From Manifesto to Mayhem: Exposing the Flaws in Luigi Mangione’s Attack on Healthcare

The shocking assassination of UnitedHealthCare CEO Brian Thompson by Luigi Mangione, a disillusioned 26-year-old, encapsulates both a heinous act of violence and an egregious misreading of the complex dysfunction that bedevils the American healthcare system. Mangione, a graduate of an elite Ivy League university and the son of healthcare professionals, left behind a manifesto labeling the healthcare industry as parasitic, citing personal frustration with his family's struggles to navigate the complexities of insurance claims and billing. His manifesto echoed familiar leftist refrains, critiquing 'corporate greed' while ignoring the regulatory nightmare largely constructed by progressive policymakers. He sought to enact a symbolic retribution. Yet, his actions illuminate not the systemic failures he purported to denounce but rather the dangerous simplicity of assigning blame to individuals within a profoundly complex ecosystem. While it is tempting to zero in on an individual as the embodiment of systemic malaise, such oversimplification ignores the intricate network of perverse incentives and regulatory distortions that define this multi-trillion-dollar industry. Our healthcare woes stem not from the machinations of a singular corporation but from a complex interplay of government overreach, market distortions, and institutional inertia, as evidenced by the extensive influence of Medicare's reimbursement policies, the stifling effects of certificate-of-need laws on competition, and the FDA's stringent approval processes that inflate drug prices.

Those who seek scapegoats—be they executives or corporations—often fail to grasp the fundamental architecture of the healthcare economy, an architecture crafted not by CEOs but by Congress and the federal bureaucracy and its maze of mandates. Let us systematically dismantle Mangione’s flawed assertions and expose the broader truths about America’s healthcare debacle.

The Killer’s Premise: “Those who profit from the suffering of millions must face accountability.”

While the sentiment is emotionally resonant, it is analytically bankrupt. Mangione’s manifesto reveals a belief that targeting Thompson would serve as retribution against a system that prioritizes profit over patient care. Targeting corporate profits in isolation from their regulatory context is akin to railing against the tides while ignoring the moon’s gravitational pull. Consider that UnitedHealthcare operates with a profit margin of merely 3.63%, translating to approximately $32,500 per employee—a modest figure when juxtaposed against other large companies. Apple’s profit margin hovers around 25%, with per-employee earnings exceeding $600,000. Google (Alphabet Inc.), on the other hand, enjoys a profit margin of approximately 21%, with employee productivity contributing upwards of $270,000 annually. These modest margins in the healthcare sector reflect the high administrative costs and compliance burdens unique to this industry. For instance, the complex layers of billing and coding standards alone account for billions in operational expenses, diverting resources away from direct patient care and driving up consumer costs. The American healthcare system is not a free-market utopia, where executives set premiums with reckless abandon; rather, it is a maze of government edicts, opaque reimbursement protocols, and protectionist policies that strangle competition. UnitedHealth and its peers operate in this complex ecosystem, constrained as much as enabled by the very rules under which they flourish.

Take Medicare, for instance. It sets reimbursement benchmarks that ripple across private insurers, forcing conformity rather than fostering innovation. Meanwhile, the tax code’s complex deductions and exemptions further distort market signals. Executives like Brian Thompson are mere players in this Kafkaesque theatre, navigating laws designed by Congress to prioritize shareholder profit. To assign them sole culpability is to confuse the puppets with the puppeteers.

America’s Healthcare Spending: $4.3 Trillion Annually with Poor Outcomes

Indeed, the sheer scale of American healthcare expenditure is staggering, eclipsing that of any other nation, with inefficiencies compounded by Democratic policies that incentivize dependency and reward bureaucratic bloat. And yes, the outcomes often fail to justify the costs. But to indict insurers as the singular culprits is to miss the forest for the trees. The true culprits are manifold: government-imposed monopolies, such as the certificate-of-need laws that throttle competition, as evidenced by the closure of independent surgical centers unable to meet these arbitrary requirements; the cartel-like behavior of hospital systems, illustrated by coordinated efforts to fix prices in regional markets; and pharmaceutical pricing models shielded from market pressures, such as the extended patent protection on insulin that has kept prices exorbitantly high for decades, despite calls for reform.

Let us not forget the cultural factors that exacerbate this morass. Americans’ predilection for litigation incentivizes defensive medicine, while lifestyle diseases—often the product of poor individual choices—swell the ranks of the chronically ill. Blaming insurers for systemic inefficiencies ignores the broader sociopolitical dynamics, including the Democrat Party’s continued push for government overreach under the guise of 'universal care,' which stifles competition and inflates costs.

UnitedHealth’s Revenue and CEO Compensation

The killer’s ire over UnitedHealth’s $362 billion revenue and Thompson’s $20 million compensation is as predictable as it is misguided. Yes, these figures provoke outrage, but they are symptoms rather than causes. The true disease lies in a system where profit maximization is tethered to regulatory compliance rather than competitive innovation.

Contrary to popular belief, insurers’ profit margins are modest as a proportion of total healthcare spending. Hospitals, pharmaceutical giants, and device manufacturers often claim far larger slices of the pie. Thompson’s pay, while ostentatious, reflects the market rate for navigating a system so arcane that even seasoned policymakers struggle to comprehend it. Reducing his salary to zero would scarcely move the needle on premiums or deductibles. However, executive compensation has become a lightning rod for public frustration, symbolizing perceived inequities and inefficiencies within the system. Addressing such compensation, even symbolically, could help restore public trust by demonstrating a commitment to systemic reform rather than perpetuating the status quo.

High Premiums and Deductibles: Illegal Immigration's Hidden Cost

Americans’ financial burdens are real, but their root causes are structural. Government-imposed price controls, fragmented care delivery, a lack of price transparency, and the unchecked strain of illegal immigration collectively inflate costs. Democrat policies fostering open borders exacerbate this crisis, with emergency rooms overwhelmed by undocumented individuals, diverting resources from legal residents and taxpayers. The current system rewards opacity; hospitals inflate “chargemaster” prices to secure higher reimbursement rates from insurers, who in turn pass these costs to consumers. This is not the handiwork of a single corporation but a systemic failure.

Corporate Lobbying and Influence

The killer decried UnitedHealth’s $8 million lobbying budget, but this pales in comparison to the lobbying expenditures of other healthcare stakeholders. Hospitals, physician groups, and pharmaceutical companies collectively outspend insurers by a wide margin. Moreover, lobbying is a rational response to a system where political influence is a prerequisite for survival. The solution lies not in vilifying lobbyists but in reforming the rules that make lobbying so lucrative.

The Call for “Bold, Systemic Solutions”

While Mangione’s diagnosis of a broken system is not without merit, his prescription—targeting individual actors with violence—is both morally indefensible and strategically impotent. True reform requires dismantling the regulatory maze, restoring market competition, and empowering consumers with transparent pricing. Specific steps include repealing certificate-of-need laws to foster competition, mandating price transparency to allow consumers to compare costs, and streamlining FDA approval processes to reduce drug development expenses and promote market access for generics. These measures have proven successful in states that have implemented them, leading to lower healthcare costs and increased consumer choice. With the recent appointment of Robert F. Kennedy Jr. as head of the Department of Health and Human Services (HHS), there is a unique opportunity to push for these reforms. Known for his commitment to transparency and challenging entrenched interests, RFK Jr. can serve as a pivotal advocate for dismantling bureaucratic inefficiencies. Partnered with Republican leaders like Trump, his efforts could pave the way for patient-centric reforms that protect American citizens from the double blow of bureaucratic mismanagement and unchecked illegal immigration. It demands a reckoning with the cultural and institutional factors that perpetuate inefficiency. Above all, it requires rejecting the collectivist impulses that have allowed the federal bureaucracy to usurp control over so much of our healthcare economy.

As conservatives, we must champion reforms that realign incentives with outcomes, eschewing the progressive fixation on punitive redistribution in favor of solutions rooted in liberty, transparency, and personal responsibility. Let us direct our ire not at the players but at the rigged game they are forced to play.

The tragedy of Brian Thompson’s death is not just the loss of a life but the perpetuation of a false narrative—one that shifts blame from the Democrat Party’s failed policies to the supposed greed of private corporations, ignoring the true systemic rot. Let us use this moment not to indulge in misplaced vendettas but to redouble our efforts to restore sanity, sovereignty, and freedom to American healthcare. This includes repealing certificate-of-need laws to foster competition, implementing transparent pricing to empower consumers, streamlining FDA approval processes to reduce costs, and leveraging RFK Jr.'s leadership at HHS to advocate for meaningful reforms. By focusing on these actionable steps, we can begin to dismantle the systemic inefficiencies and restore trust in the healthcare system.

If you don't already, please follow me on 𝕏 at https://x.com/amuse or medium .