Can we murder our way to Medicare for All?

On the limits of edgelordism.

I’m considering reviving this dormant Substack in the new year as an outlet for writing I don’t get to do in my day job — it’ll probably have a new name — but in the meantime I wanted to talk about the thing no one can stop talking about: The death of UnitedHealthcare CEO Brian Thompson. What more could we ask for? A dramatic shooting, a nationwide manhunt, a suspect from a wealthy family with made-for-TV looks, the possibility that the suspect was acting as a kind of vigilante who murdered a health insurance executive to strike back against a cruel industry. Oh, how desperately we all want there to be a good reason for violence.

You’ve probably seen the memes about how hot the suspect Luigi Mangione is and how great it is to kill health insurance executives, some of it ironic, some of it earnest, most of it a mixture of the two, none of it novel. “Edgy” humor has been around forever, and being horny for a murderer does not make you interesting — people lusted after Charles Manson and Jeffrey Dahmer too. (If criminals weren’t sexy, there wouldn’t be so many TV shows about them.)

The unusual thing about the Mangione fandom is how many of its adherents seem to believe that not only was the shooting a political act, but that celebrating the alleged shooter is a form of progressivism. Journalist Taylor Lorenz described the online celebration of murder as being a result of people being “fed up with our barbaric healthcare system and the people at the top who rake in millions while inflicting pain, suffering, and death on millions of innocent people.” The restaurateur and TV personality Eddie Huang posted a borderline incoherent rant that included the line, “Democrats and Republicans are within degrees of each other in the center… They are all fucking scum bags. The only true leader we have is The United Health Care Shooter.”

Politicians obviously don’t say stuff like that, but a few Democrats have empathized with or excused these sentiments. Senator Elizabeth Warren described the shooting as “a warning that if you push people hard enough, they lose faith in the ability of their government to make change, lose faith in the ability of the people who are providing the health care to make change, and start to take matters into their own hands in ways that will ultimately be a threat to everyone.” Representative Alexandria Ocasio-Cortez said, “we need to understand that extreme levels of inequality in the United States yield high degrees of social instability.”

Statements like these are not actually endorsing the murder — no one, except Eddie Huang I guess, goes that far — but it is sympathetic to the feting of the murderer. If you feel that Thompson deserved it in some sense, if you share a fraction of the anger the shooter must have felt, there are plenty of prominent voices on the left who will tell you, in soothing millennial therapyspeak, your feelings are valid. And more, there’s a sense that such feelings could be politically useful. “Just putting this out there: the jacket the CEO-murderer wore is flying off the shelves,” the historian Rick Perlstein wrote on X. “That sort of popular anger was there to be harvested this past November by the Democratic Party, were they led with the kind of valor, empathy, and populist courage FDR showed.”

Wouldn’t it be great if that were true?

I’ve been writing about healthcare policy for a long time, going back to the debate over the Affordable Care Act in 2010, when I was typing away about it on my personal blog for an audience of no one. For as long as I can remember, progressives have been talking about how inhumane and illogical the United States’ healthcare system is. And they’re not wrong. People suffer horribly and die or are driven into medical debt because insurance companies deny claims; many more people are hit with surprise bills because they accidentally get out-of-network care. Quitting a job or leaving a marriage can result in people losing their health insurance, putting them in a precarious position where a broken leg can all but bankrupt them. The solution the left has for all this is a “single-payer” healthcare system, a.k.a. Medicare for All, where the government provides health insurance for everyone. Medicare for All’s advocates have long argued that this would (metaphorically) kill the rapacious health insurance industry and also reduce the country’s total healthcare spending by a combination of lower administrative costs and the government negotiating lower payments to healthcare providers. The people posting about Mangione’s immaculate hog may not necessarily also post about healthcare policy, but if they’re part of the amorphous online left, they likely support Medicare for All.

But there’s reason to question the idea that there’s a huge untapped desire for Medicare for All. In 2020, Bernie Sanders, who made Medicare for All his signature issue, ran for president and seemed to have a pretty good shot at securing the Democratic nomination. Healthcare policy was a major topic of debate during the primary, and some polls showed that a majority of Democrats supported Medicare for All. But primary voters fairly decisively picked Joe Biden — who was critical of Medicare for All — over Sanders. At the exact moment when a critical mass of voters displeased with the healthcare industry could have scored a meaningful electoral victory¹, all that rage failed to materialize at the ballot box. The movement Sanders had been building since 2016 came up short.

One way to explain that defeat is that many Americans are quietly supportive of the status quo . A recent Gallup poll found that while a majority of respondents were unhappy with the U.S. healthcare system, most rated their own healthcare “excellent” or “good” — in other words, voters may feel some level of trepidation about actually swapping their insurance out for a government-provided plan. No one goes online to post, “I feel pretty OK about my insurance,” just like no one posts, “I do not want to do anything sexual with Luigi Mangione,” but there are vast numbers of normies out there, a population ignored by left-wing commentators who want to paint the U.S as a dystopia on the brink of revolution.

But clearly, the U.S. is on the brink of something. How else to explain the rapturous response to the shooting? Progressives would probably prefer to think of it as anger specifically directed at the health insurance industry, since that’s an industry they’d like to eliminate². But across the political spectrum, Americans have become more comfortable endorsing violence against their enemies. On the right, Derek Chauvin and Kyle Rittenhouse (and now maybe Daniel Penny) have become minor celebrities solely on the basis of their having killed someone in “self-defense”; Donald Trump is poised to pardon the January 6 insurrectionists. On the left, we had the whole “punching Nazis is righteous” moment in 2017, followed later by endorsements of looting during the George Floyd protests in relatively mainstream places.

This thirst for violence is only tangentially related to politics in the normal sense. It’s far outside of elections and policy debates. It’s something mainstream institutions can barely describe, much less explain: a bone-deep understanding that we have enemies, and they deserve no quarter. A man whose name you’ve never heard is gunned down on a Midtown street. Upon hearing who he was, you understand, without having to be told, that his murder was justified — there is a war of sorts going on, and anyone can become a combatant. This violence is sometimes said to be carried out in the name of various political goals but in fact there is no logical path connecting the two; the violence is always an end to itself.

Conceiving of politics as a war doesn’t just serve to excuse violence, it excuses more mundane kinds of viciousness. All your worst impulses, your cruelest jokes, your petty hatreds — all the muck from the bottom of your soul — it's all fine, actually, better than fine, it’s praiseworthy, because you are on the correct side, and that means you can never truly be wrong. When your most combative opinions are picked up by a combat-loving algorithm and your political opponents deride you, that is proof of their toxicity, because it is not your responsibility to be respectful or find common ground. You don’t even have to learn anything about whatever you’re passionately opining about. What good is knowledge when compared to righteous anger?

This atmosphere of distrust and hatred may be sometimes useful to populist politicians like Trump, but it’s anathema to progressivism. Enacting Medicare for All does not just mean the end of private insurance, it means creating a massive new government health insurance program. If Americans live in an atmosphere of distrust, will they trust that government insurer, especially when it is controlled by the political party they hate? When the bureaucrat who denies claims is a government worker rather than a corporate employee, will there be no hard feelings?

Progressivism as a political project entails the building of trust. It requires people to have faith that change will improve their lives, that they and their neighbors can benefit from new government programs, that prosperity is a shared endeavor rather than an endless, grasping competition. At a time when it’s clear that many voters are suspicious of progressivism — as Trump’s victory demonstrates — convincing people of these values is more urgent than ever. You can try to do all that, or you can make shitty little jokes online. But you do have to choose.

1. A President Bernie Sanders wouldn’t have been able to actually enact Medicare for All due to a closely divided Congress, but electing him would have sent a powerful signal.

2. I’m speaking in the third person here but for the record I’d be perfectly happy if the U.S. adopts a Medicare for All system. I don’t think that’s particularly likely, but fortunately you could also achieve universal coverage by more politically viable routes, i.e. a “public option” plus more Medicare and Medicaid expansion. Maybe I’ll write about this sometime.