Day: December 6, 2024

The execution of CEO Brian Thompson has brought the dystopian but highly profitable American health care system into the spotlight. While some are rightfully expressing compassion for Thompson’s family, the overwhelming tide of commentary is about the harms Americans suffer because of the way the health care system is operated. In many ways, this incident exposes many aspects of the American nightmare such as dystopian health care, the rule of oligarchs, the surveillance state, and gun violence.

As this is being written the identity and motives of the shooter are not known. However, the evidence suggests that he had an experience with the company that was bad enough he decided to execute the CEO. The main evidence for this is the words written on his shell casings (deny”, “depose”, and “defend”) that reference the tactics used by health insurance companies to avoid paying for care. Given the behavior of insurance companies in general and United Healthcare in particular, this inference makes sense.

The United States spends $13,000 per year per person on health care, although this is just the number you get when you divide the total spending by the total number of people. Obviously, we don’t each get $13,000 each year. Despite this, we have worse health outcomes than many other countries that spend less than half of what we do, and American life expectancy is dropping. It is estimated that about 85 million people are either without health care insurance or are underinsured.

It is estimated that between 45,000 and 60,000 Americans die each year because they cannot get access to health care on time, with many of these deaths attributed to a lack of health insurance. Even those who can get access to health care face dire consequences in that about 500,000 Americans go bankrupt because of medical debt. In contrast, health insurance companies are doing very well. In 2023, publicly traded health insurance companies experienced a 10.4% increase in total GAAP revenue reaching a total of $1.07 trillion. Thomson himself had an annual compensation package of $10.2 million.

In addition to the cold statistics, almost everyone in America has a bad story about health insurance. One indication that health insurance is a nightmare is the number of GoFundMe fundraisers for medica expenses. The company even has a guide to setting up your own medical fundraiser. Like many people, I have given to such fundraisers such as when a high school friend could not pay for his treatment. He is dead now.

My own story is a minor one, but the fact that a college professor with “good” insurance has a story also illustrates the problem. When I had my quadriceps repair surgery, the doctor told me that my insurance had stopped covering the leg brace because they deemed it medically unnecessary. The doctor said that it was absolutely necessary, and he was right. So, I had to buy a $500 brace that my insurance did not cover. I could afford it, but $500 is a lot of money for most of us.

Like most Americans, I have friends who have truly nightmarish stories of unceasing battles with insurance companies to secure health care for themselves or family. Similar stories flooded social media, filling out the statistics with the suffering of people. While most people did not applaud the execution, it was clear that Americans hate the health insurance industry and do so for good reason. But is the killing of a CEO morally justified?

There is a general moral presumption that killing people is wrong and we rightfully expect a justification if someone claims that a killing was morally acceptable. In addition to the moral issue, there is also the question of the norms of society. Robert Pape, director of the University of Chicago’s project on security and threats, has claimed that Americans are increasingly accepting violence as a means of settling civil disputes and that this one incident shows that “the norms of violence are spreading into the commercial sector.” While Pape does make a reasonable point, violence has long been a part of the commercial sector although this has mostly been the use of violence against workers in general and unions in particular. Gun violence is also “normal” in the United States in that it occurs regularly. As such, the killing does see to be within the norms of America, although the killing of a CEO is unusual.

While it must be emphasized that the motive of the shooter is not known, the speculation is that he was harmed in some manner by the heath insurance company. While we do not yet know his story, we do know that people suffer or die from lack of affordable insurance and when insurance companies deny them coverage for treatment.

Philosophers draw a moral distinction between killing and letting people die and insurance companies can make the philosophical argument that they are not killing people or inflicting direct harm. They are just letting people suffer or die for financial reasons when they can be helped. When it comes to their compensation packages, CEOs and upper management defend their exorbitant compensation by arguing that they are the ones making the big decisions and leading the company. If we take them at their word, then this entails that they also deserve the largest share of moral accountability. That is, if a company’s actions are causing death and suffering, then the CEO and other leadership are the ones who deserve a package of blame to match their compensation package.

It is important to distinguish moral accountability from legal accountability. Corporations exist, in large part, to concentrate wealth at the top while distributing legal accountability. Even when they commit criminal activity, “it’s rare for top executives – especially at larger companies – to face personal punishment.” One reason for this is that the United States is an oligarchy rather than a democracy and the laws are written to benefit the wealthy. This is not to say that corporate leaders are above the law; they are not. They are wrapped in the law, and it generally serves them well as armor against accountability. For the lower classes, the law is more often a sword employed to rob and otherwise harm them. As such, one moral justification for an individual using violence against a CEO or other corporate leader is that might be the only way they will face meaningful consequences for their crimes.

The social contract is supposed to ensure that everyone faces consequences and when this is not the case, then the social contract loses its validity. To borrow from Glaucon in Plato’s Republic, it would be foolish to be restrained by “justice” when others are harming you without such restraint.  But it might be objected, while health insurance companies do face legal scrutiny, denying coverage and making health care unaffordable for many Americans is legal. As such, these are not crimes and CEOs, and corporate leaders should not be harmed for inflicting such harm.

While it is true that corporations can legally get away with letting people die and even causing their deaths, this is where morality enters the picture. While there are philosophical views that morality is determined by the law, these views have many obvious problems, not the least of which is that they are counterintuitive.

If people are morally accountable for the harm they inflict and can be justly punished and the legal system ignores such harm, then it would follow that individuals have the moral right to act. In terms of philosophical justification, John Locke provides an excellent basis. If a corporation can cause unjustified harm to the life and property of people and the state allows this, then the corporations have returned themselves and their victims to the state of nature because, in effect, the state does not exist in this context. In this situation, everyone has the right to defend themselves and others from such unjust incursions and this, as Locke argued, can involve violence and even lethal force.

It might be objected that such vigilante justice would harm society, and that people should rely on the legal system for recourse. But that is exactly the problem: the people running the state have allowed the corporations to mostly do as they wish to their victims with little consequence and have removed the protection of the law. It is they who have created a situation where vigilante justice might be the only meaningful recourse of the citizen. To complain about eroding norms is a mistake, because the norm is for corporations and the elites to get away with moral crimes with little consequence. For people to fight back against this can be seen as desperate attempts at some justice.

As the Trump administration is likely to see a decrease in even the timid and limited efforts to check corporate wrongdoing, it seems likely there will be more incidents of people going after corporate leaders. Much of the discussion among the corporations is about the need to protect corporate leaders and we can expect lawmakers and the police to step up to offer even more protection to the oligarchs from the people they are hurting.

Politicians could take steps to solve the health care crisis that the for-profit focus of health care has caused and some, such have Bernie Sanders, honestly want to do that. In closing, one consequence of the killing is that Anthem decided to rescind their proposed anesthesia policy. Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri had said they would no longer pay for anesthesia care if a procedure goes beyond an arbitrary time limit, regardless of how long it takes. This illustrates our dystopia: this would have been allowed by the state that is supposed to protect us, but the execution of a health insurance CEO made the leaders of Anthem rethink their greed. This is not how things should be. In a better world Thompson would be alive, albeit not as rich,  and spending the holidays with his family. And so would the thousands of Americans who died needlessly because of greed and cruelty.

 

While the United States is the richest country on earth, people asking for money is a common occurrence. Last week, when I went to CVS to get my COVID shot, a person laying on the sidewalk asked me for money. I’m often approached while grocery shopping and even while running. Although I have been told I am just helping to buy someone drugs or beer, I routinely give people cash. This is a moral choice, and I would be going against my own professed principles if I did not help people, even when they might be deceiving me about what they will purchase. But some people find panhandling a problem and not in terms of people needing to beg for money.

Local officials sometimes believe panhandlers are detrimental to businesses and tourism and there have been efforts to ban begging. While local governments try to craft laws to pass constitutional muster, their efforts have generally proven futile in the face of the First Amendment. While the legal questions are addressed by courts, there remains the moral question of whether banning panhandling can be morally justified.

One starting point for a moral argument for banning panhandling is a utilitarian approach. Local officials generally want bans because they believe panhandlers are bad for businesses and tourism. For example, if potential customers are accosted by panhandlers on the streets around businesses, then they are less likely to patronize those businesses.

As another example, if a city gets a reputation for being awash in panhandlers who annoy tourists with, then tourism might decline. From the perspective of the business owners and the local officials, these effects would have negative value that outweigh the benefits to the panhandlers of being able to ask for money. There is presumably also utility in encouraging panhandlers to move away to other locations, thus removing the financial and social cost of having panhandlers. If this utilitarian calculation is accurate, then banning panhandling would be morally acceptable. Of course, if the calculation is not correct and such a ban would do more harm than good, then the ban would be morally wrong.

A second utilitarian argument is the safety argument. While panhandlers generally do not engage in violence (they are asking for money and not trying to rob people), some claim they do present a risk. One concern is that by panhandling in or near traffic, they put themselves and others in danger. If this is true, then banning panhandling would be the right thing to do.  If, however, the alleged harm does not justify the ban, then it would be morally unacceptable.

There is also the reply that safety concerns could be addressed by having laws that forbid people from obstructing the flow of traffic and being a danger to themselves and others. Presumably these laws already exist in most places. There is also the concern that the safety argument would need to be applied consistently to all such allegedly risky behavior around traffic, such as people engaging in political campaigns or street side advertising.

One can advance a utilitarian argument in favor of panhandling based on the harm that could be done by restricting the panhandlers’ rights. Following Mill’s classic argument, if panhandlers are not harming people with their panhandling, then it would be wrong to limit their freedom to engage in this behavior. This is on the condition that panhandling is merely annoying and does not involve threatening behavior or harassment. After all, politicians are allowed to annoy us with texts and emails begging for money, so they would be hard pressed to consistently oppose panhandling while asking us for money.

It could be objected that panhandling does cause harm. As noted above, the presence of panhandlers could harm local businesses. People can also regard panhandling as an infringement on their freedom to not be bothered in public. While this does have some appeal, this justification of a panhandling ban would also justify banning any public behavior people found annoying or that had some perceived impact on local businesses. This could include public displays of expression, political campaigning, preaching in public and many other behaviors. In short, the problem is that there is not something distinct about panhandling that would allow it to be banned without also justifying the ban of other activities. To simply ban it because it is panhandling would seem to solve this problem but would not. After all, if an activity can be justly banned because it is that activity, then this would apply to any activity. After all, every activity is the activity it is.

Those who prefer an alternative to utilitarian calculations can easily defend panhandling against proposed bans by appealing to a right of free expression and behavior that is not based on utility. If people do have the moral right to free expression, then reasons would need to be advanced that would be strong enough to warrant violating this right. As noted above, an appeal could be made to the rights of businesses and the rights of other people to avoid being annoyed. However, the right to not be annoyed does not seem to trump the right of expression until the annoyance becomes significant. As such, a panhandler does have the right to annoy others by asking for money, but if it crosses over into actual harassment, then this would be handled by the fact that people do not have a right to harassment.

In the case of businesses, while they do have a right to engage in free commerce, they do not have a right to expect people to behave in ways that are conducive to their business. If, for example, people found it offensive to have runners running downtown and decided to take their business elsewhere, this would not warrant a runner ban. But, if runners were blocking access to the businesses by stretching in the entrances, then the owners’ rights would be violated. Likewise, if panhandlers are disliked by people and they decide to take their business elsewhere, this does not violate the rights of the businesses. But, if panhandlers started harassing people and blocking access to the businesses, then this would violate the rights of the owners.