SAN FRANCISCO — Backstage before Monday’s performance of “Luigi: The Musical,” actor Caleb Zeringue cracked a joke about how his castmate who plays the title role has to skip the show’s European debut because such a trip could cost him his health insurance.

The barb strikes at one of the key themes in the show about alleged murderer Luigi Mangione: The whims of the U.S. health care system can drive people to do drastic things.

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