The Best Thing About the Proposed California Initiative Named After Luigi Mangione Is the Title

His name and likeness have appeared on t-shirts, in graffiti, and in so, so many memes. Now, Luigi Mangione, the alleged killer of UnitedHealthcare CEO Brian Thompson, might have his name end up in a California law as well.

Over the weekend, California news outlets reported that a proposed ballot initiative titled the “Luigi Mangioni [sic] Access to Healthcare Act” had been submitted to the California Attorney General’s Office for review.

The proposed initiative’s title is predictably drawing a lot of attention, as it is named after an alleged murderer.

The proposed initiative’s author, retired Los Angeles-based attorney Paul Eisner, says that’s kind of the whole point. “It is getting the attention it needs because sometimes things require publicity,” Eisner told CBS 8.

While it has certainly attracted publicity, the controversy over the proposed ballot initiative’s working title has distracted people from its even worse substance.

Eisner’s proposal states that no insurer may “delay, deny, or modify any medical procedure or medication” recommended by a treating physician—or even demand reduced payment for such treatments—if doing so could result in disability, death, permanent disfigurement, or the loss or reduction of “any bodily function.”

Insurers would have to rely on their own doctors to deny a claim or reduce payment for a procedure. If an insurer is sued for denying a claim, they would have to prove with “clear and convincing” evidence that the procedure is unnecessary. This would mean that an insurer couldn’t argue they are denying a claim because the provider’s proposed costs are outrageously high.

The consequences of this initiative would be sweeping and probably fatal for private insurance in California.

Almost every treatment a doctor would recommend could plausibly be defended as at least protecting some bodily function. Proving that a treatment is in fact unnecessary would be a very high bar indeed.

In effect, the ballot initiative would put insurers in a position of either immediately approving every claim submitted to them or fighting a lawsuit that they’d almost certainly lose.

Since the ballot initiative guarantees successful litigants against insurance companies treble damages and attorneys fees, anyone whose claim was denied would have a major incentive to sue.

Because the initiative effectively prohibits insurers from even reducing payment for a procedure, they would also effectively lose their ability to bargain with healthcare providers over prices.

That would give healthcare providers a very obvious incentive to raise prices on all their services.

At a minimum, insurers would have to massively raise premiums to cover the new costs they’d be exposed to under this proposed system. Spiking premiums would see them shed customers, and plausibly go out of business completely.

One couldn’t imagine a better system for creating an insurer “death spiral.”

It is easy to dismiss Eisner’s proposed ballot initiative as an unserious effort. He’s just one guy proposing a ballot initiative. He still needs approval from the attorney general to start collecting signatures in order to actually get it on the ballot. And he even spelled Mangione’s name wrong in his application.

Nevertheless, California has a history of gadflies getting far-reaching policies on the ballot that then end up winning. Liberal California likes to point to Proposition 13, which limited property tax increases, as the canonical example of this.

Another example would be Proposition 103, a 1988 initiative pushed by consumer advocates that created California’s current regulatory regime for property and auto insurance.

Prop. 103 limits insurers’ ability to raise rates on policyholders and creates a laborious system to justify whatever price increases they are still permitted.

This has prevented insurers from incorporating increasing wildfire risks into their rates. As wildfire damages have mounted in recent years, insurers have responded to Prop 103’s incentives by limiting the business they do in California wherever possible.

The design of Eisner’s initiative is slightly different. It would effectively mandate higher insurance payouts as opposed to capping upfront insurance costs.

But like Prop. 103, his initiative treats insurance companies as a source of endless money that faces no resource constraints and whose policies need not be based on market prices.

As much as people dislike insurance companies, they play an important role in America’s healthcare system. They’re one of the few institutional actors that has an incentive to actually keep healthcare costs down.

That’s not an argument that typically resonates with the public. The widespread view of insurance companies as malevolent actors is one of the reasons why Mangione’s alleged crime has turned him into a dark folk hero.

Fortunately, most people still find murder bad, even if the victim is a despised insurance executive.

Even Eisner can’t bring himself to fully endorse Mangione. In his comments to CBS 8, Eisner condemned Mangione’s alleged violent tactics, saying instead that he was trying to do things “the right way.”

While it certainly generated a lot of publicity, it’s likely that Eisner’s proposed ballot title will sap support for a ballot initiative that could conceivably have passed had it not been named after an alleged murderer.

In that way, the best thing about Eisner’s proposed initiative is its repulsive title. It’ll turn people off from voting for a potentially popular, truly destructive policy.

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