20/20 - Mangione Episode 4: "Free Luigi"

Episode Date: August 31, 2026

How did the killing of one man become a flashpoint for widespread frustration with America’s healthcare industry?   To hear the rest of the series, follow "Burden of Proof: Luigi Mangione" for free on ⁠⁠⁠⁠⁠⁠⁠⁠⁠Apple Podcasts⁠⁠⁠⁠⁠⁠⁠⁠, ⁠⁠⁠⁠⁠⁠⁠⁠Spotify⁠⁠⁠⁠⁠⁠⁠⁠, ⁠⁠⁠⁠⁠⁠⁠⁠Amazon Music⁠⁠⁠⁠⁠⁠⁠⁠, or wherever you listen to podcasts, or listen ad-free on Apple Podcasts when you subscribe to 20/20 True Crime+. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, this is Brian Buckmire, here with another weekly episode of my new podcast from ABC Audio and 2020, Burden of Proof, Luigi Mangione. Remember, you can also listen to Ad Free by subscribing to 2020 True Crime Plus on Apple Podcasts. Click the link in the description to learn more. Now, here's the next episode of Burden of Proof, Luigi Mangione. Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation Walk.

Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together we can carry the fire and help create a world free from the fear of cancer. Register today at pmcf walk.ca.ca. The defendant committed this murder in an attempt to draw public attention. to his dislike of certain businesses. This is Jamie MacDonald, the United States Attorney for the Southern District of New York.

He's speaking at a press conference after Luigi Mangione pleaded guilty in federal court to two counts of stalking and admitted to shooting Brian Thompson. We live in a civilized society governed by the rule of law. We debate, we disagree, we protest, we do not commit murder.

No grievance, political beliefs, or ideological cause can ever justify murder. There can be no celebrity in assassination. Brian Thompson's family, United Healthcare Executives, and law enforcement attended the plea hearing, and so did two rows of Luigi Mangione supporters. Any person who celebrates, encourages, or excuses, actions like these is fundamentally wrong.

Through all the changes in this case, going all the way back to December 2024, one thing has been consistent. Luigi Mangione has vocal supporters, and many of them seem as emblematic of rage against the U.S. healthcare system. I was really proud that even when admitting his guilt, Luigi was able to find a way to still put the spotlight on an end. industry, that is so unfair. How did the killing of one man become a flashpoint for widespread frustration with America's healthcare industry? From ABC Audio in 2020, I'm Brian Buckmire, an attorney and ABC News legal analyst. And this is Burden of Proof, Luigi Mangione.

Episode four, Free Luigi. In a quiet part of Baltimore, in a one-story, brick shopping center, there's a pizza shop called Vito's Pizza. We have a good reputation of good pizza, and we have a sabs, pasta, a little bit of Italian menus. That's Maria Montova. She and her husband, Giuseppe, who are in their 60s, own Vito's pizza. We spoke to them months before Luigi Mangione's guilty plea and admission.

The Montovas say that back when Mangione was a student at Gilman in the 21st, In 2010s, videos would get a lot of Gilman Boys, ordering pizzas and subs. In December 2024, the Montovas heard Luigi Mangione was the police's number one suspect in Brian Thompson's murder. Maria says that a few days after the news broke, her daughter came across a meme online, a part illustrated, part AI-generated image of St. Luigi. This picture of Luigi Mangoni in the best of a saint. Maria's daughter printed out the picture and showed it to her parents. They all got a kick out of it at the time.

To the Montovas who are Roman Catholic, it was funny. Giuseppe asked his daughter to make a couple copies. She did, and he hung one up in the storefront right above the register. A local journalist posted about St. Luigi at Vito's. And then from there started all the dramas, I would say. Social media seized on the post, with users commenting, liking and sharing it. It generated over 6 million views. And quickly, the online frenzy spilled out into the real world.

At the time, Maria said the shop was flooded with customers who wanted to support the business and, according to her, make sure that picture of St. Luigi stayed up. Though, keep in mind, this was long before Mangione admitted to the shooting. But there was also a backlash online and in person. Maria said some people accused the pizza shop of supporting Mangioni, where the time was still a suspect. Started to be a political, so-political thing, which there was no intention about that.

And this is just one example of the explosion of online commentaries surrounding Brian Thompson's murder. Gio Tolentino, a staff writer at The New Yorker, says the reactions to Thompson's killing indicated at the time that many Americans believe the private health care system is a, quote, large-scale purveyor of death. The CEO of a giant corporation gets shot on the street and people celebrate it as if a violent, murderous dictator had just been taken out by a military team. There were some messages expressing sympathy for Brian Thompson and his loved ones, but there were also jokes, sarcasm and laughter.

Lots of laughter. In fact, tens of thousands of social media accounts reacted with a laugh on Facebook to United Health Group's official announcement of Brian's death. Folk artist Jesse Wells dropped a John Prine-style protest song less than a week after the killing, with lyrics that took aim at United Healthcare. Of course, many In United Health, there ain't no me

In the company they have a choice There's hardly humans in humanity Of course, many followers of the case Also commented on Mangione's looks. They talked about the clothes he wore to court And the music he reported he listens to in jail. Some even cheered his mug shop, projected on a big screen during a dance party in Boston.

There were Mangione lookalike colleagues. in Washington Square Park in New York, and on college campuses in Florida and Texas. Luigi, the musical, reportedly performed to small sold-out theaters. But my back gave out and doctors couldn't help me as dollar signs decided who would live and who would not. Manjoni merchandise went for sale online. T-shirts, votive candles, Christmas ornaments, pint glasses,

wine tumblers, and baseball caps. baseball caps. Some featured Mangione's face. Others said free Luigi or deny, delay, depose. The words that please say were etched into the bullet casings found at the crime scene. After Mangione was charged with Brian Thompson's murder, online fundraising for his legal defense surpassed more than $1.5 million. Give Send Go, the platform that hosts Luigi Mangione's legal defense fundraiser, confirmed to ABC News that the fundraiser is still active and said that there was renewed interest in donating to the fund after Mangione pleaded guilty in federal court. Some donors posted comments like, guilty but not wrong, and Luigi is morally innocent.

Luigi Mania reached Mangione's jail cell too. He started receiving mail at the detention center. As of last summer, it was 10 to 115 letters per day, according to his attorneys. And this became more than an online phenomenon. It was impossible. to attend one of Mangione's hearings without seeing his supporters outside or inside the courthouse. So what's motivating Mangioni's supporters? And what do you think of the latest development when he stood there in court and admitted to this crime pleading guilty in federal court? What now? This show is sponsored by Chime. Most of us picked a bank when we were 16 years old and never looked back. We stayed loyal even when our bank let us down in return. But now there are other

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Chimes Bank partners. Qualifying direct deposits required terms and limits apply. Go to chime.com slash disclosures for details. Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation Wall. Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together, we can carry the fire and help create a world free from the fear of cancer. Register today at pmcfwalk.ca.ca. I'm Keanu and I leveled up my business with Shopify.

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Start your free trial at Shopify.com. Months ago, before he pleaded guilty in federal court, a few supporters of Luigi Mangione agreed to an interview with us, under the condition that we only use their first name for fear of losing their job or harassment for their support. The main reason why I cared was because it seemed like the focus was corruption in health care and health insurance, and that was something that I care about. That's Stephanie. She's a 26-year-old nurse based in Connecticut. As a critical care nurse, Stephanie treats people with immediate, often life-threatening medical issues.

She says she's also seen the high bills and claims denials that patients often face after seeking urgent care. She was already familiar with hospitals before her job. When she was a kid, she said she watched her mom go through years of treatment for stage 4 cancer. Years, she says, of watching her mom fight the sickness while also working to afford the treatment. So imagine that. I mean, you're given a prognosis of three months, and then, which thankfully was pushed to five years by the end. But she was working full time 40 hours a week. as a single parent to afford her health insurance so that she could continue to get chemo

and whatever other care she needed to treat her terminal illness. From the moment she heard about the shooting, before anyone was arrested, Stephanie says she believed it was done to send a message. I thought maybe, you know, maybe killing somebody is not necessarily what we need to do, but I liked that somebody took it upon themselves and risked everything. to make a statement, I felt like something is going to come up this, you know. So Stephanie decided she wanted to show her support. She started a pro-Mangioni account on a few social media platforms,

and they quickly grew a following. She shared tweets making fun of the New York City Purp Walk on that dock in the East River and stylized, edited videos of Mangioni in court. But she says she prefers to focus on fundraising efforts and legal updates. She acknowledges that the Manjoni posts that blow up are often the ones focused on his looks, but she says she tries to stay away from those. I mean, I think it would be silly to pretend that he's not good-looking, you know? To pretend that that has nothing to do with anything would also be ridiculous,

but the true supporters are not here for looks, and it's a pretty ridiculous thing to suggest after over a year of this. Stephanie feels like people have been quick to dismiss Luigi supporters, as some kind of fan girls. She says it's one reason why many of them are hesitant to speak to the press. You see headlines about, I don't know, let me just throw out any random number,

30 young women in line for 20 hours to see sexy killer, like, things like that. And I mean, wow, like how demeaning. And it's the fact that it's not just young women or women in general. I mean, if you go to a hearing, there's people from all walks of life, all genders, all ages. Stephanie told us that Mangione's guilty plea in federal court has strengthened her support for him. Having confirmation that he did what he was accused of and clear insight into the motive has brought a real sense of relief because now the supporters are free to stand behind him and his cause.

I'll keep supporting Luigi through every stage of his legal battles and as a person, no matter how everything plays out. My support has not changed at all. That's Jamie, a public school educator in her 50s. She has a husband and an adult son. Jamie said she donated to Mangione's Legal Defense Fund and has helped supporters leading efforts in New York City. She also says she's written to Mangione.

Jamie says she's been passionate about health care reform for a while now. But for her, this story started out much more personal. In June 2024, months before she would ever hear the name Luigi Mangione, Jamie decided to schedule an MRI. Breast cancer runs in her family, and it had been on her mind. She says she has good insurance through her job, and she believed it would cover the MRI. So she arrived at her appointment and started filling out the typical paperwork.

She was nervous. She was thinking about the different outcomes. the worst-case scenarios. But before she was taken to the MRI... They asked me for $1,800. And that was the first time I had been told that it wasn't covered or that I would have any portion to pay. Jamie says she started panicking.

She ran into the lobby and called her insurance company. She says they were just as confused as she was. It should be covered. I said, well, should. So it is a great word, but they're asking me for $1,800 right now, and I have about 10 minutes to figure this out. According to Jamie, they did not figure it out. Jamie left the appointment without getting the MRI. The bill was unexpected and way too high for her.

She remembers leaving, getting home, and bursting into tears. I didn't put myself first. and I think as women we sometimes do that, as moms especially. And I just remember this overwhelming feeling of, I've got to figure this out. Jamie says she still wanted an MRI. So a year went by and my annual exam came up again and I asked my doctor again. But the difference this time was that it was the summer of 2025.

And I had spent six months. At that point, following this story and really learning what it means to fight for myself by watching somebody fight for himself. So ultimately, I was inspired by Luigi to fight for myself and advocate with my insurance company. Jamie says it wasn't what Mangiani was at that point accused of and she was inspired by. Instead, she says she was inspired by what she learned about him outside of the allegations. What she read of his purported Reddit account were descriptions of his back problems, and comments advocating for others who struggled with similar issues,

and what she saw following the case from home, Manjonian court fighting the charges. He held his head high. He clearly was wanting, to fight these charges and did so with as much dignity as you could. Jamie thought she needed to fight harder for herself, for her health. She needed to be her own advocate and try harder for an MRI. Jamie felt pushed to research her health care coverage and made calls,

hours' worth of calls, she says, trying to get her procedure covered. Jamie says her insurance provider was extremely helpful in the process, and the provider discovered a coding error that caused the unexpected bill. The MRI was supposed to be covered. Her insurance helps her book a new appointment. In summer 2025, a full year after that first MRI, the one she'd walked away from, Jamie finally had a fully covered MRI.

I had a mammogram about three weeks prior that was clear, so I didn't have any reason to believe that the MRI would show anything, but it did. And I was diagnosed with breast cancer in August of 2025. And at first I was really angry for all the normal reasons that you would be angry when you get diagnosed with cancer. Looking back now, Jamie's at peace with the way things worked out. They caught it in time, and she's now cancer-free. This person came into the universe and became a public figure at the right time for me. And so for that, I am very, very grateful to him.

Jamie says it was tough learning about Mangione's guilty plea in federal court. I never doubted that when he pled not guilty, it was to try to get the most advantageous. result, not because he was actually not guilty. And it's different to know that and to hear him admit it. And I kept having to tell myself that this was a choice he made, that he didn't find himself in these circumstances accidentally. The idea that he might serve the rest of his life in prison is a hard thing to accept. But I think we have to know, at least for me, that this was that important to him. And that's where we all have to do our part to make sure that people get the care that they deserve. We asked AHIP, a national trade association that represents the health insurance industry about patients,

who experience delays in treatment because of insurance coverage. A spokesperson wrote that they recognize that patients are understandably frustrated when treatments or procedures are not approved as quickly as expected and pointed to providers' reliance on outdated manual processes as a source of delays. They also said that health plans are working to improve the consumer experience. We also asked AHIP about the stories people shared after Brian Thompson's murder, about their frustrations with the healthcare industry. They said most Americans rate their health plans positively,

and that we agree that much more needs to be done to reduce costs and create a simpler, more seamless experience for patients. Jamie remembers when she first heard about Brian Thompson's murder and what Mangione was accused of. She says she felt awful for Brian and his family. Obviously, murder. It was awful. And so all of those thoughts are kind of going through my head. I remember thinking, you know, obviously that I felt terribly for this person as a person.

But the public at large really understood, we kind of felt like we understood why this happened. I wouldn't say I was ever in the camp of, deserve is such a strong word, that doesn't feel like how I ever felt. But understand why. I think that's where I landed. When Manjoni pleaded guilty to two counts of stalking federal court, he brought up health care. He said during the plea hearing that he undertook his plan to stalk and shoot Brian Thompson after enduring severe pain from a broken back and obstacles from the health insurance system. Mangioni's alleged writings also include criticism of the U.S. health care system.

If Mangione's state case does go to trial, healthcare will likely come up again. So what about the system is being criticized in these alleged writings? And what do people who know the ins and outs of the health care system make of that criticism? Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, joined thousands in Toronto for the Princess Margaret Cancer Foundation Walk.

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The story of a cub who could be king. National Geographic's Lion is now streaming on Disney Plus and Hulu. In the letter to the feds, which authorities allege was written by Mangione, the writer claims that greed fuels the American healthcare industry and says, I do not pretend to be the most qualified person to lay out the full argument. but many have illuminated the corruption and greed. The writer then cites two names in parentheses, Rosenthal, comma, more. Prosecutors say the more in parentheses is Michael Moore,

the famous filmmaker who made the 2007 film Sicko exploring his views on the crisis of health care in America. And the Rosenthal, according to prosecutors, is longtime health reporter Dr. Elizabeth Rosenthal. She wrote an American sickness, a book that argues that America's for-profit medical system exploits vulnerable and sick patients. When Dr. Elizabeth Rosenthal learned her work

was cited in the letter to the fence, she could have easily found the letter and read it in one of the several places it was published and quoted online. But she didn't. I didn't really feel comfortable being connected with a murder. I was not in a place to read it.

At the time, Dr. Rosenthal was in a hospital waiting room where her husband was getting chemotherapy for stage four cancer. He was doing really badly, and he was dying, and I was fighting many of the kind of patient battles that I'd written about but hadn't experienced. Dr. Rosenthal has been a reporter for over three decades, covering health care for much of that time. She's currently senior contributing editor at KFF Health News,

a newsroom that covers health topics nationwide and conducts health policy research and polling. Before that, she was at the New York Times, and before her career in journalism, she worked as an ER doctor at the height of the AIDS epidemic. None of that prepared Dr. Rosenthal for her husband becoming so ill. And on top of that, having to grapple with the news that her work was allegedly cited by a murder suspect as pretext.

prosecutors would eventually argue. It was an awful day on so many accounts, but, you know, I just didn't know what to say. I got a lot of interview requests, and I was kind of like, I'm speechless. This is a terrible thing for someone to do, and boy, has it come to this. I never imagined that. It's been almost two years since Dr. Rosenthal was not a hospital waiting room, almost two years since that letter first appeared in the news. So when we asked her if she'd be comfortable reading the letter now, she agreed.

Dr. Rosenthal quietly looked over the letter. The criticism of this country's health care system, the reference to what prosecutors argued was herself and Michael Moore, the claim that for-profit insurance has amassed power and wealth and become greedy. When she was done, she looked up from the paper and simply said, Yeah, I mean, that's just true. It was a mix of analysis and statistics,

and also just raw anger that was not, you know, not going anywhere good. Though she might believe that the statements in that letter are true, Dr. Rosenthal wants to be really clear about something. Any attempt to kind of demonize one person or another is really, it's really wrongheaded. I mean, murdering someone is not any kind of answer to our health care problems. Rosenthal worked as a reporter overseas, and as she encountered health care systems abroad in Sweden and Italy, and then returned home and sought health care in the U.S., she says, She saw problems here.

When I came back to the United States after about a decade away, I was kind of shocked at how much everything costs. I mean, I just couldn't understand it. Dr. Rosenthal and other experts point out that compared to people in other wealthy countries in the U.S., we pay more for health care and have worse outcomes. According to one Commonwealth Fund report from earlier this year, Americans have the lowest life expectancy compared to people in other wealthy developed nations. And health care in this country is so expensive that around one in five Americans carry medical debt,

totaling about $220 billion as of 2021, according to a recent JAMA study. And part of the cost for Americans is claim denial. Another Commonwealth report from earlier this year found that one in five adults in In this country, Americans who have private insurance say that in the past year, they or a family member had a claim denied were care recommended by a doctor. For many Americans, health care has become a pocketbook issue, right? And that's the way they feel it is almost like their health care is secondary. It's like, I can't afford this stuff. After all of these years of research and reporting, Dr. Rosenthal has come to believe that the root of these debt-inducing prices is America's for-profit system.

We asked AHIP, the Health Insurance Trade Association, about this conclusion. A spokesperson wrote, quote, Health plans are the only part of the health care system focused on holding down costs and making coverage and care more affordable for consumers. They negotiate substantial discounts with providers, combat fraud and abuse, promote the use of lower-cost generic medications and help people access preventive care without cost-sharing. They pointed to fee-for-service payment models that reward volume rather than value as the cause of expensive health care, and said that they strongly support bipartisan reforms to lower health care costs for everyone. Dr. Rosenthal points out that there are many entities within America's health care. system, insurance companies, hospitals and medical providers, drug manufacturers. She says they are all

part of the system working the way it does. Everyone's a bad guy, you know, and I think that's the problem. People like to say, oh, it's the insurers or, and, you know, the, the insurers like to say, oh, it's the pharmacy benefit managers. You know, I've done panels with people from each sector, and it's like a circular firing squad. It's a very overwhelming problem. And she says it gets even more complicated because each of these different parts of the system can be owned by one company,

something called vertical integration. So Dr. Rosenthal might ask an insurance company about a bill and... They all say, oh, well, it's not us who are denying this claim. It's this claims review process. and I'm like, wait, they are you. They have a different name, but you guys are the same company.

How can that be? In some ways, Dr. Rosenthal says, it's like a twisted joke. But it's not funny, really. It's tragic. In the decades, Dr. Rosenthal has been reporting on health care in this country,

she's seeing the Clinton health care plan get introduced in the 90s, the passage of Obamacare in 2010, and the Medicare for all debates in the 2010s. But after all that, Dr. Rosenthal says the system is still deeply dysfunctional, and most Americans agree. A 2024 Gallup poll found that nearly 70% of Americans see the U.S. healthcare system as being in a state of crisis or having major problems.

In January, Congress held hearings on the cost of health care in America, and the CEOs of several major insurance companies testified, including Stephen Hemsley, the CEO of United Health Group. Like all of you, we are dissatisfied. satisfied with the status quo. And no, we must all do better. And so we are committed to doing exactly that. In his testimony, he said insurance costs are going up

because the cost of health care itself has been rising. Hospital and drug spending has soared at three times the rate of inflation since before 2000. We limit these pressures as much as possible. In their testimonies, the CEOs of Cigna, CVS Health, and Elevents also pointed to the growing cost of care as the driver of higher insurance premiums, deductibles, and the affordability crisis. Throughout the hearing, the committee members asked the CEOs about many of the same criticisms that Dr. Rosenthal and others bring up. Like the fact that in the U.S., compared to other wealthy countries, we spend more in health care but have worse outcomes. I love American exceptionalism, but why are we exceptional in this?

Why have so many other first world countries figured out how to do this and we have not? We have a system that drives volume over value and outcomes, and we have a system that drives very strong pricing. The CEOs were also asked several times about their company owning a health insurance division, as well as a pharmacy benefit manager and medical clinics, the kind of vertical integration Dr. Rosenthal mentioned. So, Mr. Helmsley, when United owns the insurer, the doctors, the pharmacy benefit managers,

and the care delivery system end-to-end, where exactly is the competitive pressure supposed to come from to keep prices down? The structure of that is in response to the marketplace to actually drive more value and drive cost down. by integrating and allowing these elements of health care services to actually serve the consumer better. There is a great deal of oversight and regulation

on the establishment of pricing within an organization like ours. They were asked about patients' frustrations with claim denials, too. Why do your patients have to fight your company? to get their claims covered. They shouldn't have to fight. We should make this much easier and intuitive, and we use technology for that purpose. We have a number of initiatives in market right now.

And they were asked about Americans' medical debt. Americans now owe $220 billion in medical debt. $220 billion. To put it simply, the system is failing the people it's meant to serve and that as the patients. Mr. Joyner, in 2024, CVS and spent a staggering $41 million in compensation to you and your colleague, Karen Lynch.

This is enough to cover the premiums for thousands of American families. How do you justify getting paid that much when so many of your patients struggle to afford skyrocketing premiums? That was not my compensation that you referenced. This past year, my compensation was $17 million. It was $17 million.

Of which 1.1, of which 1.1 was my base salary, and the rest is long-term incentives. And the bonus, based off the performance of the year, I did return my bonus back to the Employee Relief Fund. So the employees that were going through challenging and difficult times got the benefit of my bonus last year. CVS employees? Yes, sir. This hearing happened about a year after Brian Thompson's murder. And in the immediate aftermath of his death, there were conversations about health care. The United Health Group CEO at the time wrote an operative.

in the New York Times, and said the health system doesn't work as well as it should, and no one designed the system this way. But in the hearing, Brian Thompson came up just once. Hemsley was asked to state into the congressional record what kind of man he was. Brian Thompson was a force for good. He was a creative and effective man in terms of trying to address many of the challenges that have been presented today. Ultimately, Brian Thompson's murder hasn't led to any major legislation or any real political

gains for health care reform. When we asked AHIP whether the healthcare industry has made or plans to make significant changes since Brian's death, a spokesperson wrote, there was no place for violence in the health care system. There's a lot of uncertainty about where this case goes next. We know Mangione faces sentencing in his federal case in December. But we're still waiting to find out if you'll go to trial for murder in his stay case. So what should we be watching for in the coming months?

What are the different ways this story that's been with us since December 2024 could come to an end? Burden of Proof, Luigi Mangione, is a production of ABC Audio and 2020, hosted by me, Ryan Buckmeier. Produced by Vika Aronson and Audrey Mossack. Our lead producer is Camille Peterson. Edited by Tracy Samuelson, music by Evan Viola, mixing by Bob Mallory. Special thanks to Katie Dendos, Sasha Aslanian, Michelle Margolis, Tanya Simpson, Aaron Kutterski, Josh Margolin, Peter Haralambos, Jared Kofsky, Jake Lefferman, Katie Maldowney, Lauren Lantry, Sony Salzman, and Liz Nepparent. Josh Kohan is our director of podcast programming. is our executive producer.

Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation Walk. Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together, we can carry the fire

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