitedHealthcare, part of United Healthcare Group, which ranks No. 4 on the Fortune 500, is what’s known in the industry as a payer. That’s a term that might enrage a lot of people, especially anyone whose claim has been turned down for any of seemingly a million reasons and therefore is on the hook for medical costs. The payers are even using AI to process claims and make denials, taking humanity out of the process of caring for humans. Doctors say they are fed up with fighting insurance companies about providing needed medical treatments to their patients. In a manifesto found in his backpack after he was arrested, Mangione proclaimed: “These parasites had it coming.”The source of the shooter’s motivation is complicated. A product of a wealthy, well-connected Maryland family, a computer-engineering graduate with a master’s from Penn, he was social, and loved playing computer games and designing them. But he also suffered from spinal problems and severe pain that had led to spinal-fusion surgery. His reading list included anti-corporate tomes, including Unabomber Ted Kaczynski’s screed. Six months prior to the shooting, he cut himself off from family and friends. They begged him to get in touch but he apparently went someplace very dark instead. He emerged a murderer, police say.The coldblooded killing of a corporate executive triggered a similarly coldblooded wave of public vitriol directed toward Thompson and his company. Yelp reviews from hell itself. Wanted posters with pictures of health-insurance executives began popping up on Manhattan lamp posts.We know the drivers of this heartlessness toward Thompson and his peers. Healthcare bills are a leading cause of personal bankruptcy. And our money does not buy healthiness, which Mangione noted in papers found in his backpack. The U.S. spends more per capita on healthcare than any other nation, yet in medical outcomes we are not even in the top 10. In a recent Gallup poll, the segment of Americans who rated healthcare quality as “good” or “excellent” dropped 10 percentage points since 2020, to 44%. Not surprisingly, respondents rated healthcare insurance coverage even worse: 28% rate coverage as excellent or good as opposed to 41% in 2012, the high point, says Gallup.One winner in all of this: UHG, which earned a net profit of about $6 billion. That was in the third quarter alone.The vicious response to Mangione’s alleged actions reflects both the state of social media and the state of corporate America. The former allows anonymous individuals to display the most vile aspects of human nature—and then amplifies them. The latter reflects industry concentration that leaves consumers with fewer choices, and to some degree, powerless and voiceless. And angry about it.That’s true whether you are buying eggs or chickens in the supermarket—and remember that food-price inflation helped drive voters to Donald Trump—cell-phone service or health insurance. The McDonald’s in Altoona, Pa., where Mangione was arrested after an employee called the cops on him was flooded with negative reviews, as if a fast-food chain was part of the corporate conspiracy to suppress consumer discontent. Et tu, Mickie D?The UnitedHealthcare headquarters in Minnetonka, Minn., lowered its flags to half-staff last week honor of CEO Brian Thompson, who was fatally shot outside a hotel in Manhattan. (Kerem Yücel/Minnesota Public Radio via AP)Mangione spoke for many of these disenfranchised consumers, and in the worst possible way. You know this feeling of being seemingly without options. I’ve witnessed it at airports, when an angry, disgruntled—and clueless—passenger loudly informs a gate agent that “I’ll never fly this airline again.” Fat chance. You will, in fact, fly this airline again or you can drive across the country because Delta, United, American and Southwest control 80% of domestic airline traffic.This frustration is one reason that assaults on airline employees skyrocketed in the “revenge travel” period that followed the Covid pandemic. People were jammed into full flights, hit with multiple charges for seat selection, checked bags, early boarding, or whatever else the carriers could dream up. Is it any wonder that a number of them lost their shit? The problem, once limited to an occasional belligerent drunk, became so acute that the Federal Aviation Administration had to crack down on the growing number of miscreants, in some cases fining passengers $36,000 for attacking airline personnel.The frustration is everywhere and employees are feeling it. Recently I showed up at my local Hertz station in Manhattan to pick up my rental reservation; there were no cars. So I started getting agitated—and I am now practiced at this because this wasn’t the first time Hertz came up short. I was in mid-harangue when the agent pleaded: “I’m just a minion; it’s not my fault.” Fair enough. “But who else am I going to yell at?” I asked her. We’d both been through this before. Hertz had hung us both out to dry. The shooting is also a grim new chapter in our heavily armed society. We’re all too familiar with workplace shootings—going postal–in which a disgruntled employee or former employees take lethal umbrage on his boss and co-workers for whatever bad treatment or perceived slights they might have endured. But now it is seemingly the customers who are raging for revenge.This corporate assassination is raising the risks for everyone, from customer-facing employees to the big boss. But the CEOs will be able double down on their security; the front-line people will be more or less on their own. UHG’s employees, who number about 440,000, tend to like the company they work for. Until last week, the headquarters team labored in relative anonymity in Minnetonka, Minn. Now many of them feel they are under siege, likened to criminal accomplices working for a nefarious company. As one employee said. “[W]e all do the best we can to do a good job in the system we are in.”UnitedHealth, and other health insurers, have argued for years that consumers are well-served, and satisfied, by the current system. They probably have customer surveys that endorse this view. So do airlines. So what? Clearly the status quo is unsustainable. The anger that UHG’s system has generated has done what few issues in America can do: united Democrats and Republicans. Bipartisan legislation was introduced this week to break up some of the largest healthcare conglomerates by selling off their highly profitable pharmacy-benefit managers (PBMs), the drug middlemen often blamed for high prescription prices. The three biggest ones—CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx—control 80% of prescriptions in the U.S. “Critics complain that the conglomerates use their size and leverage to steer patients toward their own pharmacies, increasing costs for employers and government programs while driving independent pharmacies out of business,” the New York Times pointed out. Consider that the first round.This week I happened to have a lunch scheduled with the CEO of a healthcare-related tech startup, the source for a story I’m working on. He showed up without any security, and he didn’t plan to engage any. His company isn’t a “payer.” In fact, it helps corporate clients push back against the payers to lower their employee healthcare-insurance costs. Payers such as UHG hate me, the CEO told me, because he was attacking their profit machine. And Americans, as we now know, hate the payers even more.Bill Saporito is an editor at large at Inc. magazine whose work has also appeared in the New York Times and Washington Post. Previously, he worked as an assistant managing editor at Time magazine and as a senior editor at Fortune. He has written for From Day One on the power gap among labor unions, the myth of the “woke” corporation, and the perils of getting technology and people misaligned.Featured photo, top: alleged murderer Luigi Mangione is escorted into a Pennsylvania courthouse this week (AP Photo/Gary M. Baranec)
