The shocking story of UnitedHealthcare CEO Brian Thompson’s killing has been on everyone’s mind recently. The suspect, Luigi Mangione, has become a name I hear often, not only in the news but also in conversations with friends. What makes this especially surreal for me is that Luigi and I both attended the University of Pennsylvania and studied computer science around the same time. According to his LinkedIn profile, we even had several classes in common. While I never crossed paths with him back then, friends have been asking for my thoughts on the incident — perhaps because of our shared academic background or because of my prior work in the health insurance industry. I feel compelled to share my perspective, hoping it sparks reflection on the broader issues surrounding healthcare in the U.S.
Inside the Insurance Industry: A Push for Efficiency
During my time as a data scientist for a health insurance company, my job revolved around using machine learning to optimize processes. Like many in the field, our team’s performance was evaluated by the savings we generated for the company. This relentless focus on cost-cutting isn’t new. Long before the rise of AI, companies outsourced call centers, moved operations offshore, and sought every advantage to reduce expenses.
Now, with tools like ChatGPT and other AI models, insurers like UnitedHealthcare have pushed automation even further. For example, auto-adjudicating claims with AI significantly reduces labor costs. While this sounds efficient, it raises an essential and ethical question: how much can you automate when lives and families depend on these decisions? We all know that some treatments, if delayed, can result in lifelong pain and significant challenges to daily life.
For the projects I have worked on, my teammates and I ensured that AI models could only approve claims and authorizations. Denials were flagged for human review, ensuring a more thoughtful approach. This, to me, is a more responsible use of technology. However, not all companies follow this approach, and therein lies the problem: what happens when efficiency is prioritized over humanity?
It’s also important to recognize why cutting costs matters. Without these measures, insurance companies would have no choice but to increase monthly premiums, placing an even greater financial burden on members — especially healthy individuals who rarely use medical services. In such cases, those who don’t directly benefit from insurance would bear the brunt of the cost, adding to the frustration and inequities already present in the system.
Why Insurance Costs So Much and Why It’s Necessary
It’s easy to direct anger at insurance companies, but the reality is that healthcare in the U.S. is expensive for reasons far beyond their control. Most of us pay hefty premiums yet rarely see direct benefits, especially if we’re healthy. The math feels cruel: why pay $700 or $800 monthly as premium, plus having a $2,000 deductible, for just a handful of doctor visits each year? But this isn’t about overcharging healthy individuals — it’s about spreading costs across the population.
The numbers are startling: the top 5% of the sickest individuals account for over 50% of all healthcare spending. Meanwhile, the healthiest 50% of the population use just 3% of total premiums. Insurance exists to pool risks and cover these extremes, but the imbalance means healthy people subsidize those who are less fortunate. Without this redistribution, the sick would bear an unbearable financial burden, and our society would be even more unequal.
Still, the frustration is valid. When you’re billed $60,000 for a procedure, such as a broken ankle, it’s hard not to feel exploited. Insurers negotiate discounts, but even with their bargaining power, members still often bear significant costs. Is this procedure complicated? Not particularly. Does it take countless hours of the doctor’s time? No. So why $60,000? For most Americans, that’s an entire year’s post-tax salary, or more.
Does this sound reasonable to you? Probably not. Providers are asking for unreasonably high amounts, and insurance companies step in to negotiate these down. In this scenario, insurance fulfills two critical roles: (1) spreading risk and sharing costs across many people, and (2) bargaining for discounted rates that individuals could not secure on their own.
Without insurance, facing the full $60,000 bill would bankrupt the average family.
But even the negotiated price isn’t truly affordable. Say your insurer brings the cost down to $30,000, effectively cutting the originally asked price in half. With a $5,000 out-of-pocket maximum, you’re still paying $5,000 yourself, on top of your monthly premiums. Where does the remaining $25,000 come from? It’s pooled from your contributions and those of two or three other healthy members’ premiums.
Where does this leave us? Trapped in a system where insurance feels essential, not because we want it, but because without it, a single medical emergency could bankrupt us.
The True Culprit: An Inefficient Healthcare System
The root of the problem isn’t just insurance companies — it’s the inefficiency of the entire system. Providers charge astronomical fees, partially to offset their high operating costs and years of medical training. Hospitals, often privately owned, are locked in an arms race with each other, purchasing expensive yet rarely used equipment to stay competitive and passing the costs onto all patients. Pharmaceutical companies, too, play a significant role, with drug prices in the U.S. far exceeding those in other countries.
Every player in this system — hospitals, insurers, pharmaceutical companies — operates independently, each trying to maximize profits. This fragmented approach drives costs higher and higher, leaving patients to foot the bill. In moments of frustration, I’ve joked that only a strong, centralized government, like the Chinese government, could force a systemic change. Yet the U.S. relies on free-market competition, which, while fostering innovation, often leaves the public at the mercy of unchecked corporate interests.
Sometimes, I also question whether it’s truly necessary to demand years of intensive training and prohibitively expensive education to become a doctor. The high cost of medical school and the rigorous barriers to entry severely limit the number of qualified doctors entering the workforce. This shortage not only makes it difficult for patients to book appointments but also drives up the cost of care. If earning a 4-year bachelor’s degree isn’t enough to begin practicing medicine in some capacity, we may never have a sufficient supply of doctors to meet demand or bring healthcare costs down to a reasonable level. While rigorous training is crucial to maintaining high standards of care, it’s worth exploring pathways that make entering the medical field more accessible — whether through shorter programs for specific roles or more affordable education.
Reflecting on Luigi Mangione’s Actions
When asked about Luigi Mangione’s actions, I find myself torn. On one hand, Brian Thompson was just one piece of a much larger systemic issue, and taking the life of a single scapegoat — no matter how greedy or complicit he may have seemed — cannot truly solve the problem. On the other hand, if I were in Luigi’s shoes, I’m not sure I could have found any other way to achieve such a profound and immediate impact. This tragedy has ignited a national conversation about healthcare reform in a way few events ever have. Policies are being revisited, and public outrage is pressuring companies to urgently reconsider their practices.
As Luigi’s former classmate at Penn, I was both shocked and, in some ways, not entirely surprised by his decision. In school, we were taught to believe in innovation, efficiency, and the power of problem-solving. But life after graduation often forces you to confront challenges that no algorithm or system design can easily fix — like the entrenched inequities of healthcare or the overwhelming difficulty of creating meaningful change as a single individual within a massive, impersonal system.
I’ve felt the same disillusionment Luigi may have experienced — the days when your voice is dismissed, your opinions overlooked, and you find yourself carrying out actions that align with others’ expectations, not your own. Like him, I entered the world with ambitions to make a difference, only to realize how little freedom individuals often have to enact the changes they envision. I wonder if Luigi grew disheartened by how powerless he might have felt, standing up against a system so vast and resistant to reform.
This incident highlights the deep frustration so many feel with a healthcare system that prioritizes profit over people. When individuals feel voiceless and see no clear path to meaningful change, the unthinkable will happen. The question we should be asking isn’t whether Luigi’s actions were right or wrong — it’s how we can fix a system so broken that events like this feel, to some, like the only way to be heard.
Moving Forward
The healthcare system in the U.S. is a tangled web of inefficiencies and inequities. No single solution will fix it, but recognizing that all players — insurers, providers, policymakers — must work together is a start. True reform will require sacrifice and cooperation, something that feels far off in our profit-driven system, unfortunately.
For now, we can only hope that tragedies like this serve as a wake-up call. Real lives are at stake, and if we want a healthier, fairer system, we must demand accountability from everyone involved. Change is slow, but it starts with conversations like these.
