OPINION: An insurance CEO was gunned down. Malignant health care system in Kansas explains reaction.

I remember the room so clearly. It was a small conference space in the Concord Monitor newspaper office in New Hampshire, scarcely big enough for two people. I had ducked into the room to make a phone call to a mail-order pharmacy, one of the "conveniences" required by my health insurance company.My voice shook, and I could barely contain my emotion.Do you understand that I need this drug to live? I told the person on the other side. Do you understand that without this medicine I will die?If you want to understand why so many Americans of disparate political ideologies have cheered on Luigi Mangione, the man accused of killing UnitedHealthcare CEO Brian Thompson, you might look to that moment, one that I'm confident has been shared by countless people in recent decades. The exact medicine I was talking about doesn't matter in the grand scheme of things — some folks depend on EpiPens, others on asthma inhalers, others on insulin, others on antiretroviral therapy, still others on chemotherapy drugs.Until you find yourself on that call, begging our nation's health care cartel to keep you alive, you don't know what it's like.The shame grinds at you.But at least there's some sort of coverage underneath it all. You're not one the approximately 172 Kansans who died this year because of the Legislature's blinkered refusal to expand Medicaid. Imagine their friends and families, reeling from preventable carnage.We have numbed ourselves, I think, to the shocking cruelty of it all, to the everyday horror of begging for medicine, for medical care, for someone to listen. Insurers and the dubious shell companies they spawn (take a look into pharmacy benefit managers sometime) enjoy record profits. Meanwhile, everyday folks grit their teeth and persist.Those a rung or two lower on the social ladder? Forget about it.Mangione has been apprehended and will face justice. Murder and violence, no matter the motivation, are wrong. Killing Thompson not only wounded his loved ones and friends, but it arguably makes efforts to improve the system more difficult. No CEO wants to appear as though fear has changed their behavior.Yet when so many feel powerless as a system runs roughshod over them, we should not be surprised that some number (perhaps larger than we imagine) will condone horrifying violence.Consider that the Kansas Legislature passed Medicaid expansion — yes, passed it — a mere seven years ago. Then-Gov. Sam Brownback vetoed the bill, and lawmakers couldn't override him. Each year, advocates trek to the Statehouse in Topeka and make their case. Each year, think tanks issue papers showing how many more parents and children would be covered. Each year, the news media points out the clear good that such a move could make.One year, demonstrators even unfurled banners covered with red handprints, declaring the legislators had blood on their hands. Others have tried mildly disruptive tactics, anything to seize the attention and make the case.We know the cost — you can calculate it with publicly available numbers. Once 2024 ends in a couple of weeks, some 1,720 Kansans will have died over 10 years.Yet nothing happens.Writ large, the same story has played out across the nation. Despite the Affordable Care Act's success in covering more Americans, the law did not prevent for-profit insurance companies from playing the angles to maximize their take. It has not meaningfully lowered prices. Mangione's manifesto points out — entirely accurately — that we spend more money on health care in the United States than any other nation yet see poor health outcomes.Mangione faces first-degree murder charges in New York. If found guilty, he will face punishment from society. We punish those who commit acts of violence against others — as long as they do it one-on-one. The German philosopher Friedrich Engels described a different kind of murder in 1845. He called it "social murder," described it as occurring when society's elites created conditions for the poor that inevitable prove fatal."When society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual," he wrote.Engels also helped create communism with Karl Marx, so skepticism might be warranted. Yet he precisely defines the socially excused violence that threatens our state and nation.The political process, if working correctly, should reform the mechanisms that create such suffering. Successive generations of reformers, from Teddy Roosevelt to Franklin Roosevelt to Lyndon Johnson, created a web of safety nets. Untold numbers of lives were saved.Yet that process has solved fewer and fewer problems of late. Americans feel in their bones that something is amiss, that something has gone wrong and needs fixing. Conservatives blame liberals, while liberals blame conservatives. Neither want to blame actual culprits, the wealthy, because they underwrite each party's existence.Extremism flourishes when officials close off everyday avenues of social and government change.I fear it, from any party or ideology. Once lit, certain fires can be difficult to extinguish. We have witnessed the results of popular uprisings over the past 150 years, and they do not fill one with confidence. Revolution often ends poorly. Dictators and strongmen rise, while the ultra-wealthy flee to stable fortresses elsewhere.We know what we need to do. Create a responsive government at the state and national levels. Lower health care costs without sacrificing coverage or quality. Reorient society from a win-at-all-costs mindset to the neighborliness of an earlier age. Show others the caring we would hope they show us.Yet how can we plausibly achieve these goals? Ideological chasms yawn. Many have abandoned hope, drawn into black holes of nihilism. Those of us who dare to imagine better outcomes wonder if we lead others astray by doing so.We are all locked in that room together now, still on that phone call, begging for our lives.Kansas Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Kansas Reflector maintains editorial independence. Contact Editor Sherman Smith for questions: [email protected].