The Cost of Health: How We Got Here - The System That Created the Luigi Mangione Case (Part 1 of 3)
December 4, 2024. UnitedHealthcare CEO Brian Thompson is killed outside a Manhattan hotel. Bullet casings read: "Delay. Deny. Depose." UnitedHealth's Facebook post gets 62,000 reactions...57,000 are laughing emojis. Supporters raise over $1 million for the suspect's defense. How did American healthcare get so broken that tens of thousands cheered a CEO's death?
This is the 96-year history that explains the reaction.
WHAT WE COVER:
The Birth (1929-1945): Great Depression creates health insurance | Baylor Hospital's 50-cent plan for Dallas teachers | Blue Cross/Blue Shield as nonprofits | WWII wage controls tie insurance to jobs | 1942 tax loophole | Truman's failed national plan | AMA's "socialized medicine" campaign
The Transformation (1965-1973): LBJ creates Medicare/Medicaid | Nixon-Ehrlichman tape: "The less care they give them, the more money they make" (Feb 17, 1971) | HMO Act (1973) | How "managed care" became standard
Going For-Profit (1980s-1990s): Blue Cross goes for-profit (1994) | Managed care backlash | HMO vs PPO explained | Prior authorization becomes standard | Why doctors need insurance permission
Modern Era (2000s-Present): Affordable Care Act (2010) | Three Supreme Court challenges | What Obamacare actually does | Medicaid expansion battles
The Numbers: Top 7 CEOs earned $283M (2021) | UnitedHealth CEO: $26.4M (348:1 ratio) | Profits up 230% since 2010 | Families pay $7,000/year (up 23%) | 17% claims denied (some 49%) | Only 1% appeal | 90% of appeals win | AI lawsuit: UnitedHealth accused of using 90% error-rate algorithm to deny care
KEY TIMELINE: 1929: Baylor Plan | 1942: Employer insurance tax-free | 1945: Truman plan killed | 1965: Medicare/Medicaid | 1971: Nixon approves HMOs | 1994: Blue Cross for-profit | 2010: ACA | 2023: AI lawsuit | 2024: Thompson killed
COMING NEXT: Part 2: Culture of denial, fraud cases, "Delay Deny Defend" | Part 3: Mangione case, trial, what the reaction means
SOURCES: National Archives: Medicare/Medicaid Act | Nixon White House tapes (1971) | Blue Cross historical records | NFIB v. Sebelius (2012) | King v. Burwell (2015) | UnitedHealth AI lawsuit (2023-25) | HMO Act (1973) | ACA (2010) | AMA Journal of Ethics | Stanford Medicine healthcare history | NCBI employment-based benefits research | CMS Medicare history | Health Affairs Journal | STAT News CEO compensation | CBS/NBC/CNN case coverage | DOJ healthcare fraud data
CONTENT WARNING: Healthcare system failures, death, violence, political controversy. Listener discretion advised.
DISCLAIMER: For educational/entertainment purposes only. We present historical facts and multiple perspectives, not policy advocacy. We are not medical/legal/policy experts. Brian Thompson killing and Mangione case are active legal matters—individuals presumed innocent. Nothing here condones violence. Thompson's death was a tragedy. Public reaction discussed as social analysis, not endorsement. Healthcare views vary—we present facts, you decide. Lawsuit information reflects allegations, not proven facts. Part 1 of 3-part seri
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