Mencius’s four hearts: Reading the Manginoe’s case beyond the law

On December 4, 2024, UnitedHealth Group CEO Brian Thompson was fatally shot in Manhattan. Five days later, Luigi Mangione was arrested.

Throughout 2025, in court and in public statements, Mangione pleaded not guilty to all state and federal charges — despite what prosecutors described as overwhelming physical evidence tying him to the killing. His defence has centred almost entirely on the legality of that evidence, arguing that the gun, notebook, fake IDs, and other key items were obtained through an unconstitutional search and seizure.

By late December 2025, Mangione had attracted extraordinary public support. More than 36,000 individual donors had contributed to his legal defence fund, pushing the total past $1.4 million. The median donation hovered between $15 and $20. Many of the contributors left messages that were strikingly similar: searing accounts of personal claim denials, life-altering delays, or loved ones lost after treatment was refused by insurers.

While reading coverage of the case, I found that the usual vocabulary of the Rule of Law — due process, reasonable doubt — felt strangely hollow. It explained the courtroom battle, but it failed to touch the deeper social current running beneath the story. The experts focused on the legality of due process, while the deepest rift in the society was sidestepped. 

This case kept reminding me of Mencius and his famous principle of the “four hearts” (四心), offering itself as an entry point to introduce some timeless ideas that Mencius taught. 

Mencius taught that every human being is born with four innate moral sprouts — four “hearts.” The only question is whether we nourish them so they can grow into full virtues, or allow them to wither through neglect.

心 (xīn) is difficult to translate into English. It could be heart, feeling, intention, moral mind, or core sensibility, depending on where it is used. Therefore, instead of translating each of the four hearts into one word, let’s explain them in a sentence:

• 恻隐之心 (cè yǐn zhī xīn): The instinctive pain we feel when witnessing another’s suffering, as though the tragedy were our own
• 羞恶之心 (xiū wù zhī xīn): Shame at our own wrongdoing, and revulsion when we see others act unjustly
• 辞让之心 (cí ràng zhī xīn): The impulse to defer, share, or give way for the sake of others’s well-being  
• 是非之心 (shì fēi zhī xīn): The innate capacity to distinguish moral right from wrong and to judge accordingly

Let’s walk through Mangione’s case using these four lenses. (Important caveat: as of early January 2026, the time of writing, Mangione has said almost nothing about his motives and may never do so. Everything that follows about his inner state is therefore speculative, inferred from external evidence and his few written fragments.)

Health insurance began, historically, as a concrete expression of this very heart: we suffer when we see our neighbours ruined by sickness and medical bills, so we pool our resources to share the burden.

The modern U.S. health insurance system — especially its largest players — has drifted far from that origin. Instead of relieving pain, it has become a prolific generator of new suffering: the distinctive agony of the denied claim.

UnitedHealth has been repeatedly singled out by consumer advocates, physicians, and independent analyses as having one of the highest claims denial rates among major insurers — consistently in the 32–33% range in recent years. Once a claim is rejected, the individual is effectively powerless. The appeal process is labyrinthine, deadline-driven, and frequently fatal to the claim if any step is missed. Litigation is theoretically possible but practically prohibitive: a person must first exhaust the insurer’s internal appeals, and even then, legal costs usually dwarf the value of the disputed medical bill.

This structural powerlessness is the backdrop against which Luigi Mangione’s actions must be understood.

He came from a comfortable family, suffered a serious spinal condition himself, underwent successful surgery, and was never — to anyone’s knowledge — a UnitedHealth policyholder who experienced a claim denial. He could easily have counted himself among the fortunate and moved on with his life as an Ivy League graduate.

Yet he appears to have felt — viscerally — the pain of those who were not so lucky. His notebook entries reportedly described insurance giants as “parasitic,” suggesting that his feelings extended beyond his personal circumstances to encompass a much wider swath of American suffering.

That brings us to the second heart.

We feel shame when we ourselves do wrong (or fail to do right). We feel disgust — even hatred — when we witness others committing grave injustice and getting away with it.

Mangione’s act, however one judges it, seems to flow directly from this second heart. He apparently came to regard the health insurance industry’s profit model — extracting premiums while systematically denying care — as intolerable wrongdoing. More importantly, he seems to have felt that doing nothing in the face of it would make him complicit, would leave him ashamed of his own inaction.

It was this visceral sense of 羞恶之心 that appears to have tipped contemplation into action.

This is precisely the virtue that the contemporary for-profit insurance model most conspicuously lacks.

Unlike the original mutual-aid spirit of insurance, today’s dominant U.S. health insurers are publicly traded corporations whose overriding legal duty is to maximise shareholder value. Every dollar spent on patient care is a dollar that cannot be returned as profit or executive compensation. The structural incentive to deny, delay, or limit care is therefore built into the business itself — an incentive that has only intensified with the rise of AI-driven “autodenial” systems capable of rejecting thousands of claims in seconds with little or no human oversight.

In place of yielding and sharing, we see systematic extraction. Health insurance CEOs routinely out-earn their counterparts in tech and finance.

While the upper echelons of the industry displayed avarice, a quiet counter-movement of 辞让之心 appeared among ordinary people: hundreds of thousands of small donations sent to a defence fund for a man accused of murder — a striking grassroots gesture of care. 

Legally, the insurance companies have broken no law. Their most aggressive denial practices, while frequently called predatory, remain within the bounds set by U.S. statutes and court precedents.

Legally, it is Luigi Mangione who stands accused of first-degree murder — a crime that carries the possibility of the death penalty.

Yet once the three prior hearts are taken seriously, the picture of “right and wrong” becomes far more conflicted than the statute books can acknowledge. Before the law, almost no one will call Mangione’s act right. Before conscience, however, very few people seem ready to call the behaviour of the major insurers right either.

The spectacle of hundreds of thousands of Americans funding the defence of an alleged assassin is not, at bottom, an endorsement of murder. It is a howl of moral judgment — a collective statement that the current arrangement of power and suffering is profoundly wrong, and that conventional politics and law have proven incapable of correcting it.

You can debate statistics, regulations, medical loss ratios, and actuarial tables for years.

But you cannot argue with hearts.

In words and legal filings, the insurance giants almost always hold the stronger cards. In hearts — in the place where people decide what ultimately matters — they have already lost the argument.

When more than 36,000 people, mostly in small amounts, send money to support the defence of a man accused of killing a health insurance CEO, they are not mainly saying “murder is good.”

They are saying something simpler, older, and harder to refute:

We still feel.  

We still know shame.  

We still want to share rather than extract.  

And we still can tell right from wrong — even when the law pretends not to see it.

That is what Mencius’s teaching is all about all along.

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