Bonnie And Clyde…And Luigi

In the wake of UnitedHealthcare CEO Brian Thompson’s assassination, ‘Wanted’ posters appeared in Manhattan threatening other CEOs. Luigi hats, normally associated with a video game character but now linked to the accused’s first name, sold out online, as people bought them in solidarity with the ‘CEO killer’. It might seem like Americans are ready to rise up against the wealthy, but this is much more about the dysfunctional US healthcare system than about class consciousness. Consider that though airlines delay and inconvenience millions of people, if the CEO of an American airline was killed anyone celebrating this would be rightly seen as a ghoul. So a seeming wave of popular approval of Thompson’s killing is less about how Americans feel about business leaders, than about health insurance companies in particular. These companies are almost universally despised in American culture. More than 90% of Americans have health insurance. And according to polling from KFF, a leading health policy non-profit, 40% of them have medical debt. Three-quarters of Americans say they worry about being able to afford the healthcare services they might need. Even Americans who have insurance are right to be worried about paying for healthcare, as that insurance doesn’t guarantee their doctor’s bills getting paid. An ambulance to the hospital might be from the wrong company, or the insurance company could decide that it wasn’t necessary, leaving one to pay thousands of dollars. The hospital that ambulance takes one to, might not be part of the insurance company’s system or require approval from the insurance company before beginning treatment. Even if the hospital is covered, some services or doctors working there might not be, and the cost of those services can’t be known beforehand. This reaches absurd lengths. Even within the past few weeks, a major US insurer announced it would stop paying for anaesthesia if a surgery went on too long. Presumably, a knocked-out patient was to tell the surgeons to hurry up if they were going too slowly. In the wake of negative coverage of this policy, the company announced it wouldn’t go through with the change. But, at the end of the day, if an insurance company decides not to pay a doctor or hospital, consumers have to pay for the services themselves. Paying for middlemen, and not just at the insurance companies (doctors’ offices routinely have employees whose sole job is dealing with insurers), is a big part of why US pays more, per capita, for healthcare than any other country, while lagging the rest of the developed world in measures like life expectancy and infant mortality.Of course, not everyone in US is upset with their coverage. Groups that receive coverage directly from govt, like retired workers and military veterans, are generally happy with it. Still, proposals to move to universal govt paid healthcare have been unpopular, with many Americans worried that their own coverage might suffer. President Obama’s Affordable Care Act was able to marginally cut costs and increase access, but even that half measure — it works by forcing more people to buy insurance from private companies — was bitterly contested. This is all part of the business model of health insurance companies. They only make a profit if they charge customers more than they pay out, so they’re incentivised to deny coverage. To make matters worse, Americans don’t generally get to choose which healthcare company they do business with. For most, it’s chosen by their employer. People are forced to pay money to a business that’s trying to limit the amount of healthcare they get, with no way to switch to a different company if they’re unhappy. No wonder they’re upset. That aspect of choice is important. Americans are required to buy car insurance, but the fact that they can pick their provider means that profit margins are lower, and customers are generally happier. After all, if they don’t like their current provider, they can go somewhere else. The fact that they can’t do the same for health insurance leads to feelings of powerlessness, so support for someone who takes action against the company makes sense. US has a tradition of turning criminals into folk heroes. Thompson’s killer is unlikely to be lionised as they have been, but he has something in common with criminals of the past who were seen favourably by the public. During the depression, ordinary Americans saw robbers like Bonnie and Clyde or the Dillinger gang as fighting against banks, on behalf of the poor. Subway vigilante Bernie Goetz shot four men that he said were trying to rob him on a New York subway in 1984, at a time when the police were viewed as ineffective. The murder of a health insurance CEO speaks to many Americans for much the same reason. While everyone else is suffering, at least one man is doing something about it. Americans didn’t have to think that robbing banks was acceptable in order to cheer on depression-era criminals, or that killing was acceptable in order to sympathise with Goetz. In just the same way, they don’t have to excuse Thompson’s murder to understand why someone would kill him. The popular response to Thompson’s killing isn’t a sign that Americans are fed up with big companies, or CEOs, or the swelling ranks of the super-wealthy. Rather, it’s a sign that they’re fed up with health insurance companies, and it’s hard to argue that they’re wrong.The writer is Professor of Government and Politics at Fairleigh Dickinson University and a columnist based in New Jersey.