Nicolais: Our health care system is a patchwork jumble no one would build

Luigi Mangione, the man accused of assassinating UnitedHealthcare CEO Brian Thompson, has ascended to folk hero status for many Americans. That is a damning indictment for all involved.

The cold-blooded death of an unsuspecting husband and father is not cause for celebration. The act that led to it was callous and calculated. It tore a hole in the lives of family, friends and co-workers without regard for long-term effects. It devalued human life to prioritize another goal. 

And if you read the preceding paragraph again, it could just as easily be a description of how patients frequently get treated in America’s health care system.

The U.S. health care system operates like a giant Jenga game that has had block after block removed from its base in an effort to build higher. In this case, those building blocks have been patient care stripped out in favor of ever-increasing profits and shareholder returns.

In a must-read New Yorker article, physician and associate professor Dhruv Khullar dubbed the current era “The Gilded Age of Medicine.” Written before Thompson’s murder but published after, Khullar sets out the “gamification” UnitedHealthcare engaged in to bill the government additional diagnoses while pushing doctors to see more patients. Cuts in less profitable care programs for more lucrative ones incentivizes changes that are not necessarily the most beneficial to patients.

According to Khullar, that reduction in personal care compounded by systematic problems such as high deductible plans where patients are responsible for a large portion of the financial responsibility has created a spiraling effect.

This is not something new. More than a decade ago, Time published a groundbreaking article entitled “The Bitter Pill.” It detailed the billing process used by hospitals and how astronomical invoices became the norm.

It had little effect.

The broken pieces of our health care system have remained in ruin. And that isn’t just my opinion. Andrew Witty, the CEO of UnitedHealth Group, the parent company of Thompson’s UnitedHealthcare, wrote an op-ed in the New York Times stating the same: “No one would design a system like the one we have. And no one did. It’s a patchwork built over decades.”

Of course, Witty himself has used that broken system to earn $23.5 million per year. For people choosing between medical care and mortgage payments, such statements often ring hollow. It comes off as patronizing and adds to frustration for individuals and families across the country.

That shared frustration is what has led to an unexpected outpouring of support for Mangione’s perceived message, if not the actual act itself. Much like the murderous Bonnie Parker and Clyde Barrow garnered broad support from a Depression-impoverished public while robbing banks, people flooded social media feeds with support before Mangione had even been caught or identified. 

The public support only intensified when news broke that shell casings found at the scene with the words “Deny,” “Delay,” and “Depose” — all seemingly related to criticisms of the health insurance industry — scrawled onto them in Sharpie.

The reaction continued toward a crescendo when pictures of the photogenic Mangione were first published. A legal defense fund in his name has already raised tens of thousands of dollars. Even celebrities such as comedian Bill Burr chimed in, saying he was glad CEOs were afraid right now.

That populist outpouring should deliver a message much louder than anything Mangione wrote in his notebook or says in court.

We are now living in a world where violence is not only viewed as a realistic solution, but is being actively condoned. Kyle Rittenhouse shot and killed Joseph Rosenbaum and Anthony Huber while “guarding” businesses in a state where he didn’t live. Elon Musk has regularly promoted a coming civil war. President-elect Donald Trump has promised to pardon more than 1,600 insurrectionists who violently attacked the U.S. Capitol in 2021.

That is the country we live in right now. 

Tragically, it seems likely things will get worse — potentially far worse — before they get better. For example, Trump’s plans to eliminate the Affordable Care Act will expose millions of Americans to far-greater health care risks. Compounded by government spending cuts led by Musk and the potential for increased exposure to life-threatening illnesses if Robert F. Kennedy, Jr. is confirmed as Secretary of the Department of Health and Human Services, health care in this country could get far more costly for average Americans in rapid order. 

If that happens in concurrence with a media circus surrounding Mangione’s trial, we could be in for a rash of targeted violence we have never seen before. That would be tragic for our country.

Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on Bluesky: @MarioNicolais.bsky.social.

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