This is a particularly well written and wise posting. The phrase "people as social biopsies" is very insightful. I'll read it again this evening; there's a lot to digest. Thanks.
Brilliant and wonderful. Thank you for this essay. As a physician trying to care for people in a - in so many ways - broken system within a - in so many ways - breaking world, I appreciate you so for finding the words for this.
Thank you for digging in and asking the hard questions. It is so important that we keep asking why! We cannot fix everything that is broken in our society until we understand it and we cannot understand it if we don't discuss it.
I share your feelings re the need to discuss! Too many people are afraid to go there. However before discussing issues with those who disagree, it is necessary to try to empty oneself of judgement and self righteousness; they stoke angry emotions that show in the voice, in the face and overall body language. The negativity that shows makes an effort to connect more or less impossible.
I agree about listening with an open mind, but I would add that being curious is very important. Asking why someone has a differing opinion is part of understanding their perspective. Being a scientist rather than a judge is pivotal.
Last night I watched corporate media for the first time since the election commenting on Mangione’s arrest and in the 20 or so minutes I was asking myself how might/can/must this deplorable act and subsequent arrest result in something valuable and justifiable for the common good and what part will media play towards that action? A deplorable or honorable one?
And, then this morning I read your post Anand. May this ray of light you express so well be taken in, widely.
Thank you for sharing this wise perspective. I think this actually might be the challenge of our times… To be curious (and kind) while still condemning violence (and meanness).
Everything about this essay is good, but how do we achieve this conclusion of medical care for everyone? Seems like we’ve been trying to do it for 100 years. This seems like the reason so many people voted to tear everything down.
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.
Anand, we also need to be seeing these "individual" acts not as one-offs, but as collective indicators of systemic ills. We have to see these as indicators of collective harm that manifest as "lone wolf" or "mental health" problems. When we examine the roots of those actions, then we see how conditions of unregulated corporate greed and wealth lead to a sense of disempowerment and hopelessness. If we don't address the conditions that allow abuses to happen, they will sabotage us in the future.
A wonderful piece - thank you, Anand. For me, the horrible thing is, we HAVE been following the right way for so many years now, in the apparent illusion that things move in an upward spiral. How long? Not long... was the byword for racial inequity. It gets longer every year, not shorter; now our voting rights are under attack, not being extended. We have marched against guns for all, howled about gerrymandering, lost women's rights over their own bodies, had a countrywide fit about George Floyd's killing - and our reward is a Supreme Court that's happy to let it all go and protect the guilty. Income inequality has just hit the stratosphere, where the only qualifications for cabinet members is how you look on TV, how much money you have, and extra points for sexual predators, courtesy of the felon-in-chief. Connection to the ruling family also appears to help, though it can also mean exile.
It seems entirely possible that whatever suffering the assassin endured at the hands of for-profit healthcare drove him out of his gentle, smart mind. Someone or something radicalized him. There was a note somewhere about his being an enthusiast of some podcaster with a masculinity pitch along with the politics, so maybe he became a bro.
A friend of mine has lost her health insurance and her options are an increase of either 200 or 300% over what she had been paying, with less service and some restrictions.
She's a shrink so I don't think she will lose her mind over this, but her first uninsured visit to an endocrinologist cost her $700 and wasn't very helpful. It's hard not to think the country itself has lost its mind, by design.
At our house, our recent goal, at 87 and 86, was to live long enough to vote against Trump a third time. Will we get our new wish, to vote in the midterms?
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.
Violence should not be the quickest resort to a bad situation. Petition in large groups. Vote with large numbers who agree with you. Recognize the common humanity of those who frustrate you. Allay the fears of those in power. Follow the Golden Rule.
Thank you, Anand, for such a constructive article. I only wish we could get to universal health care. But we are headed for deeply troubling times globally and certainly crisis nationally. We need to look at root causes of this crisis as well as at the immediate in-your-face symptoms and it will take all of us. I personally think we must reform education to reflect truth and science. Talk order, of course.
You summed up my thoughts on the cause. People do feel isolated and helpless when dealing with broken systems that once protected us. My son applied for a policy thru The Affordable Care Act . His income is half of his previous salary before Covid (due to changes in the economy and his field). They recommended a company where you can never reach a real person. They sent their statement declaring that their cost to cover him is $1,000 a month. His monthly premium is lower than the $600 a month that he paid for private; but this seems a waste. He has never filed a claim with either ACA or his private company.
He was needing to see a dermatologist (family history of melanoma) so attempted to get information regarding one in their system. After several no answers to the 800 number He tried the email listed, still no response. He will not apply through ACA again. He said it is obviously a scam company and doesn't want them to profit $1,000 a month at taxpayer expense. I offered to help with a private insurance; since I feel you need it in case of major surgery in future. He declined my help because he said "if it is major they will likely 'delay and deny'" as he heard from a friend's experience. This has left him frustrated and angry. He is a calm intelligent person (and seldom negative) He is mid 50's and healthy. At this point he wishes that he would have invested the monthly premiums over the past 30 years. I do see his point.
With almost 40 years of experience in nearly every aspect of healthcare, I have a lot of thoughts on this topic, and appreciate the insightfulness of this article. For the past 5 years I've considered myself a reformed healthcare leader, and I now only work in the true non-profit part of healthcare.
It is way past time for universal healthcare. Universal means everyone has coverage - there are lots better ways to do that than Medicare 4 All (which is not the panacea some think). Healthcare also should be either not-for-profit or non-profit. As someone who spent my entire career trying to transform the industry from within, I hope these horrific events will be a tipping point for needed change.
That said, health 'insurance' (most have diversified beyond insurance) is only a fraction of the problem (30% of revenues in the largest industry in the US), even if it gets the most bad press and scrutiny. That is not in defense of UHG or UHC, because they are a microcosm for capitalism run amok and deserving of the antitrust investigation.
The whole healthcare ecosystem needs to be reviewed because everyone is making steep profits - including the skilled rehab facilities (typical profit margins of 30-40%) from which the Magione family got its wealth.
It all contributes to the cost and passing along those costs to the patients and consumers so that these entities can return more money to their owners and shareholders.
That large dermatology, orthopedic clinic, surgery, free-standing emergency room, or MRI center you go to is either owned by the docs - who are multi-millionaires- or private equity firms. The anesthesiologist, eye specialist, radiologist, and ER doc are contractors, not employees of where you saw them so a premium can be charged for their services, or they don't have to be 'in-network' and can surprise bill patients directly for their services.
Then there is big pharma, pharmacy benefit managers, med tech companies VC or PE funded, medical record companies, medical device or supply companies, and the list goes on and on. That huge medical system in that beautiful building is also likely for profit. If they say they are 'not-for-profit' chances are they have wholly owned for-profit subsidiaries.
It's a dirty secret and each stakeholder tries to distract the public by blaming the others. Each of them is contributing to the problem and squeezing the members and patients because the reality is in the USA we pay for sick care, not for keeping people well. The incentives are in the wrong place. Until we fix that it won't be better.
No one I know went into healthcare to screw people over, and many of us have worked tirelessly to change it from within, but in the past 6 years, it's gotten extreme. I hope this will be the tipping point because, in the wealthiest country in the world, we deserve something better.
As long as we focus on people ONLY as individuals and their overt mental "health" and NOT as agents/spokespeople for the "collective unconscious" which, for most folks, is a unknown and potentially "dangerous" ephemeral phenomena, we will NEVER appreciate the significance of the collective aspect present in any one person. We ALL reflect the various slivers of human awareness, even if we choose to project those we find "objectionable" onto others, mostly our perceived "enemies". The fact that there has been as much fascination and outright admiration for Mangione (on both sides of the political spectrum) strongly suggests that his action has brought feelings of outrage to the surface which TOO OFTEN lie BELOW the radar of the common collective. The ONLY people for whom this is non issue are those who are not at the mercy of health insurance companies because they have the money to get any and all the healthcare they need/desire. This next phase of our political struggle needs to identify the real issue plaguing us: the growing wealth gap and HOW that gives rise to fascism. The political right has its own cadre of elites which are peddling a false "populist" narrative. I refer the reader to "Elite Capture: How the Powerful Have Taken Over Identify Politics (and Everything Else)" by Olefumi O. Taiwo.
Let’s not forget that many people die every year, endure suffering, and/or lose their life savings and homes from medical debt that is nonexistent in countries with nationalized healthcare. So it’s not just ‘bureaucratic’ violence, which sounds like frustration with paperwork. Murder is wrong when it’s one on one, and equally wrong when it’s systemic and intentional as it is in the business model of health insurance companies, pharmaceutical companies, and other industries that calculate the cost of their liability for deaths and injuries they cause into their annual budgets.
I've attempted to do this for years... Often you are reprimanded with "it's too soon to talk about that.". This happens after school mass shootings where one wants to talk about gun control.
The more important step (and most difficult) is this... So what? What can we do about it?
Yes health care is a mess. We all know that. So what can be done? Universal health care is one answer but it is almost never going to happen in the USA. (for a million reasons).
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.
This is a particularly well written and wise posting. The phrase "people as social biopsies" is very insightful. I'll read it again this evening; there's a lot to digest. Thanks.
Brilliant and wonderful. Thank you for this essay. As a physician trying to care for people in a - in so many ways - broken system within a - in so many ways - breaking world, I appreciate you so for finding the words for this.
Thank you for digging in and asking the hard questions. It is so important that we keep asking why! We cannot fix everything that is broken in our society until we understand it and we cannot understand it if we don't discuss it.
I share your feelings re the need to discuss! Too many people are afraid to go there. However before discussing issues with those who disagree, it is necessary to try to empty oneself of judgement and self righteousness; they stoke angry emotions that show in the voice, in the face and overall body language. The negativity that shows makes an effort to connect more or less impossible.
I agree about listening with an open mind, but I would add that being curious is very important. Asking why someone has a differing opinion is part of understanding their perspective. Being a scientist rather than a judge is pivotal.
👍
Last night I watched corporate media for the first time since the election commenting on Mangione’s arrest and in the 20 or so minutes I was asking myself how might/can/must this deplorable act and subsequent arrest result in something valuable and justifiable for the common good and what part will media play towards that action? A deplorable or honorable one?
And, then this morning I read your post Anand. May this ray of light you express so well be taken in, widely.
Thank you for sharing this wise perspective. I think this actually might be the challenge of our times… To be curious (and kind) while still condemning violence (and meanness).
Everything about this essay is good, but how do we achieve this conclusion of medical care for everyone? Seems like we’ve been trying to do it for 100 years. This seems like the reason so many people voted to tear everything down.
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.
Anand, we also need to be seeing these "individual" acts not as one-offs, but as collective indicators of systemic ills. We have to see these as indicators of collective harm that manifest as "lone wolf" or "mental health" problems. When we examine the roots of those actions, then we see how conditions of unregulated corporate greed and wealth lead to a sense of disempowerment and hopelessness. If we don't address the conditions that allow abuses to happen, they will sabotage us in the future.
A wonderful piece - thank you, Anand. For me, the horrible thing is, we HAVE been following the right way for so many years now, in the apparent illusion that things move in an upward spiral. How long? Not long... was the byword for racial inequity. It gets longer every year, not shorter; now our voting rights are under attack, not being extended. We have marched against guns for all, howled about gerrymandering, lost women's rights over their own bodies, had a countrywide fit about George Floyd's killing - and our reward is a Supreme Court that's happy to let it all go and protect the guilty. Income inequality has just hit the stratosphere, where the only qualifications for cabinet members is how you look on TV, how much money you have, and extra points for sexual predators, courtesy of the felon-in-chief. Connection to the ruling family also appears to help, though it can also mean exile.
It seems entirely possible that whatever suffering the assassin endured at the hands of for-profit healthcare drove him out of his gentle, smart mind. Someone or something radicalized him. There was a note somewhere about his being an enthusiast of some podcaster with a masculinity pitch along with the politics, so maybe he became a bro.
A friend of mine has lost her health insurance and her options are an increase of either 200 or 300% over what she had been paying, with less service and some restrictions.
She's a shrink so I don't think she will lose her mind over this, but her first uninsured visit to an endocrinologist cost her $700 and wasn't very helpful. It's hard not to think the country itself has lost its mind, by design.
At our house, our recent goal, at 87 and 86, was to live long enough to vote against Trump a third time. Will we get our new wish, to vote in the midterms?
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.
A resounding 👍
Violence should not be the quickest resort to a bad situation. Petition in large groups. Vote with large numbers who agree with you. Recognize the common humanity of those who frustrate you. Allay the fears of those in power. Follow the Golden Rule.
Thank you, Anand, for such a constructive article. I only wish we could get to universal health care. But we are headed for deeply troubling times globally and certainly crisis nationally. We need to look at root causes of this crisis as well as at the immediate in-your-face symptoms and it will take all of us. I personally think we must reform education to reflect truth and science. Talk order, of course.
You summed up my thoughts on the cause. People do feel isolated and helpless when dealing with broken systems that once protected us. My son applied for a policy thru The Affordable Care Act . His income is half of his previous salary before Covid (due to changes in the economy and his field). They recommended a company where you can never reach a real person. They sent their statement declaring that their cost to cover him is $1,000 a month. His monthly premium is lower than the $600 a month that he paid for private; but this seems a waste. He has never filed a claim with either ACA or his private company.
He was needing to see a dermatologist (family history of melanoma) so attempted to get information regarding one in their system. After several no answers to the 800 number He tried the email listed, still no response. He will not apply through ACA again. He said it is obviously a scam company and doesn't want them to profit $1,000 a month at taxpayer expense. I offered to help with a private insurance; since I feel you need it in case of major surgery in future. He declined my help because he said "if it is major they will likely 'delay and deny'" as he heard from a friend's experience. This has left him frustrated and angry. He is a calm intelligent person (and seldom negative) He is mid 50's and healthy. At this point he wishes that he would have invested the monthly premiums over the past 30 years. I do see his point.
Amen! Why we are so late on this boggles my mind!
With almost 40 years of experience in nearly every aspect of healthcare, I have a lot of thoughts on this topic, and appreciate the insightfulness of this article. For the past 5 years I've considered myself a reformed healthcare leader, and I now only work in the true non-profit part of healthcare.
It is way past time for universal healthcare. Universal means everyone has coverage - there are lots better ways to do that than Medicare 4 All (which is not the panacea some think). Healthcare also should be either not-for-profit or non-profit. As someone who spent my entire career trying to transform the industry from within, I hope these horrific events will be a tipping point for needed change.
That said, health 'insurance' (most have diversified beyond insurance) is only a fraction of the problem (30% of revenues in the largest industry in the US), even if it gets the most bad press and scrutiny. That is not in defense of UHG or UHC, because they are a microcosm for capitalism run amok and deserving of the antitrust investigation.
The whole healthcare ecosystem needs to be reviewed because everyone is making steep profits - including the skilled rehab facilities (typical profit margins of 30-40%) from which the Magione family got its wealth.
It all contributes to the cost and passing along those costs to the patients and consumers so that these entities can return more money to their owners and shareholders.
That large dermatology, orthopedic clinic, surgery, free-standing emergency room, or MRI center you go to is either owned by the docs - who are multi-millionaires- or private equity firms. The anesthesiologist, eye specialist, radiologist, and ER doc are contractors, not employees of where you saw them so a premium can be charged for their services, or they don't have to be 'in-network' and can surprise bill patients directly for their services.
Then there is big pharma, pharmacy benefit managers, med tech companies VC or PE funded, medical record companies, medical device or supply companies, and the list goes on and on. That huge medical system in that beautiful building is also likely for profit. If they say they are 'not-for-profit' chances are they have wholly owned for-profit subsidiaries.
It's a dirty secret and each stakeholder tries to distract the public by blaming the others. Each of them is contributing to the problem and squeezing the members and patients because the reality is in the USA we pay for sick care, not for keeping people well. The incentives are in the wrong place. Until we fix that it won't be better.
No one I know went into healthcare to screw people over, and many of us have worked tirelessly to change it from within, but in the past 6 years, it's gotten extreme. I hope this will be the tipping point because, in the wealthiest country in the world, we deserve something better.
Thank you for what feels like the only thoughtful, big picture response to this.
As long as we focus on people ONLY as individuals and their overt mental "health" and NOT as agents/spokespeople for the "collective unconscious" which, for most folks, is a unknown and potentially "dangerous" ephemeral phenomena, we will NEVER appreciate the significance of the collective aspect present in any one person. We ALL reflect the various slivers of human awareness, even if we choose to project those we find "objectionable" onto others, mostly our perceived "enemies". The fact that there has been as much fascination and outright admiration for Mangione (on both sides of the political spectrum) strongly suggests that his action has brought feelings of outrage to the surface which TOO OFTEN lie BELOW the radar of the common collective. The ONLY people for whom this is non issue are those who are not at the mercy of health insurance companies because they have the money to get any and all the healthcare they need/desire. This next phase of our political struggle needs to identify the real issue plaguing us: the growing wealth gap and HOW that gives rise to fascism. The political right has its own cadre of elites which are peddling a false "populist" narrative. I refer the reader to "Elite Capture: How the Powerful Have Taken Over Identify Politics (and Everything Else)" by Olefumi O. Taiwo.
Let’s not forget that many people die every year, endure suffering, and/or lose their life savings and homes from medical debt that is nonexistent in countries with nationalized healthcare. So it’s not just ‘bureaucratic’ violence, which sounds like frustration with paperwork. Murder is wrong when it’s one on one, and equally wrong when it’s systemic and intentional as it is in the business model of health insurance companies, pharmaceutical companies, and other industries that calculate the cost of their liability for deaths and injuries they cause into their annual budgets.
I've attempted to do this for years... Often you are reprimanded with "it's too soon to talk about that.". This happens after school mass shootings where one wants to talk about gun control.
The more important step (and most difficult) is this... So what? What can we do about it?
Yes health care is a mess. We all know that. So what can be done? Universal health care is one answer but it is almost never going to happen in the USA. (for a million reasons).
We could have had medical care for all, and free public university education, if we'd elected Bernie Sanders for our president. We were really so close, but we couldn't quite get there.