Luigi Mangione, 26, a suspect in the New York City killing of UnitedHealth executive Brian Thompson, poses for a booking photograph at State Correctional Institution (SCI) Huntingdon in Huntingdon, Pennsylvania, U.S. December 9, 2024. File
| Photo Credit: PA Department of Corrections

After Luigi Mangione made the difficult decision to undergo spinal surgery last year for chronic back pain, he became a proponent of the procedure that changed his life for the better.

He repeatedly posted on Reddit about his recovery and offered words of encouragement for people with similar conditions, telling them to push back against doctors who suggested they had to live with pain.

But notably absent from the posts are explicit concerns about corporate greed in the health insurance industry. Those appear to have surfaced only later: in a handwritten note found after Mr. Mangione was detained as a suspect in the killing of UnitedHealthcare CEO Brian Thompson.

That short document references “parasites” in the health care system and laments the power and profits of health insurers, according to law enforcement officials. During his first public words since his arrest in Pennsylvania, Mr. Mangione emerged from a patrol car shouting about an “insult to the intelligence of the American people” while sheriff’s deputies pushed him into a courthouse.

There’s no indication Mr. Mangione was ever insured by UnitedHealthcare, a senior New York City police official said in an interview Thursday (December 12, 2024) with NBC New York.

The killing has nonetheless prompted widespread speculation about whether he had a bad personal experience with the health care system. But after his 2023 surgery, Mr. Mangione’s Reddit posts suggest he was overwhelmingly pleased with the outcome and finally relieved of chronic pain. He encouraged others not to be frightened by horror stories of surgeries gone bad. He also referenced a backpacking trip to Asia earlier this year.

The 26-year-old Ivy League graduate appears to have stopped posting on social media roughly six months ago, around the time he lost touch with loved ones.

Family and friends expressed shock at news of Mr. Mangione’s arrest, but little information has emerged about his recent mental and physical health.

Mr. Mangione’s Reddit posts reference a spinal condition called spondylolisthesis, which occurs when a fracture causes a vertebra to slip out of alignment. It can result in severe pain if the bone puts pressure on spinal nerves.

The condition, which can originate in childhood or from an injury, started negatively impacting Mr. Mangione’s life in recent years, according to his social media posts.

After earning his bachelor’s and master’s degrees from the University of Pennsylvania, he worked at the Santa Monica-based car-buying website TrueCar until 2023 and lived in Hawaii for some time starting in January 2022. During a six-month stay at Surfbreak, a “co-living” space in Honolulu, Mr. Mangione’s back pain worsened in part because of a surfing incident.

Josiah Ryan, a spokesperson for the owner and founder of Surfbreak, R.J. Martin, said Mr. Mangione had expressed growing concerns about the pain. In addition to missing out on recreational activities and exercise, he was worried about how it could affect romantic relationships.

“That was definitely a theme in his time there,” Mr. Ryan said. “He wasn’t a big complainer. So, it wasn’t like he was bringing it up constantly. But the people who knew him knew this was a significant part of his life.”

In July 2023, Mr. Mangione wrote in a Reddit post that he had decided to get surgery.

“I got caught in this loop for a year, all the while putting my life on hold in my 20’s and damaging my nerves while I waffled on the decision. I have surgery scheduled in two weeks and I keep wondering why I was so afraid of it,” he wrote. According to his posts, the operation was a success.

An image posted to an X account linked to Mr. Mangione showed what appeared to be an X-ray of a metal rod and multiple screws inserted into his lower spine.

“Surgery was painful for the first couple days, but I was shocked that by day 7 I was on literally zero pain meds,” Mr. Mangione posted on Reddit in August 2023. “Obviously will be awhile until I get into rigorous activity, but it was way less of a big deal than I had anticipated.”

Medical experts say treating back pain is almost always a challenge. “In the gross majority of treatments, surgery is when everything else has failed to provide relief,” said Dr. Jason Pittman, co-director of the Spine Center at Boston’s Beth Israel Deaconess Medical Center. He said doctors generally try conservative treatments like physical therapy, injections or medications before surgery.

Even people with health insurance can face thousands of dollars in bills from a surgery depending on their deductible and other factors, though it’s unclear whether Mr. Mangione experienced any of those issues.

Experiencing chronic back pain can also significantly impact mental health, said Dr. Padma Gulur, a pain specialist with Duke Health. “If you have underlying mental health issues – anxiety, depression – your pain can be worse because you have way more suffering,” Ms. Gulur said. “But the second aspect is pain can push you into anxiety and depression.”

Little is known about Mr. Mangione’s mental state in recent months, but it appears he was withdrawing from close relationships. Since-deleted posts on X show a friend repeatedly reaching out and getting no response. His family reported him missing to San Francisco authorities in November, police said.

Earlier, while in college, Mr. Mangione posted on Reddit about experiencing severe brain fog and restless sleep. In a July 2018 post, he said his grades were suffering and he had considered dropping out of school. But ultimately, “staying in college has at least let me maintain some semblance of normality,” he wrote.

His last Reddit post is dated May 17, but other statements around that time suggest he wasn’t experiencing unexpected complications or renewed back pain. He appears to be advocating for the type of surgery he received months earlier.

He posted in early April about the gear he brought on a two-month backpacking trip through Asia that included some cross-country motorcycling, saying he had found “the perfect balance between minimalism and practicality.” In late April, he advised another Reddit user with a back problem to “keep trying different surgeons” and, if necessary, convey an inability to keep working.

“We live in a capitalist society,” he wrote. “I’ve found that the medical industry responds to these key words far more urgently than you describing unbearable pain and how it’s impacting your quality of life.”

An undated New York City Police Department (NYPD) handout image obtained by Reuters on December 5, 2024, shows an individual wanted for questioning in connection with the killing of UnitedHealthcare CEO Brian Thompson. Photo: NYPD/Handout via Reuters.

The man charged with murder in the killing of the CEO of UnitedHealthcare made it clear he wasn’t going to make things easy on authorities, shouting unintelligibly and writhing in the grip of sheriff’s deputies as he was led into court and then objecting to being brought to New York to face trial.

The displays of resistance on Tuesday (December 10, 2024) weren’t expected to significantly delay legal proceedings for Luigi Nicholas Mangione, who was charged in last week’s Manhattan killing of Brian Thompson, the leader of the United States’ largest medical insurance company. Little new information has come out about possible motivation, though writings found in Mr. Mangione’s possession hinted at a vague hatred of corporate greed.

In his first public words since he was arrested at a McDonald’s in Pennsylvania after a five-day search, the 26-year-old Ivy League graduate from a prominent Maryland real estate family emerged from a patrol car shouting about an “insult to the intelligence of the American people” while deputies pushed him inside a Courthouse.

A law enforcement bulletin obtained by The Associated Press (AP) said that at the time of his arrest, Mr. Mangione was carrying a handwritten document expressing anger with what he called “parasitic” health insurance companies and a disdain for corporate greed and power. He wrote that the U.S. has the most expensive healthcare system in the world and that profits of major corporations continue to rise while “our life expectancy” does not, according to the bulletin.

Mr. Mangione remained jailed in Pennsylvania, where he was initially charged with possession of an unlicensed firearm, forgery, and providing false identification to police.

Manhattan prosecutors were beginning to take steps to bring Mr. Mangione to New York, but at a brief hearing Tuesday (Dec. 10), defence lawyer Thomas Dickey said his client will not waive extradition and instead wants a hearing on the issue. Mr. Mangione was denied bail after prosecutors said he was too dangerous to be released. He mostly stared straight ahead at the hearing, occasionally looking at papers, rocking in his chair or looking back at the gallery.

“You can’t rush to judgment in this case or any case,” Mr. Dickey said afterward. “He’s presumed innocent. Let’s not forget that.” Mr. Mangione was arrested in Altoona, Pennsylvania, after a McDonald’s customer recognised him and notified an employee, authorities said.

New York police officials have said Mr. Mangione was carrying a gun like the one used to kill Thompson and the same fake ID the suspected shooter had used to check into a New York hostel, along with a passport and other fraudulent IDs.

A law enforcement official who wasn’t authorised to discuss the investigation publicly and spoke with The AP on condition of anonymity said a three-page, handwritten document found with Mr. Mangione included a line in which he claimed to have acted alone.

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone,” the document said, according to the official.

Thompson, 50, was killed on December 4, 2024, as he walked alone to a Manhattan hotel for an investor conference. From surveillance video, New York investigators determined the shooter quickly fled the city, likely by bus.

Mr. Mangione was born into a life of country clubs and privilege. His grandfather was a self-made real estate developer and philanthropist.

“Our family is shocked and devastated by Luigi’s arrest,” Mr. Mangione’s family said in a statement posted on social media late Monday (Dec. 9) by his cousin, Maryland Del. Nino Mangione. “We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved.”

From January to June 2022, Luigi Mangione lived at Surfbreak, a “co-living” space at the edge of touristy Waikiki in Honolulu. Josiah Ryan, a spokesperson for owner and founder R.J. Martin, said he was widely considered a “great guy,” though he had long dealt with severe back pain that interfered with many aspects of his life.

The Mangione family, long seen as “beloved” royalty in Baltimore, is reeling from the recent arrest of Luigi Mangione, accused of killing UnitedHealthcare CEO Brian Thompson. Known for their immense wealth, philanthropy, and a long history in the healthcare sector, the Mangione family’s legacy now stands in contrast to the shocking crime allegedly committed by Luigi, a 26-year-old University of Pennsylvania graduate.

Luigi’s family history is one of immigrant success. His late grandfather, Nick Mangione Sr, often shared his rags-to-riches story, proudly recounting his rise from humble beginnings. “I didn’t have two nickels to rub together when my father died when I was 11, yet I still became a millionaire,” Nick had said to The Baltimore Sun, recalling his father’s struggles as an Italian immigrant and his own determination. “What other country can you do that in? None that I can think of.”

Nick Mangione’s empire spanned a range of industries, from owning local resorts and country clubs to operating nursing homes and even a radio station. He and his wife, Mary, were also philanthropists, donating millions, including over $1 million to the Greater Baltimore Medical Centre, where all of their 37 grandchildren were born. In honour of their contributions, the hospital even named its obstetrics unit after the Mangione family.

The Mangione Family Foundation has also made significant donations to institutions like St. Jude Children’s Research Hospital and St. Joseph Medical Centre at the University of Maryland. Loyola University’s pools are named after them, and several family members, including six of Nick and Mary’s children, attended the local college.

The family’s influence also extends into the political sphere, with Nick’s grandson, Nino Mangione, serving in Maryland’s House of Delegates.

Despite their sterling reputation, the Mangiones were blindsided by the arrest of Luigi. The motive allegedly comes from Luigi’s anger toward the US healthcare system – a sector his family has greatly supported.

According to reports, Luigi Mangione is accused of fatally shooting Brian Thompson in a Midtown sidewalk attack, allegedly fuelled by his disdain for what he viewed as a “mafioso” of greedy healthcare companies. His uncle, Jerry O’Keefe, told the NY Post, “It’s a shock for all of us. I can’t say anymore. The statement summed it up for all of us. We don’t know anything more than what’s been reported in the media.”

A McDonald’s staff is credited with the breakthrough in the manhunt that followed the murder of UnitedHealthcare CEO Brian Thompson. A witness at the Pennsylvania outlet, who saw the cops swoop away 26-year-old Luigi Mangione, said the customers were struck by the resemblance of the suspect with that of circulated images.

The New York Police Department had released photos of the suspect two days ago – after the killing sparked a nationwide manhunt and made global headlines.

The witness, identified by only his first name Larry, told BBC he had gone to the McDonald’s in Altoona town for coffee with about five of his friends. At the outlet, one of his friends talked about the suspect’s resemblance – that he was wearing similar clothes in the images circulated by the cops, but Larry felt that he was joking.

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Larry said when he asked that friend about it the next morning- after the suspect was arrested – he said, “Yes, I was serious.”

Another restaurant employee, whom Larry spoke to, said he found a similarity with his “eyes and eyebrow” while noting down his order. He was working on a laptop, wearing a mask and a beanie, that time.

A staff at the fast-food restaurant tipped the cops after another customer recognized the suspect. Mangione, who was an Ivy League student, was soon arrested from the outlet and was charged with the UnitedHealthcare CEO’s murder last night.

Read: Inscribed Bullet Shells, Photos Of UnitedHealthcare CEO’s Killer Emerge

The cops found a gun in his possession, fake IDs, and documents that suggested he had “ill will towards corporate America”. “These parasites had it coming,” said a two-page note found with him.

When they asked the suspect if he had been to New York recently, he became quiet and “started to shake”.

Thompson was attending an investors’ conference in New York last week when Mangione came from behind and fired multiple rounds in full public view. As Thompson collapsed to the ground, he fled on foot. Later, he took a bike to Central Park and boarded a bus.