By Carlos Alemany '25
“I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy…[T]he reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has all[o]wed them to get away with it…It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.” (1)
At 6:45 AM on December 4, 2024, Brian Thompson, the Chief Executive Officer of UnitedHealthcare Insurance, was gunned down—shot three times in the back on the streets of Midtown Manhattan. As the NYPD and American media scrambled to construct a narrative, the message left behind was unmistakable, engraved on the shell casings of the bullets that ended Thompson’s life:
“Delay, Deny, Depose.” (2)
While seemingly innocuous, these words have become an institutionalized catalyst for the healthcare woes of everyday Americans—an unspoken corporate doctrine where life-saving treatments are reduced to financial calculations, and the sick and vulnerable are discarded at the altar of profit. (3)
UnitedHealthcare’s public track record leading up to Thompson’s death was one marred by undeniable controversy—with lawsuits spanning allegations of patient privacy violations, fraudulent billing practices, denial of medically necessary care, and anti-competitive market manipulation. (4) As the largest healthcare conglomerate—serving approximately 50 million people and valued at over $500 billion—UnitedHealthcare dominates the U.S. insurance market while denying claims at some of the highest rates in the industry. (5) Despite generating $215 billion in revenue and holding the largest market share in the U.S. health insurance industry, UnitedHealthcare offers some of the most expensive premiums in the nation while maintaining a 33% denial rate—rejecting one-third of in-network claims, according to available data on its Affordable Care Act (ACA) marketplace plans. (6) On average, a middle-tier plan with the company costs a 40-year-old person $631 per month, compared to the national average of $621—making it the priciest major provider in the country. (7)
Investigations into the company revealed policies that systematically denied therapeutic care to autistic children—despite acknowledging it as the “gold standard” of care. (8) The company has also been exposed for its calculated use of an AI algorithm—allegedly known to contain a 90% error rate—designed to flag and reject claims for elderly patients under Medicare Advantage Plans it deemed too costly or “unnecessary.” (9) Such denials have even extended to pre-approved breast cancer surgeries, where operations were interrupted mid-procedure as insurers demanded further justification. (10) The company has also been accused of overbilling Medicare Advantage by billions of dollars through fraudulent diagnoses and rewarding doctors for upcoding conditions to inflate federal reimbursements. (11) At its worst, UnitedHealthcare has even been caught profiting from the opioid crisis, improperly filling prescriptions despite red flags, and misleading vulnerable consumers into buying fraudulent health plans. (12)
UnitedHealthcare’s controversies notwithstanding, insurers, on average, deny almost 1 in 5 claims, with some rejecting more than 1 in 3 each year. (13) Currently, 66.5% of Americans (14) who file for bankruptcy cite medical bills as the primary cause, often reporting the need to cut spending on food, clothing, and other household essentials, deplete their savings to cover medical costs, borrow from friends or family, or take on additional debt. (15) Skipping necessary care has become routine for a majority of U.S. adults, with over 57% reporting worse health outcomes as a result. (16) For nearly one-quarter of Americans, the fear of medical costs is so overwhelming that they outright refuse to call an ambulance during emergencies. (17) In three states, the average cost of childbirth exceeds 30% of per capita income, and for high-cost births—those in the 90th percentile of expenses—having a baby can consume more than one-third of an individual’s income. (18) In 11 states, these high-cost births surpass 40% of the average income. (19)
Despite the fact that most Americans have health insurance with prescription drug coverage, more than one-third of adults across all income groups say that they or a household member were told their insurance would not cover a drug prescribed by their doctor. (20)Among those who rely on healthcare the most, that number jumps to 27%. (21) Yet 69% of consumers remain unaware of their appeal rights, and an overwhelming 85% never file a formal appeal, leaving insurers free to deny coverage with little resistance. (22)
Given these realities, the American public’s reaction to the news of Thompson’s death—evidenced by over 130,000 “laughing reactions” in response to UnitedHealthcare’s public mourning of Thompson on Facebook—revealed an undeniable truth: that while such a crime may have been unthinkable to some, to many, it was inevitable—or perhaps even justified. (23)
Upon his capture at a McDonald's restaurant in Altoona, Pennsylvania, following a five-day manhunt, police discovered firearms and a political manifesto in the possession of 26-year-old Luigi Nicholas Mangione—who, rather than fitting the profile of a modern-day Unabomber, was instead revealed to be “an Ivy League tech enthusiast who flaunted his tanned, chiseled looks in beach photos and party pictures with blue-blazered frat buddies.” (24) A prolific fan base quickly emerged, propelling Mangione to Martyr-like status—with Mangione expressing through his website how such support has “transcended political, racial, and even class divisions, as mail has flooded MDC from across the country, and around the globe.” (25) A fundraiser set up for his legal defense fund has already amassed half a million dollars in donations, with many of the largest contributions originating anonymously. (26)
Public polls suggest that an increasing number of Americans sympathize with or outright condone Mangione’s alleged actions. Among Gen Z respondents, 45% expressed sympathy for Mangione, while an overwhelming 81% held a negative view of Thompson—with 48% of respondents regarding the killing as either "totally" or "somewhat" justified. (27) This generational shift in sentiment remains deeply intertwined with broader frustrations over the state of American healthcare— as Americans under 30 remain among those most likely to be uninsured. (28) Further, about 7 in 10 adults say that denials for health care coverage by insurance companies, or the profits made by health insurance companies, also bear at least “a moderate amount” of responsibility for Thompson’s death. (29)
Awaiting Mangione on the Hudson River following his extradition from Pennsylvania on December 19th was the acquaintance of New York City Mayor Eric Adams and the unrelenting gaze of the American media, as heavily armed officers led the way in a display reminiscent of a cinematic blockbuster. (30) Days later, on December 23rd, Karen Friedman Agnifilo, former Chief Assistant District Attorney in Manhattan, painted a vivid picture of “a young man… being treated like a human ping-pong ball between two warring jurisdictions” as she reminded Judge Gregory Carro of the New York Court of Appeals' ruling in Lauro v. Charles. (31) The case, she argued, "held it to be clearly established that these staged perp walks for the media, when unrelated to a legitimate law enforcement objective, are unconstitutional.” (32) Agnifilo further singled out New York City mayor Eric Adams’ comment on a local TV station expressing his personal desire to look “[Mangione] in the eye and say, ‘you carried out this terroristic act in my city.’” (33)
On December 23rd, Mangione pleaded not guilty to state murder and terrorism charges. The Manhattan District Attorney has charged him with multiple offenses, including stalking through travel in interstate commerce, stalking through the use of interstate facilities, murder through the use of a firearm, and other firearms-related charges. If convicted, he faces a maximum sentence of life without parole. (34) In addition to the state charges, federal prosecutors have brought their own case against Mangione in New York’s state trial court. Unlike the state case, the federal charges carry the possibility of the death penalty if he is found guilty.
The stage has been set—not just for Mr. Mangione, but for the American healthcare system, the justice system, and a public that seems increasingly comfortable questioning who the true villains of society are. Jury nullification, an act deliberately excluded from the jury instructions of any case, looms over these proceedings. In the United States, a jury has the power to acquit a defendant despite clear evidence of guilt if they believe the law itself is unjust or improperly applied. However, this act remains in the shadows of the legal process rather than being recognized as a protected form of speech. Courts have made clear that “the power of juries to nullify…is by no means a right or something that a judge should encourage or permit if it is within his authority to prevent.” (35)
Agnifilo and her team must walk a narrow legal tightrope, delicately pushing toward an acquittal without explicitly invoking jury nullification. But even if such a conclusion is not reached, there remains the central question that will define this trial: How could a young man from a family of affluence and success, a valedictorian who pursued Computer Science at the University of Pennsylvania, have deliberately thrown his life away while in a sound state of mind? (36)
By June 2024, Mangione had cut off contact with his social circle. (37) A debilitating back injury had left him incapable of comfortable day-to-day life, driving him into social isolation. To counter the first-degree murder charge, the defense must argue that Mangione acted under the influence of “extreme emotional disturbance”—a recognized mitigating factor in New York law. (38) Under this defense, the jury would need to consider: Did Mangione act under the influence of an extreme emotional disturbance for which there was a reasonable explanation or excuse, as understood from the viewpoint of someone in his situation?
The terrorism charge, however, remains a much higher hurdle for the prosecution. Under New York law, the state must prove that “the defendant acted with the intent that such material support or resources be used, in whole or in part, to plan, prepare, carry out, or aid in either an act of terrorism or the concealment of, or escape from, an act of terrorism.” (39) New York law defines terrorism as an attempt to “intimidate or coerce a civilian population; influence the policy of a unit of government by intimidation or coercion; or affect the conduct of a unit of government by murder, assassination or kidnapping.” (40)
Legal experts have already begun casting doubt on the terrorism charge against Mangione. Criminal defense attorney Mark Bederow, a former Manhattan assistant district attorney, has called it a “mistake,” arguing that Manhattan District Attorney Alvin Bragg has unnecessarily complicated what should have been a straightforward second-degree murder case. (41) Bederow highlights a key flaw in the prosecution’s case: New York appellate courts have historically taken a limited and traditional view of what constitutes a civilian population under its terrorism statutes. If Agnifilo’s team can successfully argue that Mangione did not act to intimidate or coerce the public at large—but instead targeted a specific individual without intent to "sow terror"—then the terrorism charge could potentially crumble. (42)
For the jury, if there was any doubt about who the state is really protecting, New York officials wasted no time in clarifying it. Following the killing, New York State officials rushed to reassure the city’s business elite, with New York Governor Kathy Hochul even considering implementing a CEO hotline—an initiative that would grant corporate leaders direct access to state officials at a moment’s notice. (43)
No matter which direction this case may go, this development only serves to reinforce what many have already concluded: Mangione’s case is not just about one man—it is about power. Who holds it, who is protected by it, and who, when they finally lash out, is made an example of to maintain the status quo. Our legal system guarantees each of us not only the right to a fair trial but also the assurance that justice will be served. The law is more than a set of rules—it is a voice, a channel through which we, as citizens, shape the very foundation of justice. If ever there was a moment to test this principle and define the true parameters of justice in America, it is now.
Endnotes
Klippenstein, Ken. “Exclusive: Luigi’s Manifesto.” Exclusive: Luigi’s Manifesto, December 10, 2024. https://www.kenklippenstein.com/p/luigis-manifesto.
Kilgannon, Alyce McFadden and Corey. “Suspect in Killing of Insurance C.E.O. Is Said to Have Used Fake New Jersey ID.” The New York Times, December 11, 2024. https://www.nytimes.com/live/2024/12/05/nyregion/brian-thompson-unitedhealthcare-news.
“Words on Ammo in CEO Shooting Echo Common Phrase on Insurer Tactics: Delay, Deny, Defend.” U.S.News & World Report, December 5, 2024. https://www.usnews.com/news/us/articles/2024-12-05/words-on-ammo-in-ceo-shooting-echo-common-phrase-on-insurer-tactics-delay-deny-defend.
“UnitedHealth Group Abuse Tracker.” American Economic Liberties Project, January 14, 2025. https://www.economicliberties.us/data-tools/unitedhealth-group-abuse-tracker/.
Feldman, Amy. “UnitedHealthcare Denies More Claims than Other Insurers - Angering Patients and Health Systems.” Forbes, December 19, 2024. https://www.forbes.com/sites/amyfeldman/2024/12/05/unitedhealthcare-denies-more-claims-than-other-insurers---angering-patients-and-health-systems/.
Staff, ValuePenguin. “Insurance Claim Denials: Worst Companies and How to Appeal.” ValuePenguin, December 20, 2024. https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals.
Feldman, Amy. “UnitedHealthcare Denies More Claims than Other Insurers - Angering Patients and Health Systems.” Forbes, December 19, 2024. https://www.forbes.com/sites/amyfeldman/2024/12/05/unitedhealthcare-denies-more-claims-than-other-insurers---angering-patients-and-health-systems/.
Waldman, Annie. “UnitedHealth Limits Access to Key Treatment for Kids with Autism.” ProPublica, December 13, 2024. https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid.
Napolitano, Elizabeth. “UnitedHealth Uses Faulty AI to Deny Elderly Patients Medically Necessary Coverage, Lawsuit Claims.” CBS News, November 21, 2023. https://www.cbsnews.com/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/.
Weaver, Christopher. “How Health Insurers Racked up Billions in Extra Payments ...” The Wall Street Journal, January 2, 2025. https://www.wsj.com/health/healthcare/how-health-insurers-racked-up-billions-in-extra-payments-from-medicare-advantage-9d4c8a89.
“Optumrx Agrees to Pay $20m to Resolve Allegations That It Filled Certain Opioid Prescriptions in Violation of the Controlled Substances Act.” Office of Public Affairs | OptumRx Agrees to Pay $20M to Resolve Allegations that It Filled Certain Opioid Prescriptions in Violation of the Controlled Substances Act | United States Department of Justice, February 6, 2025. https://www.justice.gov/opa/pr/optumrx-agrees-pay-20m-resolve-allegations-it-filled-certain-opioid-prescriptions-violation.
Staff, ValuePenguin. “Insurance Claim Denials: Worst Companies and How to Appeal.” ValuePenguin, December 20, 2024. https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals.
Himmelstein, David U, Robert M Lawless, Deborah Thorne, Pamela Foohey, and Steffie Woolhandler. “Medical Bankruptcy: Still Common despite the Affordable Care Act.” American journal of public health, March 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6366487/.
Lunna Lopes, Audrey Kearney. “Health Care Debt in the U.S.: The Broad Consequences of Medical and Dental Bills - Main Findings - 9957.” KFF, February 13, 2024. https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/.
Johnson, Steven. Medical debt, costs forcing Americans to skip care | healthiest communities health news | U.S. news, October 26, 2023. https://www.usnews.com/news/health-news/articles/2023-10-26/medical-debt-costs-forcing-americans-to-skip-care.
Healy, Bryn. “One-Quarter of Americans Didn’t Call an Ambulance during a Medical Emergency for Fear of Costs.” YouGov, June 13, 2024. https://today.yougov.com/health/articles/49738-one-quarter-americans-didnt-call-ambulance-medical-emergency-costs-poll.
Axler, Adam, and Sophia Tripoli. “What It Costs to Have a Baby in America: A State-by-State Analysis.” Families USA, February 9, 2023. https://familiesusa.org/resources/what-it-costs-to-have-a-baby-in-america-a-state-by-state-analysis/.
Ibid.
Neighmond, Patti. “When Insurance Won’t Cover Drugs, Americans Make ‘tough Choices’ about Their Health.” NPR, January 27, 2020. https://www.npr.org/sections/health-shots/2020/01/27/799019013/when-insurance-wont-cover-drugs-americans-make-tough-choices-about-their-health.
Pestaina, Kaye, and Karen Pollitz. “Consumer Survey Highlights Problems with Denied Health Insurance Claims.” KFF. Accessed February 21, 2025. https://www.kff.org/affordable-care-act/issue-brief/consumer-survey-highlights-problems-with-denied-health-insurance-claims/.
Ibid.
Kilgannon, Corey, Mike Baker, Luke Broadwater, and Shawn Hubler. “Suspect in C.E.O. Killing Withdrew from a Life of Privilege and Promise.” The New York Times, December 10, 2024. https://www.nytimes.com/2024/12/09/nyregion/united-healthcare-ceo-shooting-luigi-mangione.html.
Crane, Emily. “Luigi Mangione’s Defense Fund Donations Top $500K Ahead of Hearing in UnitedHealthcare CEO’s Death.” New York Post, February 21, 2025. https://nypost.com/2025/02/21/us-news/luigi-mangiones-defense-fund-tops-500k-in-donations/.
Pandey, Erica. “Exclusive: College Students Sympathize More with CEO Shooting Suspect than Victim.” Axios, January 9, 2025. https://www.axios.com/2025/01/09/luigi-mangione-approval-poll-gen-z.
Ibid.
Sanders, Linley, Tom Murphy, and Amelia Thomson-Deveaux. “Most Americans Blame Insurance Profits and Coverage Denials alongside Killer in UnitedHealthcare CEO Death, Poll Finds.” PBS, December 27, 2024. https://www.pbs.org/newshour/politics/most-americans-blame-insurance-profits-and-coverage-denials-alongside-killer-in-unitedhealthcare-ceo-death-poll-finds.
Lauro v. Charles, 219 F.3d 202, 212 (2d Cir. 2000).
“Transcript: Mayor Eric Adams Appears on Pix 11’s.” The official website of the City of New York, December 17, 2023. https://www.nyc.gov/office-of-the-mayor/news/970-23/transcript-mayor-eric-adams-appears-pix-11-s-pix-politics-.
Manhattan District Attorney’s Office, Indictment of Mangione, December 2024. https://manhattanda.org/wp-content/uploads/2024/12/Mangione-Indictment-FINAL-as-filed.pdf.
Bissell, John W. “Comments on Jury Nullification.” Cornell Journal of Law and Public Policy, 1997. (p. 54) https://community.lawschool.cornell.edu/wp-content/uploads/2020/12/051-Bissell.pdf.
Kilgannon, Corey, Mike Baker, Luke Broadwater, and Shawn Hubler. “Suspect in C.E.O. Killing Withdrew from a Life of Privilege and Promise.” The New York Times, December 10, 2024. https://www.nytimes.com/2024/12/09/nyregion/united-healthcare-ceo-shooting-luigi-mangione.html.
Hanscom, David. “Mangione Tragedy: Pain, Isolation, and the Survival Response.” Psychology Today, January 4, 2025. https://www.psychologytoday.com/us/blog/anxiety-another-name-for-pain/202412/mangione-tragedy-pain-isolation-and-the-survival-response.
“NYS Open Legislation.” NYS Open Legislation | NYSenate.gov. Accessed February 21, 2025. https://www.nysenate.gov/legislation/laws/PEN/125.27.
“CJI2D[NY] Penal Law Article 490.” New York State Unified Court System. Accessed February 21, 2025. https://www.nycourts.gov/judges/cji/2-PenalLaw/490/490.10.pdf
Ibid.
Bederow, Mark. “It’s a Mistake to Charge Luigi Mangione with Terrorism.” The New York Times, December 19, 2024. https://www.nytimes.com/2024/12/19/opinion/luigi-mangione-terrorism.html.
Ibid.
Reisman, Nick, Jeff Coltin, and Emily Ngo. “Security Worries .” Politico, December 13, 2024. https://www.politico.com/newsletters/new-york-playbook/2024/12/13/security-worries-00194193.
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