The UnitedHealth Insurance CEO killing and contested violence in a capitalist society

Why are many people looking past the homicide of UnitedHealthcare CEO Brian Thompson and focusing more on Luigi Mangione as a kind of hero? Thompson’s murder has generated discussions about the greed of US health insurance corporations and the US healthcare system. Many people have probably experienced firsthand the insurance corporation’s mantra “Delay, Deny, Defend” while attempting to use their coverage for medical treatments, procedures and medications. But the use of violence as a form of redress has generated certain discussions. 

Counterviolence

There is a long history of what has been called counterviolence or revolutionary violence against state oppression and violence, in both periphery and core nations. As the case against Mangione moves forward, it appears to have all the hallmarks of a non-legalistic, political action, and not the act of a “common” criminal to accomplish personal gain. Within a non-legalistic framework, actions or violence used to advance a political objective — such as to call attention to or prevent the plight of oppressed people — is not considered a political act. If we take Mangione and his supporter’s claims seriously, we need to understand historical antecedents and the present context (a period of docility and dormant organised resistance). 

The notebook police reportedly found in Mangione’s possession — the media has referred to it as a “manifesto” — presents his actions as resistance, and outlines his reasons for counterviolence: 

I do apologize for any strife of traumas, but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but has our life expectancy? No, the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allowed them to get away with it…. Evidently, I am the first to face it with such brutal honesty.1 

This glimpse into Mangione’s mindset suggests motive. Besides the initial appearance of acting alone, his alleged actions have much in common with revolutionary groups that communicate the reasons for their actions. He was still fleeing arrest after Thompson’s death, so we do not know if he planned to release this “manifesto” to the public. 

Revolutionary groups often communicate the reasons for their action by leaving communiques, claiming responsibility for their armed action, and linking their actions to a source of oppression and exploitation, such as colonialism, racism, and capitalism. Some groups in recent US history that have adopted this tactic are the Armed Forces of National Liberation (FALN) and Los Macheteros, from the Puerto Rican Independence movement. There have been other such as the Black Liberation Army, the Weather Underground and, more recently, the Earth Liberation Front and Animal Liberation Front, who employed a variety of actions (the bombings and sabotage of government and corporate institutional structures and, in some cases, expropriations and assassinations) to bring attention to their causes or retaliate for perceived injustices to their people, community, nation or the environment. 

These revolutionary groups arrived at the conclusion that armed action was required because the limitations and corruption of the political process made it next to impossible to have their claims redressed. Armed action (or armed struggle) was just one tactic in their overall strategy to achieve their objectives. These organisations were part of broader movements utilising other methods, which included political organising and engagement in the political process. 

Mangione alleged lone status does raise several issues because revolutionary groups are often viewed as collective organisations displaying a high level of solidarity and an affinity to their cause. Until there is more information provided about his politicisation and associations, it would be pure speculation to accept many of the media’s claims. There is a whole social and revolutionary literature on how prior social ties and political and economic conditions are influential in explaining why some people engage in “high-risk” political actions. 

All political acts of resistance come with a cost. Acts of civil disobedience (blocking an intersection or other public places) can result in a monetary fine or short jail stay. The higher the risk, the higher the probability of physical injury, death or lengthy imprisonment (these acts can include physical damage or harm to representatives of the institutions of the state or corporations.) At the same time, the US government fails to regulate and criminally charge corporate perpetrators that inflict social harm on humans and the environment. This knowledge, coupled with lived experiences of the pain and suffering from corporate-inflicted harm, may have been enough for Mangioni to strike out against the professional-managerial class who profit from the misery of others in the system of capitalism.

To analyse Mangione’s actions, one can consider how the duopoly political party system and its symbiotic relationship with corporate America serve to maintain the political order of a capitalist system rooted in imperialism, and limit avenues to bring about meaningful change. Rising social isolation, depoliticisation and the duopoly political party propaganda have limited and constrained the capacity for imaginative and alternative thinking and politics. In addition, the prosecution of political and social dissents (across various administrations) and repression of social movements (especially since the 1960-70s) have also hindered meaningful political collective interaction.

Frustration that stems from political grievances as a motivation to seek retribution against institutions of injustice with armed action is not exceptional. One needs to consider the US and French revolutions. This is not to say the state and corporate media would not want to present the image of the lone, psychologically unhinged individual to discredit and criminalise people who get to the point of leashing out at the system. In so doing, the system of oppression is absolved of any culpability, while the individual is assigned all the fault. 

The disciplines of sociology and criminology inform us that the definition of violence is not politically neutral. The legal definition is one that fits within the parameters of the state and its role to maintain the political order of capitalism. Even though the US public has largely been shielded from this reality and internalised the belief that violence is wrong, immoral and must be condemned, this does not mean all violence is equal. State or state-sanctioned violence is largely exempted from this condemnation and villainisation. 

When the US state utilises violence, its authority has the capacity to legitimise these actions like no other organised force. The role the state plays in ensuring the maintenance and continuation of a highly stratified society and its global dominance requires a great deal of coercion and violence. Yet, this violence is not viewed as criminal. 

With approximately 800 military bases around the world, and the largest military and military budget the world has ever seen, the US state’s global hegemony is supported by its ability to use coercion and violence. The long list of US military invasions, its interferences in sovereign nation’s affairs and elections, and its proxy wars, are all testaments of the use of coercion and violence in maintaining the US empire (Johnson 2000 and Churchill 2003). 

State officials insist that “terrorism” is a product of non-state entities who use violence to advance a political or religious cause. They do not include states, because if they did the US would be the biggest terrorist (Chomsky 2003). When speaking of US state violence in general, Martin Luther King Jr’s “Beyond Vietnam: A Time to Break Silence”2 (1967) called the US state the world’s number one purveyor of violence, attributing this to “the giant triplets of racism, extreme materialism, and militarism.” He provided examples of this in Vietnam, Latin America, and the US. 

Alongside the overt and covert violence of the US state is its coordination of interests with US-based corporations and the hidden, mostly “legal” violence produced by corporation’s pursuit of profits. Insofar as they are profitable, it usually means they have inflicted some degree of pain and suffering. The accumulation of profits is dependent on the exploitation of labour, extraction of resources and general subjugation of populations, which create the inequality and poverty often associated with a multitude of social ills. For example, these structural conditions increase people’s susceptibility to disease and illness. The capitalist system makes people sick and turns a profit on their medical treatment. Yet, the commodification of treatment has its limitations, especially when the US population are either underinsured or uninsured. 

Private health insurance corporations

Unlike many comparable industrial high-income nations, the US does not have universal health care. The US healthcare system is fragmented and largely one in which people are insured by private insurance corporations via employee and employer contributions. The largest health insurance corporations are: UnitedHealth Group Incorporated ($449.27 billion), Elevance Health Inc ($105.37 billion), The Cigna Group ($81.6 billion), Chubb Limited ($78.58 billion) and Humana Inc ($55.71 billion).3 The monetary figures represent their total stock value.4 Currently the US health insurance industry is a $1.2 trillion dollar enterprise, which continues to grow every year. Private health care industry is a very lucrative business. 

Formulas vary from industry to industry, but for much of the healthcare industry the objective is the same: to generate a substantial profit margin. In simple terms this means expenses (the cost of medical claims) is less than income (the cost of insurance premiums). There are other ways to ensure insurance companies generate profit. One of the most efficient ways is by denying insurance claims, which increase out of pocket expenses for medical treatment. Others include raising deductibles, co-payments, and out of network costs. 

Health insurance corporations have huge bureaucracies that are tasked with carrying out the science of profit maximisation. Beyond data management, billing, collections and advertising, they utilise advanced technologies, such as computerised programs and AI, to devise innovative methods of rational calculation to maximise profit, often at the cost of patient care. 

Respondents to a State of Claim survey said “the top three reasons for denials are missing or inaccurate data, authorizations, inaccurate or incomplete patient info.”5 Health insurance industry experts have given many reasons for the denial of claims, such as too much information to process and organise in filling out a single claim, which creates many opportunities for errors and omissions. In addition, with a fragmented system, there are constant changes to rules and policies, making it impossible to keep up. Lastly, staff shortages have not been conducive in rectifying these issues.6 

Health insurance corporations benefit from this chaotic system because it provides them the opportunity to divert attention away from their malice behaviour while they continue to deny claims and rack in astronomic profits. Some healthcare advocates argue insurers deliberately avoid transparency because refusing payments for medical care and medicines is an essential aspect of their business model. Those that are denied appeal less than 1% of the time.7

Denials affect patient care. According to Kaiser Family Foundation senior fellow Karen Pollitz, “This is life and death for people: If your insurance won’t cover the care you need, you could die.”8 Half of US adults say they or someone in their family had to delay or forgo needed medical or dental care in the past year because they could not afford it (see Barkan 2023:261). The lack of transparency and government enforced regulations, among many things, means there are no reliable figures for the number of claims denied by insurance companies. According to Robin Fields, “The limited government data available suggests that, overall, insurers deny between 10% and 20% of the claims they receive. Aggregate numbers, however, shed no light on how denial rates may vary from plan to plan or across types of medical services.”9 

Health care is one of the largest industries in the US: it accounts for nearly 20% of GDP. The figures of the human and economic cost of the healthcare system, and especially how many people are uninsured, underinsured, or receive substandard care, is downright diabolical. There are probably not many families that have not been negatively affected by some aspect of the healthcare system. The uninsured rate is usually at about 9.4%, but when factoring in everyone that is 65 and younger who is not covered by Social Security and everyone in any given year that loses their employment and are not covered, the rate is more 17.7%, which translate to about 71 million people being uninsured or underinsured (Barkan 2023: 286-287). The underinsured are the millions who have healthcare coverage but because of the rising cost of health insurance premiums cannot afford all the out-of-pocket expenses, so they tend to forgo medical treatment or medications. 

These figures exist even with the passage of the Affordable Care Act (ACA) of 2010. Although the ACA made some improvements, such as health insurance corporations not being able refuse to cover people with preexisting conditions, refuse or cancel someone with high medical cost, and allowed dependents to be covered up to age 26, the individual mandate and overall healthcare reform remained steeped in the market model. This has proven to not be an efficient system compared to a universal, taxpayer-funded healthcare system, in which the government regulates the cost of medical practices and medicines. So, even with the passage of the ACA, there continues to be millions of uninsured and underinsured people. The high cost of healthcare for individuals and families (deductibles and other out-of-pocket costs) and the out-of-network coverage all remain a major problem (Barkan 2023:286-287). 

Many of the treatments, procedures and medications that private insurance contest make corporations billions of dollars yearly. Health insurance corporations operate like any other corporation, putting profit ahead of any notion of public good. They often defend themselves by stating their behaviour is legal and within the parameters of a market economy, and that their obligation is to their shareholders. 

Yet, Thompson’s murder has stirred something in many people who now openly question the rationales and justifications used by health insurance corporations, their top officers, the corporate media and state officials. It may be that the veneer of legitimacy that has long shielded corporate criminality and the complicity of the US government in crimes such as the denial of millions of people health coverage may be unraveling.

A crime by any other name

Health insurance corporations are responsible for the death and injuries of millions of people. Is a person who kills another in a bar brawl a greater threat to society than a business executive who refuses to cut into their profits to make their plant a safe place for dozens, hundreds or even thousands of employees? This logic also applies to healthcare corporations. Are the actions of a health insurance CEO in denying health coverage to individuals in need of medical services as culpable as a person who kills a member of the managerial class who enriches themselves of the misery of millions of people? 

We could argue that CEOs, board of directors, and those at the top levels of the bureaucracy are more culpable because their actions involve mens rea (a guilty mind), actus reus (guilty act) and causation (their acts cause actual harm). Their acts have malice aforethought in that they know it can lead to death and injury. One can argue corporate or white-collar crime are all premeditated crimes, whereas a bar brawl that results in a death is usually adjudicated as a second-degree murder or manslaughter. 

International law illustrated that claims of carrying out state-sanctioned orders in a premeditated conspiracy are not successful legal defenses. In other words, just because the US state sanctions corporate criminal actions, with its legal system (in most cases by not prosecuting it as a crime, even although it inflicts social harm) and lack of regulatory enforcement, does not mean it is not criminal to engage in premeditated acts that cause harm and death to people. 

Jeffrey Reiman and Paul Leighton (2023) argue there are reasons why the public do not view corporate crime as destructive as the one-on-one, interpersonal crime perpetrated mainly by the poor. Street crime, they say, is a byproduct of inequality and poverty, and serves to misdirect the public’s attention away from corporate and state crime, which create the conditions for street crime in the first place (Reiman and Leighton, 2023). They provide a reason why the public is not engaged in discussion and critical analysis of why corporate and state criminality is not prosecuted in the same manner as common crime. 

According to Reiman and Leighton, corporate and white-collar crimes that have a more significant human, economic and environmental cost to society are left out and, in many cases, not even reported as crimes (2023). The criminality of private insurance corporations and much of the private, for-profit healthcare industry fall within this realm of corporate crime. Why are private healthcare insurance industry corporate criminals? Because they are complicit in the preventable deaths and injuries of millions who are denied access to or adequate health care in their pursuit of profit. 

Final thoughts

Violence is a contested phenomenon. Legitimate violence versus legislative violence is contested in terms of state-sponsored versus counterviolence and revolutionary violence, both at the individual and collective level. It can be argued that Mangione’s actions appear to be consistent with the actions of groups that take up armed struggle to retaliate and bring attention to the grievances of an oppressed and exploited population. This logically leads us to understand the legalistic and non-legalistic definitions of violence and how they are not politically neutral. The legal definition of violence fits within the parameters of the state and its role in maintaining the continuation of the political order of the capitalist system. 

When individuals, groups or movements respond with violence, it is widely and thoroughly condemned by the corporate media and state officials. Yet, at what point do non-state actors conclude that violence becomes a legitimate recourse? A question not fully taken up here is whether the pervasive docility and organised resistance dormancy created by the duopoly party system, state-sponsored violence and its coordinated interests with corporate America, make the conditions for individual resistance more probable. The lack of opportunity for meaningful change through the political process needs to be considered.

History illustrates that illegitimate and legitimate violence are not universally defined. What is key in making this distinction is the state. Max Weber, a founder of sociology, provides one of the most used concepts of the state, which is that the state “claims the monopoly of the legitimate use of physical force within a given territory” (1919). This concept is important because rather than viewing the state as a neutral form of justice or as an enforcer of some idea of a social contract, we see Western states as primarily having control of violence. 

Another founder of sociology, Karl Marx, argued the state’s interests coincide with the economic interests of capitalists, or that the state is the counsel of the ruling class (Marx and Engels, 1848; Marx, 1863, 1870). Hence, states prioritise coercion and capital accumulation and expansion, ultimately making concessions, such as democratic rights, aid and welfare state provisions, to acquire legitimacy (Tilly). That is why, to solve the contested issue of legal versus illegal violence, or state-sponsored violence versus counterviolence, we need to examine the state. 

Vince Montes is a lecturer in sociology, anthropology, and criminal justice at Northeastern University as Oakland. He earned a Ph.D. from the New School for Social Research. His research includes the US state, political economy, and the struggle for Puerto Rican independence.

References

Barkan, Steven E. 2023. Health, Illness, and Society. New York: Rowman & Littlefield.

Chomsky, Noam. 2003. Hegemony or Survival. New York: Henry Holt and Company. 

Churchill, Ward. 2003. On the Justice of Roosting Chickens. Chico, CA: AK Press. 

Johnson, Chamers. 2004. Blowback. New York: Henry Holt and Company. 

Marx, Karl. 1963. The Eighteenth Brumaire of Louis Bonaparte. New York: International Publishers.

Marx, Karl. 1970. The Critique of Hegel’s Philosophy of Right. Cambridge: Cambridge University Press. 

Marx, Karl and Friedrich Engels. 1848. The Communist Manifesto. New York: International Publishers. 

Reiman, Jeffrey and Paul Leighton. 2023. The Rich Get Richer and the Poor Get Prison. New York: Routledge. 

Tilly, Charles. 1985. “War Making and State Making as Organized Crime.” pp. 169 – 191 in Bringing the State Back In, edited by Peter B. Evans, Dietrich Rueschemeyer, and Theda Skocpol. New York: Cambridge University Press

__________.1990. Coercion, Capital and European States. Cambridge, Massachusetts: Blackwell Publishers Ltd.

Weber, Max (1946). From Max Weber. Edited by Hans Gerth and C. Wright Mills. New York: Free Press.

• 1

  Klippenstein, Ken. Exclusive: Luigi's Manifesto https://www.kenklippenstein.com/p/luigis-manifesto. Dec 10, 2024

• 2

  Beyond Vietnam: A Time to Break Silence Rev. Martin Luther King April 4, 1967 Riverside Church, New York City. https://www.crmvet.org/info/mlk_viet.pdf

• 3

  “5 Biggest Health Insurance Companies in the US.” https://www.insidermonkey.com/blog/5-biggest-health-insurance-companies-in-the-us-1163505/

• 4

  Ibid.

• 5

  https://www.experian.com/blogs/healthcare/healthcare-claim-denials-statistics-state-of-claims-report/

• 6

  Healthcare claim denial statistics: State of Claims Report 2024 by Experian Health. October 4, 2024. https://www.experian.com/blogs/healthcare/healthcare-claim-denials-statistics-state-of-claims-report/

• 7

  Fields, Robin. “How Often Do Health Insurers Say No to Patients? No One Knows.” ProPublica June 28, 2023. https://www.propublica.org/article/how-often-do-health-insurers-deny-patients-claims 

• 8

  Ibid.

• 9

  Ibid.