Photo: AFP

Luigi Mangione, the man accused of murdering a top UnitedHealth executive in a shooting, briefly clashed with officers and angrily shouted as he was escorted into a Pennsylvania courthouse on Tuesday. His arrest ended a massive manhunt, and new details about his motives are emerging.

Mangione, 26, turned toward reporters and yelled, "...completely out of touch and an insult to the intelligence of the American people!" before being pushed away by deputies. It remains unclear what he was referring to. During the court hearing, his defense lawyer informed the judge that Mangione would oppose extradition to New York, where he faces murder and other charges. This decision could delay the process but is unlikely to prevent his eventual transfer. For now, Mangione will remain in jail in Pennsylvania, where he also faces gun and forgery charges.

His attorney, Tom Dickey, stated at a news conference that Mangione planned to plead not guilty to the charges. Brian Thompson, CEO of UnitedHealth's insurance arm, one of the largest health insurers in the US, was shot dead on December 4 outside a Manhattan hotel in what police described as a targeted attack.

More clues about Mangione's possible motivations surfaced on Tuesday. When arrested, he was found with a handwritten manifesto that provided insight into his mindset, according to police. The New York Times reported that an internal NYPD analysis of the document concluded that Mangione viewed the killing as a justified response to what he believed was corruption in the healthcare industry. The manifesto reportedly stated, "These parasites simply had it coming."

Mangione suffered from chronic back pain that significantly impacted his daily life, according to friends, social media posts, and news reports. His profile on X features a background image of an x-ray showing screws and plates in his lower back. An employee at TrueCar, where Mangione worked as a data engineer from 2022 to late 2023, described him as "incredibly smart" and very friendly. The company offered health insurance through UnitedHealth, among other options.

From January to June 2022, Mangione lived at the Surfbreak co-living community in Honolulu, where he led a book club and engaged in activities like surfing, hiking, and rock climbing. The founder of Surfbreak, RJ Martin, said Mangione had back pain caused by misaligned vertebrae pinching his spinal cord and left for surgery on the mainland. However, he went "radio silent" in June or July, according to Martin. Mangione never displayed any signs of violence, Martin later told MSNBC, describing him as funny, kind, and thoughtful.

Mangione once suggested the Surfbreak book club read Ted Kaczynski's manifesto as a joke. On the book-themed social media site Goodreads, a profile linked to Mangione praised Kaczynski's book as "prescient" and suggested violence could be a legitimate form of resistance in certain circumstances.

Mangione was spotted at a McDonald's on Monday by an employee who recognized him from surveillance images. Officials said he had a loaded ghost gun and a silencer, both resembling those used in the attack. He also had multiple fake IDs, including a fraudulent New Jersey ID matching the one used to check into a Manhattan hostel before the shooting.

Mangione's family released a statement expressing shock and devastation over his arrest, offering prayers for the victim's family and asking for prayers for all involved. The gunman evaded capture for days after the attack outside the Hilton hotel in midtown Manhattan. Thompson's murder has sparked frustration among Americans struggling with healthcare costs and denied claims.

Thompson, a father of two, had been CEO of UnitedHealthcare since April 2021, with a 20-year career at the company. He was in New York for the company's annual investor conference.

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