A good reminder that the opposite of truth isn’t lies, but confusion. Far more evil is caused by lack of understanding and muddled beliefs, than by willful dishonesty.
I don’t know what’s wrong with the health care system that isn’t a cost of benefits of the larger American system. (Freedom to choose; free enterprise; high rewards for hard work, education, and entrepreneurship; personal freedoms and responsibilities.) I see some issues, but don’t think they rise to the level of evil. You’d have to tease that apart for me.
Here’s another idea worth keeping in mind, though:
Health is one thing we’ll never get enough of. We’ll never be satisfied. When our health falls apart, most of us will be desperate to spend every last dollar – and go into debt – to live a little longer, have a little less pain, have it a bit better. Yet the nature of health is that it will, ultimately, fail, and we will be disappointed. We can make priorities, but we will (probably) never have enough money, resources, technology, to make people perfectly content with the state of any health care system, whether it’s American, Canadian or Scandinavian … We’re certainly nowhere near that today.
I've talked with people in my life about the healthcare industry as a whole over the last week, and it's abundantly clear that the vast majority have zero understanding of what insurance even IS. That's not even getting into the tradeoffs of single-payer, the system we have now, or an improved system, which I don't think they've even heard of. Insurance companies are the middlemen between patients and providers in a massive, highly regulated, and insanely complicated industry that very few people have any coherent framework for. Insurance is manna from Heaven that grants or denies medical treatments in the minds of the vast majority of Americans.
I'd say this is one of the main reasons Americans are generally supportive of Obamacare. The focus of the law was always about expanding insurance coverage as opposed to the cost or quality of healthcare, which is far closer to the root of the issue than insurance costs. Luigi very clearly had no idea why healthcare was so expensive, which is why he shot Thompson in the first place.
Ignoring the evil of the killing entirely, wouldn't it make more sense to kill someone more directly responsible for high healthcare costs, like an AMA official or a congressman? The guy wasn't just evil, he was a dumbass. Our problem is that because he's attractive people are going to be parroting this garbage for the entirety of his trial when they have zero clue on how to solve genuine issues regarding healthcare cost. This man is going to get more love letters from stupid, pathologically empathetic women than anyone in human history.
I fully support the denunciation, but it’s reasonable that the healthcare system is unpopular. Despite your stats, the mere fact that it’s possible to go bankrupt via medical expenses makes people feel powerless.
There’s a real risk of missing the bigger picture and being too technocratic in responses like this. When people feel furious about their lack of power, demanding that they understand that their situation is not that bad is ineffective.
The absence of the public option is partly a result of the presence of the private companies here - they lobby against it. I don’t think that distinction is all that meaningful.
Yep - but the problem is not lying in private insurance. The problem is the absence of basic semi-public insurer (preferably in plural) that cares for the first 70-80% of the income bracket, that rations agressively and supported by linear tax on insured individuals. Unlike the situation that you have, say in Germany.
I agree that he was very likely thinking of revenue, but note that even then he was still slightly wrong!
He lists Apple, Google, and Walmart as being higher whereas the actual list is Walmart, Amazon, and Apple (i.e. ordering aside, he lists Google instead of Amazon).
Ah, either that additional clarification wasn't there when I originally read your article, or I just missed it. But yes, I agree that it is a much smaller discrepancy.
>Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument.
This was a very saddening line for me. I imagined that most of the killer's mind was degraded by whatever he had gone through and was embracing nonsense and destruction, while a sliver of his mind remained and was able to engage in introspection and recognize that he couldn't actually intellectually defend his own thoughts and actions, but the former was still in control.
I wonder when he wrote this manifesto. Probably after the crime. Conceivably, during the commission of the crime, he wouldn't have been capable of even the limited reflection he expresses in it.
It's also been noted that the manifesto is pathetic in its search for external validation, rather than bold in confident embrace and explication of a position.
I wonder again if this reflects post event clarity in which the aforementioned self-reflective ability, likely representative of his former self, was more dominant, with his weak attempts at justification aimed primarily at himself: "it doesn't matter if I don't really know much about this. I know the position is defensible. People have argued it. Books have been written about it...That Moore guy..."
I also wonder about the line:
>It is not an issue of awareness at this point
A basic objection to murdering a member of a group over the systematic behavior of groups is that the same systems will remain in place, incentivizing the same behavior. A potential defense would be that the benefit would come not from the removal of the individual himself, but from the broader awareness the murder would elicit.
I wonder if this line reflects the murderer bouncing around ex post facto justifications in his head, trying to justify his actions to himself at a moment of greater sanity: "Why did I do it? Wasn't he just a cog? Well, I guess it'll raise awareness. Is that it? Not really. Aren't people already aware, given how long the problems have been around? I guess it's something else. Power games? I guess. So if these "power games" (presumably systems that incentivize certain behavior) are in place, what did my murder accomplish? That line of thinking is then cut off.
For what it's worth, there may be some indicators that his overall cognitive ability degraded, instead of him merely having adopted very different views than he previously had.
The manifesto is short, but to me, the writing quality in it, ignoring the content, seems much worse than anything else I saw posted from him on Twitter, or elsewhere.
Most notably: "I do apologize for any strife of traumas" which doesn't even read like it was written by a native English speaker.
[It's also hard to imagine how that line could be the result of misread handwriting. Even if the 'f' in 'of' should have been an 'r', that still would still be very poor writing.]
Similarly, in the aforementioned "It is not an issue of awareness at this point" line, he writes "No the reality is," apparently lacking punctuation after 'no.' I think that would be more likely if he were writing as a stream of consciousness without having the words in his head, yet. He didn't drop a period after 'no' since he didn't know he'd want to end the sentence. Stream of consciousness writing would be consistent with the "not a matter of awareness line" being him grappling with potential justifications, in real time.
His final line: "It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.” is similarly poorly written and potentially reflects cognitive decline.
How does the last sentence flow? If the persistence of the problems isn't about lack of public awareness, but power dynamics, then how does his murder accomplish anything?
The flow isn't just lacking conceptually, but grammatically. What's the referent of 'it' in "I am the first to face it?" The power games? Then the word should be plural. Is "it" some general problem?
This crude transition to a nicely dramatic but not too coherent final sentence may reflect him searching for some neat explanation for his behavior, coming up short, and lamely concluding, "but at least I was brave."
His shouting at the courthouse could have also been in part reflective of internal self doubt and attempt at justification. How could I be wrong about all this, if it's consistent with other people's feelings? "Lived experience" can't be refuted, unlike quantifiable arguments, which he realized weren't on his side, or which he at least realized he couldn't articulate.
The company by market cap issue also jumps out, as it's a simple factual question that wasn't even central to his point. I'd think that if he retained his cognitive ability but simply adopted particular delusions or something, that he'd be less likely to err with that.
I agree that the market cap thing is very odd. His lack of quality control there screams that he didn't put in his due diligence elsewhere. It should make everything else that he said questionable, because it is such an obvious, easily-checked thing. The lack of flow is also very odd.
I ultimately think that this manifest is just narcissistic self-rationalization like a guy going, "Guys, you all agree I did good, right? Right? Look, I had reasons!"
Thinking about his shouted statement at the courthouse that "It’s completely out of touch and an insult to the intelligence of the American people and their lived experience," it's ironic that, if anything, lived experience is probably more positive towards insurance than popular sentiment.
That is, most people's personal experiences aren't as negative as their opinion of the industry as a whole. This shows up in polls where most people describe their own experiences with insurance as being positive, while describing the national state of affairs as being negative. E.g. in the polls listed here: https://news.gallup.com/poll/327686/americans-satisfaction-health-costs-new-high.aspx are illustrative, 67% of respondents were satisfied with the total cost they pay for healthcare, while only 30% were satisfied with the total cost of healthcare in the country.
As meaningless as "lived experience" is relative to hard data, even it undermines the shooter.
I was going to write a piece called "Luigi Mangione's Manifesto Sucked" or something, and I still might, but I feel less restless about it after seeing this. It was just so empty and badly written, like the kinds of PR statements given by celebrities when they have to briefly weigh in on politics or personal scandal. The fact that he admitted to eliding the complexity of healthcare and being unqualified to wade into it was especially shocking. I would never kill someone unless it was over something I was very qualified to explain, and even then I wouldn't need to kill them, since I would just defeat them with a good explanation.
I’m surprised there’s no viral tweet yet comparing him to Elliot Roger if he went after the CEO of Tinder. Anyone with a twitter following is welcome to plagiarize my idea. His motivations of “lived experience” matches closely, but is well perceived because affordable healthcare is an EHC virtue signaling topic.
Although not directly related, it's worth noting that Cremieux has pointed out that psychosis is associated with an elevated rate of homicide perpetration, and that first episode psychosis is associated with a *very* elevated rate of homicide perpetration (almost 15 times the rate for previously treated psychosis): https://x.com/cremieuxrecueil/status/1664491391139864576.
The killer was 26, which is a typical age for the onset of schizophrenia symptoms, which can include psychosis.
While something seems to have changed dramatically in the killer's state of mind in the months before the killing, schizophrenia / psychosis is just a suggestion.
The first graph works - where it does - because the author chooses individual consumption in PPP, rather than the more common GDP per capita on the X axis. Using the latter Norway would be as far to the right as the US and Luxembourg much further right as their gdp per capita is the same or higher than the US, therefore the US would seem very much an outlier on the y axis, because the health expenditure of those two is much lower.
Maybe it’s the correct graph and GDP per capita isn’t, maybe it’s the metric that proves the point. It was presented without explanation.
The second graph does use per capita gdp or rather the “predicted spending (regression w 6 procedures)” (ok?) as the label at the bottom and what it is predicted on is in fine print at the top: spending measured in $/capita at economy wide PPPs. So per capita is in. And predicted surgeries per capita with it.
That’s an odd graph too, not just in execution but concept. It doesn’t prove that the US is getting bang for its buck at all because another way of reading this is that the US is performing too many surgeries, or surgeries are more expensive when performed. I can’t say either way to be honest, however I don’t think number of surgeries should track GDP per capita.
I mean, is there any real reason for health insurance companies to exist and not to be replaced by a single-payer system? They don't create any real value, just exist as a cost-increasing layer on top of the existing system. And without them the government could use its market power as monopsonist to drive down physician salaries and pharmaceutical prices as it does in other countries. You have ridiculous cases like insulin prices being high because of patents when we knew how to make insulin years ago.
It could be an end to American dynamism and innovation in this area and I think a lot of people would be OK with that. The prices have gotten way out of control and a lot of ordinary people can't afford healthcare.
I had this argument with Hanania. He thinks populism (of the left and right varieties) is inefficient, and I kind of agree. The problem is if you don't kick enough of the excess gains from efficiency back to the general public, they get pissed off and try to overthrow you for someone who will.
It's quite likely that, say, physicians are overpaid, and that's another problem.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
No, socializing *everything* is a dumb idea. The USSR, as you point out, was dirt poor. Healthcare's one of those things like electricity that works better as a government thing. But plenty of other things don't. (SpaceX, for instance, has done a lot more than NASA lately.) Other countries get better health results with less money. I think what he says is correct and administrative costs aren't everything, but the fact remains healthcare insurance profits are effectively a load on the system a public system wouldn't have, since they're money diverted to dividends that has to come out of premiums and copays.
Since every country is a complex system where it's hard to study any part in isolation, all I can say is, "I think the European system provides a better quality of life for most people. People live longer, have more time with their families, and are less grossly obese. I am willing to sacrifice some innovation and dynamism to get closer to that, at least in healthcare where our system is becoming unsustainably expensive and making access to care impossible for many people." Maybe there won't be as many new drugs coming out; maybe fewer innovative surgical procedures. As we know from economics, you can't have everything you want.
Single payer is worst of worst. It produces a monopoly and easily goes into an extreme rationing mode. Much better is a plurality of public insurers maintained by a linear income tax with an opt-out to private for the 20% or so who want. Like the system Bismarck introduced in Germany late 19th century.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
There's something very "assume a spherical cow" about a detailed analysis of the logical arguments of an impaired man with pins in his vertebrae who plots and murders a healthcare executive in the street. Something tells me a chain-of-thought GPT trained only on the data of cold-blooded murderers might have only limited use among us boring, unincarcerated "normies".
That said, conflating health insurance with health care is part of the reason America is in the mess that it is. A better comparison pairing for health insurance would be the rate of medical debt and bankruptcies. There, the U.S. does offer some world-beating statistics.
Yes this. Not technically wrong (and the data on attribution of deaths to healthcare-controlled vs other-social factors was very interesting) but off in a meta way, as if this act could be even approximately construed as "rational terrorism".
Good point of conflating complaining about "healthcare quality" with "healthcare system/insurance".
As to bankruptcies, though, while the US rates are very high, from the little I know, I don't think any of the limited data are comparable as personal bankruptcy is a commonly used vehicle in the US to deal with debt, in ways that just isn't a thing in other systems. I might be wrong here, and it does not affect the fact that while healthcare quality WHEN OPTIMALLY PROVIDED is superb in the US (perhaps with a small caveat for overuse of extremely aggressive testing and aggressive treatments), many people have no to very limited access to that superb healthcare.
While I agree that the manifesto is incoherent, the pretty graphs supposedly showing the shining wonder that is the American health payment system miss the point. Has the author or someone close to them actually had to deal with the financial aspects of a serious medical problem? Denials (of something that is standard-of-care prescribed by a physician), redundant bills, “this is not a bill” bills, wildly expensive items that, after tens of hours on phones tracking done the right person are suddenly open for negotiation. Anyone who thinks this system isn’t seriously broken has never used it.
Mangione’s manifesto might have been an ‘F’ for content and clarity, but the broader point that American health insurers are parasitic middlemen that inject huge amounts of complexity for profit is undeniable.
It's incredibly deniable that health insurers are "parasitic middlemen". In fact, there is no real case for it that isn't an expression of a person's ideology given what they actually do. That is, insurers play the vital rationing role in America's healthcare system. That people have trouble understanding denials is mostly not the fault of insurers, either. Were it not for America's ludicrous healthcare privacy laws, it would be a lot easier for people to understand denials and perhaps they might be able to work out of the wrongful idea that denials are generally arbitrary and capricious.
Reading this marvelous point-by-point refutation has convinced me:
Come the revolution, we will witness a parade of economic commentators being dragged up the stairs to the guillotine as they complain to the mob below that it just doesn’t understand how things actually work, and it’s got it ALL WRONG.
“Please, you MUST listen to me! Your mistake is overemphasizing anecdotal lived experience as the primary context for framing your assumptions about the political and economic determinants of healthcare economics in the US. But that’s misleading. You HAVE to look at the data. For example, consider actual international individual medical care consumption per capita in modern economies…”
Only to be Interrupted, as the blade falls, by a shouted reply from below, “There’s YOUR lived experience, Je t'encule! !”
Today, of course, modern sensibilities must be observed, and media commentators provide the required disclaimers of aversion to violence – never to be tolerated, no abuse is a plausible excuse - as the mobs assemble in the public squares on Reddit and Facebook and howl for blood.
And if anything, individual anonymity has increased the vehemence, with the mob applauding, cheering, and jeering when the media replays the security camera footage, altered at the end to politely mute the carnage as a hand raises a Pharma Exe’s head" from the basket" for their gratification, preceded by a pro-forma “WARNING: viewer discretion is advised.”
Oh yes, there is a message here.
And if the “elites” (which I will define here, in this case, as the ”statistically literate” and historically knowledgeable, who applaud the time and effort spent systematically dismantling the manifesto's claims ) suppose that the lesson is that the unwashed masses and their homicidally delusional champions badly need a lesson in comparative international economics, they are, rather badly, missing the point.
For the unwashed masses, it’s not about economic analysis - of whatever political persuasion - which elevates political and economic self-delusion to a matter of statistics; they already have a confidence level of 99,99% that their anecdotal “lived experience” demonstrates that the deck is stacked, and they have an adamant conviction that those attempting to demonstrate otherwise are tools or fools.
And this at a time when we are confronting a situation in which the proprietors’ avarice has the “advantage” of being coupled with profound ahistoricism – I can’t think of another ruling class – anywhere, at any time - that encouraged the peasants to arm themselves to the teeth, hectored then for decades to suppose that the purpose was to facilitate the overthrow of any government they found inconvenient, extended the scope of hatred and disdain to the “elites”, and then reacted with surprise when - as is always the case – disaffected and disaffected members of the same elites went rouge .
So, when the mob logs on by the tens of thousands to observe that “Hey… look at that! THERE’S a guy who knows that there IS a “silver bullet” to fix the US health care system,” it’s not time to lecture them, and their “elite” sympathizers, point by point about their ignorant and unsound opinions - because wrapping yourself up in condensation and self-assumed superiority – however accurate your judgment may be in a narrow technical sense - is completly ineffective as ballistic body armor.
I won’t bother to list my own anecdotal experiences with “the healthcare system;” they would just be additions to the long liturgy of greed, abuse, and stupidity—both the randomly callous and the deviously calculated—chronicled elsewhere.
But I would recommend that anyone who thinks anything useful to the vast majority of the citizens who elect those who govern us will come for this sort of exercise to ask around at Christmas what their less well-educated relatives think about these questions, and then instead trying of “explain” how poorly they understand these questions, ponder how Antoine-Laurent de Lavoisier ended up on a tombereau.
The guy was clearly going through a serious mental health crisis. Someone who could produce a coherent manifesto wouldn’t be coherent enough to plan, execute and get away with a murder like this.
What made Ted Kaczynski able to write a mostly coherent and even interesting, 35,000 word manifesto was the same thing that allowed him to get away with terrorist attacks for over a decade.
We should expect the quality and interest of a manifesto to correspond to the success of the terrorist campaign. Luigi had at least a dozen failures, each would have gotten him caught.
A number of good observations in both the piece and the responses to it.
Oddly, very rarely mentioned by media (especially MSM) is the fact that, we are living (and some would add “dying”) under Obamacare. Why it’s hardly mentioned these days!
And didn’t Obamacare shift responsibility for management to large insurance corporations? You know, away from employers etc. (even individuals/citizens?)
And didn’t Obamacare remove competition from the insurance industry? Weren’t healthcare providers mainly physicians “nudged” into large corporate Hospital chains?
The thing any government involvement does is end competition and diminish individual decision making. See higher ed and housing etc.
The whole current healthcare “thing” is basically a shift of “guaranteed” tax funded dollars to big insurance who got a bonus of less competition in the market place.
Finally, there’s a great test case in “free” healthcare with Medicare and Medicaid (oh let’s add the VA system). Apparently, not much learning there. This as well as Obamacare is hardly mentioned in any discussions.
A good reminder that the opposite of truth isn’t lies, but confusion. Far more evil is caused by lack of understanding and muddled beliefs, than by willful dishonesty.
As Twain said - it's not what you don't know that gets you in trouble, it's what you know for certain that just ain't so
Are you referring to the murder as evil, or the issues with health care system? Seems like it applies well to both.
I don’t know what’s wrong with the health care system that isn’t a cost of benefits of the larger American system. (Freedom to choose; free enterprise; high rewards for hard work, education, and entrepreneurship; personal freedoms and responsibilities.) I see some issues, but don’t think they rise to the level of evil. You’d have to tease that apart for me.
Here’s another idea worth keeping in mind, though:
Health is one thing we’ll never get enough of. We’ll never be satisfied. When our health falls apart, most of us will be desperate to spend every last dollar – and go into debt – to live a little longer, have a little less pain, have it a bit better. Yet the nature of health is that it will, ultimately, fail, and we will be disappointed. We can make priorities, but we will (probably) never have enough money, resources, technology, to make people perfectly content with the state of any health care system, whether it’s American, Canadian or Scandinavian … We’re certainly nowhere near that today.
I've talked with people in my life about the healthcare industry as a whole over the last week, and it's abundantly clear that the vast majority have zero understanding of what insurance even IS. That's not even getting into the tradeoffs of single-payer, the system we have now, or an improved system, which I don't think they've even heard of. Insurance companies are the middlemen between patients and providers in a massive, highly regulated, and insanely complicated industry that very few people have any coherent framework for. Insurance is manna from Heaven that grants or denies medical treatments in the minds of the vast majority of Americans.
I'd say this is one of the main reasons Americans are generally supportive of Obamacare. The focus of the law was always about expanding insurance coverage as opposed to the cost or quality of healthcare, which is far closer to the root of the issue than insurance costs. Luigi very clearly had no idea why healthcare was so expensive, which is why he shot Thompson in the first place.
Ignoring the evil of the killing entirely, wouldn't it make more sense to kill someone more directly responsible for high healthcare costs, like an AMA official or a congressman? The guy wasn't just evil, he was a dumbass. Our problem is that because he's attractive people are going to be parroting this garbage for the entirety of his trial when they have zero clue on how to solve genuine issues regarding healthcare cost. This man is going to get more love letters from stupid, pathologically empathetic women than anyone in human history.
"This man is going to get more love letters from stupid, pathologically empathetic women than anyone in human history."
Right, you are. This country is full of dumbasses.
Not just your country. I saw similar comments about his attractiveness here in the UK. Depressing.
I fully support the denunciation, but it’s reasonable that the healthcare system is unpopular. Despite your stats, the mere fact that it’s possible to go bankrupt via medical expenses makes people feel powerless.
There’s a real risk of missing the bigger picture and being too technocratic in responses like this. When people feel furious about their lack of power, demanding that they understand that their situation is not that bad is ineffective.
The absence of the public option is partly a result of the presence of the private companies here - they lobby against it. I don’t think that distinction is all that meaningful.
Yep - but the problem is not lying in private insurance. The problem is the absence of basic semi-public insurer (preferably in plural) that cares for the first 70-80% of the income bracket, that rations agressively and supported by linear tax on insured individuals. Unlike the situation that you have, say in Germany.
He probably meant revenue not market cap.
Great catch! Mystery solved. He read the Wikipedia page on companies by revenue: https://web.archive.org/web/20241203120608/https://en.wikipedia.org/wiki/List_of_largest_companies_in_the_United_States_by_revenue
Better coverage: https://companiesmarketcap.com/usa/largest-american-companies-by-revenue/
He might not have known the difference or it might've just been an honest mistake. Either way, it's irrelevant since United also has huge expenses.
I agree that he was very likely thinking of revenue, but note that even then he was still slightly wrong!
He lists Apple, Google, and Walmart as being higher whereas the actual list is Walmart, Amazon, and Apple (i.e. ordering aside, he lists Google instead of Amazon).
Yep, that's noted in my article. Confusing Alphabet and Amazon seems like a simpler mistake than butchering the market cap list.
Ah, either that additional clarification wasn't there when I originally read your article, or I just missed it. But yes, I agree that it is a much smaller discrepancy.
>Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument.
This was a very saddening line for me. I imagined that most of the killer's mind was degraded by whatever he had gone through and was embracing nonsense and destruction, while a sliver of his mind remained and was able to engage in introspection and recognize that he couldn't actually intellectually defend his own thoughts and actions, but the former was still in control.
I wonder when he wrote this manifesto. Probably after the crime. Conceivably, during the commission of the crime, he wouldn't have been capable of even the limited reflection he expresses in it.
It's also been noted that the manifesto is pathetic in its search for external validation, rather than bold in confident embrace and explication of a position.
I wonder again if this reflects post event clarity in which the aforementioned self-reflective ability, likely representative of his former self, was more dominant, with his weak attempts at justification aimed primarily at himself: "it doesn't matter if I don't really know much about this. I know the position is defensible. People have argued it. Books have been written about it...That Moore guy..."
I also wonder about the line:
>It is not an issue of awareness at this point
A basic objection to murdering a member of a group over the systematic behavior of groups is that the same systems will remain in place, incentivizing the same behavior. A potential defense would be that the benefit would come not from the removal of the individual himself, but from the broader awareness the murder would elicit.
I wonder if this line reflects the murderer bouncing around ex post facto justifications in his head, trying to justify his actions to himself at a moment of greater sanity: "Why did I do it? Wasn't he just a cog? Well, I guess it'll raise awareness. Is that it? Not really. Aren't people already aware, given how long the problems have been around? I guess it's something else. Power games? I guess. So if these "power games" (presumably systems that incentivize certain behavior) are in place, what did my murder accomplish? That line of thinking is then cut off.
For what it's worth, there may be some indicators that his overall cognitive ability degraded, instead of him merely having adopted very different views than he previously had.
The manifesto is short, but to me, the writing quality in it, ignoring the content, seems much worse than anything else I saw posted from him on Twitter, or elsewhere.
Most notably: "I do apologize for any strife of traumas" which doesn't even read like it was written by a native English speaker.
[It's also hard to imagine how that line could be the result of misread handwriting. Even if the 'f' in 'of' should have been an 'r', that still would still be very poor writing.]
Similarly, in the aforementioned "It is not an issue of awareness at this point" line, he writes "No the reality is," apparently lacking punctuation after 'no.' I think that would be more likely if he were writing as a stream of consciousness without having the words in his head, yet. He didn't drop a period after 'no' since he didn't know he'd want to end the sentence. Stream of consciousness writing would be consistent with the "not a matter of awareness line" being him grappling with potential justifications, in real time.
His final line: "It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.” is similarly poorly written and potentially reflects cognitive decline.
How does the last sentence flow? If the persistence of the problems isn't about lack of public awareness, but power dynamics, then how does his murder accomplish anything?
The flow isn't just lacking conceptually, but grammatically. What's the referent of 'it' in "I am the first to face it?" The power games? Then the word should be plural. Is "it" some general problem?
This crude transition to a nicely dramatic but not too coherent final sentence may reflect him searching for some neat explanation for his behavior, coming up short, and lamely concluding, "but at least I was brave."
His shouting at the courthouse could have also been in part reflective of internal self doubt and attempt at justification. How could I be wrong about all this, if it's consistent with other people's feelings? "Lived experience" can't be refuted, unlike quantifiable arguments, which he realized weren't on his side, or which he at least realized he couldn't articulate.
The company by market cap issue also jumps out, as it's a simple factual question that wasn't even central to his point. I'd think that if he retained his cognitive ability but simply adopted particular delusions or something, that he'd be less likely to err with that.
I agree that the market cap thing is very odd. His lack of quality control there screams that he didn't put in his due diligence elsewhere. It should make everything else that he said questionable, because it is such an obvious, easily-checked thing. The lack of flow is also very odd.
I ultimately think that this manifest is just narcissistic self-rationalization like a guy going, "Guys, you all agree I did good, right? Right? Look, I had reasons!"
It all reminds me of crime and punishment.
Thinking about his shouted statement at the courthouse that "It’s completely out of touch and an insult to the intelligence of the American people and their lived experience," it's ironic that, if anything, lived experience is probably more positive towards insurance than popular sentiment.
That is, most people's personal experiences aren't as negative as their opinion of the industry as a whole. This shows up in polls where most people describe their own experiences with insurance as being positive, while describing the national state of affairs as being negative. E.g. in the polls listed here: https://news.gallup.com/poll/327686/americans-satisfaction-health-costs-new-high.aspx are illustrative, 67% of respondents were satisfied with the total cost they pay for healthcare, while only 30% were satisfied with the total cost of healthcare in the country.
As meaningless as "lived experience" is relative to hard data, even it undermines the shooter.
I was going to write a piece called "Luigi Mangione's Manifesto Sucked" or something, and I still might, but I feel less restless about it after seeing this. It was just so empty and badly written, like the kinds of PR statements given by celebrities when they have to briefly weigh in on politics or personal scandal. The fact that he admitted to eliding the complexity of healthcare and being unqualified to wade into it was especially shocking. I would never kill someone unless it was over something I was very qualified to explain, and even then I wouldn't need to kill them, since I would just defeat them with a good explanation.
I’m surprised there’s no viral tweet yet comparing him to Elliot Roger if he went after the CEO of Tinder. Anyone with a twitter following is welcome to plagiarize my idea. His motivations of “lived experience” matches closely, but is well perceived because affordable healthcare is an EHC virtue signaling topic.
Although not directly related, it's worth noting that Cremieux has pointed out that psychosis is associated with an elevated rate of homicide perpetration, and that first episode psychosis is associated with a *very* elevated rate of homicide perpetration (almost 15 times the rate for previously treated psychosis): https://x.com/cremieuxrecueil/status/1664491391139864576.
The killer was 26, which is a typical age for the onset of schizophrenia symptoms, which can include psychosis.
While something seems to have changed dramatically in the killer's state of mind in the months before the killing, schizophrenia / psychosis is just a suggestion.
The first graph works - where it does - because the author chooses individual consumption in PPP, rather than the more common GDP per capita on the X axis. Using the latter Norway would be as far to the right as the US and Luxembourg much further right as their gdp per capita is the same or higher than the US, therefore the US would seem very much an outlier on the y axis, because the health expenditure of those two is much lower.
Maybe it’s the correct graph and GDP per capita isn’t, maybe it’s the metric that proves the point. It was presented without explanation.
The second graph does use per capita gdp or rather the “predicted spending (regression w 6 procedures)” (ok?) as the label at the bottom and what it is predicted on is in fine print at the top: spending measured in $/capita at economy wide PPPs. So per capita is in. And predicted surgeries per capita with it.
That’s an odd graph too, not just in execution but concept. It doesn’t prove that the US is getting bang for its buck at all because another way of reading this is that the US is performing too many surgeries, or surgeries are more expensive when performed. I can’t say either way to be honest, however I don’t think number of surgeries should track GDP per capita.
I mean, is there any real reason for health insurance companies to exist and not to be replaced by a single-payer system? They don't create any real value, just exist as a cost-increasing layer on top of the existing system. And without them the government could use its market power as monopsonist to drive down physician salaries and pharmaceutical prices as it does in other countries. You have ridiculous cases like insulin prices being high because of patents when we knew how to make insulin years ago.
It could be an end to American dynamism and innovation in this area and I think a lot of people would be OK with that. The prices have gotten way out of control and a lot of ordinary people can't afford healthcare.
I had this argument with Hanania. He thinks populism (of the left and right varieties) is inefficient, and I kind of agree. The problem is if you don't kick enough of the excess gains from efficiency back to the general public, they get pissed off and try to overthrow you for someone who will.
It's quite likely that, say, physicians are overpaid, and that's another problem.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
No, socializing *everything* is a dumb idea. The USSR, as you point out, was dirt poor. Healthcare's one of those things like electricity that works better as a government thing. But plenty of other things don't. (SpaceX, for instance, has done a lot more than NASA lately.) Other countries get better health results with less money. I think what he says is correct and administrative costs aren't everything, but the fact remains healthcare insurance profits are effectively a load on the system a public system wouldn't have, since they're money diverted to dividends that has to come out of premiums and copays.
Since every country is a complex system where it's hard to study any part in isolation, all I can say is, "I think the European system provides a better quality of life for most people. People live longer, have more time with their families, and are less grossly obese. I am willing to sacrifice some innovation and dynamism to get closer to that, at least in healthcare where our system is becoming unsustainably expensive and making access to care impossible for many people." Maybe there won't be as many new drugs coming out; maybe fewer innovative surgical procedures. As we know from economics, you can't have everything you want.
Single payer is worst of worst. It produces a monopoly and easily goes into an extreme rationing mode. Much better is a plurality of public insurers maintained by a linear income tax with an opt-out to private for the 20% or so who want. Like the system Bismarck introduced in Germany late 19th century.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
Sure, put the institution responsible for 99% of the dysfunction in the American healthcare system 100% in charge. Because central planning works so spectacularly well that the richest country in the history of the world is the USSR.
There's something very "assume a spherical cow" about a detailed analysis of the logical arguments of an impaired man with pins in his vertebrae who plots and murders a healthcare executive in the street. Something tells me a chain-of-thought GPT trained only on the data of cold-blooded murderers might have only limited use among us boring, unincarcerated "normies".
That said, conflating health insurance with health care is part of the reason America is in the mess that it is. A better comparison pairing for health insurance would be the rate of medical debt and bankruptcies. There, the U.S. does offer some world-beating statistics.
https://worldpopulationreview.com/country-rankings/medical-bankruptcies-by-country
And yet, medical debt matters so little: https://x.com/cremieuxrecueil/status/1802748754191151125
Nevertheless, it's a huge fear factor.
Yes this. Not technically wrong (and the data on attribution of deaths to healthcare-controlled vs other-social factors was very interesting) but off in a meta way, as if this act could be even approximately construed as "rational terrorism".
Good point of conflating complaining about "healthcare quality" with "healthcare system/insurance".
As to bankruptcies, though, while the US rates are very high, from the little I know, I don't think any of the limited data are comparable as personal bankruptcy is a commonly used vehicle in the US to deal with debt, in ways that just isn't a thing in other systems. I might be wrong here, and it does not affect the fact that while healthcare quality WHEN OPTIMALLY PROVIDED is superb in the US (perhaps with a small caveat for overuse of extremely aggressive testing and aggressive treatments), many people have no to very limited access to that superb healthcare.
While I agree that the manifesto is incoherent, the pretty graphs supposedly showing the shining wonder that is the American health payment system miss the point. Has the author or someone close to them actually had to deal with the financial aspects of a serious medical problem? Denials (of something that is standard-of-care prescribed by a physician), redundant bills, “this is not a bill” bills, wildly expensive items that, after tens of hours on phones tracking done the right person are suddenly open for negotiation. Anyone who thinks this system isn’t seriously broken has never used it.
Mangione’s manifesto might have been an ‘F’ for content and clarity, but the broader point that American health insurers are parasitic middlemen that inject huge amounts of complexity for profit is undeniable.
It's incredibly deniable that health insurers are "parasitic middlemen". In fact, there is no real case for it that isn't an expression of a person's ideology given what they actually do. That is, insurers play the vital rationing role in America's healthcare system. That people have trouble understanding denials is mostly not the fault of insurers, either. Were it not for America's ludicrous healthcare privacy laws, it would be a lot easier for people to understand denials and perhaps they might be able to work out of the wrongful idea that denials are generally arbitrary and capricious.
Do not make schizophrenic comments in my comment section.
Reading this marvelous point-by-point refutation has convinced me:
Come the revolution, we will witness a parade of economic commentators being dragged up the stairs to the guillotine as they complain to the mob below that it just doesn’t understand how things actually work, and it’s got it ALL WRONG.
“Please, you MUST listen to me! Your mistake is overemphasizing anecdotal lived experience as the primary context for framing your assumptions about the political and economic determinants of healthcare economics in the US. But that’s misleading. You HAVE to look at the data. For example, consider actual international individual medical care consumption per capita in modern economies…”
Only to be Interrupted, as the blade falls, by a shouted reply from below, “There’s YOUR lived experience, Je t'encule! !”
Today, of course, modern sensibilities must be observed, and media commentators provide the required disclaimers of aversion to violence – never to be tolerated, no abuse is a plausible excuse - as the mobs assemble in the public squares on Reddit and Facebook and howl for blood.
And if anything, individual anonymity has increased the vehemence, with the mob applauding, cheering, and jeering when the media replays the security camera footage, altered at the end to politely mute the carnage as a hand raises a Pharma Exe’s head" from the basket" for their gratification, preceded by a pro-forma “WARNING: viewer discretion is advised.”
Oh yes, there is a message here.
And if the “elites” (which I will define here, in this case, as the ”statistically literate” and historically knowledgeable, who applaud the time and effort spent systematically dismantling the manifesto's claims ) suppose that the lesson is that the unwashed masses and their homicidally delusional champions badly need a lesson in comparative international economics, they are, rather badly, missing the point.
For the unwashed masses, it’s not about economic analysis - of whatever political persuasion - which elevates political and economic self-delusion to a matter of statistics; they already have a confidence level of 99,99% that their anecdotal “lived experience” demonstrates that the deck is stacked, and they have an adamant conviction that those attempting to demonstrate otherwise are tools or fools.
And this at a time when we are confronting a situation in which the proprietors’ avarice has the “advantage” of being coupled with profound ahistoricism – I can’t think of another ruling class – anywhere, at any time - that encouraged the peasants to arm themselves to the teeth, hectored then for decades to suppose that the purpose was to facilitate the overthrow of any government they found inconvenient, extended the scope of hatred and disdain to the “elites”, and then reacted with surprise when - as is always the case – disaffected and disaffected members of the same elites went rouge .
So, when the mob logs on by the tens of thousands to observe that “Hey… look at that! THERE’S a guy who knows that there IS a “silver bullet” to fix the US health care system,” it’s not time to lecture them, and their “elite” sympathizers, point by point about their ignorant and unsound opinions - because wrapping yourself up in condensation and self-assumed superiority – however accurate your judgment may be in a narrow technical sense - is completly ineffective as ballistic body armor.
I won’t bother to list my own anecdotal experiences with “the healthcare system;” they would just be additions to the long liturgy of greed, abuse, and stupidity—both the randomly callous and the deviously calculated—chronicled elsewhere.
But I would recommend that anyone who thinks anything useful to the vast majority of the citizens who elect those who govern us will come for this sort of exercise to ask around at Christmas what their less well-educated relatives think about these questions, and then instead trying of “explain” how poorly they understand these questions, ponder how Antoine-Laurent de Lavoisier ended up on a tombereau.
You may be interested that his remark that "we rank roughly #42 in life expectancy." is also likely to have come from Wikipedia:
https://en.wikipedia.org/wiki/Healthcare_in_the_United_States#Health_in_the_US_in_global_context
The guy was clearly going through a serious mental health crisis. Someone who could produce a coherent manifesto wouldn’t be coherent enough to plan, execute and get away with a murder like this.
What made Ted Kaczynski able to write a mostly coherent and even interesting, 35,000 word manifesto was the same thing that allowed him to get away with terrorist attacks for over a decade.
We should expect the quality and interest of a manifesto to correspond to the success of the terrorist campaign. Luigi had at least a dozen failures, each would have gotten him caught.
A number of good observations in both the piece and the responses to it.
Oddly, very rarely mentioned by media (especially MSM) is the fact that, we are living (and some would add “dying”) under Obamacare. Why it’s hardly mentioned these days!
And didn’t Obamacare shift responsibility for management to large insurance corporations? You know, away from employers etc. (even individuals/citizens?)
And didn’t Obamacare remove competition from the insurance industry? Weren’t healthcare providers mainly physicians “nudged” into large corporate Hospital chains?
The thing any government involvement does is end competition and diminish individual decision making. See higher ed and housing etc.
The whole current healthcare “thing” is basically a shift of “guaranteed” tax funded dollars to big insurance who got a bonus of less competition in the market place.
Finally, there’s a great test case in “free” healthcare with Medicare and Medicaid (oh let’s add the VA system). Apparently, not much learning there. This as well as Obamacare is hardly mentioned in any discussions.