This is What Systemic Violence Looks Like: The US Healthcare System

In this op-ed in The Guardian, Arwa Mahdawi asks what forms of murder are socially acceptable. While condemning Luigi Mangione’s assassination of Brian Thompson, CEO of the health insurance company United Healthcare, she rather darkly suggests ways Mangione could legally have gotten away with murder. One of them is becoming an executive at United Healthcare or another US health insurance company. Such companies routinely deny people vital healthcare, which Mahdawi argues is essentially legalized murder. Mahdawi raises an important issue but falls conceptually short in framing it in individualized terms. One of the reasons healthcare executives can get away with this is because this is systemic violence. Too often, we think of violence solely as something people directly do to each other. Systemic violence can certainly take this form—think of police brutality. But real violence can be done in seemingly more abstract ways, such as company policies that deny people necessary healthcare. Because it happens through abstract policies, it doesn’t look like what we think of as violence. As sociologist Dorothy Smith argued in The Everyday World as Problematic, in a bureaucratic society like ours what she calls “relations of ruling” take place primarily through such abstract policies. But just because the policies are abstract doesn’t mean they can’t have a devastating impact on our lives. In the case of denying people vital healthcare coverage, this devastation is done to people’s bodies, robbing them of their health and their lives. And what is this, if not systemic violence? All this reinforces the urgent need to fundamentally transform our healthcare system in the US so it is focused on actual healthcare and not profitability.