‘A permission structure for violence’: what the murder of a healthcare CEO and the cult of Luigi Mangione tell us about the alienation of young America

A year ago today, the chief executive of one of the US’s largest healthcare companies, UnitedHealthcare, was shot dead outside the New York Hilton in Manhattan at 6.44am. Brian Thompson, a father of two young children, was about to deliver a speech at an investor conference.

The words “delay,” “deny” and “depose” were found written on shell casings used in the killing. The words are thought to be linked to the title of a 2010 book, Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.

Five days later, Luigi Mangione, then 26, was arrested at a McDonald’s in Altoona, Pennsylvania as he ate hash browns and a steak sandwich, Christmas music playing in the background. He was later charged with Thompson’s killing. Police said they found a pistol and silencer, both created by a 3D printer, in his backpack. He faces two separate murder trials: one from charges brought by New York state and another brought by the federal government. Federal prosecutors are seeking the death penalty. He has pleaded not guilty to both the state and federal murder charges. 

Shortly after his arrest, police revealed they had recovered a notebook in which Mangione allegedly detailed his plan for a “targeted, precise” attack, writing: “What do you do? You whack the CEO at the annual parasitic bean-counter convention. It’s targeted, precise and doesn’t risk innocents.” 

The internal police report on the notebook, according to the New York Times, claimed that Mangione “appeared to view the targeted killing of the company’s highest-ranking representative as a symbolic takedown and a direct challenge to its alleged corruption and ‘power games.’”

Mangione underwent back surgery in 2023 after an accident the previous year. Following the surgery, he frequently posted on Reddit to encourage others to have the surgery and resist doctors who said they should, and could, live with pain. “Surgery was painful for the first couple days, but I was shocked that by day 7 I was on literally zero pain meds,” Mangione posted in August 2023. There is no evidence that Mangione was insured by UnitedHealth. 

John H Richardson’s Luigi: The Making and the Meaning is the first book on Mangione. Richardson, a former writer at US Esquire and New York magazine, has spent many years writing about groups and individuals who inhabit dark or fringe ideological spaces. From rightwing extremists to eco-terrorists, and from loner radicals to prepper communities, many of these share a belief that the system, or systems, that govern society are broken.

In the course of his journalism, he forged an interest in the writings of Theodore “Ted” Kaczynski, often referred to as the Unabomber, a Harvard-educated mathematician who carried out a nationwide mail bombing campaign that killed three people and injured 23 others between 1978 and his arrest in 1996. His 35,000-word manifesto, Industrial Society and Its Future, laid out his beliefs about how modern technology was destroying the natural environment and curtailing human freedom.

Richardson, who conducted a five-year correspondence with Kaczynski, wrote an article, Children of Ted, in 2018 for New York magazine, in which he explored the motives of a new generation of Kaczynski admirers and acolytes who were in thrall to his anti-technology philosophy.

In Luigi: The Making and the Meaning, Richardson probes the extraordinary reaction to Mangione – an explosion of support online, fundraising campaigns, essays, fashion reviews, articles on his Spotify playlist, assorted memes and merchandise –  and explores where, if at all, Mangione’s politics and ideology fits in the dark fringe universe of people and groups radicalised, alienated and drawn to violence towards, or defiance of, mainstream institutions and systems of power.

John Mulholland: Let's start with the immediate reaction to Luigi Mangione in those first 24–48 hours online. You mention that you were “mesmerised by the explosion of glee and sympathy that swept the world”.

John Richardson Well, in the initial hours, his photos had not been released, and one of the spokesmen for the Luigi Mangione defence fund said to me that even then, there were contributions trickling in. But when the photos started coming out, money started pouring into the fund, and there was a kind of wild enthusiasm that was shocking to many. And then there were the warriors on the other side who, I guess you would say, properly say: “This is shocking. How can you cheer? This is an innocent man shot in the back, regardless of the problems with the healthcare system.” 

And then the public came roaring back at that. And this was, I think, the really interesting part: nobody was going to be shamed. They were like: “What about his responsibility? What about people who get denied healthcare and die?” And then people who were contributing to his fund were saying, “My mom’s cancer treatment was denied and she died three months later.” And then the gatekeepers, as I call them – the responsible figures – kept pushing back and saying: “This isn’t how we solve our problems.”

You distinguish between the initial online response and the response from what might be called legacy media, which, you suggest, reacted differently – acting “as gatekeepers” in the face of this explosion of support for Mangione.

JR The New York Times and the Washington Post and the responsible publications said: “This is a terrible thing. Someone has been shot, an innocent man shot in the back, father of two children. He, Brian Thompson, is not responsible for the system.” And that argument was made a lot: “He’s not responsible.” And people continued to roar back and say: “Well, he’s the CEO. He’s as responsible as anyone.” Then they started digging into the research and saw that there was a pending case against him for using an algorithm to kick people off their healthcare.

(During Brian Thompson’s time as CEO, UnitedHealthcare faced a class-action insider trading lawsuit alleging executives sold stock based on non-public information about a DOJ antitrust probe. The lawsuit alleges: “UnitedHealth was aware of the DOJ investigation since at least October 2023. Instead of disclosing this material investigation to investors or the public, UnitedHealth insiders sold more than $120 million of their personally held UnitedHealth shares. In the four months between learning about the DOJ investigation and the investigation becoming public, UnitedHealth’s Chairman Stephen Hemsley sold over $102 million of his personally held UnitedHealth shares and Brian Thompson, the CEO of UnitedHealthcare, sold over $15 million of his personally held UnitedHealth shares.” The company also faced lawsuits regarding improper claim denials, including allegations of using a flawed AI algorithm, and disputes over provider reimbursements. The lawsuits are ongoing.) 

For non-US readers, could you explain what it is like to deal with US healthcare and the bureaucracy involved?

JR I will tell you that during this process, my fiancee had cancer, and I was researching the book. I was about a month in, and she was having chemotherapy infusions. And we had one scheduled for a few days later, and they called us up and they said: “We can’t pay for your chemotherapy infusion.” Well, it was: “We can’t pay for a drug that helps recovery from the infusion, and therefore we can’t do the infusion.” And the drug is $6,000. She was just sitting there in shock.

We had $6,000, that’s not a problem. But the problem is feeling helpless. It’s like, suddenly: “Oh, $6,000. What if it was $50,000? What if it was $100,000?” For me, that brought it home. It wasn’t just an intellectual exercise. And it’s not an intellectual exercise for Americans. It was disturbing because I’m reading these things, and as a responsible, grown-up, mature grandfather: I’m like, “Well, of course, we don’t go out and kill people because we think the system is bad.” And on the other hand, I'm also trapped in the system and feeling that people are being just monstrously misused.

The reaction by some on the right – Joe Rogan, Ben Shapiro – was to paint this as a left-right issue. What happened there?

JR For me, this was particularly interesting because the rightwinger guys like Joe Rogan were initially like: “This is terrible. These left-wing crazies.” But then they got pushback from their own readers, and in a pretty dramatic way, saying: “No, this isn’t a left-right issue. This is poor versus rich. This is about capitalism.”

Also, little by little, the alleged shooter’s documents started coming out through police releases and it became more and more clear that he was specifically targeting this CEO. Specifically targeting him at the annual investment conference where they sell the company to Wall Street.

It seemed like he was making an anti-capitalist gesture. But it’s not entirely clear.

At one point you talked to your sister and you were surprised by her reaction.

JR My sister’s reaction was … let me just preface this by saying she’s 73 years old. She walks with a cane. All she ever does is sit around her house and, now that her cats are dead, make crafts.

But she called me up, and she was like: “Finally, a good guy with a gun.” And I was like: “Jennifer, you are kidding me, right?” And she’s like: “No, you know, these CEOs”, and she immediately clued in on the CEO aspect of it.

And she said: “They get like 300 times more than their lowest-paid staff.” For her it was the class division, the economic exploitation. And, I should say, she’s struggled with her health for the last 20 years, and she could really use some drugs that she’s not being given because of cost. So she is bitter. And I don’t think she’s wrong.

Talk about your relationship with Ted Kaczynski over the years.

JR I started trying to get an interview with Kaczynski, who was in prison in Colorado, and began writing him letters. I wrote him my first letter in 2015, and he said: “Read these two books and get back to me in a year.”

You exchanged quite a few letters over five or so years?

JR Yeah, 25, 30, and he wrote back quite extensively.

That seems a good point to talk about Mangione’s connection to Kaczynski. He refers to Kaczynski on various online platforms. 

JR Well, this is really what got me to want to write the story. He had done a review of Kaczynski’s [manifesto] on his Goodreads account. [The review said]: “You can’t deny that this man was prescient about many things.” And he said that he was a killer, that he had killed people, and that was wrong. He gave him four out of five stars.

And when I reread the manifesto and read his other works, I was pretty stunned at the specificity of some of his things, particularly about AI, which I didn’t even know existed in 1995, when the manifesto was published. And Kaczynski was saying that we would come to a point where AI – we wouldn’t understand why AI was doing what it was doing or how it was doing it, and we would have the choice of letting it do things or stopping it. And it wasn’t likely that we would stop it based on our history. At the moment that I was reading those predictions, they were coming true. 

The other thing about Kaczynski that is important, I think, is his – what you might say is the rightwing side. He had a concern for nature, like many on the left, but the other side of him was a concern for agency. And that’s more coded rightwing in America. Like, are we cogs in a system? Do the elites run things? Do we have any agency?

This was Kaczynski’s biggest concern, really. Nature was a place where he could be free, but being free was the point. And I think, in Mangione’s terms, he was interested in agency, and was interested and frequently referred to this idea of there being “NPCs” – non-player characters. He was a big gamer. There are players that are active in multiplayer games, and those are lit up. And then there’s all these gray, blank faces that are just humanity. Those are the NPCs. 

Mangione put some distance in his writings between him and Kaczynski. Can you explain a little bit about his ambivalence, or criticism, of Kaczynski?

JR I think this is really interesting, because it's partly based on what police revealed. It wasn’t until six months after he was arrested and in prison that they revealed the portions of his diary that really criticised Kaczynski and called him a terrorist.

For six months he was associated with a mass murderer who killed people pretty much randomly. They were not targeted attacks on a CEO or a politician. He was killing ordinary people. And Luigi Mangione zeroed in on that and said it was a terrible thing.

You delved into Mangione’s social media accounts, his postings on Reddit, Goodreads and elsewhere – what did you detect about his politics? On X he followed Joe Rogan, Alexandria Ocasio-Cortez and Robert F Kennedy Jr.

JR Well, his politics are mysterious. When he registered, he registered non-partisan. Although his parents seem to be on the Republican side, he deliberately did not choose a side.

And in his reading, he seems to be pretty widespread. At one point he was reading a lot about rationality. He seems to have very consciously tried to look at both sides.

He was very interested in Tim Urban’s book on political division, What’s Our Problem? A Self-Help Book for Societies. That is sort of his ideal book. Because it goes into the rightwing point of view and the leftwing point of view, and then tries to come to a harmony at the end.

You mention that he had an email correspondence with Urban who writes about a kind of online centrism and one of his central concepts is this notion of being “high rung”. You say Mangione seemed drawn to this idea.

JR “High rung” is about being above political divisions. Not falling into tribalism of left and right. Independent thinking, not just conforming to existing beliefs. Truth-seeking. As I wrote in the book, Mangione posted on X in the summer of 2024: “Both parties – Trump with his refusal to accept the results of an election, and Biden with his refusal to accept his age and step down – are simultaneously proving how desperately individuals will cling to power.” He was determined to follow Urban’s advice and stay on the high rungs.

Aside from his extensive reading of books, he struck up relationships with some slightly more esoteric figures online.

JR: Well, this sort of is one of the mysteries of what went on in his mind. But as he went through this process — a process of discovery for him, of sorts — he seems to have gotten cruder. And I base this on the writers he was reading in the last year or so.

And then a little while later, he went dark and began planning — apparently, allegedly — the shooting. Stopped speaking to his family, stopped posting, stopped texting friends. Went completely dark for six months. So these figures are the last voices of authority for him, it seems.

To me, it’s just really sad.

At one point, Mangione is reading Jonathan Haidt, Yuval Harari, Michael Pollan, Richard Reeves. But he ends up in a different place, given what he was reading in his last year or so.

JR Yeah, definitely. I feel like he's going down. He's going down into a more desperate or more urgent space – urgent is the word, I guess.

If you look at the things he writes, his syntax becomes a little cruder, more rushed. And the messages coming from some of what he was reading at that time was: young men have to do things. Young men have to break rules. Young men have to have courage.

It’s trending in a direction that seems just simpler, cruder, more urgent. Yeah.

Although I’m not really still clear about his political ultimate leanings. I think he probably thinks both parties are nonsense, and that it’s about money and capitalism and control.

But I’m not sure. But he definitely seems to have gone on a journey where he was thinking about these larger cultural issues — and a lot of them to do with the struggles of men in this society.

Towards the end of the book you have a quote from Bàrbara Molas from the Rand Corporation, a nonprofit think tank, about hybrid ideologies. The quote is: “We’ve seen a lot of hybrid movements and ideologies, new trends that we can’t categorise under the traditional categories. They pick and choose – a little neo-nazism here, a little Kaczynski-inspired neolithism here. Everything is accelerating, whether we like it or not – slightly faster and faster to the edge.” Where do you think Mangione comes into that swirl of hybrid ideologies?

JR I definitely think that separating things into left and right is simplistic and not that useful at this point. There are all these swarms of ideas. Some of them are anti-capitalist. Some of them are anti-technology. Some are anti-race.

I think what we have is a sense of a civilisation shaking. And some people fix on something and say, “It’s about the birthrates. It’s about immigration. It’s about technology.” People are just looking for answers. And there is no simple answer, right? So they’re going to grab on to a lot of different things. Luigi seems to have been really a hybrid.

So he wasn’t anti-science. He doesn’t seem to have even been anti-AI. He thought AI could get out of control. He thought it could be a force for good.

But maybe he actually couldn’t make up his mind. Maybe he couldn’t answer that question. And he just decided: this I know. He did write in his notebook, “I'm glad I delayed. The target is insurance,” as if there were other possible targets before deciding.

Close to the end of the book you write: “But in the end, pinning down Luigi’s motives misses the point. His elusiveness is what really matters. For a growing group of Americans who seem to be vibrating with essential anxieties, he became a screen on to which they projected their fears and dreams of an era when the centre didn’t hold.” What was Mangione’s relationship to that sense of dislocation, anxiety, existential fright, at what is happening in parts of the world?

JR I guess it relates to what he was reading and the people he was attracted to. I think the extent to which people sympathise with Luigi Mangione is because he’s sort of feeling what we all feel. A sense of helplessness. A sense that the world is getting out of control. I mean, a sense that the grown-ups are not doing their jobs. That things are falling apart.

And in that sense, what he was thinking, and whether he’s got a partner or had childhood traumas, are not that relevant. Because it is this large sweep: there is this sense that things are out of control, and that the systems are not working. And somebody has to step into the breach. And I think, to the extent that people are doing terrible things in that breach, we have to, as a culture, take responsibility too.

If this were a nice, civilised era, then these young people would not be so agitated. And so many people wouldn’t feel that a permission structure had been created to take the law into their own hands. And so that gets into some very specific and troubling things about American politics – about a permission structure for violence.

The violence, the distress, is always in some levels of society. But it’s not always encouraged to come out in the way that it seems to be now. I don’t understand it. I’m doing my best.

Luigi: The Making and the Meaning by John H Richardson is published by Simon & Schuster, £20

John Mulholland is a former editor of the Observer and of the Guardian US. He is now Managing Editor, California at State Affairs and an adviser on the Nerve