Insurance Denials, Chronic Pain, and a Nation’s Rage

On Monday, 26-year-old Luigi Mangione was arrested for the murder of UnitedHealthcare CEO Brian Thompson. In the days following the December 4 shooting, the unknown assailant who gunned down Thompson became a floating signifier in the public imagination. Angry and frustrated people nationwide channeled their politics, grievances, and outrage into speculations about the killer's ideology and experiences, with many voicing hopes that he would evade capture. Right-wing media figures denounced these reactions, which they characterized as left-wing bloodlust. However, it soon became apparent that many people on both the left and the right sympathized with the shooter or even supported his actions. That hasn’t changed the right-wing narrative, as Fox pundits continue to insist that support for Thompson’s killer is a left-wing phenomenon. This narrative position is important to the right, as 11 billionaires prepare to assume key roles in the incoming Trump administration. For the ruling elite, a surge in class consciousness, particularly one tied to an act of violence against a multi-millionaire, is a deeply unsettling development.

The last time I saw a floating signifier capture the public’s imagination as profoundly as Thompson’s hooded shooter was in 2011, during the rise of the Occupy movement. A floating signifier is a symbol or concept whose meaning can shift depending on the perspectives and agendas of those interpreting it. The tents that sprung up, first in Zuccotti Park, and then, in cities around the country, meant different things to different people. In a country where nearly 10 million people had been displaced by the 2008 housing crash, some viewed the seizure of public space as a reclamation of land, dignity, and of spirit. Some protesters saw themselves as targeting the banks directly, which was apparent in the ever-present chant, “Banks got bailed out, we got sold out!”

On my first day at Occupy, I spoke with some Occupiers who wanted the executives responsible for the 2008 collapse incarcerated, and others who viewed the movement as a chance for social transformation, and the creation of a society where we would not resolve our problems by caging people. Some viewed the protests as a bid to save democracy itself, as billionaires and corporate forces continued to buy influence and dictate policies. In those early days, there were anarchists, socialists, libertarians, Democrats, and people with no political affiliation marching under the banner of Occupy. As they created encampments, or got arrested attempting to do so, they were projecting their grievances and their political aspirations onto the tents they raised. This diversity of aspirations left the movement unable to formulate demands, and yet, Occupy’s raw political will was nonetheless a major development in US politics. At a time when the left in the US barely had a pulse, the act of raising tents brought thousands of people together to discuss what they had lost and what they might gain if they fought in collectivity. 

Am I comparing a murder to a moment of mass protest? No, I am not. Murders happen every day. I am talking about the way many people chose to relate to the person who pulled the trigger and the deluge of pain and outrage that has colored this story for the last week. People of different backgrounds, bound by the experience of being screwed over by insurance companies, became a defiant chorus. They collectively rejected prevailing norms about how they ought to respond to Thompson’s killing. They refused to denounce the shooter’s actions and rebuffed those who attempted to shame them for applauding a homicide. (I was one of the people who lashed out at such critics.) Instead of mourning the death of a CEO, they mourned the tens of thousands who die each year in the US because they lack health insurance. They mourned their spouses, parents, and children whose potentially life-saving care was not covered by their insurers. They mourned their lost mobility. They mourned the lives they used to live, but could not maintain, due to untreated chronic pain. Rather than centering Thompson’s humanity, as scolding voices have demanded, they centered their own, and the humanity and suffering of others who were harmed by the insurance industry.

While much has been made since Mangione’s arrest about his well-to-do background and apparent right-wing politics (including a fondness for Elon Musk), it seems clear that his hatred of insurance executives was not motivated by right-wing or left-wing ideology. The most telling selections featured in his now private Goodreads account were Cathryn Jakobson Ramin’s Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery and Dr. Stuart McGill’s Back Mechanic.

As a chronic pain sufferer, I have a copy of Back Mechanic on my own bookshelf.

In a handwritten message that police say was found in Mangione's possession, he reportedly takes full credit for the killing, stating that no one abetted his actions, which he asserts “had to be done.” The note also includes a “reminder” that “the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy.”

On Tuesday, I read an online manifesto which some have attributed to Mangione. The document may or may not be legitimate, but if Mangione didn’t author the screed, that, too, tells us something about this moment and how Mangione’s story has become a vehicle for a larger narrative of suffering. The manifesto, entitled “The Allopathic Complex and Its Consequences,” and subtitled “luigi mangione's last words,” tells the story of a young man who watched his mother’s health and life deteriorate as UnitedHealthcare refused to cover the tests, specialists and treatments her chronic pain required. The author writes, “The pain was so bad I would hear my mother wake up in the night screaming in pain. I would run into her room, asking if she’s OK. Eventually I stopped getting up. She’d yell out anguished shrieks of wordless pain or the word ‘fuck’ stretched and distended to its limits.”

Whether or not the experience described here is Mangione’s, someone else’s, or apocryphal, it is familiar to many of us. Countless caregivers know the anguish of watching a loved one suffer–the powerlessness of being unable to ease their pain and the rage that surfaces when insurance denials block access to care. The frustration of knowing relief might be possible, while care is thwarted by a profit-driven company employing bad-faith practices, faulty algorithms, and profit-first policies, is a near-universal experience. The document’s author also narrates his own descent into chronic pain and describes his pending actions as “an act of war.” He justifies his intentions, writing, “People are dying. Evil has become institutionalized. Corporations make billions of dollars off the pain, suffering, death, and anguished cries in the night of millions of Americans.”

Again, we have no way of knowing, at this time, if Mangione authored this document. (The author’s pejorative use of the word “capitalistic” is notably inconsistent with what we know about Mangione’s politics.) But regardless of who penned the piece, its narrative of suffering is clearly representative of something larger than one man’s motive or experience. The manifesto’s account of chronic pain, ruined lives, and the persistent denial of care is indistinguishable from the countless stories of suffering and deprivation that people have shared on social media in recent days.

Will we see more writings attributed to Mangione in the coming days? Will it ever be clear where his story ends and the projections of others begin?

During the Luddite movement, demand letters and pronouncements written by activists were often attributed to Ned Ludd–a legendary figure who supposedly launched their movement against labor exploitation. Ned Ludd may or may not have been a real person. If he was real, he certainly could not have been responsible for the many direct actions and letters Luddites attributed to him. He was a character in a story that workers were telling about themselves. In some ways, that’s who Mangione has become in this moment. 

People are furious and heartbroken, and they know they have been wronged. Some are working themselves to death, laboring through illness or amid the deterioration of their joints or spinal discs, because they can’t afford to stop. Some pay insurance rates they can barely afford and still receive astronomical medical bills. Many have watched their loved ones suffer and die needlessly or while in unnecessary pain. Still more are constantly struggling to get the basic tests and medications they need to maintain their health. They know that people like themselves are dying when they could be saved. If they are not suffering today, they know that they could be tomorrow–that they could be struck by chronic pain or a chronic illness that would render them surplus and disposable in a billionaire’s world. The working class is marked for violence, as corporate policies and algorithms decide if our bodies are worthy of maintenance–or if we should simply be left to die. 

Could this moment be ground zero for the class awakening we desperately need? As the United States becomes an unapologetic mafia state and a new era of smash-and-grab politics gets underway, could a new wave of popular outrage begin not with a tent, but with a bang?

If it sounds like I am romanticizing violence, please understand I am merely assessing conditions–conditions that I and the rest of the working class did not create. I do not romanticize gun violence. However, it bears mentioning that gun violence happens every day and that the average person barely takes notice. We are surrounded by violence. Premature death is manufactured every minute of every day in the United States and in the many places where this country’s corporate and militaristic tentacles extend. That churn of suffering and death is generally treated as background noise. For some people, the death of a CEO was an exception to that norm–they were disturbed that this man was gunned down and that so many people expressed sympathy or support for his killer. For others, it was the background noise itself that was amplified by this moment. The normalized hum of organized abandonment, failed Gofundmes, insurance denials, pained screams, and senseless loss became a collective wail.

When people react to a floating signifier, it’s because something is simmering beneath the surface. When the tension at the surface breaks, and that underlying hurt begins to boil, the instigating action and actor should not be our primary focus. The question is, what can we do with the energy and outrage that is clearly roiling? At a time when the left and its movements are horribly fractured and the political landscape is marked with bitterness and despair, we need a revival of popular outrage against inequality and against the billionaire class. We need a shared recognition that we are all suffering in wholly preventable, manufactured ways–and that corporations and billionaires are our collective enemies.

Does it say something about the state of our society that our present stirring was triggered not by the raising of tents, but the firing of a weapon? Yes. I believe our condition is deteriorating. One might call this development “a morbid symptom” of a late-stage sickness, which, at present, remains untreated. So, what remedy shall we seek for what ails us?

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