Healthcare and Its Victims

by Luigi Mangione

Update: Since this post, questions have arose about the validity and sourcing of this version of the manifesto.

It appears that most of the press is stuck on the 286-word short little “manifesto” by Luigi Mangione. There is a longer one that is currently being taken down from various places online. It’s called “Healthcare and Its Victims.” This, of course, echoes Ted Kaczynski’s Industrial Society and Its Future, albeit significantly (lol) shorter.

I think that it’s a bit morally dubious to reproduce it here, but alas, I think at this point the cat is out of the bag. Also, as someone who studies this stuff, I think perhaps my small little Substack is a better frame for this kind of writing than most.

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Healthcare and Its Vicitims

By Luigi Mangione
December 3rd, 2024

In this era of towering skyscrapers, artificial intelligence humming quietly through hospital corridors, and the endless litany of self-congratulation over the triumphs of medical science, I find myself compelled to break my silence. Our civilization boasts of its healthcare systems as if they were not only the apex of scientific achievement, but also a paragon of human morality. Yet I stand here, pen in hand, seething with indignation, filled with profound sadness, and forced at last to cast aside all pretenses. I must speak the truth: our modern healthcare system, especially in this country, is a cathedral built on sand—beautiful in its architectural conceits, but rotten at the foundation, a monument to hypocrisy and greed. Do not mistake my words as those of a lunatic or a lone fanatic. On the contrary, I have observed long and hard, meticulously compiling evidence, listening to the cries of the afflicted, and studying carefully the machinery of oppression that masquerades under the guise of healing. To some, I may appear as an isolated voice, an aberration within a culture that seems hypnotized by the glow of technological progress. But I know there are countless others who share my despair, who have looked, with aching hearts, upon loved ones left untreated, patients bankrupted by basic therapies, researchers stifled by corporate interests, and communities abandoned by hospitals that deem their existence “not profitable.” My decision to articulate this scathing condemnation arises not from hatred of humanity, but from a profound love for what humans could be if we only tore away the veil.

The Illusion of Care

We have long been told to trust the medical establishment, to believe that doctors and nurses, with their stethoscopes and white coats, stand as paragons of virtue. Indeed, many individual practitioners do sincerely devote their lives to healing the sick. But individuals alone, no matter how compassionate, struggle futilely within an institutional framework that undermines their noblest intentions at every turn. Healthcare as it currently stands is not designed to keep people healthy. It is designed to maintain a perpetual market for healthcare services, pharmaceuticals, and insurance policies. Our society brandishes statistics: improved survival rates for certain cancers, the advent of robotic surgeries, targeted gene therapies, and so forth. Yet behind these numbers, carefully chosen by public relations departments and government spokesmen, lurks a grim truth. The overall metrics of health—infant mortality rates, maternal health outcomes, life expectancy compared to other industrialized nations—tell a story of persistent failure, regression, and moral collapse. These discrepancies are not accidental. They are symptoms of a system that never had true universal care at its heart. When we say “healthcare,” we summon a reassuring image of a caring physician at a patient’s bedside. Yet, observe more closely: that bedside is now crowded by administrators, insurance adjusters, corporate attorneys, and pharmaceutical representatives. The doctor stands there, to be sure, but they are outnumbered, outmaneuvered, and often overshadowed by the intricate lattice of profit-oriented bureaucracy that defines the modern medical world. When the patient cries out in pain and seeks relief, the response that returns to them is not simply that of a healer ready to help, but of a cost-benefit analyst weighing whether their suffering is worth alleviating given the balance sheets. We are told that competitive markets improve quality and lower costs. This is the refrain of our times, the economic dogma that has been allowed to infiltrate even our perception of the sanctity of human life. But if competition were truly the engine of improvement, why do we witness skyrocketing prices for common drugs that have existed for decades? Why do hospitals close in rural areas, leaving entire regions bereft of care for hours around, simply because the population density is too low to justify investor interest? Why do insurers find convoluted ways to deny claims, to pile up obscure terms and conditions, all to ensure that their profit margins remain robust?

A System Designed to Fail

It is a mistake to call our healthcare system “broken.” To do so would suggest it once functioned well and now falters by accident. But this system was never designed to safeguard the health of the many; it was engineered with the aim of financial gain for the few. It is a labyrinth deliberately constructed of administrative barriers, obfuscated billing practices, and legal complexities. This is not an unintended consequence—this is the blueprint. Bureaucracy swallows countless billions that could have built hospitals, funded research into neglected diseases, or delivered treatments to remote regions. Instead, those billions vanish into the machinery of profit, into ever-expanding layers of management and red tape. Insurance companies have become medical gatekeepers, wielding outsized power over decisions that rightfully belong to physicians, caregivers, and patients themselves. With every referral, every denied claim, every inflated cost for a pill that costs pennies to manufacture, they tighten the noose around public health. The apparatus is designed to confuse and exhaust patients until they simply give up, accepting substandard care or crushing debt. It is a system that counts on resignation, on the quiet despair of individuals who lack the means to fight back. I have watched this unfold from the inside. I have seen the incessant forms, the endless cycles of “pre-approvals,” the letters informing patients that their treatment—no matter how necessary, how urgently prescribed by their physician—is not “covered.” I have witnessed patients be told that their life-saving procedures must wait until an elusive committee of cost analysts determines whether their existence holds sufficient monetary value. I have seen healthcare institutions, purportedly philanthropic, gleefully profit off human pain, turning patients into revenue streams rather than human beings in need.

The Human Cost of Indifference

Every abstract policy, every line of fine print in an insurance contract, has a human face attached. Behind these faceless mechanisms are real lives unraveling. Families teeter on the brink of financial ruin because they dared to seek help for a sick child. Elders ration their medication—cutting pills in half, skipping doses altogether—because the market demands a price that can mean the difference between eating and treating a chronic illness. The cruelty is not confined to one class; it spreads and infiltrates the very fabric of our communities. The supposed moral society allows these tragedies to go on, day after day, in plain sight. Meanwhile, at the summit of this colossal edifice of inequity, the executives of vast health conglomerates earn salaries and bonuses that dwarf the cost of entire medical wings. They dine lavishly, clinking glasses and celebrating their fiscal quarters while, just a few floors below, patients beg for help and healthcare workers struggle with understaffing and burnout. The irony is as obscene as it is deliberate. As some lives are prolonged with the best treatments money can buy, others are cut short by conditions easily treated were it not for the cruelty of cost-based rationing. We pour billions into the development of groundbreaking drugs, yet we erect paywalls so high that only a fortunate fraction of patients will ever see them. The promise of modern medicine lies not only in its discoveries but in its equitable distribution—a promise we have so brazenly betrayed. I have lost friends—good, hardworking individuals—who slipped through the cracks because they could not afford the tests, the scans, the referrals. I have watched family members endure humiliating phone calls, pleading with insurance representatives who could not care less about their plight. I have seen the despair etched into their faces as they realize their options have run dry. It is a quiet kind of torture, a slow, bitter death of hope and trust in a system that was supposed to provide solace, not suffering.

A Call to Arms: Revolt Against the Status Quo

Words alone are not enough, though I must start here. Actions, no matter how shocking, seem necessary to awaken a population lulled into accepting this desolation as normal. My manifesto is a desperate attempt to shake the foundations of a world that has allowed itself to be governed by heartless spreadsheets and corporate-led moral arithmetic. When I act, I do so in the name of humanity, not spite. It is not hatred that drives me, but the very opposite: love for a people who have been betrayed, compassion for those who die unremarked and unmet within the shadows of this market-driven machine. Our current passivity has been the nourishing soil in which this vile system thrives. We must not only acknowledge the problem but commit ourselves to radical, systemic changes. The solution does not lie in half-measures or superficial reforms but in a complete reimagining of how we structure healthcare. We must strip the profit motive from medicine. We must eradicate the legal structures that allow insurance companies to profiteer on misery. We must demand transparency, accountability, and equity at every stage. Healthcare should be a public good, not a speculative venture. Look at the models around the world where universal coverage is not just a slogan, but a reality. Study the nations that refuse to let a single individual go untreated because of an inability to pay. Understand that this transformation is not a pipe dream but an attainable goal, provided we have the courage to wrest power back from those who have proven, time and again, that they do not deserve our trust. We must demand that our leaders confront the issue head-on, tearing down the frameworks that perpetuate healthcare inequality. We must push for policies that prioritize patient outcomes over corporate earnings, that place moral purpose above shareholder dividends.

My Legacy and Your Responsibility

If my words and actions serve as a catalyst—if they spark a shift in your perspective, or perhaps even a grand movement—then my life will not have been lived in vain. I have chosen this moment to speak my truth because I know that many others feel it too but remain in silence, fearing repercussions, or simply overwhelmed by the scale of the catastrophe. Let my voice echo for them. Let it represent the countless silent sufferers who have not been allowed the dignity of proper care. I do not ask for your pity, nor do I seek your admiration. I do not want my name etched in stone as a martyr. Instead, I beg of you: scrutinize the system that calls itself “healthcare.” Look beyond the sensationalism that will inevitably surround my actions—spun by media outlets that rely on shock value. Penetrate the veil and see the underlying disease. Question every assumption about why a pill costs hundreds of dollars, why a specialist is out of reach, or why an insurance claim can be denied with impunity. Challenge every premise that leads to the commodification of health. I hope that future generations might look back at this turbulent era and wonder how we tolerated such cruelty under the guise of care. I hope they will marvel at how we once let human beings suffer and die while wealth piled up at the top, and I hope they will praise the efforts of those who dared to resist. If what I do today contributes a small brick to the foundation of a new healthcare paradigm, one defined by equity, compassion, and universal access, then my role in this story is meaningful. This manifesto is my final testament, my earnest appeal to the conscience of a world that has grown too comfortable with moral contradictions. Let the cost of my sacrifice be not in vain. Let it serve to ignite a transformative discussion and, more importantly, real action. The world desperately needs a healthcare system that honors its name: a system that is centered on healing and grounded in love, not money. Through this plea, I offer you a choice: continue to stand by as millions suffer, or join in building a legacy of decency, empathy, and genuine care.

In raw desperation—and with a sliver of hope—

Luigi Mangione