The cover story for our latest issue of National Underwriter Life & Health is called "Tragic Tale," and it is an in-depth look at the life and near-death of Bill Mantlo, a fellow who had a brilliant career writing comics for Marvel Comics in the 1970s and 1980s, and then switched to become a public defender, of all things. His career was cut short when he was hit by a car in 1992 while rollerblading. Bill suffered severe head injuries that left him permanently disabled, and also put him into a long and hard journey through our healthcare system.
Bill's insurer in this was CIGNA, which unfortunately could not provide much information to the story.The upshot is that eventually, CIGNA made the call that Bill's healthcare coverage had run its course, and Bill was no longer able to receive any further rehabilitation. Once that call was made, Bill basically fell out of getting any kind of care that could improve his condition, and he landed at an unimpressive nursing home on the far side of Queens, New York, that has been described by his family as little more than "three hots and a cot." It is where Bill was sent to live until he dies. Nothing more. The question to be asked was whether CIGNA made the right call or not. It is easy to speculate. But that is all anybody can do on this case: speculate.
Having said that, CIGNA doesn't look very good in this story. And I knew it when I began compiling it. I wrote this story not to go after any health insurer or even to go after anything at all. I knew of Mantlo from his writing, learned he'd been in a horrible accident, was permanently disabled, and that his fans had held some fundraisers to raise money for his care. It was that last part that interested me. Fundraisers? For Bill Mantlo? Where was his health insurance, I asked myself. A speculative call to Bill's brother, Mike, and I suddenly realized there was an interesting story here, and down the rabbit hole I went.
I called CIGNA while writing this and explained to them what this story was shaping up to become, and that I'm not a fan of attack journalism. Would CIGNA like to be part of the story? There are two sides to everything, and National Underwriter has a good relationship with the company. I could easily get Bill's family to sign a HIPAA waiver on his case so CIGNA could talk about it, but the company was not interested. That is unfortunate, because in cases like Bill's, the natural tendency is to assume that the health insurer had the worst motivations in mind when it essentially cut off coverage. But I really don't think anybody at CIGNA or any other health insurer ever wakes up thinking, "Today's the day I'm going to make somebody unhappy." Maybe I'm naive, but I really don't think very many people intentionally set out to cause villainy. I think what happened in the Mantlo case was our healthcare system - and more importantly - the risk financing mechanism that makes it all possible - acted exactly in the manner it was supposed to. When you think of health insurance acting as a machine, the machine in this case did not malfunction. But if you get your hands stuck in the gears, it can cripple you. And I think that is what happened here, to some degree.
I have written a separate editorial for the print book explaining that this story takes a hard look at all health insurers, not just CIGNA in this one case, and indeed, in the case of Bill Mantlo, CIGNA didn't act in any way other than it should have. The question is, when it comes down to the mission of delivering healthcare to people, is this really the best way it can be done? I'm not saying that by default, the answer is PPACA, because it is not. (In fact, a point of "Tragic Tale" is just how poorly PPACA achieves its stated aims.) And I'm not saying that medicine cannot be a for-profit business either. I don't know what the answer is. I just get the nagging feeling, having learned about Bill Mantlo's case, that someway, somehow, there must surely be a better way than this.
I don't want the healthcare industry to dismantle. Nor do I want to replace it with a government equivalent. I have less faith in the government to fix things than in private enterprise. But maybe the biggest problem with health insurance is that as a business, it is in the practice of managing risk. And the thing about risk management is it often reduces one's risk tolerance to an extreme degree. That sort of thing can create problems, and in the case of private health insurance, an extreme risk avoidance reflex is a natural barrier to innovation. Innovation is the key to improving healthcare delivery, service and profit. We did not see enough of it quickly enough from the industry before a wellspring of public backlash empowered politicians to pass some pretty intense reforms. Can the industry still be the master of its own destiny? Can it innovate a solution that makes future lawmaking unnecessary? Absolutely. And I truly hope that it does. But so far, I am not sure we are seeing it. And as the Bill Mantlos of the country grow old in out-of-the-way nursing homes, it raises difficult questions with even more difficult answers.
Image courtesy of Marvel Comics