Luigi Mangione’s real manifesto: The cost of care

In the heart of New York City, a scene unfolds amidst the backdrop of daunting skyscrapers and the frenetic rhythm of urban life. The CEO of United Health Care steps out of a his hotel, his tight jeans and cornflower-blue blazer almost camouflage against the cold steel edges of the surroundings. He walks purposefully towards the conference center, a burly figure embodying the grotesque success associated with modern health insurance—but at this very moment is a potent symbol of the dichotomy that defines the industry.

I watch the now infamous cctv footage of him as he strides toward the conference, and I reflect on the words of Luigi Mangione, whose manifesto, “Healthcare and Its Victims,” dismantles the façade of progress in the medical world, unveiling not just a system in dysfunction but a society held hostage by its greed and neglect. Mangione stands as an emotional epicenter in a landscape where compassion is often eclipsed by corporate interests. His eloquence serves as both a mirror and a megaphone—reflecting the suffering of the many while amplifying the cries of those silenced beneath the weight of bureaucracy.

Mangione’s ire burns bright against the backdrop of self-congratulation pervading the healthcare narrative. “Our civilization boasts of its healthcare systems as if they were not only the apex of scientific achievement,” he writes, yet he poses a stark challenge to this belief, remarking that beneath the accolades lies a troubling truth: “a cathedral built on sand—beautiful in its architectural conceits, but rotten at the foundation, a monument to hypocrisy and greed.” This sentiment resonates deeply as I think of the scores of individuals who, like Mangione, have felt the weight of the system crushing their hopes.

The CEO, marching confidently toward the stage, seems oblivious to the suffering that underpins the empire he represents—a corporate structure that prioritises profit above patient care. Indeed, Mangione prompts us to examine the very fabric of our healthcare system, which, he argues, is constructed to generate financial gain for a select few rather than to provide adequate care for all.

The Illusion of Care

Mangione’s critique centers around a disillusionment with the illusion of care presented by the healthcare establishment. He insists that the comforting image of dedicated healthcare providers standing bedside—stethoscopes in hand—is largely a deceptive narrative. While individual practitioners indeed frequently dedicate their lives to healing, they often find themselves ensnared within a labyrinthine bureaucracy that undermines their noble intentions.

“Healthcare as it currently stands is not designed to keep people healthy,” he argues, “it is designed to maintain a perpetual market for healthcare services, pharmaceuticals, and insurance policies.” The statistics parade before us, proudly boasting improved survival rates and technological advancements. Yet, lurking behind the numbers is a grim reality: rising infant mortality, stagnant life expectancy, and a glaring disparity in care distribution.

“These discrepancies are not accidental,” Mangione states, “they are symptoms of a system that never had true universal care at its heart.”
As I contemplate the corporate executives prepping for their conference, their confidence underscores the system’s inherent flaws—flaws that manifest most painfully at the individual level. This disconnect—between the triumphal declarations of success and the lived experiences of countless patients—highlights the hypocrisy at the core of modern healthcare.

A System Designed to Fail

Yet, to call the system “broken,” as many do, misrepresents the issues at hand. Mangione argues persuasively that it is not merely malfunctioning; rather, “this system was never designed to safeguard the health of the many; it was engineered with the aim of financial gain for the few.”

The healthcare apparatus, with its complex layers of administration and legal hurdles, functions as a thoroughfare for profit at the expense of care. Medical gatekeepers—insurance companies—wield enormous power, shaping the paths of treatment not based on patients’ needs but on cost-efficiency.
Mangione’s observations echo through the murmur of self righteous media pundits: “The apparatus is designed to confuse and exhaust patients until they simply give up.” Indeed, this struggle is not abstract; it plays out in the lives of families navigating the harsh realities of healthcare costs. The desperation is palpable, as families face financial ruin due to high medical bills, while others ration medications, caught in a cruel balancing act between survival and affordability. These human stories, illuminating the real cost of indifference, strike at the heart of Mangione’s manifesto.

In a world where healthcare should be a fundamental right, we see instead the specter of neglect haunting the halls of medical facilities, where “patients beg for help and healthcare workers struggle with understaffing and burnout.” This dialogue between corporate interests and patient suffering expresses the hashtag “compassionate care,” which has become a hollow promise in the face of financial realities.

The Human Cost of Indifference

Every statistic can be tied back to a human face—a mother forced to skip doctor visits, a child denied necessary treatment due to insurance roadblocks. “Behind these faceless mechanisms are real lives unraveling,” writes Mangione. His words echo the emotional landscapes of families torn apart by the financial ravages of seeking healthcare, illuminating the pervasive sense of abandonment felt by patients left in the shadows of corporate decision-making.

As I reflect on the irony of the conference, where the executives unfazed continued to present their glossed-over vision of healthcare after they knew about their CEO bled out in the street of Midtown Manhattan, I am keenly aware of the stark contrast between their celebration of profit margins and the hidden tragedies that loom just below the polished surface. Mangione compels us to confront these disparities head-on: “The supposed moral society allows these tragedies to go on, day after day, in plain sight.” The irony is stark—some lives are prolonged with the luxury of modern treatments, while others succumb to preventable conditions, deprived of basic care due to the commodification of health. “We pour billions into the development of groundbreaking drugs, yet we erect paywalls so high that only a fortunate fraction of patients will ever see them.”

A Call to Arms: Revolt Against the Status Quo

Mangione’s clarion call cannot be ignored. His manifesto is not merely an indictment of the current state of affairs; it’s an urgent plea for systemic change. “We must strip the profit motive from medicine,” he declares, advocating for a radical reimagining of healthcare as a public good. His vision is not abstract; rather, it is firmly grounded in the real-world implications of policy decisions and the dire need for accountability and transparency. This resonates deeply as I imagine the conference attendees, thrilled by advancements and metrics, yet willfully oblivious to the systemic injustices festering beneath the surface. Mangione’s vision for a healthcare system centered on healing rather than profit challenges the industry giants to reassess their priorities.

“We must demand policies that prioritise patient outcomes over corporate earnings,” he writes, and this is a sentiment that should resonate loudly amid the applause for profit-driven innovations. It is a question of ethics—a question of humanity’s responsibility. This moment in time calls for introspection and activism, forcing us to reconcile our moral imperatives with the reality of our healthcare structures.

A Legacy of Decency and Care

As I wrap up my reflections, I recognise that the USA-ian healthcare system stands at a pivotal juncture. They must navigate the tension between advancements and access, between profit and compassion.

Luigi Mangione’s voice, vibrant and unwavering, serves as a necessary reminder that health is a human right, not a commodity to be traded.
His words ignite a call for transformation—a vision that seeks to reclaim healthcare’s fundamental purpose.

“Let my voice echo for them,” he implores, and in this defining moment, each of us must choose: to remain passive witnesses to suffering or to engage actively in the fight for a healthcare system that truly serves its purpose.

The judicial system looms over him, but the real question remains: will those in power listen, or will they continue to thrive in a system that thrives on inequality? In Mangione’s impassioned plea, we find a generation’s battle cry for a humane approach to healthcare.  We must strive to ensure that the promise of health—equitable, compassionate, and just—becomes a reality for all.