Where was America's most wanted man likely to resurface? In a McDonald's, naturally. It was at a branch in PennsylvaniaA US state with a population of nearly 13 million. that the police caught up with Luigi Mangione, the man who allegedly shot UnitedHealthcareA US health insurance company. It is accused of using AI to deny claims, and is expected to have a revenue of 0bn in 2025. CEOThe Chief Executive Officer is the highest ranking person in a company. They are responsible for making decisions about the company's future. Brian Thompson last week.

Why might he have done it? There are two clues in his online presence.

The first is a positive review that he left on GoodreadsA social media site on which people can share their book reviews. of a book by Ted KaczynskiAn American mathematician and terrorist. He killed three people in a bombing campaign, targeting people he believed were advancing modern technology and destroying the environment. , an environmentalist terrorist known as the Unabomber.²

The second is an X-ray of a damaged spine in the cover photo of his X profile. Friends confirm that Mangione had undergone surgery to correct a back problem.

Which is why some suspect that personal experience of the US health insurance industry, and a desire to send a message, might have been what led Mangione to kill Thompson.

Hatred of that industry seems to be one of the rare causes still capable of uniting left and right in US society.³

Americans do not automatically get health insurance. The poorest Americans can qualify for MedicaidA US government programme that provides medical and health-related services to people on low incomes. , a government programme that provides health insurance for 20% of the population.⁴ However, 8% of the US population has no health coverage at all.⁵ 

And even those who have insurance can struggle to get treatment.

A 2010 book called Delay, Deny, Defend - similar to the words the killer wrote on the casings of the bullets he used to shoot Thompson - argues that US health insurance companies use trickery to avoid paying for their customers' care.

But if they cannot claim the money on their insurance they have to cough up for their treatment themselves. And this is eye-wateringly expensive. A three-day stay in a hospital costs around $30,000 (£23,478).⁶ Many simply have to go without care.

Is US healthcare a disgrace?

Yes: The US spends the most on healthcare of any developed country, only to get some of the worst outcomes: a low life expectancy and a high rate of preventable deaths.⁷

No: The US health system is not especially fair, but it is suitable for the country's political culture. It generally provides excellent care for those with high-paying jobs, and many think this offers an incentive to climb the income ladder.

Or... US healthcare is not itself the problem. It is simply the natural product of a culture that prizes individual self-help above all else, and sees poverty as a consequence of bad choices.