“The System Is Rigged. The Cavalry Is Not Coming. We’re on Our Own,” by Anand Giridharadas, New York Times, Sept. 14, 2026
For a few moments on May 1, 2023, an extraordinary amount of American life was compressed into one New York subway car.
There was Jordan Neely, a 30-year-old Black man, homeless and suffering from mental illness, frightening passengers beneath a city still shaken by Covid. There was Daniel Penny, a white former Marine from Long Island who put him in a chokehold. There were bystanders facing a dilemma that would feel familiar to many Americans: wait for the system to work, take matters into their own hands or withdraw. And hovering in the air of car No. 9774 was America’s deepening crisis of trust — in institutions, in strangers and even in the belief that anyone is coming to help.
When Mr. Neely died in that encounter and Mr. Penny was charged with killing him, an American tragedy was instantaneously reduced to an American Rorschach test: What did you see in Mr. Penny, a hero or a vigilante? Was Mr. Neely a victim or a menace? … A death on the subway that seemed to prove that Americans now inhabit perfectly sealed, irreconcilable moral universes actually revealed one of the last things we have in common — abandonment.
[Giridharadas notes: Neely was abandoned by underperforming social service systems, and Penny by underperforming law enforcement.]
These sentiments will be familiar to many Americans. The defining political emotion of the age may be the sense that power, and with it the ability to push back on what bears down on you, is somewhere other than where you are, that you are unheard and unseen, that you are acted on but lack the means to act. Beneath so many disparate political phenomena — the Epstein files, A.I. doom, immigration, prices, housing, weak leadership — is that feeling of being undefended.
Why is a sense of abandonment so potent in America today — and so widespread across the divides of party and tribe and geography? … For many Americans, public authority has come to feel impossibly erratic. …
Then one day during jury deliberations in the Penny case, news rippled through the courtroom that the chief executive of UnitedHealthcare, Brian Thompson, had been shot and killed in Midtown Manhattan. Soon the murder suspect, Luigi Mangione, would be brought before the law, and some of the same reporters would pivot to covering a new case in the same building. And just as quickly as in the Penny case, Mr. Mangione began to be described by some on the left in the same terms as Mr. Penny was being framed on the right: as someone stepping into the void — in this case, into the byzantine, claim-denying vacuum left by health insurance companies.
Comment:
By Jim Kahn, M.D., M.P.H.
Abandonment is a potent frame for US health insurance. The system isn’t a “system” – it’s a collection of poorly functioning components that together grossly fail to achieve the goal: quality health care for all.
Echoing the analysis by Giridharadas, abandonment in today’s health care has three critical elements: “The system is rigged” … resources flow preferentially to the well-insured (and rich). “The cavalry is not coming” … no public institution can fix the current approach. And, “We’re on our own” … day-to-day responsibility is pushed onto individuals, families and communities, who lack the information and resources to solve the problems.
The individual is a consumer feebly navigating daunting insurance tasks. Pick the right plan. Find the right in-network doctor. Determine whether a service is covered. Compare prices and cost-sharing. Appeal denials. When all else fails, set up a GoFundMe.
In other words, rather than rely on a collective institution designed to be effective and efficient, as shown possible in all other wealthy nations, we abandon responsibility (and daunting choices) to the individual. The government operates some health insurance programs and tries to regulate private insurance, but these efforts are riddled with gaps. The result is friction, omissions, errors, and unnecessary suffering.
Health care is a textbook example of the proper role for collective action, because the requirements of well-functioning economic markets — information on quality and prices, bargaining power, ability to defer purchase, and predictable need — are absent (again: thanks to Ken Arrow for demonstrating this decades ago).
An insurance system that offers people 47 plans creates the illusion of “choice” while decreasing people’s actual control over their lives.
The principal purpose of health reform is to replace unworkable individual responsibility for navigating financing with a collective public solution – Medicare for All.
That’s what I call, “de-abandoning” health care.
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