Luigi Mangione-inspired ballot initiative targets health insurance denials | Hacker News Reader

Luigi Mangione-inspired ballot initiative targets health insurance denials

newsweek.com

75 pointshoward941123 comments

I know this is an unpopular opinion here, but Luigi Mangione as martyr figure makes me extremely uncomfortable. This is a very different situation than the Aaron Swartz or any of the other victims of abuse by powerful people and corporations.

What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal political agenda? It's one thing when you agree with the motive, but are we ready to accept the inevitable outcome that someone decides to engineer a high-profile murder to push a different agenda?

In a lot of ways this is like all the media attention on school shootings: we will see copycats, and the next one may not be targeting an unsympathetic healthcare CEO.

It's becoming acceptable to people because many people increasingly feel their means for change are being suppressed or their voices ignored. This kind of violence is just the beginning. It's what happens when societies start to collapse.

> This kind of violence is just the beginning. It's what happens when societies start to collapse

Well, no. It’s what forms popular pretext for expanding police powers. If we get a second or third Mangione, search and arrest powers will have to be expanded.

Why? We have a few thousand murders in the USA each year, why would a few more deaths cause a need for expanded police power when several thousand other deaths didn’t require it?

> why would a few more deaths cause a need for expanded police power when several thousand other deaths didn’t require it?

Visibility.

Sorry, I meant to say, "other than the fact that the additional deaths are rich people." I know that the real reason is "because they are rich and powerful and the cops serve them as masters" but I was curious if you had another reason.

You act like police powers haven't been continuously expanded for decades despite crime rates dropping regardless of local police presence.

> like police powers haven't been continuously expanded for decades

They have also seen periods of reduction, e.g. in the wake of George Floyd (until the abolish the police nutters took the loudspeaker).

Can you time line that out for me? I didn't follow those events too closely but what you're saying doesn't really line up with how I remember them.

https://en.m.wikipedia.org/wiki/Police_reform_in_the_United_...

The defund police advocacy wasn't really anything of note until George Floyd. You are saying the same movement that caused a reduction is the exact same movement that stopped the reduction? Also George Floyd was in 2020, a few select cities making some minor moves for a few years doesn't make up for decade after decade after decade of rampant expansion of police powers and armaments across the entire nation. I don't see any significant reduction in our prison population despite the consistent drop in crime, a prison population that dwarfs basically most of the rest of the world's prisoner-to-population ratio other than a few small countries that are either notably oppressed or completely politically unstable.

> You are saying the same movement that caused a reduction is the exact same movement that stopped the reduction?

Yes. Though there were two movements, a criminal-justice reform movement that went too far with e.g. bail reform. And “defund the police,” which was mostly attention-seeking behaviour that animated a backlash.

> don't see any significant reduction in our prison population

They’ve been falling for years [1]. Particularly in state prisons.

[1] https://www.prisonpolicy.org/profiles/US.html

By your own source, yeah incarceration rates dropped for a few years, but are still over 5x as high as it was in the 70s, and is now on a sharp increase again. None of that is encouraging in any way or makes me think police powers are anywhere near a reasonable level or have been curtailed in any meaningful way. There are only 4 countries in the entire world with higher incarceration rates, and being anywhere near places like Rwanda and Turkmenistan is completely absurd.

It makes people on this site uncomfortable because they are seeing that while they build their AI powered debt collectors and insurance denier startups, the general public would celebrate them being shot.

>What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal political agenda?

No one's setting it. Things have been that way in the past. A lot of laws now are designed to avoid allowing organizations to brutalize people so badly that those people view violence as the only recourse.

When there are no judicial penalties for running a vast machine of death like UnitedHealthcare, then eventually people seek extrajudicial ones. Our goal should be to make sure that this doesn't happen. Luigi is a symptom, not the sickness to be treated.

When was the last time we named a law—informally or otherwise—after someone because they committed a high profile murder and wrote a manifesto about it?

>When there are no judicial penalties for running a vast machine of death like UnitedHealthcare, then eventually people seek extrajudicial ones. Our goal should be to make sure that this doesn't happen. Luigi is a symptom, not the sickness to be treated.

Where do you draw the line between "When there are no judicial penalties [...] eventually people seek extrajudicial ones" and "some nutjob went on a shooting spree"? There's no shortage of people killing because of "the great replacement" or "pedophile elites", issues the government aren't exactly in a hurry to address. Are those also examples of "When there are no judicial penalties [...] eventually people seek extrajudicial ones", or can we just chalk them up to the shooters being nutjobs? Is the former just what people say when they're sympathetic to the shooter, similar to how terrorists you support are "rebels" or "freedom fighters"?

One big difference is that one is true and the other isn't.

Truth doesn't matter when the question is what kinds of tactics we want to officially endorse for moving the political needle. Any tactics you adopt become fair game for your opponent, and if we start seeing laws named after Luigi we will start seeing laws named after the next conspiracy theorist killer.

If the framing is merely "When there are no judicial penalties [...] eventually people seek extrajudicial ones", then it doesn't really matter whether it's objectively true or not, only whether people think it's true or not. And to the people who are aggrieved by "the great replacement" or "pedophile elites", they most certainly think it's true. Moreover, it's not hard to think of steelman versions either conspiracy theory that are true. For instance there might not be an actual coordinated conspiracy to replace white American voters with foreigners, but there's certainly a push on the left to allow for more migration, and just a decade ago Democratic strategists were bragging about how demographic change was going to mean they were going to be assured victory for the next few decades.

Steelman as much as you like, the fact is that health insurance companies really are evil, and the "great replacement" is wingding nonsense. We can't have a standard applies to both real political grievances and fake lunatic ones.

>Steelman as much as you like, the fact is that health insurance companies really are evil, and the "great replacement" is wingding nonsense

The point of the steelmaning isn't so "the great replacement" can be declared as "true", it's to point out it's not hard to come up with a slightly revised cause that isn't "wingding nonsense". Sure, it's easy to write off the guy who shoots up a school because of "the great replacement", but what if the next guy is shooting over Biden's immigration policy? Does he get a pass now because "The Biden administration really are evil", on the basis that "they're putting immigrants ahead of Americans" or whatever?

>We can't have a standard applies to both real political grievances and fake lunatic ones.

I'm so glad that there's a universal standard of what counts as a "real political grievances" that everyone can agree on!

There isn't a universal standard.

Right, we're not doing politics on a frictionless infinite plane though. At some point, somebody has to make a judgment about the actual content of the complaint. Should we do single payer to prevent violent wingnuts from offing people in broad daylight to the tearful applause of millions? Yes, probably. Should we turn up the horror on the southern border even more to appease your uncle who is complaining about Qanon in the Craigslist "missed connections" section? Probably not. Why? We thought about it and decided the former is a good idea related to a real problem but the latter is just pointless cruelty that doesn't solve anything, not even getting people to stop complaining (since they'll just pick some other made-up problem). If you disagree, you're my political enemy and we have to work it out, hopefully without violence.

United Healthcare had a 6% profit margin last year. They spend something like 85% of revenue on medical care. Health insurance is one of the most regulated industries in the country. What is your proposed change to fix healthcare in the US?

A lot of people's understanding of the American health insurance system is closer to one of the "lunatic ones".

I can think of two potential solutions:

Single payer healthcare. At least governments are (at least somewhat) accountable to the people.

Progressive wealth taxes. It's possible that the only solution is for CEOs to be accountable to the general public. Currently, their wealth insulates them from normal methods of holding them accountable (e.g. loss of social standing, stores refusing to do business with them, etc.) so people turn to methods like shooting them. Perhaps if taxation made them more accountable then people would have other methods available.

How does single payer healthcare solve problems? You point out that this means people can blame the government for poor quality service, but you don't actually explain how this will improve service.

The murdered United Healthcare CEO wasn't even all that wealthy. IIRC he had something like 20 million. Way more than the average American, sure, but not even wealthy enough to be impacted by the wealth taxes proposed by Bernie Sanders. Compared to the likes of Musk or Thiel, his wealth was nothing.

Most research into the outcomes of single-payer healthcare universal coverage systems shows that they deliver better patient outcomes for less money. I don't know how they give better service, and I'm not familiar with the oversight mechanisms, but the documented results are that they do.

Wealth taxes are controversial. I suspect they should be based on a combination of aggregate wealth and financial transaction taxes. IMO, $20 million should have been enough to trigger a wealth tax.

I think there is probably a lot of claim denial and bullshit rolled up into the 85% number. You make it seem like they are an efficient distributor of healthcare where which they are not. Every provider hates them because they create a ridiculous amount of Paperwork overhead and cost to the entire system. They are the healthcare equivalent of DOGE.

People have contradictory expectations of healthcare. They want it to be more efficient and avoid waste, but when the healthcare company institutes systems of accountability people complain about paperwork.

What's your silver bullet to make healthcare better? The companies are already spending almost all their revenue on healthcare, there is very little profit anyway.

> The companies are already spending almost all their revenue on healthcare, there is very little profit anyway.

It would be more accurate to say that insurance companies are paying most of their revenue to healthcare providers (many of which are owned by the same people who own insurance companies), who are known to charge obscene amounts of money for services that cost a fraction of the cost elsewhere in the world.

Looking at the financial reports of insurance companies in isolation is insufficient when they're part of a much larger corrupt system.

Honestly the Keiser Permanente insurer/provider hmo model is pretty decent. There isn’t a lot of profit in it but it does a decent job rationing out care in appropriate and ethical ways.

> Where do you draw the line

The converse question is also valid - when do we accept that the system is so unjust and broken that people need to take justice into their own hands? Where do YOU draw the line?

This is the interesting question to me. I mean not one line or the other but the idea that both instances of "drawing the line" are just positions on the same spectrum. If you imagine a continuum of societal scenarios from blissful idyllic peace to total dystopian chaos, on the one end murdering someone as a mechanism for accomplishing something is clearly unwarranted, and on the other end it's pretty clearly warranted. So the question is where are we on that continuum and where would we have to be to justify this?

In my view when police are kidnapping people off the streets for expressing political viewpoints, when government power is nakedly being used to benefit the individuals wielding it, and so on, we're moving pretty quickly towards a situation where there's not much rational basis for believing the system will hold wrongdoers accountable. That's setting aside the fact that the wrongdoing by the health insurance industry has been going on for decades with little accountability.

I wouldn't say we're at the point where a killing like this is justified, but we're a lot closer than we were a year ago.

The particularly frustrating and worrisome bit is that there are obvious moves forward that I think would greatly reduce the likelihood (and perceived acceptability) of vigilantism, but the people in power are unwilling to make those moves. These are things like passing laws to make large swaths of current health industry behavior illegal, with specific penalties against executives, board members, large shareholders, and others who profit from the bad acts, and then rushing in to prosecute and imprison those people and confiscate the majority of their wealth. No more mister nice guy, no more dithering, just direct, forceful, unstinting action against everyone who has gotten rich off other people's suffering --- but doing it via the mechanism of law and justice to demonstrate that it is an implementation of the will of the people. That would make people feel like the system is working. But when those in government are unwilling to do that, it makes people feel like those in government would rather have the occasional vigilante killing, and that they are on the side of the executives rather than everybody else --- and that in turn makes a small minority of people more willing to give those officials what they asked for.

> Where do you draw the line between

This is where individual opinion basically doesn't matter. This is where collective opinion ends up setting discourse.

There is a reason no one really mourned for the CEO. And a reason Luigi is seen as a hero in the vast majority of circles.

>And a reason Luigi is seen as a hero in the vast majority of circles.

source? Only 17% of americans find the killing was "acceptable", which isn't same question as "hero", but I think most would agree that an action being "acceptable" is a prerequisite to being a "hero". At best, he's anti-hero.

https://www.axios.com/2024/12/17/united-healthcare-ceo-killi...

I suspect the flaw in this poll is being willing to openly admit support would feel precarious to many generations outside seemingly Gen Z due to how other generations were raised.

I think private support - the kind you can’t poll - is far far higher

>I suspect the flaw in this poll is being willing to openly admit support would feel precarious to many generations outside seemingly Gen Z due to how other generations were raised.

1. the opposite can also be true, ie. people taking anti-establilshment stances to be edgy or whatever. https://www.pewresearch.org/short-reads/2024/03/05/online-op...

2. Your argument seems to basically "17% or 41% is far lower than I observe, therefore it must be because people are cowed into hiding their actual opinions". That might be the case, but it's also possible you're in a filter bubble that's not representative of the public as a whole. For instance if you were on reddit last year you might have gotten the impression there was a universal consensus that Trump had zero support and that Mangione did nothing wrong, but know now that the former was obviously false.

>1. the opposite can also be true, ie. people taking anti-establilshment stances to be edgy or whatever

Hence suspect. I didn't state it definitively for that reason alone. I can only infer based on things like sentiment analysis and reading volumes of comments, reports (news and otherwise) and of course, polls. It all offers very conflicting ideas of how people really feel about him, what he did, and the CEO. That all take in sum, seems to suggest there is more support than any one poll captures.

That said, I understand that is all sociological qualitative analysis, therefore must admit it could be wrong.

>2. Your argument seems to basically "17% or 41% is far lower than I observe, therefore it must be because people are cowed into hiding their actual opinions". That might be the case, but it's also possible you're in a filter bubble that's not representative of the public as a whole. For instance if you were on reddit last year you might have gotten the impression there was a universal consensus that Trump had zero support and that Mangione did nothing wrong, but know now that the former was obviously false.

It does not, which is why I never said anything like that. See my response above. Its based on a number of factors, of which anecdotal evidence is not a factor.

Honestly the fact that this murder is even a thing where we can’t agree on how condemned it was is already multiple orders of magnitude higher than the median murder that happens.

This is still a very useful signal if you’re thinking long term society health.

To me it’s a sign that the system has become broken. Not yet beyond repair, but rapidly approaching such.

This should have an opportunity for folks to have serious conversations about reform and making things better, but my expectation of what I think will happen vs what is happening unfortunately don’t match

We share the same view!

> I can only infer based on things like sentiment analysis and reading volumes of comments, reports (news and otherwise) and of course, polls.

> of which anecdotal evidence is not a factor.

Comments are absolutely anecdotal. Luigi was extremely popular with the typical politically active Reddit base. Additionally, the people that don’t support him aren’t going to come out and say “well I’m against murder”.

So you end up with huge echo chambers that vastly overstate the support because it’s 2% of the people cheering each other on.

Two signs might be: are people of otherwise good character with reputations to lose doing these actions, and does society find their action to clarify a need to redress at the expense of the victim’s class. I’m just speculating about a line and not opining on a specific crime.

> Where do you draw the line between "When there are no judicial penalties [...] eventually people seek extrajudicial ones" and "some nutjob went on a shooting spree"?

Perhaps the point where people like you try to depict regular people acting out of despair as nut jobs.

Think for a minute: one of the most popular tv shows in modern history is a story of a man with an elite education going to the extreme of running a small criminal organization due to financial pressure caused by a life-threatening medical condition. That was what the US watched for years for escapism.

>Perhaps the point where people like you try to depict regular people acting out of despair as nut jobs.

Mangione was most certainly not "acting out of despair". He came from a wealthy family, had ivy league education, and wasn't even denied coverage. At best you could argue he was in "despair" because of his botched back surgery, but that's hardly a reason to shoot the UNH CEO.

>Think for a minute: one of the most popular tv shows in modern history is a story of a man with an elite education going to the extreme of running a small criminal organization due to financial pressure caused by a life-threatening medical condition. That was what the US watched for years for escapism.

It really isn't. Any critical viewing of the series would reveal that Walter was doing it out of pride rather than necessity. His ex-business partners at Grey Matter even offered to pay for his treatment, but he refused.

> Mangione was most certainly not "acting out of despair". He came from a wealthy family, had ivy league education, and wasn't even denied coverage.

You’re arguing despair is only driven by socioeconomic factors. This ignores the very real despair one can go through and have a lasting effect on going through the medical system, seeing loved ones, friends and colleagues struggle with it, and a myriad of other vectors that can and do cause feelings of despair

>This ignores the very real despair one can go through and have a lasting effect on going through the medical system, seeing loved ones, friends and colleagues struggle with it, and a myriad of other vectors that can and do cause feelings of despair

Surely if he was pushed to violence for personal reasons, you'd expect him to shoot up the hospital that botched his back surgery? Why shoot the CEO of a company where he had no personal connection to? Does "despair" just mean any sort of grievance? Can you say that someone shooting up a planned parenthood clinic was because "despair" at "babies being killed" or whatever?

I feel this situation is similar to that of Jacobellis v. Ohio in which Justice Potter Stewart could not define what hardcore pornography was, but he knew it when he saw it.

Theres 2nd order effects at play in this case that make it unique and unlike other ones. Even including other cases where there are acts of violence for what on the surface would seem like similar reasons.

Therefore no I don't think you can extrapolate this into broader politically motivated violence and/or forms of despair. This case is sufficiently unique in its context and should be viewed as such.

Folks are free to disagree, that is how I feel about it though.

And as for the accused, I will not try and speak for the accused, as its not my place to.

> Mangione was most certainly not "acting out of despair".

Was Luigi already tried and found to guilty? Don't let your bias show.

Also, your blend of argument feels like a straw man. You're not actually debating who pulled the trigger, but why millions of people suddenly and enthusiastically support a random assassination of a CEO of a health insurance company. Why do you think that happens? Can you conceive any explanation?

One of the other most popular shows is about a serial killer. Another is about corporate lawyers fighting for power.

People didn’t care about the premise of medical debt at all. It could have just have easily been coercion to pay a ransom. The plot only needed him to be innocent for the initial hook.

And just like that, the justification.

It’s been interesting watching feathers get ruffled over this justification, while the justification of the healthcare industry sees no push back.

Humans are so interesting when you put them in groups.

The healthcare industry gets an enormous amount of pushback in the US.

I don’t disagree

My comment wasn't an implicature. I'm not sure how you came to that conclusion other than a desire to make this discussion more inflammatory.

> vast machine of death

UnitedHealthcare was my health insurance provider when my daughter got her heart transplant. They paid over $2M over several years, without a single hitch. I think the only thing we were rejected for was when we asked them to cover baby formula (it was a long shot).

Mangione wasn’t even a UHC customer.

The only machine of death here was in that lunatic’s hand.

It is a lot harder for an insurance company to deny a need for a heart transplant than many other conditions that aren't imminently fatal or with a fairly straight forward solution to a problem. Just because your particular case went fine doesn't mean there isn't a problem though.

I don't think Mangione is ever going away. He's outright embraced by left-leaning folks as a hero and an answer to current ills [1].

America is a land of revolutionaries that fought to the death. That's still in our cultural DNA, and we still sell guns to people. If a Mangione incident happens again, it may embolden folks even more and become an increasingly frequent phenomena. (Teaching others how to behave through mimetic behavior and normalizing it.)

The French Revolution wasn't that long ago. A lot of incredibly violent rebellions happen all over the world. If you push people to a point, they'll act.

This is probably just the start.

[1] https://www.reddit.com/r/pics/comments/1jnfgnb/antiteslamusk...

You say he is embraced by "left-leaning folks" as if he isn't embraced by conservatives as well. Ben Shapiro tried to play the same card you are and his fanbase ate him alive saying "stop trying to make this left vs right. It's a bi-partisan issue." When Ben Shapiro's fans are able to see the light for a brief moment, I think it's fair to say this specific issue reaches across the aisle.

All members of the political spectrum have or have known people that have had serious issues with insurance and saw the resulting fallout, such as denied coverage or bankruptcy due to insurance not covering something etc.

There’s enough of that happen that it is in the majority of people’s living memories across age spectrums too.

A true issue that unites all political leanings it seems

I really don't think this is bipartisan at all.

I've lurked in /r/conservative out of curiosity expressly with respect to this topic. Between that and the other conservative commentary I've read on the matter, conservative folks have mostly dumped on Mangione and called his actions terrorism. Even you state that he isn't enduringly popular with Ben Shapiro fans. I'm no expert here, but I'm pretty sure I'm right about conservatives not liking Mangione.

Moreover, I do think I know what moderates and Joe Biden-style neoliberals think, as that's mostly my circle of friends. They don't look favorably on Mangione's actions, either.

Are you saying neoliberals are not left-leaning?

If the system were capable of holding companies and CEOs accountable for behavior that causes obvious and irreparable harm to thousands or millions of people, there would be no need for people like Luigi, and he would not be viewed the way that he is.

That is a totally separate question from whether this precedent will directly cause deaths that you and everyone else here will feel bad about. What happens when people internalize that it's not only okay but good to go kill the "bad guys" since the law won't?

What happens when society internalizes that it’s okay for a CEO’s actions to cause the deaths of thousands, and that that somehow weighs less heavily on the scale than one murder? The UHC CEO in my opinion did a lot more harm to people than Luigi.

The point is that people won’t internalize that vigilantism is the right path unless the system is broken. If you don’t want that, fix the system.

> society internalizes that it’s okay for a CEO’s actions to cause the deaths of thousands

How did they kill thousands? Insurance companies doesn't determine your treatment, doctors do. If you mean they deny some optional treatments, that is what socialized healthcare has to do as well, are you saying European politicians are also the cause of thousands of deaths since they deny some expensive treatments that could save lives, and thus should be killed?

> Insurance companies doesn't determine your treatment, doctors do.

I'm sorry you don't understand how insurance in the US works. This is patently false. Insurance companies absolutely determine your treatment, and not just for "optional treatments" whatever that means.

It is not false, doctors has to treat you if you have a life threatening condition. Insurance companies only decide for stuff that are unrelated to that.

That's only true in the case of very specific life threatening conditions. If your having a heart attack, sure the insurance company doesn't get a say. Long term illness? 100% the insurance determines treatment.

My sister has MS. After failing to respond to a variety of interventions, and losing her ability to walk (for context: this is a woman who ran an ultra marathon the year she was diagnosed) her neurologist wanted to put her on a new drug with lots of studies backing it. Insurance said no. Both my sister and the hospital appealed. Still refused. Sure technically the doctor was still free to prescribe it, but with my sister unable to pay out of pocket, what good does a prescription you can't actually get do?

It wasn't until about a year and a half later when she landed in the emergency room for two weeks that the insurance company finally relented.

MS is a progressive condition. The nerve and brain damage done during those 18 months will be with her for the rest of her life, and will shorten her lifespan.

The idea that insurance companies only make calls on "optional" things that don't affect if the patient lives or dies is simply false.

This is easily searchable given all the news around it. Here’s a fine start: https://fortune.com/2024/12/05/unitedhealthcare-ceo-brian-th...

Well, are you reading it properly? It seems like they have to be cheaper since

> According to personal finance platform ValuePenguin, UnitedHealthcare denies 32% of claims compared to the industry average of 16%.

Since there are laws mandating they have to pay out a certain amount, they can't just pay out less than other insurance companies. So either they have lower premiums, meaning it wasn't the CEO that caused the deaths, it was the person choosing a cheap health insurance, or they have more expensive patients covered, which leads to the same conclusion the insurance needs to get more expensive to cover those patients.

I don't see how the CEO is evil here, if he makes a worse insurance but is more affordable to people?

I guess people read this "Under his leadership, profits for UnitedHealthcare surged from $12 billion in 2021, to more than $16 billion in 2023", and think they get more profits by denying more people, but that didn't happen since their revenue shot up proportionally. They pay out the same fraction as before.

So all you show here is you are easily misled by statistics, that caused an innocent man to get murdered and now you celebrate.

Edit: Its also possible he said "Lets focus on life saving treatments and deny the cheaper claims", and thus denial rate shot up since now they cover more life saving treatments than other insurance companies. But still they paid out the same fraction of everyone else, they didn't earn profits by denying people that is just a lie.

Denying life saving treatment to bolster your bottom line for shareholders is also murder by any other name. If you consider murder as requiring malice aforethought then it certainly fits the bill. Just because someone hides behind legalease does not release them from the moral and ethical corruption. No different than the death penalty this is simply a form of murder society has decided is acceptable.

So then it should be easy to see why a large portion of Americans vocally approved of this. So much so, that the media couldn’t even run enough cover to deaden even half the sound of the cheering.

I don’t know a single person who has gone through, or watched a love one going through horrific health insurance “process” in order to gain life saving care, that wouldn’t want someone to be “paid in kind” for their suffering.

Is “murder someone” just? No. Do I agree that this was how we should’ve approached fixing healthcare? Absolutely not. But there is an interesting moral and ethical dilemma that, much like everything else in life, paints a picture that is not exactly black or white. Many people view healthcare as an inalienable right. You can see how this creates a potentially dangerous high stakes conflict. The proper solution is, of course, to use our legal system to provide safeguards for the most vulnerable health insurance customers. If we focused hard on this, as we should, this entire situation could’ve been completely avoided.

I'm not especially interested in the moral and ethical dilemma of whether it's okay to murder—in my own frame of ethics it's not up for debate, and I don't share axioms with people who think it is. I'm far more interested in the fact that not everyone has the same set of values and the next victim of a politically motivated murder by someone looking to make a statement will probably be a victim that those here won't consider to have deserved it (but of course the murderer will!).

Denying is not for shareholders, it’s for policyholders. A health insurance provider that doesn’t put guardrails on treatments will fail because the required policy rates will go up so much that the healthy people will go to a lower cost provider.

People are happy saying the insurance provider should just pay for everything until the bill comes due in higher monthly premiums.

Insurance companies are doing the only thing they can to exist in this fucked up system where people can bail when prices increase.

This is a function of limited risk pooling. Health insurance companies are state-locked. In the limit they function as options sellers in a stock market. If they can’t hedge off volatility with a larger risk pooling strategy they do something you can’t do at the market - simply deny care.

This problem is due to manufactured monopolies and regulatory capture. Open up cross state healthcare, allow larger risk pools, and use this to hedge off the risk of the 1/10% of customers who represent the highest risk pool. Costs go down for everyone and quality of care goes up. It’s not quite single payer but it’s simple probabilities. I find it hard to believe they wouldn’t lobby for this unless it’s vastly more profitable to stay state locked and deny care.

Of course though you are correct, in that a treatment still should have utility. But the average person being denied something as simple as a PET scan does not represent a maximization of utility. That is greed.

And if we focus hard on it in the future, we can hopefully avoid it in the future. Requiring people to glorify murder as the price of healthcare reform is a great way to negatively polarize people away from it; speaking for myself, I'm absolutely unwilling to make common cause with murderers, and if this initiative makes it to the ballot I will vote no even though I support its text.

>What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal agenda?

None. It already is. People murder other people all the time, sometimes to make progress on their personal agendas. Vigilantism isn't new, it's been romanticized and elevated as noble and virtuous ever since Thomas Jefferson waxed poetic about watering the tree of liberty with the blood of tyrants.

I don't understand why so many people consider this one incident so existentially threatening. Is it just because the victim was rich? Why did everyone clutch their pearls and worry about the fate of civilization because one rich guy got shot, but write off countless other victims of gun violence as just the price of living in a free society? Is it just that people were surprised there was such little sympathy for the victim? Have you seen the way people talk about black victims of police violence? was that callousness and lack of empathy just shocking because the victim was white?

I mean, it didn't even move the needle on anything. There was no uprising, no revolution. Just fucking memes.

> don't understand why so many people consider this one incident so existentially threatening

Nobody, perhaps other than his supporters, does because it wasn’t particularly important. Just visible because of where it happened and that the shooter is hot.

There seems to be an increasingly large subgroup of people who would never have the nerve to commit murder but are participating in the radicalization of people that _are_ capable of doing such things. They are mostly OK with it now because it's benefitting them. The problem will arise when things inevitably get out of control.

>There seems to be an increasingly large subgroup of people who would never have the nerve to commit murder but are participating in the radicalization of people that _are_ capable of doing such things.

I've come to believe that the average Redditor is mentally ill. A recent comment: <https://np.reddit.com/r/California_Politics/comments/1jmqsbn...>:

>There was a question on r/askreddit yesterday. If you woke up tomorrow with Superman’s powers. What would you do. 90% of the comments immediately jumped to murdering the president and every Republican

A reply:

>You weren't kidding <https://np.reddit.com/r/AskReddit/comments/1jmd6c8/you_wake_...>. There was even talk about launching Cyber Truck's into space with their passengers.

> What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal political agenda?

If you head a big corporation like say Exxon, and you sign off on lobbying efforts to reduce pollution regulations, deny climate change etc. which will inevitably kill thousands of people, all in the service of the CEOs political agenda, is that different somehow?

Yet the police aren’t arresting those folks

> In a lot of ways this is like all the media attention on school shootings: we will see copycats, and the next one may not be targeting an unsympathetic healthcare CEO

I wonder if we dug into most CEOs of public companies if they’d be sympathetic.

After all, they say psychopaths excel at two things, being CEOs or being serial killers.

I suspect the skeletons in the closet are quite voluminous for many, many of these folks

> Yet the police aren’t arresting those folks

Do you really want the police to take the law in their own hands and just start arresting people they don't like?

Don’t like? I am talking about people that are in fact responsible for the death of thousands of people, you realize that is the result of the choices right?

I'd be pretty content if legislative bodies passed laws that empowered prosecutors to actively go after white collar criminals with the same fervour that they went after people who grew some weed in the 90s.

And of course I'd like to see law enforcement actually act on those powers, and the powers that they currently have to stop white collar crime from doing the kind of damage that it does to our society.

This[0] is a good example of the kind of stuff that we should be excising from our society because the cost of not doing so is unchecked corruption that hoovers up resources that could be fixing all kinds of social ills that we both are worse off from.

[0] https://www.forbes.com/sites/brianbushard/2023/02/21/mormon-...

> In a lot of ways this is like all the media attention on school shootings: we will see copycats, and the next one may not be targeting an unsympathetic healthcare CEO.

Would it target unsympathetic CEOs in other industries? I am just trying to measure the pros and cons here.

Jokes aside, that Luigi Mangione is a martyr to some subset of the population is hardly surprising. Unlike school shootings, where the senseless violence victimizes only eminently innocent people, what Mangione did victimizes someone seem by a large section of society as a perpetrator.

I agree that it is unsettling, but only in the sense that it feels like some important piece of the social contract has been lost along the way, and it is hard to know where it will end.

The social contract was lost when big business and its execs stopped caring about the humans they employ or serve as customers. Eventually, when regular people see that laws and ethics don’t apply to the rich and powerful, they decide they shouldn’t have to follow stupid laws either.

The leaders of America started it, of course the followers of America will follow.

> Would it target unsympathetic CEOs in other industries?

Industries that are essential to living, sure. I think the health insurance industry is so egregious is because you PAY them money and they DENY you health care.

It evokes a very strong response, because it can clearly be interpreted as theft.

I can't imagine a comparable scenario in e.g. grocery industry where you'd pay for something in a grocery store and get nothing for it.

Some insurance claims get denied, but plenty of them are approved. It might surprise you to learn that most Americans are satisfied with their health insurance: https://www.nytimes.com/2024/12/13/us/elections/health-insur...

If health insurance is as bad as you say, why aren't people just cancelling their plans and paying for everything out of pocket?

> If health insurance is as bad as you say, why aren't people just cancelling their plans and paying for everything out of pocket?

Because it makes no sense to cancel a subsidized (by your employer) plan. So for the same reason people don't come to their employer and request to cut their own benefits.

> It might surprise you to learn that most Americans are satisfied with their health insurance:

Ah yes, the "fuck you got mine" status quo approach. No wonder people are upset about it.

> Ah yes, the "fuck you got mine" status quo approach. No wonder people are upset about it.

Again, most people aren't upset with their healthcare, as per the linked research. Your perception that Americans are largely disappointed with their health insurance is not true.

To take a slightly broader perspective: I don't think this is actually particularly new or unusual. Criminal folk heroes have a long history. See for example Robin Hood, The Outlaws of the Marsh, Jessie James, and murder ballads (https://en.wikipedia.org/wiki/Murder_ballad).

Whether popular or not makes no difference. The guy murdered.

Nonetheless I also feel a sense of helplessness given the current political climate.

I posted once that if you invite violence to dinner you'll find you have a guest unwilling to leave. It was not a popular comment. Most of the responses said something to the effect of, "So you don't think violence ever accomplished anything?" I thought that was orthogonal and was an appalled frankly by the apparent justification for violence.

Having said the above though, I am surprised that with so many denied health care and — facing essentially a death sentence — why do we not see more of them going postal?

>Having said the above though, I am surprised that with so many denied health care and — facing essentially a death sentence — why do we not see more of them going postal?

Did Mangione's even have personal beef with UNH, or even with the insurance industry? I thought he wasn't covered by UNH, and although he had a botched back surgery, he wasn't denied coverage?

Yeah, I don't know. My sense is that he is a very entitled young man though and so, no, he is not someone that would be reacting to his own situation. I didn't mean to imply that he was — but that there are plenty of others though.

>Yeah, I don't know. My sense is that he is a very entitled young man though and so, no, he is not someone that would be reacting to his own situation.

Mangione is an Ivy League engineer from a wealthy East coast family, while Thompson was a Iowa state school accountant whose father worked on grain elevators.

He had nothing to do with UNH. He just really really wanted to kill someone that he didn't like and chose the UNH guy.

> Whether popular or not makes no difference. The guy murdered.

The people who tried to blow up Hitler in the 20 July plot were trying to commit murder.

Hitler’s concentration camps weren’t murder under German law at the time.

“Unlawful” and “immoral” are often the same, but not always.

>I know this is an unpopular opinion here

This always poisons the tone of a comment. Just like, "I know this will get downvoted": You should just state your opinion without proactively casting yourself as the minority voice. It feels like self-pity, and at the same time implicitly colors disagreement with you as dog-piling or talking-down.

That said:

>Luigi Mangione as martyr figure makes me extremely uncomfortable

Is that even a minority opinion? Glorifying assassination should make everybody uncomfortable, no? That's a big, central part of the point of glorifying his crime.

>This is a very different situation than the Aaron Swartz

Is a comparison to Aaron common? I mean specifically in terms of the imposition of law onto them. I haven't seen that opinion here, personally. Just because people have sympathy for both of them doesn't mean there is an implication that what they each did is comparable.

>What precedent are we setting by explicitly making "murder someone" a viable path to making progress

An extreme one. And not a novel one.

> This always poisons the tone of a comment. Just like, "I know this will get downvoted": You should just state your opinion without proactively casting yourself as the minority voice. It feels like self-pity, and at the same time implicitly colors disagreement with you as dog-piling or talking-down.

I wish it weren't necessary, but it's pretty much the only way to get a minority opinion any traction. It's primes the few who do agree with you to preemptively upvote before the mob of downvotes sets in, and it does also work to reduce the number of reactive downvotes that get added.

I try to avoid "I know this will get downvoted" because it's too meta, but yes, it accomplishes the same thing.

> Is that even a minority opinion? Glorifying assassination should make everybody uncomfortable, no? That's a big, central part of the point of glorifying his crime.

In the comments section of HN, it absolutely has been. Every Mangione thread is filled with his fans, and every comment that critiques the glorification of what he did is mobbed by them.

> What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal political agenda?

If this is what you are worried about, America is pretty far behind the leading edge:

https://en.wikipedia.org/wiki/Assassination_of_Shinzo_Abe

https://www.cnn.com/2025/03/25/asia/court-dissolution-unific...

> Luigi Mangione as martyr figure makes me extremely uncomfortable

Mangione is viewed sympathetically by like 20% of Americans [1] and about double that fraction among 18 to 29-year olds. You can find similar stats for flat Eartherism (10% yes, 19% including unsure [2]) or Nazism (10 and 17%, respectively) [3]. Essentially, there is no evidence he is a martyr beyond the baseline fraction of crazy beliefs in society. (Note: I am not suggesting he’s viewed favourably by Nazis. Just that everyone has some niche beliefs, some more, some fewer, and they have a weird tendency of distributing such that about a fifth of the population entertains one of the popular ones.)

In this case, the Mangione connection will help get the initiative on the ballot before promptly guaranteeing its failure.

[1] https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabRepor...

[2] https://carsey.unh.edu/publication/conspiracy-vs-science-sur...

[3] https://www.langerresearch.com/wp-content/uploads/1190a1Trum...

A third of young people aren't flat Earthers or Nazis, what the hell.

> third of young people aren't flat Earthers

Just about!

“4 percent of the 18- to 24-year-old age group said they actually believe the world is flat. Rather, there seem to be a relatively large number in this age group who are willing to entertain doubts: 9 percent said they had always believed the world was round but were recently having doubts, 5 percent said they had always believed the world was flat but were becoming skeptical of that conclusion and 16 percent just weren't sure” [1].

[1] https://www.livescience.com/62220-millennials-flat-earth-bel...

If they target someone unsymathetic, they won't get plaudits. Simple.

“Those who make peaceful revolution impossible will make violent revolution inevitable." -John F. Kennedy

The thing about MLK, is that he existed as a backdrop to more violent alternatives. He is celebrated for being the better of those options, but when companies are not willing to negotiate with the nicer option, eventually they will make the violent one inevitable.

Additionally, I think the thing people get wrong about the "Luigi as martyr figure" is that UHC is itself a violent organization responsible for many deaths. When you project that you are only able to listen to "profits" and people don't have any way to provide feedback via "profits" to you, then they're going to look for other kinds of speech. And unfortunately, this kind of speech was made clear to work (see insurance companies sitting up and fixing a couple of the policies they had in the pipeline as a result of this action, and people's response to the UHC CEO being not negative).

I don't like this direction we're headed in, but I'd be lying if I said I saw other ways to make headway here. Especially given the current administration's interest in regulation.

> What precedent are we setting by explicitly making "murder someone" a viable path to making progress on your personal political agenda?

I think you got it backwards.

The question you should be asking yourself is why did so many Americans supported and even applauded the idea of murdering a CEO of a medical insurance company.

You barely get this level of reaction from condemning sadistic murderers with the death penalty. But when it happened to a specific CEO of a specific healthcare company, you saw a wave of popular support across the US.

Why do you think regular working people leading regular working class lives enthusiastically applauded it?

I agree, but Luigi only killed one. The insurers murder many and by default torture the entire country constantly. The reason Luigi exists as a positive figure in our zeitgiest is because government is captured by industry and doesn't represent the will of the voting public.

Good, your insurance company should get no say on this matter. If your doctor prescribes it, insurance pays. If you think the doctor is committing fraud then you can take that up with the doctor, not the patient.

The mistreatment by insurance companies is so normal now that people are just defeated. My MIL has been trying different treatments for over a decade and finally found a drug that can manage her chronic spinal pain. She's finally mobile enough to play with my nephews. And because her work switched insurance she now going through years of needless bullshit to prove to this insurance company that no really, this is the only thing that works. And now she has to pay for it out of pocket and it's over $1000/mo. I know, I know, you would really rather pay for the cheaper thing that doesn't.

No developed country gives doctors absolute power to authorize treatments.

There isn't an infinite bucket of money to draw from. At some point, spending priorities have to be made and elsewhere, it's usually based on cost vs. years of quality of life improvement, so giving antibiotics to dozens of children wins out against a third MRI for acute back pain for an 80 year old.

The US is abnormal in how much discretion it gives doctors and we are incredibly inefficient with our spending because of it.

The world you've envisioned sounds nice except:

1. That's not the trade that's happening. Every person in the US is paying for their own health insurance. Having Aetna tell you your claim is denied because someone else needed a heart transplant makes no sense. Also this is unrelated but the whole "years of quality of life" is such a made up bullshit thing it's laughable. It's reasonable on the physician end especially when treatments have hard recoveries but for the insurance end it's ridiculous. Can you imagine your car insurance not paying out after an accident because they decided you don't have enough years driving left? That's just patently not your job to evaluate.

2. For most treatments the fight with insurance happens after the services are rendered and even when you do get prior auths they're not binding so that's always fun for people. The money is already being paid, the only question is who.

3. Doctors aren't given absolute power under this system, they're still limited by all the same restrictions they had before—medical board, government regulations, standards of care—except there isn't a private 3rd party with a direct financial incentive to deny care inserting themselves in the middle.

It's very interesting that insurance companies take so much of the blame for healthcare costs in the US, given that they are essentially the only player in the entire system, (alongside the patient), that is against price increases and overbilling by providers.

I recently had an endoscopy done. Simple 15 minute operation where they look at your insides with a camera. They put you under for it. I got the itemized bill in the mail and the anesthesiologist alone charged $738 for the 15 minutes. Of course they probably also did some work pre/post op, but the fact that there were 4 people in the room and one charged $738 for 15 minutes makes it very hard to imagine healthcare costs going down without pinching providers. AKA doctors. My insurer isn't even for-profit.

It's a great point. But then the other side of the equation is, when the providers charge too much and the insurance won't approve, or later (months later) decided they weren't paying and now there's a bill, then guess who gets the surprise in the mail. It's the customer, the patient, who has to mediate between these kafkaesque entities.

If insurance fought behind the scenes with each provider instead of blaming the patient, maybe they wouldn't be viewed as the bad guys so much.

The health care system - insurance and provider - needs a centralized perspective rather than attacking this or that piece of it. That's also how reform should happen - no one wants to hear it, but it has to be planned centrally or at least a central authority should expand the legal guard rails. It already exists with Medicare, why not expand on that idea and cover more ages?

Associating a political initiative with an unrepentant murderer is a pretty bad idea. Imagine anti-abortion activists decided to make James Kopp the centerpiece of the movement.

Ballot initiative, informally named....

I think the article might be trying to be a little too edgy with its title.

The insurers are genocidal torturers who exploit everyone who's forced to interact with them. They're backed by all law enforcement.

This is a very Californian solution to the problem. Prediction: we’re going to see a lot more MRIs.

No you're not.

You are going to see health insurance companies leave the state, just like the property insurance carriers did.

> You are going to see health insurance companies leave the state

They’ll first raise rates. If those get rejected, they’ll leave. In the meantime, private equity will extract a payday [1].

[1] https://www.chcf.org/publication/private-equity-in-health-ca...

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