Political Violence Is Inevitable

The performative condemnations of Brian Thompson’s assassination shows the underlying premise of journalism is still alive – never go beyond the surface issues. The brutality of Thompson’s assassination is comparable to the brutality of a private healthcare system that condemns tens of thousands of American people to live in chronic pain, miss cancer diagnoses and avoid treatments. An insurance system that regularly denies claims, with UnitedHealth being one of the worst providers for claim denials[1]. News coverage is nothing if not ephemeral, focusing on the manhunt for the killer and airing condemnations of the act. It should be remembered that this is in a country where people celebrated the assassination of Osama Bin Laden on the streets.

Of course, that belies the point that political violence isn’t about morality, it’s about legitimacy. The assassination of Brian Thompson is illegitimate because it is the wrong way to attack the American healthcare system. Voting and political activism are the correct way to change systems. Never mind that UnitedHealth are a major lobbyist with influence far outstripping that of its policyholders[2], who hold monopoly power over healthcare providers and physician networks and have upcoded Medicare patients so as to swindle taxpayer money[3]. If you vote hard enough or engage in the labyrinthine farce of legislative change (which is rigged at all levels by lobbying networks like the American Legislative Exchange Council) only then can you have a say over healthcare outcomes.

The capacity to force people to make life-altering decisions on the basis of affordability of treatment is itself legitimate, despite the lawsuits and antitrust actions against it (lobbying efforts will inevitably dilute such things). The assassination makes no significant difference, other than to potentially obfuscate the dire state of American healthcare. But then, there is no other solution either. It is a system that begets violence, yet is condemnatory when violence is directed its way. The restriction of surgical anaesthetic, preventions of cancer screenings and denial of coverage are themselves violent, as they perpetrate physical pain on those that have extremely limited options.

Violence of this type is systematic rather than individual, endogenous to the dynamics of modern bureaucracies. Bureaucracies, funded through violence in taxes and subsidies, that are dysfunctional, faceless and largely unaccountable. The distinction between public and private breaks down in these structures, defined by a shared system of understandings and intricacies that mean even antagonistic action is subsumable in a larger field of lobbying and collusion.

These systems are also sclerotic, more interested in self-preservation than service delivery. The capability to receive adequate care recommended by a medical professional is intermediated by a smorgasbord of institutions that are opaque in their functioning and whose role in the delivery of care is difficult to discern. Chapman describes it as no system, no interface, no fault, no local fix. A non-systemic system in that officially there is a healthcare system that runs from diagnosis to cure, but with each part of the system lacking communicative interfaces for care delivery and where fault is spread to each part, with no ability to assign responsibility.

“It appears that 73% of the labor cost of a health care organization is spent on trying to communicate with other health care organizations that have no defined interface”. “Organizations in sectors afflicted with inefficiency disease try to push their own administrative work outside. Both out into other organizations, and—more visibly—they force it onto you, the customer”[4]. This is a wider description of most bureaucratic systems, from healthcare and education to infrastructure planning and construction. Disordered organigrams with no fixed point. A typical experience of trying to find someone responsible for something involves being passed around constantly from one part to another, eventually either bribing someone if you have the means and knowhow or giving up. Imagine trying to do that while dealing with a terminal or severe diagnosis.

Modern degradation of services is reflective of cost disease, where prices increase as efficiency of delivery stagnates or declines. In real terms, “the average 1960 worker spent ten days’ worth of their yearly paycheck on health insurance; the average modern worker spends sixty days’ worth of it, a sixth of their entire earnings”[5]. It also means the USA has huge healthcare expenditures with little to show in terms of life expectancy increases (which are more attributable to lifestyle changes and workforce composition as manual labour is significantly reduced as an employment market factor). Taking into consideration the modern obesity rate and prescription rates[6], it would suggest this expenditure has retarded healthy lifestyles and made people reliant on increasingly expensive drugs and treatments which are overprescribed and unnecessary. UnitedHealth’s practices of overbilling and upcoding speak to this.

Part of this is administrative bloat, the HRification of industries[7] that plough increasing amounts of money into employee development and regulatory compliance, creating a cannibalising feedback cycle of more administrative courses and codes justifying increased expenditure on administrators, compliance officers and managers. Even in the face of a deregulatory government that cuts red tape these compliance procedures and regulatory apparatuses stay put. Dobbin & Sutton make the point that the legacy of equal opportunities employment and health and safety codes created a private adjunct to public regulations introduced through the Civil Rights Act and Occupational Safety and Health Administration.

“The state issues ambiguous mandates to organizations, changes rules frequently in response to protracted political negotiations and litigation, and enforces its rules in a fragmented and indecisive way. Although these features cause it to appear weak, we argue that they produce a peculiar kind of state strength. First, because the state leaves the terms of legal compliance unclear, organizations commit considerable resources to devising compliance measures. Second, because the state signals uncertainty about the legitimacy of its own authority, organizations develop rationales for those compliance solutions that locate authority in the market”[8].

In relation to college education, Alexander makes the point that “some of it is the administrative bloat that you would expect. But a lot of it is fun ‘student life’ types of activities like clubs, festivals, and paying Milo Yiannopoulos to speak and then cleaning up after the ensuing riots”[9]. While Alexander appears to be distinguishing these, administrative bloat and experience are two sides of the same coin. One of the major justifications for administrative expansion in universities is to improve the student experience, as well as acting as a bulwark against the demands of academic education. Thus the expansion of student welfare services and student representation on college committees. None of it means very much, as most proposals get lost in meeting minutes and buried in delivery costs, but the constant desire for experience as an end in itself partly explains this expansion of costs at the expense of efficiency.

Alexander also talks of risk reduction as another factor creating cost disease, which again feeds into the managerial discourses of employment law, equalities laws, health and safety codes, etc. In the UK, the expansion of equalities law into indirect discrimination[10] has created the ridiculous situation of comparing jobs on arbitrary criteria to determine whether a person has been discriminated against on the basis that their job is comparable to another job, meaning they should have been paid more despite not doing the same work. In future, this means a potential reduction in pay across an organisation so as to equalise pay rates to meet the legal criteria and reduce the risk of multimillion pound lawsuits like that bankrupting Birmingham City Council. “As more things become institutionalized and the level of acceptable institutional risk tolerance becomes lower, this could shift the cost-risk tradeoff even if there isn’t a population-level trend towards more risk-aversion”[11].

“These intricate institutions all run on the systematic mode of relating to meaning”. “In summary, the systematic mode demands that society operate according to a structure of justification, built from chains of reasons. It is ‘rational’ at least in that everything has to make sense, in terms of ‘this, therefore that’”[12]. This is the mechanism of growing social complexity and the subsequent goals it sets. The determination of healthcare success is in life expectancy, irrelevant of quality of life, because life expectancy is measurable and calculable. The determination of a nation’s education is in the level of qualification attained, irrespective of the content learned or subject matter. Thus, an overproduction crisis of care needs, educated elites and demographic alterations (gerontocratic societies and below replacement fertility rates) which the current systemic mode cannot solve. It can only create more of the same.

Currently, there is no socio-political force seemingly capable of articulating what this shift would entail. Instead, there is regression back to the communal mode of face-to-face interaction and personal cultivation (i.e. knowing the right people). And within that communal mode is the desire for violence against elites who are obviously gaming the system and enriching themselves.

“I’m more worried about the part where the cost of basic human needs goes up faster than wages do. Even if you’re making twice as much money, if your health care and education and so on cost ten times as much, you’re going to start falling behind. Right now the standard of living isn’t just stagnant, it’s at risk of declining, and a lot of that is student loans and health insurance costs and so on”[13]. This is the stage many societies are at. The outcomes will become increasingly violent, not in the sense of revolution but in the normalisation of everyday violence. In a growing selfishness relative to other’s needs. Interacting with institutions aggressively or bribing people to get things accomplished. “The institutional configurations that previously understood the traditional roles of territory, place, scale and network are now fumbling in the dark for some coherence”[14].

The assassination of Brian Thompson is the same impulse seen on the right who demand judges, whose sentencing recommendations for violent minorities and paedophiles are nonsensical and highly lenient, become afraid of the general public when making those decisions. It’s the same impulse that encouraged the Capitol and Southport riots in the USA and UK respectively. Ways of life, means of employment and the accessibility of services are blatantly degrading, yet there is no political force willing to reckon with the cost of and requirements needed to tackle it. On healthcare, immigration, infrastructure and service provision generally the governing elites are much happier with managed decline. The flipside of that decline are bullets, political mobs and the return of the spectacle of violence à la Foucault. Particularly when those targets are the only obvious representation of institutions that are venally corrupt and exist to profiteer.

[1] https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals

[2] https://socialistworker.co.uk/international/unitedhealthcare-ceo-got-a-dose-of-his-own-medicine/

[3] https://www.economicliberties.us/data-tools/unitedhealth-group-abuse-tracker/#

[4] https://metarationality.com/post-apocalyptic-health-care

[5] https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

[6] https://pmc.ncbi.nlm.nih.gov/articles/PMC10656114/

[7] https://www.newstatesman.com/business/2024/11/hr-britain-how-human-resources-captured-the-nation

[8] https://www.journals.uchicago.edu/doi/10.1086/210044

[9] https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

[10] https://www.legislation.gov.uk/ukdsi/2023/9780348253191

[11] https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/

[12] https://meaningness.com/communal-vs-systematic-politics