America’s cheers for Luigi Mangione and jeers for health insurance

This image provided by the New York City Police Department shows a man wanted for questioning in connection to the investigation of the killing of UnitedHealthcare CEO Brian Thompson outside a Manhattan hotel, Wednesday, Dec. 4, 2024. (New York City Police Department via AP)

I just got implants. Dental ones.  But all is not well.

For a key back molar, my health insurance company does not honor dental implant surgery. Says it’s not medically necessary. Apparently, chewing, or as they say, mastication, in the act of feeding is considered cosmetic.

It is cosmetic when I eat too much.

A molar, however, is essential unless I’m slurping my favorite vegan sinigang and rice noodles.

On the other hand, replacing a hockey player’s missing tooth with a dental implant – that’s cosmetic.

So, I begin this column mad, but I do not advocate murder. I run amok in my columns, but I do so metaphorically.

There are other ways to get at the healthcare companies. You write letters to the insurance company, to Congress, maybe to your local television consumer person. Certainly, you vote for someone who advocates “Medicare for All.”

None of that amounts to a sexy manifesto.

Do you assassinate someone? Not in America.

But do I understand the frustration of Luigi Mangione.

We all do.

Here’s where the insurance companies are wrong.

The way the system works

When insurers treat rejected insured’s claims in dot-matrix style form letters or communicate to us like we’re just a number to them, where’s that sense of loving humanity for all those premium dollars we’ve paid them?

They don’t really care about you.

Insurance is all about money.

Not about people.

Actuaries are paid the big bucks to figure out the odds. And then they charge the correct premiums that sit in a big pool of money ready to be paid out when people get sick.

But if insurers set the numbers right, they never have to.

They’re like health bookies. We pay them money. They’ll “cover” us. Just don’t get sick, and everyone’s happy.

What a deal.

When we pay monthly and are insured, and we stay well, all that money keeps sitting in that insurer’s big pool of cash earning interest—for the company. They loan it out and invest it. And profit from it. That’s why billionaire Warren Buffet is in insurance. And his mascot is a gecko. Cute but still a reptile.

It’s all about money. Not the premium paying human customer.

Your “lucky day” comes when you get sick with a legitimate claim.

Then they pay out. Or not.

But it’s all figured in. It only hurts the insurer if they got the numbers wrong and more people get sick.  But they have the money from all those premium dollars you’ve paid in. They’re in that big pool of money and making what Rush Limbaugh used to call “confiscatory profits.” It’s a pittance compared to what they payout.

So stay healthy, pay your premium, and everyone’s happy.

Now when you’re rejected, it’s only because the insurers screwed up the numbers. Too many people got sick. In that scenario, when you want some of that pool money back, the insurers will fight you for it until it’s no longer profitable.

Insurers only gladly pay you because they’ve made so much money from your fellow customers who gave them money and stayed well.

But if we all got sick at once, forget it. They will delay and deny us to death.

And to add insult to injury, there’s so many customers (insurers love your premiums), that often the first line of defense isn’t even a person. According to a recent Pro Publica investigation, insurers now routinely deny millions of claims using AI, the anti-human.

AI, which can be racist and bias, runs the show too often.  Increasingly, the human aspect is not even in the equation, a file is often never seen by a doctor.

Bottom line, don’t get sick in America.

Medicare-for-all?

The  system would work so much better if they made one significant adjustment – add the word “universal” to the phrase “health care.

That means everyone’s in the pool. And everyone means everyone (remember the move for worker mandates?)

The bigger the pool, the better the coverage.

Actuaries would still have to figure how much would be paid based on the illness experience of the customers. But the law of large numbers has a point where everyone is happy. Insurers and customers. It only works when the largest number of people are in the pool.

So why don’t we have “universal” health care insurance?

Oh, you mean “socialized medicine?”

Because capitalists want to have their own insurance companies and have their own smaller pools to make their own big profits.

Older people have the best health insurance in the form of Medicare, which is one big pool of people over age 65 run by the government. It’s the reason “Medicare-for-All” has been a battle cry for consumer advocates. Why not let it work for everyone? It’s considered the best insurance by industry pros. But of course, the private insurers are trying to horn in with the misnumbered “Medicare Advantage.” It’s cheaper than Medicare when you’re well, but the advantage disappears when you’re sick.

Overall, the corporates like the way the system works now for the rest of us, where you pay more money in premium than you ever get back because you’re well.

Or they simply deny claims because the corporation needs to stay even healthier than you.

This is the system Luigi was mad about. And he has a point. It just shouldn’t be made with a ghost gun and a bullet.

Now, New York District attorney, literally is throwing the book at Mangione, claiming  he’s a terrorist.

Mangione is a scion of the wealthy, generally seen as on the side of the CEOs. A terrorist is like a suicide bomber who goes into a crowd indiscriminately. Just on form, Luigi doesn’t act like a  terrorist. He’s  alleged to have gone after a single individual in the break of dawn in a nearly empty Manhattan street.

To attach terrorism to the charges seems more like a reaction to the public response and intended to put a chill in the air, especially when Luigi is being made into some folk hero in social media.

Luigi is no folk hero, but people have a First Amendment right to call him one

What he’s really done is made people pay attention in order to understand and explain health care insurance like it matters.

That’s no small thing in a country where treatment for getting sick is determined by profiteers, and not doctors.

Emil Guillermo is a journalist, commentator and humorist, who has also studied and worked in the insurance industry.  He writes a column for the Inquirer.net’s US Channel. See his micro-talk show on www.patreon.com/emilamok.