The Pathology of Despair: From Systemic Failure to "Social Banditry" in American Healthcare. Is Luigi a new Robin Hood / Pancho Villa?

The Pathology of Despair: From Systemic Failure to "Social Banditry" in American Healthcare. Is Luigi a new Robin Hood / Pancho Villa?

by Donald Harvey Marks, MD PhD

Emeritus Fellow, American College of Physicians

17 January 2026

Introduction: A Diagnosis of Systemic Sepsis

As a practicing physician and researcher, I have long argued that the United States healthcare system suffers from a deep-seated pathology—a dual crisis of unsustainable spending ($4.8 trillion annually) and abysmal health outcomes [1]. I have previously outlined a specific, six-point protocol to restore the system’s health, including mandating universal coverage, lowering the Medicare age to 55, and, most controversially, requiring all licensed physicians to accept Medicaid as a condition of their medical license, as repayment of the public’s investment in their training [2, 3].

However, recent events—specifically the assassination of UnitedHealthcare (UHC) CEO Brian Thompson—have shifted the conversation from policy reform to the violent consequences of systemic neglect. This tragedy compels us to examine not only *how* to fix the system but *why* a segment of the American public has begun to view such violence not as a crime, but as an act of "social banditry" against a predatory industry [4].

The Evidence of Harm: "Delay, Deny, Defend"

I have sought to determine if there is a documented link between insurance business practices and patient mortality. The evidence is not merely anecdotal; it is structural.

Investigations reveal that major insurers, particularly UnitedHealthcare, have increasingly deployed artificial intelligence—specifically a model known as "nH Predict"—to systematically deny post-acute care to elderly patients [5, 6]. Allegations suggest this algorithm has a 90% error rate, yet it is used to override the medical judgment of treating physicians [7]. The strategy appears to be a cynical calculation: deny care knowing that only a tiny fraction (roughly 0.2%) of patients will navigate the labyrinthine appeals process [8].

The human cost of this "money game" is quantifiable [9]. Legal filings and investigative reports have identified specific patients whose deaths were allegedly precipitated by these administrative denials:

*  Jackie Martin: Died five days after his nursing home coverage was cut off, a decision his family describes as a "money game" [9, 10].

*   Mary Grant: Died after an Optum (UHC subsidiary) nurse practitioner allegedly utilized a "treat in place" protocol to deny her transfer to a hospital despite symptoms of a traumatic brain injury [11, 12].

*   Cindy Deal: Died after a three-hour delay in hospitalization while foaming at the mouth, allegedly due to insurance protocols prioritizing cost over emergency transport [13, 14].

The Legal Question: Can "Systemic Murder" Justify Homicide?

This brings us to the most provocative question raised in recent discourse: Could Luigi Mangione, the accused shooter, successfully use a legal defense arguing that his actions were necessary to prevent UnitedHealthcare from causing further patient deaths?

Although I am not a lawyer, I can say that the moral outrage driving this question is palpable. A sober analysis of legal precedent suggests that such a defense faces insurmountable hurdles in a court of law.

1. The "Necessity" Defense and Imminence

The defense of "necessity" (or the "lesser of two evils") requires a defendant to prove they faced a choice between two evils and chose the lesser to avoid *imminent* harm where no legal alternative existed [15, 16].

*   The Barrier of Imminence: Courts generally reject the necessity defense for political acts because the threat (in this case, future administrative denials of care) is not "imminent" in the way a physical attack is [16]. The harm caused by UHC, while lethal, is statistical and administrative, not an immediate physical threat that could *only* be stopped by a bullet.

*   Legal Alternatives: The law insists that remedies must be sought through the courts or legislature, not violence. Precedents such as United States v. Schoon (involving protests against IRS policy) and State v. Roeder (the murder of an abortion provider) explicitly reject the necessity defense for acts motivated by political or policy grievances [16, 17].

 2. The Defense of Others 

Similarly, a "defense of others" plea generally requires that the defendant used force to protect a specific third party from the imminent use of unlawful force [18]. Killing an executive to prevent future, hypothetical denials of care for unidentified patients falls outside this narrow legal scope.

3. The "ERISA Shield" and the Reality of Accountability

A critical irony is that while Mangione cannot legally claim he acted to punish corporate malfeasance, the corporations themselves are often immune from punishment. Under the Employee Retirement Income Security Act of 1974 (ERISA), patients in employer-sponsored plans generally cannot sue HMOs for punitive damages or wrongful death resulting from coverage denials [19, 20]. They can only sue for the cost of the denied benefit [21, 22]. As noted in the Congressional Record, ERISA has evolved into a "shield of immunity," leaving families like the Corcorans—who lost an unborn child due to a denial of hospitalization—with "no remedy, State or Federal" [23, 24].

Conclusion: A Warning, Not a Solution

While it appears that a  "justification" defense will likely fail in court, Luigi's defense team may still introduce evidence of UHC’s denial practices during the sentencing phase to mitigate the penalty, or to subtly encourage jury nullification by exposing the "public danger" posed by the insurance industry [25].

The fact that such a defense is even being debated by the public signals a dangerous erosion of trust. When a system effectively grants immunity to corporations that use algorithms to deny life-saving care [7], the public begins to view the legal system as broken. To prevent the further normalization of violence and "social banditry" [4], we must implement the structural reforms I have proposed: universal coverage, mandated provider participation, and the removal of profit-driven barriers to care [2]. We must replace the "pathology of profit" with a protocol for healing.

References

Here are the references used to construct the blog post, formatted for inclusion at the end of your document. The bracketed numbers indicate the specific source passages from the provided text.

 References 

1.   Aboulenein, A.  (2024). "U.S. healthcare spending rises to $4.8 trillion in 2023." Cited in Balkrishnan, R., "How to Save the US Health Care System From a Complete Collapse," *The American Journal of Managed Care.

2.   Marks, Donald H.  Fixing USA Healthcare: My suggestions, as a practicing physician, to fix critical problems with the USA healthcare system.

3.   Marks, D. H. (2024). Should All Medical Doctors Be Required to Accept Medicare and Medicaid as a Condition of Licensure?

4.   Times of India.  "'Social banditry': Why many Americans are celebrating killing of a CEO." (December 12, 2024).

5.   Estate of Gene B. Lokken et al. v. UnitedHealth Group.  *Class Action Complaint*, United States District Court, District of Minnesota. (November 14, 2023).

6.   Pollitz, K., et al.  "Claims Denials and Appeals in ACA Marketplace Plans in 2021." KFF. (Cited in Class Action Complaint). 

7.   Joseph, George.  "‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care." The Guardian

8.   The Guardian.  "UnitedHealth reduced hospitalizations for nursing home seniors. Now it faces wrongful death claims."

9.   Consumer Watchdog.  "The Law on Lawsuits Can Be Confusing." (Discussing the case of Robert Dewey). 

10.  Tong, Noah.  "UnitedHealth, CVS and Humana increasingly deploy AI and deny post-acute care claims, Senate report finds." *Fierce Healthcare*.

11.  Wikipedia.  "Necessity (criminal law)." 

12.  United States v. Schoon , 939 F.2d 826 (9th Cir. 1991). 

13.  State v. Roeder , 300 Kan. 901 (2014). 

14.  Reddit Community.  r/legaladviceofftopic: "Say Luigi Mangione wants a trial for the purpose of exposing... corruption." 

15.  Congressional Record.  106th Congress, 1st Session (July 15, 1999). "Patients' Bill of Rights Act of 1999."

16.  Corcoran v. United Healthcare, Inc. , 965 F.2d 1321 (5th Cir. 1992). (Cited in Congressional Record).

17.  Pear, Robert.  "Hands Tied, Judges Rue Law That Limits H.M.O. Liability." *The New York Times*. (Cited in Congressional Record). 

18.  Marks, D. H. The Inevitability of Universal Basic Income UBI for the Homeless & the Addicted - Bad idea or coming necessary? With my added comments in the context of a post-labor economy.

19.  Network Contagion Research Institute (NCRI).  "Killing With Applause: Emergent Permission Structures for Murder in the Digital Age." 

20.  Daily Journal.  "United Healthcare subsidiary OK'd to arbitrate wrongful death case."

21.  Cutler, David M.  "Reducing Administrative Costs in U.S. Health Care." *The Hamilton Project*, Policy Proposal 2020-09. 

22.  Commonwealth Fund.  "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System."

23.  Marks, D. H. (2023). Reducing the Influence of Politics in Healthcare.

24.  Marks, D. H.  The potential for GLP-1 drugs such as Ozempic and Wegowy... to totally wreck the Financial Stability of Medicare, Medicaid and the US Healthcare in general. 

25.  Marks, D.H. Top Medical Journals including JAMA and NEJM Challenged by Department Of Justice. My personal experience with writing peer-reviewed medical studies 

Balkrishnan, R. (2024). How to Save the US Health Care System From a Complete Collapse. The American Journal of Managed Care  https://www.ajmc.com).