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 finally 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. CEO Brian Thompson last week.

Why might he have done it? Some thought he might have been politically motivated, especially after he was found to be carrying a manifesto including the phrase "these parasites had it coming". 

But this Ivy LeagueA group of eight American universities, that are considered the most sought-after US universities. computer science graduate and fan of tech billionaires Peter ThielA German-American entrepreneur and venture capitalist with a net worth of .24 billion. and Elon MuskA South African-born entrepreneur whose companies have included the online payment service PayPal. He now controls Twitter, renamed 'X'. is hardly a 21st Century Che GuevaraAn Argentina Marxist revolutionary, who was a major figure of the Cuban revolution. He died in 1967. .

In fact, while journalists have been poring over his online profile, only two things stand out as possible motives.

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.

And this seems to be one of the rare causes still capable of uniting left and right in US society. When conservative commentator Ben ShapiroAn American conservative political commentator and media host. released a video scolding left-wingers for turning Mangione into a folk hero, he received a flood of replies from fellow right-wingers saying that they admired the shooter too.³

Why, then, is the US healthcare system so universally hated?

In most countries, everyone automatically gets healthcare. In some systems, like the UK, this is paid for out of general taxationMoney workers pay to the government to pay for services like roads and hospitals. . In others, especially in Europe, workers and employers each pay into a national insurance system.

The US system is more complicated. Larger companies are legally obliged to offer health insurance, but this might not cover all treatment. Smaller companies have no such obligation.

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, those just above the lowest income bracket, who still might struggle to pay for private insurance, cannot get any state help.

As such, 8% of the US population has no health coverage at all.⁵ But even those who have insurance can struggle to get treatment.

Unlike their European counterparts, US health insurance companies are profit-making. So they have an incentive to find ways of not paying for the care people need.

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 - details the tactics US health insurance companies use.

Delay: make people wait as long as possible for their claim to be processed. Deny: turn down the claims. Defend: hold off the ensuing lawsuits. People often get so frustrated that they stop trying to claim the money they need for their medical 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

Little wonder last year more than a quarter of US adults went without some form of medical treatment because they could not afford it.

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.

Pennsylvania - A US state with a population of nearly 13 million.

UnitedHealthcare - A US health insurance company. It is accused of using AI to deny claims, and is expected to have a revenue of $450bn in 2025.

Ivy League - A group of eight American universities, that are considered the most sought-after US universities.

Peter Thiel - A German-American entrepreneur and venture capitalist with a net worth of $7.24 billion.

Elon Musk - A South African-born entrepreneur whose companies have included the online payment service PayPal. He now controls Twitter, renamed 'X'.

Che Guevara - An Argentina Marxist revolutionary, who was a major figure of the Cuban revolution. He died in 1967.

Goodreads - A social media site on which people can share their book reviews.

Ted Kaczynski - An American mathematician and terrorist. He killed three people in a bombing campaign, targeting people he believed were advancing modern technology and destroying the environment.

Ben Shapiro - An American conservative political commentator and media host.

Taxation - Money workers pay to the government to pay for services like roads and hospitals.

Medicaid - A US government programme that provides medical and health-related services to people on low incomes.