BALTIMORE - Luigi Mangione was a young prince of this city, his family’s name emblazoned on the walls of buildings and civic institutions. Teachers at his elite prep school described him as a student leader bound for an Ivy League education. Classmates called the valedictorian, athlete and budding engineer an inspiration, someone focused on society’s future. More accolades followed during college in Philadelphia.
Then came worsening back pain, time abroad and a period of discontent. Friends said they lost track of the 26-year-old this year, struggling to confirm his participation in a wedding. His mother later filed a missing person report.
As Mangione’s once-charmed life seemed to crumble, Brian Thompson’s fortunes appeared to rise. The 50-year-old executive from a small town in Iowa was entering his fourth year as CEO of the nation’s largest health insurer, UnitedHealthcare. He was well-liked by employees and respected in the industry - even as some patients complained about the company’s denial of care.
**‘Very optimistic’**
“I feel really good,” Thompson told investors on a January call. “Very optimistic about UnitedHealthcare … a lot to look forward to here in the year.”
The two men’s paths collided on a Manhattan sidewalk early Dec. 4, according to police charging documents, with Mangione accused of lying in wait for Thompson in what authorities are calling a targeted shooting. Police who arrested Mangione on Monday in Pennsylvania found a handwritten manifesto blaming “parasites” and reportedly railing against UnitedHealth Group, the parent company of UnitedHealthcare and the nation’s largest health-care organization.
Mangione appeared in court Tuesday as prosecutors sought to extradite him to New York to face five charges, including second-degree murder, in connection with Thompson’s death. Separately, he faces five counts in Pennsylvania, including presenting false identification to police. During Tuesday’s court hearing, Mangione appeared to struggle with officers and seemed to shout at journalists about “an insult to the intelligence of the American people.”
He was denied bail. The extradition process to New York, which he is fighting, could take weeks.
The developments have staggered those who watched Mangione’s early rise and are now grappling with how the promising high school and college student ended up in a Pennsylvania prison cell. Many spoke on condition of anonymity to avoid being publicly linked to Mangione or the shooting of Thompson.
**‘Not the boy I know’**
“That’s not the boy I know,” said one of Mangione’s former teachers at Gilman School, the all-boys private school in Baltimore where Mangione was the top graduate in 2016. Other teachers and students described him as humble, kind and affable. Classmates from the University of Pennsylvania similarly recalled a well-liked engineering student and fraternity brother who graduated in 2020.
What radicalized Mangione and fixated him on the health insurance industry remains unclear, though clues exist in his personal health history and online activities. Friends said Mangione struggled with years-long back problems, which worsened his quality of life. He moved to Hawaii after college in pursuit of better health. An X-ray he posted on social media appears to show spondylolisthesis, a spinal condition that can cause chronic pain, according to physicians.
“When my spondy went bad on me last year (23M), it was completely devastating as a young athletic person,” read a Reddit post from an account previously linked to Mangione’s personal programming site. Reddit declined to confirm whether the account, deactivated this week, belonged to him.
Friends said Mangione’s pain hampered his social life and culminated in major surgery last year. The X-ray showed a “lumbar spine with posterior spinal instrumentation, possible fusion,” said Dr. Zeeshan Sardar, an orthopedic surgery professor at Columbia University Medical Center, who reviewed the post. While patients are warned that such surgeries may worsen their condition, the Reddit account described the procedure as a success.
Mangione had long focused on societal issues, posting commentary online and summarizing his reading, including on Goodreads. In a 2021 review of "The Unabomber Manifesto", he gave it four stars and shared a controversial comment: “When all other forms of communication fail, violence is necessary to survive. You may not like his methods, but … it’s not terrorism, it’s war and revolution.”
By 2023, selections from a book club Mangione started in Hawaii began to raise concerns, said Sarah Nehemiah, a producer and researcher who met him in 2022 and later moved into his co-living space.
**‘Discomfort in his book choices’**
“Several members left due to discomfort in his book choices,” Nehemiah said. “'The Unabomber Manifesto' is what really pushed people over the edge.”
Investigators are piecing together what led Mangione to allegedly fixate on Thompson. UnitedHealthcare, which provides coverage for roughly 1 in 7 Americans, declined to comment on whether Mangione or his family were customers.
UnitedHealth Group has faced scrutiny from Congress, watchdog groups and patients who allege its subsidiaries wrongly denied claims, sometimes using artificial intelligence. Complaints about health care crystallized in the public response to Thompson’s killing.
In Baltimore, residents wrestled with the revelation that Thompson’s alleged killer is part of the prominent Mangione family, which has longstanding ties to Little Italy and owns Lorien Health Systems, a network of skilled nursing and assisted-living facilities. The family’s philanthropy extends to local institutions, including a Baltimore art museum and a hospital boasting a “Mangione Family Center” in its atrium.
**‘You would not think a member of the family would be accused of this’**
“You would not truly think that a member of the Mangione family would be accused of this,” said Thomas J. Maronick Jr., a criminal defense attorney in Maryland familiar with the suspect’s relatives.
The family released a statement Monday night saying they were “shocked and devastated” by Mangione’s arrest.
“We offer our prayers to the family of Brian Thompson and we ask people to pray for all involved,” the statement read.
**A star student and engineer**
Mangione’s teachers remembered him as a builder. A 2016 video posted by Gilman shows him leading a robotics team to success in a tournament.
At Penn, Mangione took on leadership roles, such as helping to found a video game development club. By December 2018, the club had grown to 60 members, according to a Penn-affiliated news outlet. Mangione graduated with bachelor’s and master’s degrees in four years and worked as an engineer for TrueCar, which confirmed he left during 2023 layoffs.
Mangione spent early 2022 at Surfbreak HNL, a co-living space in Honolulu, before leaving in April. Nehemiah said his back injury, exacerbated by surfing and hiking, may have prompted his departure.
Posts on X this year show friends trying to reach Mangione. In July, one wrote: “Hey man I need you to call me … (You) made commitments to me for my wedding and if you can’t honor them I need to know.”
**Darker portrait**
Former classmates said they couldn’t reconcile Mangione’s current situation with his past.
“I can’t help but feel sorry for Luigi … he had so much to offer,” said a former Gilman student. “As I knew him, he was a creator, not a taker of life.”
Mangione’s 2022 speech to Gilman seniors reflected optimism about progress: “We may have been born into one of the most exciting times on earth. … The world is changing fast.”