Luigi Mangione case exposes cracks in America's healthcare system — experts

Brian Thompson was a name known in the corporate world — a CEO at the helm of UnitedHealthcare, a man overseeing one of the most powerful companies in the American healthcare system.

His tragic assassination-style murder in Midtown Manhattan shocked the nation, but the story that unravelled in its wake told a deeper, darker tale of systemic failures, desperation and the human toll of a fragmented healthcare system.

The accused killer, Luigi Mangione, 26, now sits in a Pennsylvania jail, fighting extradition to New York. A privileged young man, valedictorian and Ivy League graduate, Mangione's spiral from promise to tragedy mirrors the cracks in a system that too often pushes individuals to the edge.

Dr Linda Cartwright, a healthcare policy expert in Washington, DC, sees Mangione's story not just as a tragedy but as a symptom.

"No matter how much righteous anger we may feel, violence has no place in our society, but everyone understands the frustration," she told TRT World.

"The despair in this case is not unique to Mangione. He's an extreme manifestation of what millions of Americans who deal with health care experience daily."

And the numbers back her up.

According to the Commonwealth Fund's Mirror, Mirror 2024 report, the United States ranks last in overall healthcare performance among 10 high-income countries.

Despite spending a staggering 16 percent of its GDP on health care — more than any other nation — the US lags in all departments: equity, access, as well as outcomes.

Man behind the manifesto

Mangione was born into opportunity. He attended Maryland's prestigious all-boys Gilman School, excelled in athletics and graduated as an overachiever from the elite University of Pennsylvania with dual degrees in engineering.

His future seemed boundless. But behind the achievements was a young man quietly drowning in a storm of physical agony and emotional turmoil.

Persistent back issues troubled him for years culminating in surgery in 2023. But relief never came. Instead, his pain worsened, coupled with debilitating "brain fog" that he often vented about on Reddit forums.

His posts, tinged with frustration, hinted at a deeper disillusionment — not just with his body but with the system he felt had failed him. Over time, his communications with family and friends dwindled, until, six months ago, they stopped altogether. His mother filed a missing-person report, and Mangione disappeared into the shadows.

A symbolic takedown

On November 30, Thompson was gunned down in the heart of Manhattan. The head honcho of a company ranked 8th on the 2024 Fortune Global 500 was allegedly shot by Mangione with a 3D homemade gun.

A massive manhunt followed. The media swarmed, igniting a frenzy. Days later, Mangione was arrested at a McDonald's in Altoona, Pennsylvania, sitting alone with a manifesto.

The three-page document, now part of a New York Police Department's report, described the murder as a "symbolic takedown" of the healthcare industry, which Mangione called exploitative and corrupt.

"Frankly, these parasites simply had it coming," he allegedly wrote.

According to media reports, the manifesto details his anger at a system he claimed prioritised profit over people. It painted Mangione as a self-proclaimed martyr for those he believed were crushed by America's healthcare machinery.

While the Affordable Care Act and pandemic-era policies drove critical coverage expansions in the US to a record-low uninsured rate of 9.6 percent by 2022, the underlying issues remain.

For 26 million Americans who remain uninsured — and millions more underinsured — the system can often feel like an impenetrable maze of bureaucracy, high costs and unmet medical needs.

Mangione's act, he claimed, was not just about his own pain but about the millions who "suffer in silence."

It's a sentiment that echoes throughout the US, from heated discussions on social media to political debates. For many people, health care is viewed not as a basic right but as a privilege — one that is often financially unattainable.

Oscar Health CEO Mark Bertolini, who also served as the CEO of Aetna from 2010 to 2018, recently noted, "I think that system is largely now broken, and it has been broken for some time. I've been an advocate for change for a long time, and believe that we have ways to get it better in this country."

A tale of two systems

The contrasts are stark. While in the US, Mangione's back pain aggravated and his frustrations grew, in nations like Türkiye, Australia, the Netherlands and the United Kingdom, the medical systems prioritise equity and quality access.

Universal coverage, capped out-of-pocket expenses and robust primary care networks ensure that health care is a given, not a gamble.

Türkiye, being a welfare state, has universal healthcare coverage offered via its Genel Saglik Sigortasi (GSS) system paid for through government subsidies and obligatory contributions to social security. The Turkish system is cheaper and easily accessible compared to the US system.

In Germany, for example, out-of-pocket costs are capped at a percentage of income, and patients are guaranteed access to after-hours care.

The UK's National Health Service offers free care at the point of use, a sharp contrast to the US system, where inefficiencies in administration and unchecked pricing are the norm.

Dr Cartwright sums it up: "We're the richest nation in the world, yet we've built a system that prioritises profit over people for the majority of cases. It's unsustainable."

Humanising the crisis

As support pours in across social media for Mangione, many have latched onto the document the young man allegedly wrote, which, as CBS News reported, "speaks to both his motivation and mindset."

The social media chatter on the issue has been striking, with many expressing sympathy for Mangione's struggles and calling out what they describe as "gaslighting" by a broken medical system that leaves countless people feeling abandoned and unseen.

Three days after his arrest, Luigi Mangione is a top trend on X. Netizens and podcasters are discussing everything from the accused killer's looks to his motives.

Even though Mangione comes from an affluent family that owns several country clubs and healthcare centres, his "fans" have still rallied together, raising thousands of dollars to support his legal defence.

Many are asking uncomfortable questions. What drives an intellectually gifted, young and vivacious individual to such extremes? Was he pushed to the edge by pain, bureaucracy or an unyielding system?

The answers aren't simple, and they are not coming quickly enough. But one thing is clear: Mangione's story, tragic as it is, is a reflection of a system that has failed to prioritise its people, experts say.

"We can’t dismiss this as just a crime," said Dr Cartwright. "Violence is never acceptable but this is also a human story — a cry for help that we ignored until it was too late."