What Luigi Mangione Got Wrong...

The Truth About The British National Health Service

Like many people, I suspect, I’ve felt uncomfortable about the reaction to the arrest of Luigi Mangione for murdering UnitedHealthcare CEO Brian Thompson.

Of course the act of cold-blooded, calculated murder is evil. And there are no “justifications” for taking a life.

And I think Elizabeth Warren, Bernie Sanders, Joe Rogan etcetera are plain wrong for giving wishy-washy caveats. “Violence is never the answer, but people can be pushed only so far,” said Elizabeth Warren. Rogan has said health insurers are “fucking gross.”

Brian Thompson, the murdered CEO of UnitedHealthcare

But Luigi Mangione wasn’t pushed - at least not specifically by UnitedHealthcare. There is no evidence he was ever even a member of United.

Further, I’d argue young Mangione (and the tragedy here, is that he is per his manifesto, clearly young) was wrong in his assumption that single payer systems, like the one we have in my native Britain are better. Reportedly he talked to the British writer Gurwinder Bhogal months before the murder and “complained about how expensive healthcare in the US was, and expressed envy at the UK’s nationalized health system.”

Mangione’s mugshot on December 10, 2024 in Huntingdon, Pennsylvania

I’m a dual citizen: British and American, so I have experience of both systems.

Neither, I have to tell you, is perfect. It’s a case of pick your poison.

Yes, the system we have here in the US is absurdly expensive, labyrinthine and patient-unfriendly: it’s a “patchwork built over decades” United Health Group CEO Sir Andrew Witty (a Brit, incidentally, not that you’d know it from his please-love-me-folksy tone) described it, in his op-ed today in the New York Times. “No one would design a system like the one we have. And no one did,” he wrote.

UnitedHealth Group CEO Sir Andrew Witty

He also wrote: ”Health care is both intensely personal and very complicated, and the reasons behind coverage decisions are not well understood.”

I’ll say.

In October I was denied an MRI, despite the the fact I pay an absurdly high monthly premium for my insurance (Oxford, which is part of United). I’d been suffering excruciating nerve pain in my neck for three weeks and neither PT, anti-inflammatories, nor oral steroids had worked. Per protocol, the next step was a steroid injection in the cervical spine. So my doctor at New York’s Hospital of Special Surgery ordered an MRI. Oxford took a week to process the order and then denied it. Because, they said, I needed to suffer pain for a full six weeks, and also get steroid injections before they’d pay for an MRI.

I don’t know what quacks they have advising them at Oxford, but I have asked around and there is no way any decent pain management doctor is going to plunge a seven inch needle into a cervical spine without first looking at an MRI.

I was in too much pain to argue, so I wound up paying for an MRI out of pocket. (The sliding scale on the cost of those also makes zero sense.)

A further problem I’ve encountered with US healthcare is that, due to its financial incentives, the practice of medicine is siloed. And that approach, rather than a holistic one, is harmful.

Twelve years ago, around Thanksgiving I had what I thought was a cold until I started to get blurred vision and pain in my face. If you touched it, I screamed. I saw an internist and then two different ENT specialists. I had my vision tested multiple times: it was fine; I had X-rays and MRIs of my sinuses. They were clear. I was given antibiotics, steroids, and yet I did not get better. Finally, my internist, a man, gave up. ”I think you have hysterical blindness,” he told me referring to a centuries-old explanation for women who had psychosomatic symptoms. To be told that in 2012 felt like a nadir.

A week later when I bit down on a piece of toast, it emerged that the problem was not psychosomatic. I had a tooth abscess. The symptoms had been the result of the poison going around my system. In all their rush to look at the specific parts, eyes and sinuses, none of the doctors had thought to stand back, look at the big picture and check my teeth.

One of my closest British girlfriends, a GP in England heard this story, and rolled her eyes at the “Americans”. As for me? I have always referred to this time in my life as my “House of Mirth” moment (a reference to the Edith Wharton tragic novel set in the Gilded Age about a New York woman, Lily Bart, who holds a lot of promise but who finds herself on a never-ending trajectory to the bottom).

Gillian Anderson as Lily Bart in the film adaptation of House of Mirth (Dir. Terence Davies, 2000)

Fortunately, however, I did not die from despair and a laudanum overdose. Instead I found a new internist, a woman, whom I love, and who sees me even when I have a bad cold, as I do right now. I’ve discovered that sometimes the adage ‘you get what you pay for” - can be true.

One of the things Americans often forget about the Brits is that Brits take their vacations extremely seriously. Six weeks a year is standard. My parents even thought I should turn down my first job in the US, on account of the two-week vacation allowance, which they deemed barbaric.

So, the National Health Service notwithstanding, you really don’t want to get seriously sick in England when the Brits are on holiday - which they are, obviously around Christmas and the New Year.

When my kids were very small - not yet two - we took them to my family home in the middle of the English countryside for Christmas. Think Jane Austen. But imagine also that the plumbing and the heating is not much advanced from the time of Jane Austen, so therefore the first word my older son spoke, when he woke up on day one, and stood up in his crib was “cold”.

From there, both kids developed fevers, respiratory problems and listlessness, and on Boxing Day (the British holiday on December 26th) we phoned a doctor at a local hospital and asked what we should do. He told us that either we could take the boys into the ER where we would likely have to wait for at least six hours, or we’d just have to wait several more days (we were headed into a weekend) until the local general practitioner’s office opened.

“So, what would you do if you were us?” my then husband asked.

“What would I do?” the nice man mulled on the other end of the line.

“Honestly, if I were you I’d get on a plane and fly them back to America…” he said.

I don’t think much has changed since then.

Two years ago, it was like groundhog day. We were in England, at my family home for Christmas and one of my sons suffered a grand mal seizure on Boxing Day. (He’d later be diagnosed with epilepsy.) It was very frightening. My brother-in-law phoned for an ambulance and he was asked by the operator if my son had regained consciousness. He had. In that case, he was told that “it will be a seven hour wait.”

We drove him to the local ER, we sat and waited. And waited. We got his New York neurologist on the phone long before we were seen by the British doctor on call; Ultimately, both doctors agreed the best course of action was to get him back to New York asap - but meanwhile to put him on a small doze of clonazepam, an anti-seizure medication every 8 hours. However, the British doctor explained, we wouldn’t be able to actually obtain the clonazepam in the hospital - or anywhere - because on that particular year, December 27th was a national holiday, too…

So, just before everyone assumes that the single-payer system is the answer to everyone’s prayers…a word of caution.

We all know what is wrong with the US healthcare system: but do we know how to fix it? What to replace it with?

It isn’t clear to me that there’s a simple answer.

And if only that had been clearer to Luigi Mangione.