Two Forms of Violence, One Path to Justice
On December 4, 2024, Luigi Mangione allegedly shot Brian Thompson outside a Manhattan hotel in Manhattan. Surveillance cameras captured the event and cartridge cases at the scene were inscribed with the words “delay,” “deny” and “depose.” Shortly thereafter, Attorney General Pam Bondi announced that federal prosecutors had been directed to seek the death penalty in the case.
But here is what the cameras did not show…the decades of deaths that happened quietly in hospital rooms and living rooms across our country as insurance companies, including the one Thompson led, denied care that could have saved lives. These deaths have no footage. No manifests. No criminal charges. Yet they are just as real.
Much of the national conversation has focused on whether Mangione should face the death penalty. That is the wrong question. The right question is what kind of justice responds to both forms of violence…the bullet and the denial letter…without creating more suffering. The answer is not execution. The answer is systemic reform paired with accountability. Anything less is a distraction from the justice we all need.
The Violence We Choose Not to See
Brian Thompson served as CEO of UnitedHealthcare, the insurance arm of UnitedHealth Group, from April 2021 until his death in December 2024. During his tenure, UnitedHealthcare covered more than 49 million Americans and generated roughly $281 billion in revenue in 2023. Thompson’s total compensation that year was approximately $10.2 million, including salary, stock and option awards and non-equity incentive pay.
In 2024, the Senate Permanent Subcommittee on Investigations issued a report criticizing major Medicare Advantage insurers, including UnitedHealthcare, Humana and CVS, for allegedly using algorithmic tools to deny or limit post-acute care claims, prioritizing profits over patient needs. But numbers alone cannot convey what denial means. Let me be specific with real cases.
Jeff Hall of Estero, Florida, became paralyzed from the neck down after developing Guillain-Barré Syndrome in February 2024. His Florida Blue insurance plan capped the number of days he could remain in acute rehabilitation. After being forced to step down to a lower-level nursing facility, his health deteriorated so rapidly within six days that he was sent to the emergency room, placed on a ventilator and required a second tracheostomy. Hall believes the coverage limits set his recovery back by months.
Eric Tennant, a 58-year-old safety instructor from West Virginia, was diagnosed with stage 4 bile duct cancer that spread to his bones. His oncologist recommended histotripsy, a noninvasive procedure using targeted ultrasound waves to destroy liver tumors that could extend his life and reduce his need for grueling chemotherapy. His insurance denied the treatment.
Social media accounts documented further examples. One person wrote that Thompson’s company put multiple family members in debt they would be paying for the rest of their lives and denied care for an uncle which led to his death. Another remembered the day United Healthcare denied a one-night hospital stay for a twelve-year-old child as medically unnecessary following heart repair surgery.
Of course, these are people who survived to tell the tale. Imagine all who did not. These are not abstractions. These are slow deaths by spreadsheet. They are legal. They are profitable. And they are continuous.
Luigi Mangione : Reported Motive
As of December 2024, investigators report that Luigi Mangione’s alleged motive was ill will toward the health insurance industry. According to a diary released by the prosecution, he left behind a handwritten document criticizing the healthcare system and health insurance companies. While any use of violence is wrong, his reported concerns reflect a broader problem…the healthcare system extracts wealth from human suffering. It creates algorithmic harm that is systematic, predictable and designed to maximize profit at the expense of patient well being. This type of harm contributes to more deaths each year than any mass shooter but happens quietly, behind terms like “prior authorization” and “out of network coverage.”
Why the Death Penalty Is a Distraction
Bondi’s announcement framed the shooting as premeditated and called for the death penalty. The call for execution satisfies something primal in us…the desire to see evil punished, to watch justice served visibly and finally. But execution accomplishes nothing except spectacle. It does not bring Brian Thompson back. It does not prevent the next act of rage fueled violence. It does not address the despair that breeds in a system where people feel powerless. Most importantly, it lets us avoid the harder conversation about accountability for the systemic violence that created the conditions for this incident.
Consider what executing Mangione would communicate…that America takes murder seriously when it’s committed by an individual with a gun, but not when it is committed by a corporation with a claims processing algorithm. That a CEO’s life matters, but Jeff Hall’s, Eric Tennant’s and countless others whose stories were never told do not. That we will mobilize the full force of federal law to punish one alleged killer, but will not lift a finger to hold accountable systems that harm tens of thousands of patients annually. This is not justice. This is theater.
The Case Against Luigi Mangione
Luigi Mangione faces serious criminal charges and, if convicted, will face severe punishment. According to prosecutors, he reportedly arrived in New York City on November 24, 2024, more than a week before the shooting, and allegedly conducted reconnaissance near Thompson’s hotel. On December 4, 2024, he is reported to have positioned himself between two cars on West 54th Street and, as Thompson passed by, fired several gunshots from a 9mm pistol, resulting in Thompson’s death.
Killing an individual does not fix a system. It creates suffering for Thompson’s family, his children, his loved ones…people who had nothing to do with corporate policy. If Mangione intended to reform healthcare, the reported actions have failed. They did not change a single policy…at least in the short term. They only elevated the industry’s profile and created trauma for reformers trying to advocate for systemic change…who are now concerned that their work is going to be destroyed by the reckless actions of one.
Mangione was indicted by a Manhattan grand jury on eleven counts, including one count of murder in the first degree, which alleges he killed the executive in furtherance of an act of terrorism, defined as an intent to intimidate or coerce the civilian population or a government unit. *The terrorism charge was ultimately dropped. Mangione was also indicted on a plethora of federal charges as well (which is where the death sentence could possibly come from…since the State of New York does not have the death penalty). Life imprisonment, if convicted, is the appropriate response. It removes a dangerous individual from society. It punishes severely. It satisfies accountability while avoiding the moral complications of state sanctioned killing.
The prosecution’s case also highlights that Mangione reportedly believed the only way to achieve accountability was through violence. He appears to have thought the system was so indifferent to suffering that murder was rational. He was wrong about the method. But his reported beliefs point to systemic failings that demand attention.
The Accountability We Owe
If Luigi Mangione is executed, violence is answered with violence. Retribution may be satisfied, but the conditions that made Thompson’s death feel like justice to a desperate individual remain unaddressed. True justice requires responding to both forms of violence…individual murder and systemic harm through denial of care. It requires holding Mangione accountable, if convicted, and the healthcare industry accountable for ongoing systemic harm.
Healthcare reform worthy of this moment must include mandating public disclosure of denial rates. Every insurance company should publish, by diagnosis and treatment type, their approval and denial rates. Sunlight is the best disinfectant. We need independent medical review boards that take denial appeals out of the hands of insurance companies and establish state or federal boards of practicing physicians, not insurance employees, to review disputed denials.
We should criminalize fraudulent denials. If an insurance company denies a claim that an independent review later determines was medically necessary and the denial leads to death or serious harm, executives should face criminal liability. Administrative costs should be capped so that insurance companies spend at least 85% of premium revenue on actual healthcare, with administrative costs capped at 15%.
A victims’ compensation fund should be established so that families who can demonstrate that insurance denials led to preventable death or serious harm have access to compensation from a mandatory fund funded by insurers based on denial rates. Finally, we must ban AI-driven denials without human review. Any AI-assisted denial must be reviewed by a licensed physician who examines patient records and explains, in writing, why care is refused.
These reforms are not symbolic. They save lives. They restore accountability. They address the despair that reportedly motivated Mangione’s actions. They demonstrate that society takes all forms of violence seriously, not just the ones captured on camera.
The Precedent We Set
Every decision in a case like this sends a message.
If Luigi Mangione is executed and healthcare remains unchanged, the message is clear…individual violence against executives is punished with death, but corporate harm is tolerated as business. Rage at the system may be understandable…but suffering is the only option.
If Luigi Mangione is imprisoned and healthcare reform pursued, the message is different…violence is unacceptable regardless of the perpetrator. Individuals who kill are punished. Systems that harm patients are reformed. Accountability is universal…and justice addresses all forms of harm.
The first scenario breeds more violence. The second prevents it. Mangione is accused of murder and, if convicted, will spend the rest of his life in prison. But the conversation should not end at sentencing. Treating the reported crime as isolated rather than a symptom of systemic failure guarantees others may reach the same despair driven choices.
Mercy, Justice and the Path Forward
Mercy is not weakness. It is the strength to resist the easy answer. The death penalty offers finality but no path forward. Life imprisonment preserves the possibility of integrity. It says we will not respond to killing by killing.
Justice requires addressing both sides of the violence equation. We must hold Luigi Mangione accountable if convicted and the healthcare industry accountable for taking thousands of lives. This is not a choice between punishing Mangione or reforming healthcare. It is a demand to do both. Anything less is cowardice disguised as justice.
What We Choose: Death Penalty for Luigi Mangione?
Brian Thompson is dead. If convicted, Luigi Mangione will face the consequences of the legal system. These facts cannot change. Luigi Mangione does not deserve the death penalty. Neither did Brian Thompson. Thompson did not deserve to be ambushed outside a hotel. He was a human being, a father, a husband, a person whose life mattered. His death was tragic and unjustifiable.
The base line is simple…no one deserves to die for corporate decisions, personal rage or state retribution. Not the patients denied care like Jeff Hall and Eric Tennant. Not the thousands who will die from denied claims this year. Not Thompson. Not Mangione.
The question is whether society has the courage to pursue real justice…responding to all violence, not just the violence that makes headlines.
So, let us reject the false comfort of revenge and recognize that violence only begets more violence. True justice does not replicate the harm it condemns. It safeguards communities, protects the vulnerable and addresses the root causes of suffering. In ethically reflecting on the lives of both Brian Thompson and Luigi Mangione, we affirm that no one is beyond accountability and no one is beyond humanity. Let us choose policies that prevent death, heal wounds and create a society where compassion and fairness guide our laws. Justice is not measured in executions or the deaths we cause…but rather in the lives we save and the dignity we uphold.
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