A Study in Contrasts

A murderer, and a hero, and what separates them in the streets of NYC

I didn’t want to write about Brian Thompson’s murder again this week, but the conversation last week remained dominated by it. Social media buzzed with pictures of the murderer, whom some users claimed to find attractive or alluring. Part of his manifesto indicting the healthcare industry made the rounds.

But the more facts began to trickle out about him, the less anyone could reasonably hold the murderer out as a victim of insurance cold-bloodedness or a hero of the working class. It turned out that he was the scion of a wealthy family, who attended an Ivy League school, and was covered under his parents’ healthcare plan until he turned 26, the age at which he shot Thompson in the back. I believe he was never a customer of United Healthcare.

It is almost never the victims of poverty who perpetrate anti-capitalist violence. It is almost always the well-off, who are bored and see themselves as the heroes of a new age. This murderer wanted an excuse for his violence and a convenient target. He wanted a sympathetic audience. He had no legitimate grievance against Brian Thompson. (Not that a grievance would have justified murder.)

Moreover, Brian Thompson was not the poster child of wealthy elitism. The son of a grain elevator operator, he attended a state university and started at United Healthcare in 2004, working his way up to CEO while fathering two children. If his murder was meant to strike a blow against corporate greed, in the end it only exposed the lie that corporate greed justifies the sins of envy and hatred.

I wrote last week that this was the time to pray for Thompson’s family, not the time to have a healthcare debate. I still hold that that is the polite and respectful thing to do. But some are determined to have that debate, and see the attention on this murder as a convenient excuse to do so. “If not now, then when?” they ask.

Very well. If we are going to have a discussion of healthcare, let’s have a discussion. I would prefer not to have it now, but sometimes you need to fight fire with fire. Lest those expressing “joy” at Thompson’s murder and paying for Mangione’s legal bills set the terms of the debate, I want to set the record straight on a few things.

Why Does Healthcare Cost So Much?

Some people seem to think “universal” means that any and allhealthcare is free. In a magical kingdom in which tradeoffs no longer exist (because the greedy capitalists have been vanquished, I suppose), everyone can have everything they want at no cost to themselves.

It is worth pointing out that if our government is to pay for the healthcare of every American, it will continue to fall deeper into fiscal insolvency. Most Americans seem to believe if we cut waste, fraud, abuse, and foreign aid, the budget would be balanced and we could suddenly afford a puppy for every family and luxury healthcare “for free” on demand. Alternatively, if the rich paid more in taxes, the theory goes, we could afford universal healthcare.

Let’s be clear about something. Unless you, dear reader, make a multi-six-figure yearly income, your taxes and my taxes are a rounding error on federal revenue. The vast majority of the money the federal government takes in every year is paid by the rich. We could eliminate taxes on individuals making under $100,000 a year without eliminating the majority of federal revenue. In fact, the top ten percent of earners pay more dollars in taxes than the bottom fifty percent combined. It isn’t entirely true that the one percent subsidizes everyone else, but it’s truer than the notion that the one percent pay less than janitors and mail clerks.

But I digress. If we are going to be adults about fiscal conversations, we should also talk about how no system on Earth has yet been able to cover every treatment or procedure for every person. There is always rationing of care. As The Dispatch’s Kevin Williamson points out, in our system, the people assigned to do the dirty work of rationing are insurance companies. The murderer’s bullet casings had words like “deny” written on them, to invoke the denial of claims United Healthcare engages in to stay in business. But in a single-payer system, care is denied all the time. It’s just done by bureaucrats. And the delays are far longer than the delays here in America. In Canada, you could wait two or three years for a hip replacement.

No Americans travel to Britain or Canada for their healthcare treatments. But Brits and Canadians travel to America all the time to pay for elective treatments they either are not allowed to obtain in their home countries or would have to wait absurdly long to receive. The truth is that Americans like choice and we aren’t going to put up with a system that constrains our choicesin ways which reduce our standard of living, life expectancy,and health.

Indeed, other countries are forced to ration far more than we are. Because we still have some tiny semblance of freedom in our healthcare marketplace, medicine isn’t entirely zero sum. But in a single-payer system, by definition care is zero sum. The only economic system which has ever been positive sum (the only economic system which has ever worked in any meaningful way) is free market capitalism. While only a fool could look at the American medical system and think “free market capitalism,” we still have just enough capitalism that spending heavily on a treatment for one person is also an investment in future treatments for other people.

In a single-payer system, this is never the case. Care for one person requires denying care to someone else. Unless there is enough to go around (and, because the economics doesn’t work, there is never enough care to go around), a single-payer system will always require heavy rationing, which means that promising resources to one person requires taking resources from someone else.

Still, everyone wants to know why healthcare costs so much in this country. There are a variety of factors driving up the cost. However, I will focus on a few.

First, we are the richest nation in the world. Healthcare costs more here because American labor costs more than labor anywhere else and American real estate costs more and American technology costs more. We are also more likely than anyone else to spend on all sorts of elective or experimental procedures or drugs. We go to far greater length to keep our loved ones alive and we spend more to ensure our lives are less painful and smoother.

Which brings me to the second important reason. Most of the research is done here. Most of the drugs are developed here. There is a reason the most effective COVID-19 vaccines were developed in America in record time, while the rest of the world struggled to come up with safe and effective vaccines. We also subsidize the costs of drugs which many companies are selling in other parts of the world at a loss. We pay more so Europeans pay less.

But more importantly, the primary reason healthcare costs so much in America is that most healthcare is paid for by a third party. For most people, that party is their insurance company. But for a growing percentage of Americans, that party is the government. (And, in some cases, because the Affordable Care Act subsidizes insurance premiums, it’s sort of both.) In either case, the outcome is the same: the cost goes up. Insurance companies work hard to control costs (i.e., by denying claims). But cost increases are inevitable in third-party-payer systems. This isn’t simply because people are wiser when spending their own money than they are when spending other people’s, but that’s one reason.

If we really wanted to bring prices down, the only reliable way to do it would be to have insurance cover only a small number of the most expensive and most catastrophic claims and require people to spend their own money on the rest. I don’t bill my car insurance company to buy gas. Which is why gas doesn’t cost $200 a gallon.

It isn’t the insurance companies’ fault. It isn’t the hospitals’ fault that their lack of price transparency contributes to the excessivecost overruns. Each are simply responding to the environment in which they are constrained. A less-constrained environment, with better competition, would not suffer the same problems.

Another Contrast

I’d like to close by focusing on a different contrast from last week, not that between the murderer and Brian Thompson, but that between the murderer (whom you’ll by now have gathered I’ve elected not to name because he doesn’t deserve the attention) and Daniel Penny. The same lefties who want to free this twisted kid wanted Penny to go to jail.

It is telling that Alvin Bragg, who likes to let hardened criminals off with a light sentence while inventing fake crimes to charge Donald Trump, throws the book at a guy whose only crime was defending himself.

But that’s the sick logic of the vicious attacks on Daniel Penny. The only crime, according to the progressive theory of prosecution, is self-defense. Why is this a crime? Because standing up for oneself violates the ideology of victimhood, whereby the greatest status is conferred on those who have been most oppressed. Because Penny won the fight and Neely did not, Penny was the oppressor and Neely was the victim. Because Neely was black and Penny is white, Neely is the oppressed. Never mind that Neely had been in jail for fracturing an elderly woman’s face, and that he was saying on the train that he was about to kill someone for real this time. Never mind that other passengers helped Penny restrain Neely. Never mind that Penny’s chokehold might not have been the real cause of death for a disturbed man with illegal drugs in his system.

You might say that it’s better when private citizens don’t take the law into their own hands. I agree. That’s why we have law enforcement to police the streets and arrest violent criminals.

But if we are in a situation where the police fall down on the joband a violent criminal is about to hurt or kill us or someone else, what are we supposed to do? Let ourselves die? Watch others die? Would that make us righteous in the minds of those who believe powerlessness confers morality?

I think it’s sick and cowardly for an able-bodied man to sit and watch another man attack innocent bystanders and not lift a finger to defend them. That may not be polite, but this isn’t a polite subject. Penny did the right thing. He risked his own life to save innocents on that train. That there are some people openly arguing Penny should go to jail and Thompson’s murderer should go free is evidence of how depraved and immoral our current discourse has become. According to their logic, such wrongs are necessary in order to balance out past wrongs. But if evil is necessary in order to achieve equality, then equality is evil.