【企业社会责任与可持续发展】| CSR & Sustainability

By Give, Jointing.Media, in Shanghai, 2025-06-01

The Healthcare Crisis: A Ticking Time Bomb Before the Gunshots

The pathologies within America’s healthcare system were already deeply entrenched.  In 2023, per capita health spending hit $14,570—nearly 20% of GDP—yet the nation ranked just 49th globally in life expectancy.  Approximately 24.7 million Americans under 65 remained uninsured, while over 20 million insured Americans carried medical debt.  Of these, 3 million owed more than $10,000.

UnitedHealth Group faced exposure for deploying AI systems to accelerate claim denials.  Its 32% rejection rate—double the industry average (16%)—blocked coverage for roughly 16 million policyholders.  For ordinary Americans, daily life became a battle against insurers.  As one ER nurse testified: “Watching dying patients get denied coverage made me physically ill.”  Young leukemia patient Sucalas, confronting $13,000 monthly out-of-pocket drug costs, was forced to halt treatment for three months—”No one should wage war against cancer and insurance companies simultaneously.”

America’s healthcare reform history reads as a chronicle of defeat:

• 1920s: The American Medical Association (AMA) stigmatized universal healthcare as a “Bolshevik plot,” killing early reform efforts.
• 1965: President Johnson established Medicare (senior care) and Medicaid (low-income coverage), yet universal coverage remained elusive.
• 2010: Obama’s Affordable Care Act reduced the uninsured by 20 million, but persistent premium hikes and service disputes continue to draw criticism.

Structural Malignancy: Who Feeds at the Top of the Healthcare Food Chain?

The neoliberal policies of the Reagan administration in the 1980s—slashing public health funding and deregulating the industry—ignited the rise of for-profit “managed care,” transforming healthcare into a commodified system.        Intensive lobbying by interest groups and partisan gridlock have made the U.S. the only OECD country without universal healthcare coverage.

Within this ecosystem, insurers and Pharmacy Benefit Managers (PBMs) formed a monopoly stranglehold:

Big Three PBMs (owned by UnitedHealth, CVS, and Cigna) control 80% of U.S. prescription flows, profiting through demanding massive drugmaker rebates that inflate medication prices.

Pharmacies saw profits plummet after Medicare negotiations, while hospital specialty pharmacies faced PBM revenue squeezes.

Doctors drown in insurance paperwork as patients fall into deductible traps—individual workers now face average deductibles of $1,787, a 47% surge over a decade.

When UnitedHealth CEO Andrew Witty admitted the system “doesn’t work well,” Luigi’s shell-casings engraved with “Delay, Deny, Defend” stood as the public’s collective indictment of the industry’s predatory nature.

Healthcare, meant to be society’s safety net, has become a feast for capital in America. Luigi’s bullets pierced not just a CEO’s heart, but the last veil of decency over America’s healthcare myth. So long as the profit-first logic persists, so long as 24.7 million remain uninsured, the “Modern Robin Hood’s” violent catharsis marks not an end—but a bloodstained dawn to a darker era.

Ethical Dilemma of Institutional Violence and Individual Resistance

The Luigi case resonated so deeply precisely because it exposed the structural festering wounds of America’s healthcare system.  When institutions become legalized killing machines, the desperate resistance of citizens carries a tragic social origin.  When hospital bills morph into death sentences, violence is a mirror to the system, not its cause.

In the aftermath of the gunfire, American society plunged into polarization and introspection.  Polls reveal that 41% of Americans aged 18–29 consider the shooting “acceptable,” while 81% express anger over healthcare costs.  A Florida woman threatened insurers with “you’re next,” and the CEO of an Oregon insurance company had his home shot at.  Mark Zuckerberg spends over $24 million annually on personal security, as healthcare and energy giants scramble to conceal executives’ information.

The Department of Justice politicized the case, seeking the federal death penalty for Luigi—which, if approved, would be New York’s first execution in 70 years.  Defense attorney Agnefello slammed the move as “state-sanctioned murder” designed to protect insurance conglomerates.

America’s healthcare system causes far more “legalized deaths” than individual violence.  Johns Hopkins University research indicates approximately 25,000 Americans die annually from unaffordable care—equivalent to 68 people “executed by the system” daily.  In 2023 alone, over 1 million filed for bankruptcy due to medical debt, while pharmaceutical giants hiked insulin prices by 1,200% (1996–2024).  Rural Mississippians live 20 years shorter than Manhattan elites—a life-expectancy chasm stemming not from genetics but institutional design.

When insurers use AI algorithms to automatically deny critical claims, and drug companies monopolize life-saving patents for profit, blood stains the hands of suited decision-makers.  This “lawful violence” escapes moral condemnation precisely because it disperses through systemic gears.  Rebuilding medical ethics demands not mere policy tweaks, but a cultural reckoning that banishes profit motives from emergency rooms—for any civilization’s worth is ultimately measured by how it treats its most vulnerable lives.

The Third Way: How Can Nonviolent Resistance Move Mountains?

Luigi’s supporters hailed the shooting as “slaying a greedy beast,” yet history reveals the limits of violent retribution: its inability to replace systemic solutions and the risk of societal moral erosion.  In the 1960s, the Black Panthers’ armed resistance failed to end racial discrimination but intensified state crackdowns.  Killing a CEO cannot dismantle the profit-driven logic of the insurance industry—UnitedHealth’s stock dipped merely 2.3% post-shooting before hitting record highs three months later.  In the Oregon copycat attack, bullets struck a nursery wall in the CEO’s home—a stark reminder that uncontrolled violence first devours the innocent.

Luigi himself embodies systemic contradictions: elite education taught him to critique the system yet offered no tools for change, ultimately twisting his intellect into a weapon of vengeance.  True transformation in American history often springs from synergy within and beyond institutions.  Consider:

• 1964’s Mississippi Freedom Summer: Medical teams provided unlicensed care to Black communities, compelling federal passage of the Civil Rights Act to ban racial segregation in healthcare;
• 2023’s UnitedHealth lawsuit: Patient groups sued over AI claim denials, winning $870 million in damages and forcing algorithmic transparency;
• 1,200+ free clinics nationwide: Volunteer-run facilities serving 1.8 million uninsured annually, forging a parallel care ecosystem.

These efforts may seem gradual, yet they erode institutional foundations like vines cracking stone.  Today, 29 states advance universal healthcare ballot initiatives—California’s pending bill could cover 98% of residents.  The ember of reform still glows.

The Luigi case transcends individual crime, exposing how profit-first logic erodes public health.  His violence channels collective despair over institutionalized exploitation.  The DOJ’s push for the death penalty—criticized as “suppressing dissent”—evades healthcare’s core crises.  Without systemic reform, tragedies like Luigi’s will recur.

Urgent actions needed:

• Legislation: Ban AI claim denials;  cap drug price hikes (e.g., Germany’s 5% annual limit);  abolish medical debt credit reporting.
• Mid-term reforms: Establish public drug procurement pools (modeled after Canada);  break up insurer-PBM monopolies.
• Constitutional amendment: Enshrine healthcare as the 28th Amendment, affirming that the right to life supersedes profit rights.

EDITOR’S NOTE:

U.S. Attorney General Pam Bondi announced on April 1, 2025, that she had directed federal prosecutors to seek the death penalty for Luigi Mangione.
Born into wealth, Luigi never personally faced healthcare hardships. Yet while working at his family’s nursing home, he witnessed countless elders perish in despair after insurance denials. These seniors lacked the means to challenge corporate giants, left only to await death. Luigi saw systemic injustice; his conscience seared by innocent suffering. He knew conventional paths couldn’t reform this profit-rigged system controlled by entrenched interest groups. Thus he chose an extreme path—attempting to deliver justice through his own hands.

Robin Hood robbed the rich to aid the poor—his defiance of feudal exploitation fought for the survival rights of the oppressed. Was Luigi not the same? His target wasn’t personal gain, but liberation for millions crushed by the healthcare machine.

The U.S. Constitution was crafted to protect citizens’ rights. Yet today’s healthcare system strips fundamental medical rights from countless people. In this light, Luigi’s act embodies a defense of constitutional ideals—an attempt to awaken the nation to its founding promise of safeguarding human dignity.

We must judge Luigi not merely by legal statutes, but through the lens of social justice. He is a tragic figure—both victim of America’s healthcare failures and resistor against them. To condemn him as a mere criminal while ignoring systemic rot ensures more “Luigis” will emerge. May this case ignite healthcare reform to prevent such tragedies. And may this modern-day Robin Hood receive leniency—that he might someday reform society through nonviolent means.

中文原文

Edited by Wind, Youdao and DeepSeek

Photo by Fengsheng

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