“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” -Martin Luther King
In a busy week of news that featured President Biden pardoning his son Hunter, the temporary declaration of martial law in South Korea, and the fall of the Assad regime in Syria, the news of the brazen murder of Brian Thompson, the CEO of United Health, outpaced everything else. I first saw the headline in a StatNews article. I was horrified to see someone senselessly killed in the middle of midtown Manhattan early on a busy workday. But then, something truly unprecedented happened. Instead of the typical outpouring of sympathy for the victim, social media postings joked about the CEO’s death. It was as if millions of people were channeling the comedian Jeffrey Ross, who is most famous for roasting celebrities and ordinary individuals (he would have at least softened the joke by asking, “Too soon?”). What was happening?
Every fall, I co-teach a course on Justice and Healthcare. We discuss whether there is a right to healthcare (most of my students think there is). We read works by a variety of scholars, most notably the late Paul Farmer. Farmer’s work is especially powerful, as he draws on Catholic social teaching with its emphasis on the preferential option for the poor. He also draws from the work of Norwegian peace studies scholar Johan Galtung, who first conceived of the idea of structural violence. Such a concept reflects the reality that we do violence to certain groups of people through the unjust structures we have created.
Although well-known in certain academic circles, Galtung is hardly a household name. Yet, his name was mentioned in a recent New Yorker piece by Jia Tolentino. Tolentino describes the difference between someone who actively commits violence and someone who passively commits it. As Tolentino describes in her piece:
There is either— Galtung notes that this is the most important distinction—a person who acts to commit the violence or there is not. Violence can be intended or unintended. It can be manifest, or latent. Traditionally, our society fixates on only one version of this: direct physical violence committed by a person intending harm. The pretty girl killed by a boyfriend, the C.E.O. shot on the street, the subway dancer strangled by the ex-marine.
The media often focuses on the kind of violence that is direct and physical. Witness the amount of attention being paid to the suspect who has so far eluded authorities (until today). In comparison, the kind of indirect violence committed by faceless insurance companies gets very little attention. Yet, the outpouring of dark humor by thousands of individuals who feel that insurance companies get away with gross injustices was startling. How do such entities whose mission is to deny as many claims as possible while enriching their leadership with salaries of a million dollars a month get away with this?
As Cassius famously stated in Julius Caesar: “The fault, dear Brutus, is not in our stars but in ourselves.” We have created the structures that allow healthcare to be primarily delivered in a free-market system that enriches shareholders and C-suite leadership. The dark and even gleeful humor that erupted over the death of Brian Thompson reflects many Americans’ view that our healthcare system is deeply unjust. The history of healthcare reform shows how hard-won certain gains have been made. Yet many feel that a healthcare system that is built to “deny, defend or depose” any claims for legitimate healthcare needs is perverse and wrong. How do we go about fixing such a system?
Other scholars that we read in my course offer some solutions. For instance, Daniel Dawes, author of The Political Determinants of Health, powerfully argues that the political determinants of health (voting, government, and policies) are the foundational drivers of health that shape the social determinants of health we are all familiar with. He also spends a great deal of time discussing the details of how the Affordable Care Act was passed during the Obama administration. As commentator Keith Boykin has stated, one party in this country has at least tried to implement incremental healthcare reform over the last century; the other party has consistently opposed any attempts. Yet, despite these gains, as a recent StatNews article has explained, many regard the quality of health care to be at its lowest nadir in over a generation. The same StatNews piece quotes fellow bioethicist Yolanda Wilson: “I think that says something really important about how people are experiencing health care in this country…I don’t think it’s just anger. I think it’s pain. I think a lot of people have pent-up pain, and they haven’t had a place to put it.”
Injustice in healthcare is a systemic problem. It’s not the fault of any one individual or even one leader. The morbidly gleeful humor that greeted the death of Brian Thompson is repugnant. But so is a healthcare system that does not justly meet everyone’s needs.
Kayhan Parsi, JD, PhD, HEC-C is a Professor of Bioethics & Health Policy at the Neiswanger Institute for Bioethics, Loyola University Chicago.