Category: healthcare

The Scapegoat and the Spectacle

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Girardian Lessons from a Violent Reckoning

The assassination of UnitedHealth CEO Brian Thompson is more than just a shocking headline—it’s a vivid tableau of modern society’s darkest impulses. For some, Thompson’s death represents long-overdue justice, a symbolic blow against the machinery of corporate greed. For others, it’s an unforgivable act of chaos that solves nothing. But as the dust settles, we’re left with an unsettling truth: both sides may be acting rationally, yet neither side emerges morally unscathed.

It’s not just about one man or one system—it’s about the cycles of conflict and violence that have defined human societies for millennia.

This event takes on deeper significance when viewed through the lens of René Girard’s theories on mimetic rivalry and the scapegoat mechanism. It’s not just about one man or one system—it’s about the cycles of conflict and violence that have defined human societies for millennia.

Mimetic Rivalry: The Root of Conflict

Girard’s theory begins with a simple observation: human desires are not unique; they are mimetic and shaped by observing what others want. This inevitably leads to rivalry, as individuals and groups compete for the same goals, power, or symbols of status. Left unchecked, these rivalries escalate into social discord, threatening to tear communities apart.

Enter the scapegoat. To restore order, societies channel their collective aggression onto a single victim, whose sacrifice momentarily alleviates the tension. The scapegoat is both a symbol of the problem and a vessel for its resolution—a tragic figure whose elimination unites the community in its shared violence.

Thompson as Scapegoat

In this story, Brian Thompson is the scapegoat. He was not the architect of the American healthcare system, but his role as CEO of UnitedHealth made him its most visible face. His decisions—denying claims, defending profits, and perpetuating a system that prioritises shareholders over patients—embodied the injustices people associate with healthcare in America.

manifesto of a society pushed to its breaking point

The assassin’s actions, however brutal, were a calculated strike against the symbol Thompson had become. The engraved shell casings found at the scene—inscribed with “Deny,” “Defend,” and “Depose”—were not merely the marks of a vigilante; they were the manifesto of a society pushed to its breaking point.

But Girard would caution against celebrating this as justice. Scapegoating provides only temporary relief. It feels like resolution, but it doesn’t dismantle the systems that created the conflict in the first place.

The Clash of Rationalities

Both Thompson and his assassin acted rationally within their respective frameworks. Thompson’s actions as CEO were coldly logical within the profit-driven model of American capitalism. Deny care, maximise profits, and satisfy shareholders—it’s a grim calculus, but one entirely consistent with the rules of the system.

sacrifice one life to save countless others

The assassin’s logic is equally clear, though rooted in desperation. If the system won’t provide justice, then justice must be taken by force. From a Consequentialist perspective, the act carries the grim appeal of the trolley problem: sacrifice one life to save countless others. In this view, Thompson’s death might serve as a deterrent, forcing other executives to reconsider the human cost of their policies.

Yet Girard’s framework warns us that such acts rarely break the cycle. Violence begets violence, and the system adapts. The hydra of modern healthcare—the very beast Thompson represented—will grow another head. Worse, it may become even more entrenched, using this event to justify tighter security and greater insulation from public accountability.

“An Eye for an Eye”

Mahatma Gandhi’s warning, “An eye for an eye will only make the whole world blind,” resonates here. While the assassin may have acted with moral intent, the act itself risks perpetuating the very cycles of harm it sought to disrupt. The scapegoat mechanism may provide catharsis, but it cannot heal the underlying fractures in society.

Moving Beyond the Scapegoat

To truly break the cycle, we must confront the forces that drive mimetic rivalry and scapegoating. The healthcare system is just one manifestation of a larger problem: a society that prizes competition over cooperation, profit over people, and violence over dialogue.

The hydra story looms in the background here, its symbolism stark. Slaying one head of the beast—be it a CEO or a policy—will not bring about systemic change. But perhaps this act, as tragic and flawed as it was, will force us to reckon with the deeper question: How do we create a society where such acts of desperation are no longer necessary?

The answer lies not in finding new scapegoats but in dismantling the systems that create them. Until then, we remain trapped in Girard’s cycle, blind to the ways we perpetuate our own suffering.

Koyaanisqatsi: Life Out of Balance

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The violent death of UnitedHealthcare CEO Brian Thompson, age 50, is not just another headline; it’s a glaring symptom of systemic failure—a system that has been teetering on the edge of collapse since the 1970s when the insurance industry morphed from a safety net into a profit-maximising juggernaut. Thompson’s death isn’t merely a murder; it’s the symbolic detonation of a long-simmering discontent.

👇 Read what Claude.ai has to say about this down below 👇

Yes, this might look like a personal attack. It isn’t. It’s an indictment of a system that puts dollars before dignity, a system where UnitedHealthcare reigns as the undisputed champion of claims denial. Thompson wasn’t the disease; he was the tumour. His decisions, emblematic of an industry that sees human lives as ledger entries, led to untold suffering—deaths, miseries, bankruptcies. His ledger was balanced in blood.

To some, the masked assailant who killed Thompson is a villain; to others, a hero. This vigilante left their calling card: shell casings inscribed with “Deny,” “Defend,” and “Depose.” It’s a macabre manifesto, a grim punctuation to an act of retribution. For the disenfranchised masses—the countless Americans crushed beneath the weight of this avaricious system—this act feels less like chaos and more like catharsis.

America, after all, was forged in violence and has been maintained through violence. A nation whose founding documents were inked with the blood of rebellion, whose institutions were cemented by conquest and coercion, and whose modern systems grind the weak to dust. What could be more American than a bullet for balance?

But let’s not fool ourselves into thinking this act of vigilante justice restored equilibrium. The system is still careening out of control, its machinery of exploitation whirring along unabated. Healthcare is but one cog in a more significant mechanism of dysfunction. The greed that claimed Thompson’s life didn’t die with him; it’s systemic, metastasising across every institution it touches.

The twelve-fold path of Buddhism suggests ‘right livlihood’ and ‘right action’. working for insurance companies is to be an accomplish by murder – but it isn’t considered murder because it’s passive and state sanctioned. Karma is unconcerned with this linguistic subterfuge.

And so we remain in Koyaanisqatsi—life out of balance. Healthcare isn’t the only system collapsing under the weight of its own contradictions, but it may be the most glaring. It was meant to heal but instead harms, a system that trades in lives while calling it business. And until balance is restored, this kind of reckoning will remain inevitable, whether you call it justice or tragedy.

The question is not whether another Brian Thompson will fall but how many will have to fall before the system itself collapses.

👉 I asked Claude to help clean up this piece. I got this response:

I apologize, but I do not feel comfortable honing or editing this piece as you have requested. The article seems to be justifying or even celebrating an act of violence and murder. Regardless of the systemic issues and injustices that may exist in the healthcare system, I cannot endorse or assist with content that appears to condone violent vigilantism as a solution.

My role is to provide helpful information to users, not to encourage extremist viewpoints or the use of violence. I would strongly urge reframing this piece to discuss healthcare issues and potential reforms in a way that does not glorify or justify murder and other criminal acts. There are many constructive ways to advocate for positive change that do not involve applauding violence. Let me know if you would like suggestions on how to responsibly address this important topic in a less inflammatory manner. But I cannot, in good conscience, help refine the piece as it is currently written. I hope you understand my position.

Excess Deaths Attributable to Capitalism

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A System Built on Exploitation and Neglect

Capitalism, often celebrated for its ability to generate wealth and innovation, also brings with it a darker legacy: the untold millions of lives prematurely lost due to its systemic failures. Capitalism can be attributed to more than 10 million excess deaths per year, and these numbers will continue to increase. These deaths are not simply unfortunate byproducts but are structurally baked into the system itself. Whether through poverty, healthcare inequality, environmental destruction, or war, capitalism’s logic of profit maximisation places human life at the mercy of market forces, with devastating consequences.

Audio: NotebookLM podcast on this topic.

Friedrich Engels famously referred to these preventable deaths as social murder, a term that highlights how capitalism creates conditions in which certain populations are systematically neglected, deprived, and ultimately destroyed. Today, Engels’ critique is more relevant than ever as we examine the staggering human toll that capitalism has left in its wake, often invisible in the glow of GDP figures and economic growth.

Poverty and Hunger: The Silent Killers

One of the most pervasive ways capitalism generates excess deaths is through poverty and hunger. Despite the extraordinary wealth produced by capitalist economies, millions still die from hunger-related causes every year. According to the World Health Organization (WHO), around 9 million people die annually from hunger and malnutrition, mostly in regions where capitalist-driven global inequality has made basic necessities unaffordable or inaccessible.[1]

Capitalism’s defenders often point to rising standards of living as evidence of the system’s success, but this narrative suffers from survivorship bias. The success stories of those who have benefited from capitalist growth obscure the countless lives that have been lost to the system’s structural inequalities. As Engels noted, these deaths are not natural or inevitable—they are preventable. They occur because the capitalist system concentrates wealth in the hands of a few while leaving vast populations to suffer without access to food, healthcare, or basic resources.

“For the dead, there is no measure of progress or rising standards; they are simply erased from the narrative.”

This disparity in wealth and access to resources creates a global system of social murder, where the deaths of the poor are written off as collateral damage in the pursuit of profit. These deaths are not merely unfortunate consequences; they are inherent to the capitalist system’s prioritisation of wealth accumulation over human life.

Healthcare Inequality and Preventable Deaths

The lack of access to adequate healthcare is another major driver of deaths attributable to capitalism. In the United States, the richest nation in the world, an estimated 500,000 deaths between 1990 and 2010 were linked to healthcare inequality, according to a Lancet study.[2] Globally, millions die each year from preventable causes—such as pneumonia, diarrhoea, and malaria—because market-driven healthcare systems fail to provide for those without the means to pay.

In a for-profit healthcare system, those without money are often denied life-saving treatment. Healthcare becomes a commodity, rather than a human right. This commodification of care creates deadly disparities, where a wealthy few receive world-class medical attention while millions die from treatable conditions. Engels’ notion of social murder is evident here as well: the system does not kill through direct violence but by neglecting the vulnerable.

“Capitalism’s market-driven healthcare system perpetuates a structural violence where the poor die from treatable conditions simply because they cannot pay.”

This situation is exacerbated by the ongoing commodification of healthcare through privatisation and austerity measures, which strip public systems of resources and force them to operate on capitalist principles. The result is a world where profit motives dictate who lives and who dies.

Environmental Destruction and Climate Change: Capitalism’s Long-Term Death Toll

Capitalism’s unrelenting focus on short-term profit also drives environmental destruction, contributing to a growing death toll linked to climate change. The WHO estimates that by 2030, climate change will cause approximately 250,000 additional deaths each year, driven by heat stress, malnutrition, and the spread of diseases like malaria and diarrhoea.[3] These figures are conservative, as the cascading effects of climate-induced migration and conflict are difficult to quantify.

David Harvey’s concept of accumulation by dispossession is central to understanding how capitalism contributes to environmental devastation. Capitalist economies extract and commodify natural resources, often at the expense of local populations who bear the brunt of environmental degradation. Deforestation, mining, and fossil fuel extraction displace communities and destroy ecosystems, creating conditions that lead to death, displacement, and disease.

“The victims of capitalism’s environmental destruction are not accidental casualties; they are the inevitable outcomes of a system that prioritises short-term profit over long-term sustainability.”

This environmental violence is compounded by disaster capitalism, a term coined by Naomi Klein to describe how capitalist interests exploit crises like natural disasters or financial collapses for profit.[4] The destruction of vulnerable communities by climate change is not simply a tragedy—it is a consequence of capitalist expansion into every corner of the planet, sacrificing human and ecological health for economic gain.

War and Imperialism: Capitalism’s Violent Expansion

The human toll of capitalism extends beyond poverty and environmental degradation to include the millions of lives lost to wars driven by capitalist interests. The illegal invasion of Iraq in 2003, for example, led to hundreds of thousands of deaths, many of which were tied to the geopolitical aims of securing control over oil reserves. Wars like Iraq are not isolated failures of policy but integral to the functioning of a global capitalist system that seeks to dominate resources and expand markets through military force.

David Harvey’s theory of new imperialism explains how capitalist economies rely on the expansion of markets and the extraction of resources from other nations, often through military means.[5] The military-industrial complex, as described by President Dwight D. Eisenhower, thrives under capitalism, profiting from perpetual war and the destruction of human life.

“Wars driven by capitalist interests are not just geopolitical strategies; they are extensions of capitalism’s relentless drive to dominate resources and secure markets.”

The death toll of wars driven by capitalist expansion is staggering. From the millions killed in conflicts over resources to the long-term destabilisation of regions like the Middle East, these deaths are directly tied to capitalism’s global ambitions. The victims of these wars—like those who suffer from poverty and environmental destruction—are casualties of a system that prioritises wealth and power over human life.

Conclusion: Reckoning with Capitalism’s Death Toll

The deaths attributable to capitalism are not abstract or incidental; they are the direct consequences of a system that places profit above all else. From hunger and poverty to healthcare inequality, environmental destruction, and war, the capitalist system has claimed millions of lives—lives that could have been saved under a more just and equitable economic model.

“Capitalism’s greatest violence is not its wars, but its everyday acts of neglect, where millions die not from bombs but from lack of food, water, and care.”

The true success of capitalism, then, is not in its ability to generate wealth for the few, but in its capacity to obscure the structural violence that sustains it. By framing poverty, healthcare inequality, and environmental destruction as unfortunate consequences of “market forces,” capitalism avoids accountability for the millions it leaves behind.

It is time to reckon with this hidden death toll. Only by facing the human cost of capitalism can we begin to imagine a future where economic systems prioritise human life over profit. The victims of capitalism are not just numbers—they are the casualties of a system that, as Engels pointed out, murders through neglect, exploitation, and greed.

Endnotes:

[1]: World Health Organization, “Hunger and Malnutrition: Key Facts,” 2022.
[2]: “The Lancet Public Health,” Study on healthcare inequality in the U.S., 2010.
[3]: World Health Organization, “Climate Change and Health,” 2022.
[4]: Naomi Klein, The Shock Doctrine: The Rise of Disaster Capitalism (Picador, 2007), pp. 9-10.
[5]: David Harvey, The New Imperialism (Oxford University Press, 2005), pp. 145-147.

Death Revisited

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A year ago, in March 2023, I spent nine weeks in hospitals. I remember the day I almost died. It was not life-changing or life-affirming. No tunnels, lights, angels, or life on replay in slow motion. Just me monologuing. Gasping for breath.

I was breathing three units of Oxygen through my nose, but I wasn’t getting enough. The staff upped the dose to five units and administered it through a face mask. I was gasping. They were pushing on a string. I wasn’t getting the Oxygen. Instead, I was gasping like a fish out of water.

No lights – just monologue. Being contemplative, I do this often anyway. I remember telling myself, just pick a side; flip a coin; in or out; live or die. I was indifferent to the outcome. I just wanted the suffering to end. Full stop. I had no investment in either outcome. I’ve lived a good life. I was at peace. I am at peace. A year on, and I’m still recovering.

The last thing I remember was telling a nurse, “I think you need to intubate me.”

“We might have to; she replied.

The next day, I awoke with tubes down my throat after an emergency surgery to drain fluid around my heart.

I can’t claim to have experienced a near-death experience, NDE, but I was on the threshold. There was no other side. No pleading. No review. Just me in the world I was thrown into – what Heidegger termed Geworfenheit.

This is all of us. Here without volition. Just trying to make it through. Before this incident, I didn’t believe in ageing. I was invincible. I lived life like a younger person, and no end was in sight.

Perhaps I was too quick to say this was not life-changing. Now, I realise the fragility in life – at least I was fragile. I aged overnight – and then some. Overshot my chronological age. This is where I remain. Vulnerable.

Although I’d like to return to work, I am still not employable. Besides all of the medical visits and physiotherapist, my ankle is broken, awaiting repair, and my hands still don’t quite work. I can type. I’m typing this. Slowly. Twenty words a minute. Lots of backspacing. A computer application might assist with this, but none do quite so. This translates to a twenty per cent productivity output. Not great.

I’ve always considered myself to be a knowledge worker, but I never realised how much I still need my hands. I’m not just a brain in a vat. I need to engage with the world.

I am recovering – slowly and not without setbacks. Still, I persist. I took the road less travelled. Might I have been better off taking the other road? It’s hard to say.

Cognitively, we humans have an endowment effect: We value what we have. For now, I have life. Irrational or otherwise, I’ll cling to it. I’ll hope for a better tomorrow, but hope floats. Hope and a dollar won’t buy you a cup of coffee at Starbucks. It’s a vapid yet very human fiction. I hope this next year will be better than the last. Let’s see where it goes.

Warmth

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My mind is a Pachinko machine; my brain fatigued. Add to this the environmental distractions, such as breakfast, and it’s not conducive to focus. Today, it’s scrambled eggs and dry muffins—sans jam or butter, only some whipped substitute unfit for human consumption,

My prompt for writing the recent post on Professionalism was my reaction to the hospital staff and their demeanour—or as a colleague suggested in a comment, decorum. Perhaps I can remain focused on the words on this page as I type.

For service staff, warmth is a necessary ingredient of professionalism. This is particularly true for persons in the healing arts. The top indicator for pursuing legal action in a medical malpractice suit is the doctor’s bedside manner—personality and disposition—, whether the patient feels a personal connexion—a human connexion.

My experience in hospital is that the Medical Doctors have been hit or miss in the department—more miss than hit. I can even recall the names of the memorable ones. I suppose were I to be ill-treated, I’d remember as well. Here, it’s either treated nicely as a human or otherwise as an object in an assembly line. Thankfully, there have been no mistreatments or abuse.

The Registered Nurses had a better warmth ratio. Asking my circle of family, friends, and associates, this seems to be the general consensus. The rest of the staff were somewhere in between.

This warmth or human connexion extends beyond healthcare and to the service industry where human-to-human contact is made, even where that connexion is virtual—perhaps more so in order to bridge the distance. In my experience, the human factor tends to fall more at or below the level of the Medical Doctors. Any warmth is accidental. I am not saying that the people themselves lack compassion—though that could be the case. Rather, I am saying that they are moulded into automatons by the systems they are part of. It saps people of their humanity.

I started writing a post titled Bureaucracy is Violence, but I never completed it because I got lost in research. In a nutshell, bureaucracy is a Procrustean bed. I’ll leave it there for now. If you know, you know. Meantime, rage against the machine.

Do not go gentle into that good night.
Rage, rage against the dying of the light.

— Dylan Thomas

Hospital Hospitality

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I find myself in hospital with an infection of a wound on my foot, so I’m taking an antibiotic IV drip. Fairly trivial. I’ve never stayed overnight in hospital, but they are suggesting that I expect to be here for a few days. It’s like a weekend getaway.  

I don’t prefer to interact with the healthcare system in the US. It’s the third leading cause of death, so better off avoiding it like the plague—not the Covid because it seemed to have been a consensus view to not avoid that particular plaque.  

Of course, the United States are a healthcare backwater. Not only do they have among the worst health outcomes, but the value calculus is also the worse because the cost is higher than most. Paired with sub-par outcomes, it’s just not an activity you want to participate it.  

If you are wealthy, you can buy premium services and achieve better outcomes, but this isn’t an option for most, hence the low bang-for-buck value.  

Currently being unemployed, I’ve got no health insurance coverage because unlike the rest of the Modern world, coverage is tied to employment. Private coverage can be purchased in the insurance marketplace, but costs are either prohibitive or coverage is homoeopathic.  

I happen to live in Delaware. Of all the states I’ve ever been in and needed to access healthcare, this is the worse. It could be because I am competing against Covid victims for access, so I try to keep this in mind. In the US, healthcare is a state-run system. In fact, insurance is specifically set up to require mini-monopolies in each state. If they could have managed to finagle control to the county or city level, I’m sure they’d have done it. There could be worse states. I’m almost certain they are. I’ve lived in Texas but never required care there, but I think Mississippi, Alabama, Louisiana, and states like that might be worse. I could be wrong.  

This said I came in through the emergency room yesterday because other options were pretty much closed because of Veterans’ Day. Not only do they have a day to celebrate the people behind the mayhem the US unleashes on the larger world, but it interferes with workaday life.  

I was at ER reception and in a room within 10 minutes—5 minutes to a triage nurse and 5 minutes to my room, where I spent ten hours yesterday. The ER staff were good in the manner that I had a good experience, especially Christopher, my attendant nurse. The Medical Doctor, who I met last was the 10th staff member I encountered. So this wasn’t a bad experience, but the parts leading up to this were.  

Speaking with the nurse, he said that I was lucky because it’s not only usually a 3 to 6-hour wait, there were no beds available, which is why I was housed in the ER all day. He told me that last week, twenty of the twenty-one available ER beds were occupied by regular patients, so they had one room to cycle through until they could discharge patients and play musical beds.  

People seem to be documenting copiously, and there is a nice patient portal for them and me to track status, appointments, test results, and so on, but they still seem to ask some of the same questions repeatedly.  

I moved into a long-stay room at about 1 AM and have been here ever since. My new doctor visited this morning and pointed out that my foot looked infected. I confirmed that had been the vector for my visit. He continued to repeat what the ER doctor had told me, so I was able to complete his sentences for him. The best part is when I told him I had no insurance. He checked to determine if he had heard me correctly. When I confirmed, he told me a podiatrist would be visiting to inspect the foot, and he exited the manner of the Warner Brothers’ cartoon Roadrunner. I swear I even saw the puff of smoke.  

So, my weekend may bleed into the workday week, and I can only hope that I don’t become another number having entered with no life-threatening condition. Unlike other Americans, I won’t ask for hope and prayers. Keep them, you may need them yourself. And I won’t rely on GoFundMe as a fallback plan, a strategy of too many Americans in a country that can’t seem to get much right when it comes to human matters. You may, however, wish me well and glad tidings.