Luigi Mangione and the problem of making a suspected killer into a hero

To understand why the name Luigi Mangione, belong to the man charged in the killing of UnitedHealth executive Brian Thompson, suddenly started trending on American social media you need to first understand the unbelievable complexities of American health care. Public interest in 26-year-old Mr Mangione includes news reports, TikTok videos, a lookalike competition and endless social media posts.

He became famous, or infamous, as a result of his arrest by police investigating the shooting and murder of Mr Thompson on December 4. Mr Mangione has now become one of the most polarising figures in America in ways that are inexplicable without understanding the good, bad and ugly of the healthcare industry in which Mr Thompson worked.

The good is that some of the best doctors and best health care in the world is available in the US to those who can afford it. My own American doctor in Washington used to joke that for the richest patients “death is just a health care choice.”

The bad news is that poor, middle income and even quite successful American families have limited healthcare choices. Some are bankrupted by healthcare costs, insurance payments and a complex bureaucracy including “deductibles” and other jargon.

Healthcare costs are in fact the biggest cause of personal bankruptcy in the US. The ugly is that after decades of political rows about health care and the Clinton and Obama reform plans, healthcare outcomes in the US are not outstandingly better than in other developed countries. The US spends 17 per cent of its GDP on healthcare. In Britain, the figure is around 11 per cent. Of course, British health care also has many problems.

The UK’s National Health Service is loved but not always admired. Its bureaucracy is not copied around the world. Yet as a 2010 report for the Journal of the Royal Society of Medicine put it, despite the US historically spending a much greater proportion of GDP on health than the UK, “life expectancy at birth in the US is 78 years, the same as in Cuba and lower than in the UK [80 years].”

Bill Clinton was one of a number of American presidents who tried (with limited success) to end some of the more obvious problems caused by the largely private US healthcare system. One key feature is the enormous – and much disliked – healthcare insurance bureaucracy. The shooting victim, Brian Thompson, was an important leader in that bureaucracy.

Some years ago, filming a healthcare documentary in Bill Clinton’s home state of Arkansas, I was told the shocking news that in the 75 counties in Arkansas, a third – more than 20 counties – had no obstetrician-gynaecologist. Why? I was told that obstetricians and gynaecologists are doctors at high risk of being sued for millions of dollars if childbirth goes wrong.

That’s because problems in childbirth can damage two patients – mother and child – and newborns might suffer impaired health for the rest of their lives. That meant obstetricians needed to pay six figure sums every year in “malpractice insurance” to protect them from lawsuits. In less wealthy areas, such as in parts of Arkansas, an obstetrician could not make enough money from medical fees to cover those insurance costs.

All this is context for the way the allegations against Mr Mangione have made him a bizarre hero for some Americans. Healthcare insurers are not very popular in the US since – in the view of many Americans – they represent a costly and sometimes unhelpful bureaucracy that requires great skill and effort to navigate at times when you are sick. Such is Mr Mangione’s fame that there have been funding campaigns aimed at raising money required for his defence.

His Twitter (now X) account is claiming many more verified followers than before his criminal notoriety. The communications director of one site, which enables crowdfunding, GiveSendGo, issued a statement on the case which insisted: “We do not support or condone vigilante justice. However, people have a constitutional right to a strong legal defence, and access to that defence should not be reserved only for the wealthy or those who fit a particular narrative.

"Our role is to give people and their communities the opportunity to fundraise for that defence, because true justice is served when everyone has equal access to a fair trial – regardless of the verdict.”

A group calling itself the December 4th Legal Committee is said to be behind the funding with reports putting the money raised so far at $100,000.

Wherever the police investigation now leads, Mr Thompson is the victim of a clearly abhorrent crime and the police investigation will continue. But so will the way in which this shooting reopens the question of why health care in the richest nation on earth is so divisive both in politics and in outcomes.

The Manhattan District Attorney Alvin Bragg was appalled by some of those appearing to cheer on the murder of the insurance executive. "Celebrating this conduct is abhorrent to me. It's deeply disturbing," he said. Of course that is true. Gun crime, especially murder, is a blight on American society. But so is the deeper problem of why Americans spend so much on health care with often such poor, and clearly divisive, results.