Is the US healthcare system so flawed that it could drive someone to murder?

Kevin Dwyer, a cystic fibrosis patient, had to enlist a team of lawyers and share his story on the Today Show to gain approval for a life-changing medication.

Dwyer comes from a family of seven children, four of whom, including himself, suffer from cystic fibrosis—a genetic disorder caused by a defective gene.

This disease severely impacts the lungs, pancreas, and liver, leading to an arduous daily life for patients.

When Kalydeco, a groundbreaking medication designed to target the defective gene itself rather than just the symptoms, became available, both Dwyer and his sister filed claims with their insurance provider, UnitedHealthcare, to access the drug.

While Dwyer’s sister eventually secured approval after an appeal, Kevin’s claim was denied—despite submitting identical information. Without the medication, Kevin was nearing the need for a lung transplant.

“The thought of getting this medication that could stop my decline was everything to me,” Dwyer shared in an interview.

UnitedHealthcare only approved Dwyer’s claim after his story gained widespread attention through legal advocacy, support from health representatives, and a feature on the Today Show.

Against this backdrop of systemic hurdles within the healthcare industry, a shocking event unfolded: a 26-year-old Ivy League graduate fatally shot UnitedHealthcare CEO Brian Thompson in broad daylight.

The targeted killing sent shockwaves through the healthcare sector, reigniting debates about the immense challenges within the $4.9 trillion US healthcare system.

Brian Thompson’s assassination

On December 4 in Manhattan, Brian Thompson, CEO of UnitedHealthcare, was fatally shot in a targeted attack outside a hotel.

The assailant, identified as 26-year-old Luigi Mangione, was apprehended days later in Altoona, Pennsylvania.

Mangione now faces state and federal charges, including first-degree murder in furtherance of terrorism—a rare and significant charge.

This legal designation alleges that the killing was intended to intimidate the public or influence government policy.

Under New York law, such charges carry harsher penalties when tied to acts designed to incite fear or pressure government action.

At the federal level, Mangione is charged with murder involving a firearm, using a silencer during a violent crime, and interstate stalking, offenses that could lead to life imprisonment if convicted.

On December 23, Mangione pleaded not guilty to murder and terrorism charges in state court.

Public support for the 'hot hitman'

Mangione’s case has sparked an unexpected wave of public fascination, with some casting him as a folk hero.

Supporters have rallied outside courtrooms, shared ballads on TikTok, and launched the #FreeLuigi campaign, which continues to gain traction.

The internet quickly uncovered intimate details of Mangione’s life, painting a picture of a complex figure.

A Maryland native from a prominent family, Mangione attended private school, graduated as a valedictorian, and earned a computer science degree from the University of Pennsylvania.

Social media sleuths have even unearthed his Goodreads reviews and alleged that he suffers from chronic back pain due to a spinal injury—a detail some have spun into speculative narratives about his personal life and relationships.

This intense interest reflects the hyper-focus of today’s “chronically online” culture.

Mangione’s striking appearance has also contributed to his polarizing appeal. As journalist Jonn Elledge noted on The Bunker Podcast:

“I think it’s more about people enjoying chaos … people like pretty boys.”

While the act of violence has been universally condemned, Mangione has garnered empathy across the political spectrum—an anomaly in an otherwise divided society.

His actions have become symbolic of broader public frustration with the healthcare system, transcending ideological boundaries and sparking renewed debate about systemic inequities.

Government and corporate response to the attack

In the wake of Brian Thompson’s assassination, major health insurers took swift action, temporarily removing executive profiles from their websites and postponing in-person shareholder meetings.

Legal experts noted the unusually high number of charges against Luigi Mangione and the heightened security surrounding his transfer to a New York detention facility, where he awaits trial.

Manhattan District Attorney Alvin Bragg described the attack as "an act intended to intimidate and sow terror."

New York's anti-terrorism law, enacted after the September 11 attacks, broadens the definition of terrorism to include acts aimed at intimidating civilian populations or influencing government policy.

While typically used to prosecute extremist plots, prosecutors argue that Mangione’s actions meet the statute’s criteria.

Historically, the law has been applied in cases involving synagogue bombings, white supremacist violence, and recruitment efforts for extremist groups.

The application of this statute to Mangione’s case underscores the perceived threat his actions pose to the corporate and societal fabric of America.

However, his case raises unsettling questions: What drove a middle-class valedictorian to commit such an act of violence? Why has his story garnered empathy across political divides?

The corporate grip on America’s healthcare system

The US healthcare landscape is a mix of publicly funded programs like Medicaid and a sprawling network of private insurers.

For most Americans, access to healthcare is mediated by private insurance, either through employers or personal plans.

The cost of care depends heavily on negotiations between insurers and providers, leaving patients largely powerless in the process.

This private industry dominance not only shapes individual access to care but also wields immense influence over Congress.

In 2020, healthcare lobbying expenditures reached $713.6 million, more than double the $358.2 million spent in 2000.

Professor Amy McKay’s book, Stealth Lobbying: Interest Group Influence and Health Care Reform, sheds light on the profound impact of lobbying during key legislative moments, such as the introduction of the Affordable Care Act (2008–2010).

Through statistical analysis and investigative methods, McKay traced how lobbying efforts—including donations, fundraisers, and meetings with senators—directly shaped legislative outcomes.

Her research revealed that groups contributing to key committee members were significantly more likely to see their preferences reflected in draft legislation and amendments.

Campaign donations and private fundraising events greatly increased the likelihood of senators offering amendments favorable to these groups, especially during less visible stages of the legislative process.

The study highlights how “stealth lobbying,” carried out through financial contributions and personal interactions, allows interest groups to influence policy away from public scrutiny.

This systemic control not only exacerbates the inequities within the healthcare system but also fuels public discontent—a factor that may have contributed to the tragic escalation witnessed in Thompson’s case.

Healthcare spending and inequities

The US healthcare system is the most expensive in the world, with spending projected to reach $4.9 trillion by the end of 2024—nearly 17% of the nation’s GDP.

Despite this staggering investment, a study by KFF reveals that nearly 50% of adults struggle to afford healthcare.

One in four Americans delays necessary treatments due to cost, and almost half of insured adults face unexpected medical bills.

The employer-sponsored insurance model, which covers 78% of the workforce, intensifies these challenges.

Many workers remain in jobs solely for health benefits, a phenomenon economists call “job lock.” At the same time, gig workers, part-time employees, and freelancers often face significant gaps in coverage, leaving them more vulnerable to financial and medical hardships.

Healthcare disparities

Healthcare inequities are further exacerbated by structural racism and systemic bias.

A 2021 study published in the Journal of the American Medical Association (JAMA) found that Black and Hispanic patients receive lower-quality care than their white counterparts.

These disparities contribute to higher rates of chronic illness, preventable hospitalizations, and mortality within marginalized communities.

Rural areas also bear the brunt of healthcare inequities. Many of these regions are classified as medical deserts, with limited access to healthcare facilities and services.

Residents face fewer preventive care options, longer wait times, and higher rates of untreated conditions, perpetuating cycles of poor health and economic instability.

Affordable Care Act: progress but gaps remain

The Affordable Care Act (ACA) has made significant strides in expanding healthcare coverage, particularly among non-white populations, and has lowered uninsured rates across the US.

However, it was never intended to fully address all gaps in the healthcare system or evolve into a universal healthcare model.

The United States remains the only developed nation without universal healthcare, heavily relying on private insurers—a system critics argue perpetuates inequities and coverage gaps.

This reliance leaves patients vulnerable to high out-of-pocket expenses. Families with employer-sponsored insurance, on average, pay over $25,000 annually in premiums and deductibles, with additional costs for procedures, medications, and specialist visits.

A 2023 Commonwealth Fund report found that 23% of Americans were underinsured, with the majority (66%) in employer-sponsored plans, while 17% were enrolled in Medicare or Medicaid.

The US healthcare system in global comparison

When compared to other developed nations such as the UK, Canada, and France, the US is a glaring outlier in healthcare performance.

Despite spending over 16% of its GDP on healthcare in 2022—the highest among developed nations—it produces some of the poorest outcomes.

In contrast, top-performing countries like Australia and the Netherlands spent significantly less, at 9.8% and 10.1% of their GDP, respectively.

Americans face the greatest barriers to accessing and affording care, have the shortest life expectancy, and experience the highest rates of avoidable deaths.

The UK's National Health Service (NHS), for example, ranks high in affordability, while Germany and the Netherlands excel in controlling out-of-pocket costs and expanding general practitioner availability.

While the US struggles with inefficiencies in a heavily privatized system, the UK’s NHS faces its own crises due to chronic underfunding.

The NHS has been under severe strain since the pandemic, with ambulance waiting times reaching 90 minutes, overcrowded emergency rooms, and rising avoidable mortality rates—bringing the UK’s performance dangerously close to the US.

The NHS's troubles are largely attributed to insufficient funding.

Over the past eight years, the UK’s healthcare budget has grown by an average of 2.8% annually, compared to 3.6% over the previous 50 years.

Combined with long-standing productivity issues, the UK’s healthcare system is becoming increasingly precarious.

The US pours enormous resources into healthcare but struggles with inefficiency and inequity, while the UK’s NHS faces challenges from underfunding and systemic strain.

Both systems highlight the need for sustainable reforms that prioritize access, affordability, and quality care for all.

Insurance claim denials

Insurance claim denials are among the most pervasive and misunderstood problems in the US healthcare system.

Investigations reveal that major insurers frequently use algorithms to deny claims without adequate medical review.

A ProPublica report highlighted how companies like UnitedHealth and Cigna rely on AI to reject treatments, often overruling physician recommendations.

Patients must navigate complex and time-consuming appeals processes, which disproportionately impact vulnerable populations. In severe cases, individuals are denied life-saving treatments, further eroding trust in the healthcare system.

A KFF analysis found that insurers offering plans on HealthCare.gov denied nearly 17% of in-network claims in 2021, with rates ranging from 2% to 49%. Of these denied claims:

• 14% were for excluded services.
  
• 8% cited lack of preauthorization or referral.
  
• Only 2% were based on medical necessity.
  
• The majority of denials—77%—were attributed to “other reasons.” On appeal, insurers upheld 59% of denials.

Transparency around denial rates remains inconsistent.

For example, UnitedHealthcare does not disclose its approval rates, despite the Affordable Care Act (ACA) requiring such data from non-grandfathered employer-sponsored and marketplace plans.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society, noted that at the federal level, insurers are required to disclose this data, but some states simply don’t enforce it.

Beyond an isolated act of violence

The murder of Brian Thompson goes beyond an isolated act of violence—it underscores deep flaws in a healthcare system that many argue prioritizes profits over people.

Public fascination with Luigi Mangione, the man charged in the case, reflects more than a societal tendency to humanize white male suspects.

It signifies a collective frustration with a system burdened by skyrocketing medical bills and inequities.

As investigations continue, Thompson’s death could spark critical debates about healthcare policy.

Advocates hope this tragic incident will become a turning point, driving meaningful reform to alleviate the financial and emotional strain on millions of Americans.