As is typically the case after a high-profile murder, people are speculating about suspect Luigi Mangione’s state of mind when he allegedly killed United Healthcare CEO Brian Thompson outside a Hilton hotel in Manhattan.

We have a likely (political) motive in the form of a handwritten statement Pennsylvania police say they found on Mangione when they arrested him. “Frankly, these parasites simply had it coming,” it reads. “A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the (indecipherable) largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No, the reality is, these (indecipherable) have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allowed them to get away with it. … It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty.”

Thompson’s death immediately prompted the widespread assumption that his killer had to have been motivated by something personal. The CEO must have been the victim of a vengeful patient, or someone who loved and lost a person to an insurance denial. There are, after all, numerous Americans whom United Healthcare refuses to cover for medical treatment. Some die. But the man they arrested doesn’t fit the bill. Though Mangione’s social media feeds indicate that he had major back surgery following an injury, the operation appears to have been successful. There is no evidence that an insurance company denied his claim. United Healthcare says Mangione has never been their customer.

This looks like a case of self-radicalization.

Mangione was privileged and high functioning. If he can become a one-man terrorist group, anyone can.

The establishment press can’t wrap its collective head around it.

Writing in The New York Times, David Wallace-Wells is among the many journalists who wondered aloud: “We’ve seen the video of him shouting at the press as he’s pulled into the courthouse, which suggests perhaps some disquiet. But we also haven’t heard from anybody who interacted with him at any point in his life who found him anything but levelheaded, cleareyed, calm and even kind.” Why might someone with Mangione’s background (white, well off, Ivy educated), looks (women have been swooning over him online) and social currency (he was friendly and popular) stalk a business executive he’d never met and gun him down?

Perhaps, some reports suggested, back pain from spondylolisthesis drove him insane. Or that pain made it impossible for him to have sex and that made him nuts. Or his turn to violence was inspired by Ted Kaczynski’s Unabomber manifesto. He was 26, the average age when schizophrenia first manifests — maybe a mental time bomb was behind his psychotic break. One of these explanations may prove true. Or none. Mangione may be sane. He may simply be a class traitor.

Wallace-Wells continued: “In many ways, the obvious explanation is that the attack was the result of some kind of breakdown. But aside from the shooting itself, we haven’t seen any real signs of a breakdown.” (Except for shouting at the press. Wallace-Wells thinks that makes you unwell.)

Interesting questions arise from the assumption that mental illness is “the obvious explanation.” We are going to have to radically rethink our society if that’s true.

Are prison employees who administer capital punishment insane? What about combat troops who kill enemy soldiers whom they have nothing against personally, simply because they’re given an order? Are members of the military lunatics? Must one be crazy to serve as president, a job that involves ordering men and women to shoot and bomb other people — sometimes en masse — and signing off on extrajudicial assassinations, as with drones? Harry Truman dropped The Bomb. Was he psycho? What of a police officer who shoots a suspect? If a health insurance company unfairly denies lifesaving medical care to a patient and the patient dies, which one can argue is tantamount to murder, does that make a CEO like Thompson a murderer too — and therefore insane?

If everyone who kills a human being is psychotic, shouldn’t every killer be granted an insanity defense and automatically be sent to a psychiatric facility rather than prison?

What about farmers who kill animals? Vets who euthanize them?

When Marianne Bachmeier entered a West German courtroom in 1981 and shot to death the man who raped and murdered her 7-year-old daughter, there was no confusion. Everyone understood her motivation. It was personal and relatable, and therefore there was no talk that she might be bonkers.

Should it turn out that Mangione’s motive was personal, and that he or someone he cared about suffered pain at the hands of the health insurance industry, the discomfort of the chattering classes would be mitigated. Oh. That makes sense.

It is possible, though — likelier, really — that Mangione engaged with the question of America’s for-profit health care system impersonally and intellectually yet passionately. Like those who marched against the Vietnam and Gaza wars despite having no personal stake in the conflict, it is hard not to feel disgust and outrage when one hears horrific accounts of insurance companies denying and delaying valid claims as they rake in billions. Mangione had to have known, as everyone does, that there is no prospect of health care reform coming out of a Washington in which neither political party wants to fix the system.

People kill other people in service to far more abstract concepts than affordable health care. Political leaders kill over such dubious controversies as arbitrary borders and the domino theory and NATO expansion and the Shia-Sunni schism, yet nobody thinks they’re insane.

Murder, all societies agree, is wrong — unless it’s committed by someone officially authorized to take life. Vigilantism is problematic because, taken to its logical extreme, the rule of law would collapse.

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Dismissing a vigilante’s actions as the product of an unsound mind, however, thoughtlessly brushes off the question of why he feels compelled to resort to an act so drastic that it will probably end his own life as well. When one is confronted with massive suffering and heinous injustice, when society doesn’t offer a legal mechanism to stop these horrors, is it inherently insane to say to yourself, “someone should do something”? Or to conclude, “if the answer is yes, why not me?”

Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, co-hosts the left-vs-right DMZ America podcast with fellow cartoonist Scott Stantis.