This article follows the murder of United Healthcare CEO Brian Thompson. The murderer, Luigi Mangione, has received condemnation from the corporate media, Ben Shapiro, and some of the American public. Mangione, however, has more broadly received sympathy, tacit approval, and even celebration from most of the American people.

For those curious as to why, or for those strongly disgusted by this approval of violence, we set out in this article to explain the underpinnings of Mangione's support. How could people support such an act violence?

As it turns out, the violence was not done by Mangione alone. Nor was the larger portion of the violence committed by Mangione. Nor are his supporters the only ones celebrating violence.

Quick violence is easier to recognize in an individualistic society. Quick violence constitutes acts committed by individual actors. These acts bring about immediate suffering and even death on whoever is being acted upon.

Slow violence is not as visible. Slow violence can be committed by individuals. Societies, institutions, and even healthcare companies commit slow violence as well. Acts as well as processes which incur death and suffering over a period of time constitutes slow violence.

(Slow violence is different from what Orlando Patterson called "social death" regarding African slaves in the chattel system. According to Patterson and Afropessimist thinkers, the slave was not only legally made property. The slave was also made ontologically, in their very being, "an object of accumulation and fungibility." [1] This absolute power structure continues even after slavery for Patterson and the Afropessimists.)

Is this idea about slow violence a modern one? Not at all. The ancients have long recognized that violence is not only immediate and individualistic; it can be collective and gradual as well.

The thesis here is not that Mangione's violence is morally justified. However, his act of violence and the support thereof cannot genuinely be understood apart from the violence he responded to. As Mangione faces New York and Pennsylvania's court systems, we place United Healthcare on trial.

There are several instances of slow violence in the Bible and Christian tradition. Consider Christ's rebuke against the Pharisees. After the woes against the scribes and Pharisees, Jesus links their hypocrisy to their ancestors. The Pharisees honored the prophets through tombs and monuments. But in neglecting the teachings of the prophets, Jesus says,

you are witnesses against yourselves that you are the sons of those who murdered the prophets. Fill up, then, the measure of your fathers' guilt. Serpents, brood of vipers! How can you escape the condemnation of hell? (Mt. 23:31-32, NKJV).

According to Jesus, their hypocrisy results in the damnation of those who follow in their footsteps (vv. 13, 15 and 27). And this hypocrisy is a direct continuation of the same violence which killed God's prophets. We see here Christ indicating the long trajectory of violence, physical and spiritual, that the scribes and Pharisees are participating in.

While the Pharisees never killed anyone as far as the Gospels say, they did enact physical and spiritual forms of slow violence by dishonoring the prophetic tradition and leading followers to hell.

In Church tradition, there are also many instances of conceiving violence beyond the individual act. The Summa Theologica by St. Thomas Aquinas, essentially a baptism of Aristotle's philosophical system, contains a segment on law. Aquinas, famous for natural law theory, had some key insights about the nature of law.

For Aquinas, law measures and rules on human action. And the end/purpose (telos) of law is what he calls "beatitude," or what may be called blessedness, happiness, or the Christian formulation of eudaimonia (the good life). When law fails this chief end, it is unjust. Aquinas writes,

an unjust law . . . has the nature, not of law but of violence. Nevertheless even an unjust law, in so far as it retains some appearance of law, though being framed by one who is in power, is derived from the eternal law; since all power is from the Lord God, according to Romans 13:1 (ST I-II, Q. 93, Art. 3, ad. 2).

An unjust law has not the nature of law, which should bring common goodness to the people. In itself, it has the nature of violence. Again, there is no act of quick violence. Unjust laws form their own processes of slow violence by diverting the people away from beatitude.

We could bring up more examples from Scripture and Tradition, but we must now turn back to the task at hand. This suffices to prove that the Christian conception of violence is not confined to individual acts of physical force. Violence is broader than that, be it spiritual, historical, or legal.

America's healthcare system is privatized. This means that rather than being covered by the public pooling tax dollars into the system, patients must pay for services themselves. Healthcare is so expensive that without aid, very few Americans could ever afford consistent care, including dental, psychiatric, and so on.

The government has Medicare and Medicaid programs to assist those who meet certain income or age criteria. But excepting these criteria, Americans must choose between paying unaffordable costs or paying insurance companies to help cover costs. Insurance companies charge monthly premiums. Each company collects funds from people which are then pooled into covering care for anyone who needs it.

Americans are so dependent on health insurance that they are likely to die without it. The U.S. loses nearly 45,000 working age Americans every year who do not have health insurance. Insurers impose a severe amount of red tape onto doctors working with patients. Even if doctors propose treatment, insurers are free and quick to delay and deny claims.

There are stories like that of solo practitioner Dr. Anthony Ekong, who was told by WellCare's auditor Cotiviti that he had been overpaid for services. Cotiviti asked Ekong for $300,000, an amount that Ekong would need to go bankrupt to pay off or impose heavier charges on his patients who themselves were financially struggling. Dr. Richard Lechner, a dentist, had to hire administrative staff who spent days dealing with insurers. And Lechner only had himself and two hygienists working in the office. (These and similar stories are available here.)

Speaking of bankruptcy, healthcare costs and debt is the leading cause of bankruptcy for families in the US.

The first charge we levy against the health insurance system and United Healthcare in particular is that they overcharge patients yet underserve them. Julie Rovner puts it well in a recent podcast episode with KFF Health News:

One of the big arguments against "Medicare for All" or any kind of sort of government-run health care is that they end up rationing care. Well, we seem to have the worst of both worlds, where we're having rationed care and profit-making in health care.

Ever since 2000, health insurance cost increases have mostly outpaced inflation rates. And regardless of inflation, premiums for families and for individuals have consistently gone up throughout the years. As Gallup's polling shows, the vast majority of Americans disapprove of healthcare costs.

Though the cost bar has risen, returns for insurance customers have not. The KFF has found that in 2021, some insurers denied nearly half (49%) of all received insurance claims. The reason for denial 77% of the time is unspecified by insurers. They write that "consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision."

In fact, a 2021 lawsuit against United Healthcare alleged that the company employed an AI program (with a 90% error rate!) that denied significantly more claims that human employees did, as a means of maximizing profits. And the use of AI in judging claims is quite common amongst insurance companies.

It is in the business interests of companies like United Healthcare to hike up premiums for both families and individuals. It is also in their business interests to deny claims, keeping customers from enjoying the fruits of their contributions to the health insurance industry.

Lew Daly, a Christian scholar who works with Demos, authored a book titled Unjust Desserts: How the Rich are Taking Our Common Inheritance. In a talk about Unjust Desserts, Daly discusses the 19th century rent system that John Stuart Mill and David Ricardo criticized on moral grounds.

As Daly explains, landlords owned land. Through charging rent to tenants and through land development, landlords gained value from something that they themselves did not contribute to, other than holding a piece of paper legitimating their ownership. A noble with a piece of land in London in the 1800s could hold a deed to the land. And after London became developed, that deed would be many times greater in value.

Daly asks,

Much more is to be said of the health insurance industry and its alternatives. The health insurance industry overcharges the people. The promise of paying into these companies is assistance in paying medical costs, the leading cause of bankruptcy in the US. Despite the rise in costs which outpaces inflation, customers are denied claims at often absurd rates. Even when denials are appealed, insurance companies defend their original decisions. Customers are therefore underserved.

But this is not by accident. It is in the very design of the insurance system. Overcharging and underserving are specifically geared towards maximizing profits. And CEOs like Brian Thompson did little but play with numbers (and play with lives) to maximize these profits and extract value from the suffering and lack of the American people.

This is the slow violence of the health insurance system: commodifying the fears of being unable to afford health insurance, then sacrificing customer trust to meet and surpass business quotas. This is slow violence, and it is absolutely sinful. Denials send Americans into bankruptcy, economic insecurity, psychological panic, physical suffering, and ultimately the risk (and sometimes actualization) of death.

In closing, let us read and reflect on some stories that people have shared under the comment section of a video about the whole situation. Though, keep in mind, there are countless other comment sections like this throughout the internet, and countless more stories like the ones below.

@queenli3047: My father was actively having a heart attack and I was on the other side of town. I was begging him to call an ambulance and he refused because he said he couldn't afford the bill. He waited almost 25 minutes for me to come and pick him up, then the amount of time it took for me to take him to the ER. The whole time in the ER until they took him up for emergency surgery, all he talked about was how high the bill would be that he couldn't afford. When they told him they had to do surgery he asked if there was a cheaper option. The man was dying, that broke my heart.

@bulletproofzest: My aunt, while dying of cancer, decided with her husband to get divorced so that he wouldn't be on the hook after she died. So ridiculous that this is a reality for so many people.

@jasonspain3554: Over the past 10 years I have been budgeting, carefully considering every penny that leaves my pocket. I've provided for my family of four and really attempted to save for my kids college and also save for my retirement. It could all go away in a blink if one of us needs major medical care. That's the reality of today's America. The health insurance industry is disgusting and yet election after election nothing is done about it. The great American heist of the middle and lower class continues...

@bhlv89: I went to ER last summer for dehydration. The doc said I will check your electrolytes and give you some fluids. I was there for 2hrs ish. Just got a bill of $2,200 and that's because I have health insurance. It's absolutely disgusting.

@jamesloehr649: My uncle died because he didn't have insurance and did not go to the hospital despite his family asking him to. He wasn't feeling well for a long time before he had a massive heart attack that killed him. If we had universal healthcare, he likely would still be alive. So it hits close to home for me. I have insurance and have over 5k in medical bills. Tired of this system and its cruelty.

May God bring justice to a society in which healthcare is a commodity and the hurting are undeserving customers.

1. the editors, Afropessimism: An Introduction, (Minneapolis: racked & dispatched, 2017), 8. See also Jonathan Tran, Asian Americans and the Spirit of Racial Capitalism (New York: Oxford University Press, 2022), 274-281.