The Italian Job: The Murder of a Healthcare CEO as an Ethics Case Study

Note: In these paragraphs, I look at the important difference between individual and systemic sin, and why addressing both is the key to building a solid ethic. Regular readers can expect a more hopeful Christmas post on Monday

Luigi Mangione’s murder of Brian Thompson, the United Health Care CEO, captured America’s attention.  He was shot in New York on his way to a meeting, which in itself is a story because of Mangione’s apparent care in planning and carrying out the killing, and the obviously apparent motives surrounding what Mangione viewed as an unjust healthcare system.  You can read here about how the murder birthed an outpouring of support and praise for Mangione, due to the pent up anger many people have toward a health care system that is, by nearly every measure, broken.  Americans pay more for health care, get less, and have a lower life expectancy than any other developed nation.

The reason this is a case study in ethics is because the differing responses to this murder point to differing senses of right and wrong.  There are plenty of people (appropriately) condemning the killing without condition or reservation.  ‘We don’t solve problems this way,’ ‘murder is always murder, always wrong,’ ‘we do not kill people in cold blood to resolve policy differences or express a viewpoint,’ and ‘no circumstance can ever justify this’ are just a snippet of the thousands of comments posted, published, and spoken in this vein.

The ethical construct of such comments focuses on the personal nature of sin and wrongdoing.  Each of us are responsible for our own individual choices, and we will reap what we sow, as the Bible says.  Sow hope and peace, reap the same.  Sow violence and destruction, and you should pay for it.  This is what we sometimes call ‘the rule of law’ and its true.  The Bible says, ‘You shall not kill’ therefore murder is wrong. End of story, right?

Almost the end, but not quite. This truth, though true, isn’t the whole truth.  A different facet of truth was exposed by the overwhelmingly public outcry of support for Mangione and what he did.  When the United Health Group posted on its facebook page that it was’ deeply saddened at the passing of our dear friend and colleague’ it was met with 80,000 responses, 75,000 of which were a ‘haha’ emoji. A legal defense fund was birthed for the killer in the form of a Go Fund Me page, gaining broad support. Mangione gained 400 thousand followers on his twitter account, and a number of cruel ‘he had it coming’ comments bouncing through social media wasn’t a few snowflakes; it was an avalanche.  The killing of a healthcare CEO unleashed a pent up level of frustration with a system that is deeply flawed.  That that CEO was entering an investor meeting where he would boast of the company’s profits, knowing that denial of coverage and delay of approval for treatments are verified strategies for maximizing shareholder return, became the spark that erupted a long gathering pile of tinder dry frustration.  Now there’s a roaring fire and, lacking an ethical anchor, there are many who feel that violence is justified.

Please hear me.  The violence is NOT justified.  But, as this doctor notes: the reaction, even in its objectionable vitriol, matters for how it lays bare Americans’ deep-seated anger toward health care. Around the country, anecdotes were unleashed with furor.

This kind of violence has happened before, of course, over and over again in history, and it happens when a culture fails to address forms of systemic sin which steal shalom. Systemic sin isn’t  an individual doing wrong things, but a collective set of policies that enflame forms of injustice, oppression, and poverty.  Precisely because its collective, nobody feels responsible.

One the one hand, lets consider Brian Thompson.  Here’s just a little snippet of what we know about him:

Thompson graduated from the University of Iowa in 1997 with a bachelor’s degree in business administration with a major in accounting. He graduated as valedictorian, according to his LinkedIn. He was a Collegiate Scholar, Carver Scholar, State of Iowa Scholar and Faculty Scholar. He graduated from South Hamilton High School in Jewell, Iowa, in 1993 and was the valedictorian of his class, Heather Holm, the superintendent for South Hamilton Community School District, told CNN.

“During his time at South Hamilton, Brian was a star student, athlete, homecoming king, and a respected leader. His achievements and character left a meaningful legacy within our schools and community,” Holm said in a statement. “We join all who are mourning in remembering Brian’s life and legacy.”

As outstanding a human being as he was, and as vile and wrong as his murder was, acknowledging that Brian is part of a system that’s broken is also appropriate.  We can both condemn murder and challenge systemic sin. Brian was heading to a meeting for investors in New York City because ultimately, Brian worked for the investors, who are looking for a maximum and stable return on their investments in the company he led.

The strategies of health insurance companies for maximizing investor’s return on investment has led to increasing levels of frustration on the part of both doctors and patients as they try to access heath care and use insurance.  In this article, a doctor explains the fickle nature of health care coverage, and how it undermines his credibility as a physician when he can’t promise that an advised procedure will be covered.  Denial of treatment is undeniably on the rise, and its killing people.  The parents of the seven year delayed the treatment and the child died.  In other news, the leading cause of personal bankruptcy in America is medical debt.

If the question ‘Who is to blame for this mess?’ is asked, the answer is nobody, and nearly everybody.  It’s nobody in the sense that Brian Thompson is just doing his job, because he has his own life, and is leveraging his skill sets to make a living, just like the barista, or the cook, lawyer, doctor, or Amazon delivery driver. You don’t kill a man for doing his job.

The truth is that his job, at the least, seems to be about maximizing profit and the blame for that resides with shareholders who, if you have any sort of retirement plan at all, likely includes you and me.  We give proxy power at shareholders meetings to someone working ‘for us’ to maximize our return for a company working within a system that doctors, patients, and politicians all know to be profoundly broken.  Collectively we have neither a path forward nor the political will to make it happen because the politicians need to get re-elected, and you don’t do so by angering major donors called lobbyists, and nobody lobbies more for status quo than the health insurance industry.  And they do that, at least in part, because we all want a return on our investments.

So who is to blame for this mess?  The answer is that this is systemic sin, which means its a collective dysfunction that rises up as the result of numerous self-interested parties and ideologies.  If personal sin is like a single ingredient recipe (think of drinking a glass of milk, or cooking a steak), systemic sin is like a cake, or a soup: throw a bunch of ingredients together and you get a sum that is greater than its parts.  In the case of cake, its greater taste.  In the case of systemic sin, its greater pain for some, maybe greater wealth or power for others.

When the prophets of old brought issues to light and called for a change of direction (which is really what repentance means), they were almost always speaking to the collective rather than a single individual.  There was systemic oppression, systemic greed, and systemic neglect of people on the margins.  No single individual changing their ways would ever be able to address systemic sin.  It requires the collective to change. These prophets called for collective repentance and change, which included leaders, but wasn't limited to them.

Systemic change happens in a monarchy when the king has a revelation and responds to it, as in the case of Josiah.  In a democracy it happens when elected officials see the need for change and take steps to address what needs to be changed to move toward a more just and compassionate culture. Which brings us to 2024 and three observations about ethics:

Our fixation with either/or has blinded us to both/and

Is the murder of a CEO wrong? Yes - absolutely and without qualifications.

Does it reveal a pent up anger over systemic injustice?  Also yes.  This second yes, though, requires a sense of understanding and empathy for those hurt by the system, and a belief that their pain is a collective problem, not just their problem.  This is why a vision of shalom (see previous post) is so vital. If you’re fine and unaffected by the problem, it's tempting to not see.

There are people who look at poverty, for example, or a family’s bankruptcy due to health care costs, and blame bad choices and lack of planning.  And sometimes they’re right.  Credit card debt and profligate spending is out of control in our culture and it means lots of people are in the hole financially due to spending beyond their means, leaving no margins for the crisis when it comes.

There are others, though, who blame the system, declaring that no amount of ‘cutting back on eating out’ would have stemmed the bankruptcy that came from the all too often reality of 1) got sick 2) lost the job 3) lost the health care 4) lost the house.  In many of these cases the problem is a broken system, not a lack of personal responsibility.   

The mess we’re in is a result of both personal choices and systemic problems. When we see that we’ll take care to make responsible choices, and (eventually, hopefully) take steps to address the systemic issues.  I say eventually because of the next point…

The good news: When systemic sin gets bad enough, the system that created it collapses. 

If you know history, you know there was an American Revolution, and then a French one, and then an American Civil War, and then a Russian revolution, and then the Germans, Italians, and Spanish had their own forms of revolution.  In every case, the revolution arose because a leader gave voice to grievances that were the result of systemic problems, usually economic.

One could rightly argue about the legitimacy of the systems that arose in the wake of revolutions, and I address that below.  But the revolutions themselves, in almost every case, arose because of a conspicuous absence of shalom, by which I mean that a vast quantity of the populace was suffering under systemic oppression or, at the very least, a laissez faire form of neglect.  The moral of the story is that we ignore the disappearing middle class and the pain of people on the margins at our peril, a topic which will be addressed in the post on economic ethics.

The bad news: without a solid moral framework, what’s rebuilt might be even worse than the original problem

When Hitler’s poisonous revolution ate itself alive, the German people sought moral re-education for its brightest and best who’d been poisoned by the Hitler Youth ideologies.  The new German government responded by sending hundreds of these youth to a Christian Bible Center in England called Capernwray Hall, which is the founding center of the movement where I’m privileged to teach around the world.

Another strategy was to address the systemic problems that led to the disappearance of the middle class, and this is why Germany was one of the first countries in the world to institute single payer health care, along with other social programs that sought to ensure the continuity of the middle class in the midst of a capitalist system.

In contrast to that, the Russian revolution gave birth to atheistic communism with all its poverty and totalitarian controls.  The post civil war American culture also embedded systemic oppression into its culture via Jim Crow laws and lots of political upheaval. As the historian Jon Grinspan wrote about the years between 1865 and 1915, “The nation experienced one impeachment, two presidential elections ‘won’ by the loser of the popular vote and three presidential assassinations. And neither political party seemed capable of tackling the systemic issues disrupting Americans" lives.” No, not an identical situation, but the description does resonate with how a great many people feel about the direction of the country today.

The practical next step for all of us? We need to pay attention to our own personal responsibility, and to the systems of our culture as well, because sin is both individual and collective.  Until we can see both/and, plus build our systems on a divine ethic, our solutions will always fall short.

next up... Drink a Cup of Joy: How Gratitude Feeds Our Capacity to Impart the Life Giving Ethic of Shalom