The Riddle of Luigi Mangione
gurwinder.blog
gurwinder.blog
>While it’s true that UnitedHealthcare has the highest denial rate for medical claims, the CEO doesn’t set the approval rate of a health insurance company’s payouts — that’s done by the actuaries, who themselves are constrained by various considerations, such as the need to keep costs low, including for policyholders.
By this logic, what can Brian Thompson be said to be responsible for? It's very strange to me to assign more responsibility for a companies denial rates to its actuaries than the actuaries' bosses bosses boss. So why exactly does UHC have higher denial rates than other companies? It just happens to be that it's actuaries are more frugal? This explanation doesn't hold water and I think it's a strange response to the shooting of a CEO to say, well actually CEOs aren't responsible for the things their corporations do. Of course they are, now they aren't solely responsible, but they probably have more responsibility than any other single individual. It can be completely true that killing Brian Thompson was wrong AND that he was no saint, being responsible for (and getting rich off of) large amounts of human misery inflicted on UHC policy holders by the organization he headed.
The actual problem is the system where United exists at all. Health insurance provides exceedingly little value for a very high cost.
One issue now is that being in the way of healthcare is now so large as to have its own gravity. Just healthcare administration (no caregiving or treatment) is now about 2% of GDP itself. Restructuring healthcare would mean tens of thousands out of a job.
It's not hard to see where it is! Go look up the 2022 NHE, which includes a giant spreadsheet breaking down where all the spending is in the system (you want the "by type and program" sheet).
https://www.macpac.gov/publication/national-health-expenditu...
Looked at the table and could not plainly see the problem. Would imagine that time series presented like with an analog of Tim Morgan's Energy cost of Energy for energy markets might help..
What’s the problem, again?
The dislocation would be far larger than the tech layoff.
Since UHC is a publicly traded company, this action would actually be illegal sice teh CEO's job is to protect the shareholder.
I can image many people here have stock in these companies. So, tell me who is responsible? There is greed everywhere you look if you are honest with yourself.
That said, this jumps the gun:
> The idea that trauma is passed down epigenetically is not only unscientific, it’s also un-agentic; if you believe your trauma is hardwired into your DNA, you’re prone to passively accept it rather than actively trying to overcome it.
Recent research is pretty convincing that the "folk wisdom" of trauma being passed down to later generations is a real thing.
https://www.scientificamerican.com/article/fearful-memories-...
https://www.nature.com/articles/nn.3594
Edit: and I'll add that the mice were able to overcome the inherited trauma, too, so you could argue that it's actually an empowering concept. Even though we can't control what we inherit, this shows you can overcome it.
"Descendants of Holocaust Survivors Have Altered Stress Hormones": https://www.scientificamerican.com/article/descendants-of-ho...
It seems to me that going from "F1 and F2 generations of mice respond differently to the smell of acetophenone if their parents were exposed to it" to "well, human trauma is inherited and there isn't anything we can do about violent behavior" is somewhat far-fetched and smells like neo-eugenics.
> In summary, we have begun to explore an under-appreciated influence on adult behavior—ancestral experience before conception. From a translational perspective, our results allow us to appreciate how the experiences of a parent, before even conceiving offspring, markedly influence both structure and function in the nervous system of subsequent generations. Such a phenomenon may contribute to the etiology and potential intergenerational transmission of risk for neuropsychiatric disorders, such as phobias, anxiety, and post-traumatic stress disorder. To conclude, we interpret these results as highlighting how generations can inherit information about the salience of specific stimuli in ancestral environments so that their behavior and neuroanatomy are altered to allow for appropriate stimulus-specific responses.
Mainstream consensus on this as reported in the popular press is nothing like the actual credence of the guys in lab coats. I know serious biotech people at serious schools who won’t fuck with mMRNA vaccination personally. As long as they’re not quoted on it.
When you get your bioscience from The Atlantic? Be ready to be wrong soon.
Real scientists don’t mouth off like this. They choose an emphasis when writing a grant application like a cover letter.
The truth is that the average person is indifferent to the murder, or right-down approving. HN is a bubble about this for obvious reasons. This a stronger signal for the power-brokers to take it easy and fix some of the perverse incentives than a long career in activism.
We live, and always have lived in a world in which a stranger can decide that you’re a bad person, and kill you. Knowing this reality isn't condoning it, or believing that common political violence is a good state of affairs.
At some level of oppression violence is obviously indicated. The whole of the current Western order is premised on that.
At some point it’s too far. Today is not that day.
I feel like the murderer wouldn't be so widely commended if that were true. Justice is what is supposed to prevent vigilantism, and apparently lots of people here felt that the murder was just.
The Kleptocracy has a year, two at the outside to make some concessions near as I can tell, before they can’t walk the streets of NYC safely full stop. Or Chicago, or …
We'd all do well to, in our rush to decry the murder itself, be mindful of the mistake of losing sight of the reason behind the massive support for Mangione's actions.
Measure twice and cut once on such things.
> We'd all do well to be mindful of the mistake of losing sight of the reason behind the massive support for Mangione's actions.
What I fear is that while screaming that vigilantism isn't ever justified, that this very same act justifies it.
Luigi has tens of thousands of women lining up to marry him, multiple academics doing long pieces about how to achieve jury nullification, and saying he’s the bad guy is not a popular move basically anywhere with a lot of people in it.
If it’s amplified then the amplifier is the public.
There are a very fucking small number of people who own any significant equities, or have their interests actually materialize politically.
That’s the group I’m lobbying to get your shit correct before Luigi is fucking everywhere.
You do have some better definition of merit than “currently profits myself”?
Maybe we could do the same but with the hardest working? It’s not that either. You ever seen guys making a highway in Arizona? Nah, not the hardest working.
Maybe we could backdate pure fucking blind luck in parents and mentors and shit and call it merit and just push that on the previous two groups like the greasy pimps we are for so long we forgot it was a scam and we actually start believing it. And then use it to justify atrocities at the scale of millions (Brian Thompson) but condemn violence at the retail level (shooting him).
Yeah. John Galt forever. I meant Spring Break.
That's around 50 million people.
how about a fucking unprecedented number of people are vigorously endorsing an assassination? How about a fucking huge number that’s a big deal?
My point --- I think obviously --- is that 15% support in an opinion poll is a meaningless metric. Tens of millions of Americans do not in fact support Hitler. There's a whole literature on why these kinds of crazy results pop out of opinion polls (read up for instance on acquiescence bias).
Kanye seems to like him.
Trump has said positive things about him.
There are more white supremacists around than you might think.
There is the concept of the lizardman’s constant for polling wacky ideas but it is more like 4%.
https://slatestarcodex.com/2013/04/12/noisy-poll-results-and...
OK then, what crime did the CEO commit? Simply presiding over a business that people don't like, which he has no real power to change, is not a crime in any sense.
Vigilantism only makes sense when there is no justice for real obvious crimes with known guilty parties. And even then, it has many downsides.
A loud minority (or even majority) of people condoning this does not make it right. In the absence of an articulable crime for which the victim is responsible, this is simple murder. You can rationalize it all you want but your logic could be used to justify lynch mobs.
Insurance companies aren't overtly or covertly killing people. They might not be paying for their healthcare in every single instance where they should. As a business, they must decide what services to cover and at what price or they won't be in business for long. They face extensive regulation to ensure that they are not doing exactly the thing you're accusing them of. Yes that means everything has a limit.
Luigi was a rich kid. Neither he nor his family had any business with this insurance company or the CEO, as I understand it. So this action on his part is the result of some insanity plus radicalization, perhaps by people like yourself who have the gall to compare 100% legal businesses to Nazi concentration camps. Our political discourse has really degraded in my lifetime, with one large faction now frequently accusing everyone they disagree with of being Nazis. No good can come of this.
>The CEO of a company has the most power to change it, and definitely enough power to say "fuck this, find another CEO".
Perhaps he could change something but you can't articulate what that is exactly, because you don't care. You just hate the industry as a whole. Even if the industry needs a lot of improvement, it is entirely legal and regulated, and not a charity. The CEO has no reason to leave because he's got a great job at what most people regard as an upstanding business.
It could be argued that Luigi's murder of this CEO and the public reaction to it could make insurance worse. How? Think about it. What competent CEO-type would want to work at a company if it might put a target on his back? A lot of normal people would not want to. So you're less likely to get a competent and relatable CEO, and more likely to get a cutthroat or incompetent one. The kind of person who doesn't care that lots of people would celebrate his death just for having held the position. And an incompetent one could lead to more deaths, because insurance is basically a finance business that must make enough money to cover its expenses. If they go broke, then nobody is getting covered.
At the time of Nazi rulership in Germany concentration camps were 100% legal.
Health insurance is a modern invention. People lived for thousands of years without it, and even in recent times most of the world does not have it. If you don't like insurance, you have the option of saving and investing your money to pay for whatever you can. Some people cannot afford to pay their expenses by saving, but those people cannot afford insurance either. Someone has to pay for whatever is on offer. I don't think insurance should be used for common health care, only for catastrophic things that you can't anticipate. Imagine how expensive car insurance would be if you insisted on having it pay for oil, tires, carwashes, etc. That is how people treat health insurance and it's stupid.
nice strawman
Because the publics and their representatives made the law that this is a perfectly legal and acceptable thing to do.
Killing a CEO does very little, as there are hundreds of millions of people lined up to take their job.
It would be more effective to go out and kill your neighbors who vote differently than you, and reject things like single payer healthcare or reform.
I can't tell if this is a joke or not but I'll argue as if it isn't. First of all, nobody knows if single payer or any reform would lead to anything better. It's a complex issue that boils down to trying to get something for nothing (or at a price lower than the limited supply of healthcare dictates), which leads to enslaving other people to pay for one's own needs. You can do something about corporate corruption such as in the insurance industry. But state corruption is much more insidious. If you feel that strongly about state-sponsored healthcare then there are lots of other countries you can choose to live in that allegedly have the benefits you want, rather than just hating or doing harm to your neighbors. Furthermore, the MAJORITY of people who approve of the current system aren't going to stand by helpless as random wannabe tyrants attack them.
It makes sense that a young man would lash out this way. Violence should indeed be the last resort, and for many folks the alternatives are dwindling.
Once that starts, that’s a forest fire that burns in ways no one can control.
We can take down this cancerous thing via more civilized means. It’s that civilization that separates us from the thugs we oppose.
Otherwise we’re just the new thugs.
The only revolution I’m willing to die for is one where the goal is a better model: a better way for people to live.
I cannot see a way that killing people is a path to a better world. Killing people without thought or empathy is what the adversary does.
I think we can flip everything upside down via wit and endurance and humanity and sheer will.
Violence is for people who fail in all of that.
Yes. But the amount of people that still failed after all of that is ever growing.
Violence is literally the last thing a person can do. If there is violence then all other means have been tried.
Violence can change things very rapidly in a superficial way: change who is holding the gun mostly.
More substantial and lasting change generally requires ideas framed by compelling words and cemented by personal sacrifice.
That’s the sort of change I’m signing up for.
Any idiot can kill someone.
The US isn’t a society governed by justice, fairness, or even the truth. The rich should be scared because so many support this “execution”.
Of course, they are way ahead, and Robin Hood’s merry supporters will find out that prince john has an army of mercenaries happy to take his coin.
It's not a switch. When your level of oppression rises, the probability of violent acts increases. When the level is high enough, you have a sudden cascade of events releasing pent up anger, which we typically call a revolution. You can't predict the moment exactly. We don't have a revolution yet, but tensions are rising.
The (more likely) real [1] one isn't as easily dismissed.
0 - https://leadstories.com/hoax-alert/2024/12/fact-check-fake-m...
Luigi is more popular than Joe Biden lol [0]. 60% of New Yorkers would acquit him [1] (100,000 sample size).
0 - https://www.msn.com/en-us/news/politics/suspected-unitedheal...
1 - https://www.econotimes.com/Shocking-Poll-60-of-New-Yorkers-S...
"The poll, conducted by PoliticsVideoChannel". Heh.
That's a failure of both logic and reading comprehension on your part, I'm afraid.
It's honestly odd that you'd think this to be true. It reads as if you're a little too keen to find a 'gotcha'.
The alleged manifesto outlines that while there are more knowledgeable experts on the corruption and greed at play, who have been opining for decades, no one has taken action and the problems have remained. To reinterpret this as it "dismissing itself" is far from justified.
> I'd be interested in what led you to think it was strong.
I never said it was strong, or implied such. I said it wasn't as easy to dismiss as the proven fake manifesto, and I said that many people broadly agree with its points.
As an academic essay, or as a finished draft to try and justify murder, it has serious flaws. However, I think that if it were as easily dismissed as you insist, then at least one of the mainstream news organizations would have published it.
That is his central claim. He murdered someone over it. It's luridly false.
No, it isn't. If you want to claim that all of those numbers are explained by heart attacks and guns, then you need to ask yourself how many of the gun deaths are due to poor mental health resources, and how many of the heart attacks could have been prevented with more equitable and affordable healthcare.
And if you still believe it's so "trivially falsifiable", then why do you think most Americans (and the rest of the world, for that matter) believe otherwise? US healthcare is undeniably a global laughing stock. We are the poster child for why capitalism in healthcare is an evil and stupid idea.
Our system works well for people with either a looooot of money, or premium insurance through their employment.
It doesn't work so well for the hundreds of thousands forced into medical bankruptcy each year, or the diabetics dying because they can't afford insulin, or the 27% of Americans who skipped medical care because they couldn't afford it last year [0]. 27%! That's utterly indefensible. No society can long withstand such stress.
It doesn't work so well for non-white infants dying in childbirth at shocking rates, or the families left destitute due to over-costed end of life care. Try telling the people who had their lives financially ruined because someone called a $4,000 ambulance for them that we outperform in healthcare.
Etc, etc.
> when it comes to the treatment of illness, we outperform.
On a dollar per dollar basis? Nope. To all citizens with any approximation of equality? Nope. If you have a high 7 figure net worth? Sure; glad you're alright Jack - but don't expect America to believe you when you say the system works.
0 - https://usafacts.org/articles/how-many-people-skip-medical-t...
Yeah, most of the world sees that as a mental health issue. "Gun nuts" is the term most often used.
And, over half of all gun deaths are suicides, so I stand by my statement that better mental health services would greatly reduce the number of gun deaths.
> and more car deaths because we drive a lot more.
I didn't say anything about car deaths. That was you, and I didn't take issue with it. That said, the fact that road safety has fallen so far over the past couple decades doesn't speak well to our collective mental health.
> I think researchers broadly agree with me.
This is at least your fourth distinctly misleading appeal to authority in our short chat.
> you do you; this doesn't seem like an especially promising discussion.
I'm afraid not. I tried though.
I will leave you with this: our health care system has the same structure in basically all 50 states. But CVD outcomes vary wildly among states: Minnesota, California, Massachusetts, and Colorado have outcomes that exceed those in the rest of the G8, while Oklahoma, Mississippi, and Alabama are so bad they drag the whole country down. Health insurers in Oregon and Rhode Island don't function differently than they do in Alabama.
No part of our life expectancy gap has anything to do with health insurance.
If there's a huge, outlying number of homicides, but there's even more suicides by gun death, does that sound like a mental health system that's working? It's so weird that you'd think this strengthens your case somehow.
> our health care system has the same structure in basically all 50 states. But CVD outcomes vary wildly among states
As you would expect, because:
1. Not everyone in every state has equal access to coverage. States like Alabama and Mississippi have higher rates of uninsured people.
2. Wealthier states with better public health systems invest more in preventive care.
3. Poorer states may have fewer resources that discourage routine doctor visits. A hospital in Massachusetts might have state-of-the-art facilities and specialists, while rural hospitals in Alabama might lack funding or staff.
And, there's lots of other variations by state which could affect CVD outcomes; diet, smoking rates, pollution etc (which often lead back to healthcare, and access to it).
> No part of our life expectancy gap has anything to do with health insurance.
I urge you to reconsider this stance; not just because it's deeply wrong, but because it ignores and enables some really evil stuff. I've given you all the pieces you need to see that, because I know that you have all the intelligence necessary to put them together. I do hope you put them together.
[life expectancy gap causal statistics]
[national health expenditure]
Two useful searches for you.
Insurers are simply not where the costs in our system come from. In fact: if you allowed Medicare to enroll patients of all ages, its administrative efficiency statistics would quickly regress to those of private insurers, for mathematically simple reasons.
It is though. It’s deeply and profoundly wrong; blatantly wrong; a child could see that it's wrong; every other country in the world can see that it's wrong; and most Americans see it as wrong despite deacdeas of unanimous corporate propaganda.
That’s why there have been many books and documentaries about how US insurers are a huge problem. Luigi's manifesto even called two out by name: Rosenthal [0] and Moore [1].
It would have been nice to see you acknowledge the weakness of your last argument instead of responding by accusing me of "defending a narrative" (that's called 'projection' btw). Asking me to google vague phrases is an even weaker line of argument.
> Insurers are simply not where the costs in our system come from.
Do you realize how many times now you've just stated something as if it were fact when there have been shelves of books written demonstrating the exact opposite? It's not normal tptacek, and intellectually incurious in the extreme.
This particular statement of yours is so obviously wrong it's hard to imagine where to begin: Where do those billions in profit come from? Why was the DoJ launching an antitrust investigation against United? Why were there credible accusations against Brian Thompson of insider trading? ... If you want hundreds more examples, try reading a book about this topic: Maybe 'Delay, Deny, Defend', or 'The Price We Pay: What Broke American Health Care—and How to Fix It'. There are dozens to choose from, and you don't seem to be able to even acknowledge that they exist; it's almost spooky.
At the very least, please, try to acknowledge that actually there might be something very wrong here. Plugging your fingers in your ears, and making outrageous and aggressive claims as if you were delivering mathematical proofs with certainty, is really disappointing stuff.
0 - https://stanmed.stanford.edu/how-health-insurance-changed-fr...
https://pmc.ncbi.nlm.nih.gov/articles/PMC9154274/
(you don't even have to read that, just look at the charts, which are excellent)
https://www.cms.gov/data-research/statistics-trends-and-repo...
Want more? Here's relative doctor compensation in the G8; notice anything?
https://www.physiciansweekly.com/how-do-us-physician-salarie...
Here's the AMA explaining how Medicare artificially restricts the supply of doctors, driving up costs:
https://www.ama-assn.org/about/leadership/more-medicare-supp...
What they don't explain is how the AMA lobbied for that scarcity in the 1990s, to avoid an "oversupply" of doctors.
I don't know that "a child" could read this and understand what I am saying, but I expect you can.
And having moved on without comment from "proving" your position that insurance companies have "no effect" on life expectancy (?!) by comparing CVD across states, you're now "proving" it by posting physician's salary data across countries??
You point-blank refuse to look at any data, books, examples or documentaries which shows they are, not even the sources specifically mentioned in Luigi's manifesto... But pointing out the books and examples which show they are in fact killing people makes me an ideologue committed to a narrative, while you love "the data"?
... Wew. I haven't felt this gaslit here since someone tried to claim that detonating thousands of pager bombs, murdering and maiming children and healthcare workers, wasn't a war crime or a violation of the Geneva Convention.
The social media section gives quotes from several accounts that I don't think exist. Like, it's the only result is you search "@JusticeSeekerNYC".
Given you were talking about people being duped by a fake manifesto I am not sure why you'd share this link.
I don't think anyone who has been on the internet the last couple weeks can argue in good faith against Luigi's broad popularity across left and right; that's why I didn't put effort into verifying the source. I still ought to have tried a bit harder there though.
Dzhokhar Tsarnaev had noisy fans on the Internet! Rolling Stone put a glamor shot of him on its cover. People misread Internet fandom as popular support constantly. There is nothing too stupid or repellant for the Internet to create a fandom for it.
Don't take my word for it. The manifesto itself says that the guy doesn't understand any of this stuff. Didn't stop him from murdering something. A first, I think, in murderer manifestos!
Now you're just flat lying. That's not what it said at all, and in fact I explained this to you only hours previous.
Here's what the alleged manifesto said:
> Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play.
This is some of the poorest debating I've seen on HN in a long while. I really don't know why you think it's okay to make shit up like this, and then repeat it long after you were patiently corrected. Who do you think you're going to convince this way? Do you have that low an opinion of the crowd here?
And, I'd still love to hear why you're flat-out lying about Luigi "dismissing himself" even after it was explained to you?
Btw that's not how the word 'antecedent' works.
No, Luigi, that police officer wasn't being overly complicit, he's annoyed that you're not gathering bystanders around the man and calling 911(119) yourself, doubly so because you're not getting it.
> The Civil Rights movement succeeded because it was guided by leaders who had clear, specific, and realistic goals, and were able to negotiate to achieve them.
Implying that Just Stop Oil doesn't fulfill these characteristics sans the prominent leaders. Their original objective seems to have happened [1] (JSO influence is debatable of course) and have defined new clear goals [2]. Lumping this with Israel-Palestine outrage on Twitter and the UK riots seems to make the criteria for not being effective social movements a.k.a "neotoddlerism" is "I don't like it / They annoy me".
Would this attitude result in "denouncing / joking about Seneca Falls" with era appropriate socialization? Doesn't seem that far farfetched.
0. https://substack.com/@gurwinder/p-147486907 1. https://www.bbc.com/news/uk-scotland-scotland-politics-65945... 2. https://fossilfueltreaty.org/
This is an absolutely massive number. It could easily prevent hundreds of unnecessary deaths per year.
Interesting! I agrees he's a crank, but RFK jr seems to appeal to a specific personality type that's common among high-powered individuals. People that like to appear scientific, but hate going along with certain things despite a strong scientific consensus. I recently had a very surprising conversation with a company director where they sang RFK's praises, and came down firmly in the alt-right camp's position on classic trigger topics like Ivermectin, fluoride and COVID. This is someone who outwardly advocates being data-driven and loves phrases like "data doesn't care about your beliefs". And yet their entire view on these topics coincides with the cherry-picked data and misleading interpretations in RFK's book.
I somewhat disagree, our democracies were built on violent, illegal revolutions. Vigilantism is not always wrong.
> I told him about my favorite philosophy, Stoicism, and how it could teach him to ignore distractions and focus his mind on living more deliberately.
It's funny how many of these online libertarian-ish guys preach "stoicism", a philosophy which famously asks you to be satisfied occupying your "natural" place in the universe, be it slave or Emperor or the Roman Empire.
Ultimately, I think this culture of "agentism" pushes some to a particular brand of individualism, in which it may seem that history is written by great men, heroes, who take actions in their own hands.
> Vigilantism is always wrong.
We should stop saying this because we can be nuanced. It's okay to have edge cases. There are circumstances where it is justified to run a red light or abandon a truck trailer. All rules are made to be broken, because no rule can be perfectly specified. Language is limited and time marches on. It does no good to continue saying this, in this way.
Vigilantism is __rarely__ justified, and this is not an instance where it is. But we also must admit that this instance has sparked a larger national conversation. One that was going on for a long time but was routinely quickly quenched. This action catalyzed the conversation and gave it much more fire. __THIS__, I feel deeply uncomfortable with. There's certainly ways to do this same thing without killing a person (even an evil person), and I would hope that we can do better as a society to do that (you, me, and everyone. Not just "them", "US"). We shouldn't need to kill someone to have a real conversation, to solve problems, to get angry, to make change. It's here and I don't want to kill that conversation now that it has catalyzed, but neither do I want that to be the lesson learned from this. Because if it is, then vigilantism is justified much more often, and __that__ is not something we want. That is precisely how we end up creating the reality that everyone wants to avoid when they say "vigilantism is _always_ wrong."
This is a sensitive topic, and I think we should be careful. There's always ways to misinterpret others, especially if you try. But it is hard to listen, to see past the words, and find the intent. It is easier to fight and pick sides, especially when we're on the same one, than it is to actually solve problems. Problems that are complex, nuanced, and need deep understanding and care to resolve. It is easy to make them simple and pick tribes on that. Many of us want the same end goal, and we can do better by focusing on that. If we reach an impasse, so be it, but we should at least try.