The neighborhood of Far Rockaway, Queens, N.Y. is the picture of urban blight, a crammed mixture of public housing blocks, shuttered storefronts, brownfields and small churches in what used to be homes. Most of the fences are topped with razor wire. Large piles of garbage lay scattered on broken sidewalks. The most recent sign of commercial development is a billboard advertising $300 divorces. No spouse signature required.
Tucked away on Beach 19th Street is the Queens-Nassau Rehabilitation Center and Nursing Home, a bare-bones geriatric and head-trauma facility. Small and tightly quartered, its halls are partially blocked by old, frail-looking patients wearing ragged clothing.
Bill Mantlo was born in Brooklyn, NY in 1951, the first of three brothers—himself, Mike and Adam. Bill became an avid reader and artist early on, with a love for comic books. But it was in 1962, as the Amazing Spider-Man began to hit the shelves, that he became a die-hard fan of Marvel Comics in particular.
Bill got into the Marvel fandom on the ground floor. Although the company had been publishing comics since the 1930s, it was in 1961 when Marvel began evolving into the engine of pop culture that it is today. Writer and editor Stan Lee and artists such as Jack Kirby reinvented the superhero genre, telling stories that were set in real-world New York, filled with characters who were more human (at least to readers) than their counterparts at other comic companies. Characters who are now household names, such as Spider-Man, Captain America, the Incredible Hulk, Iron Man, the Avengers and the Fantastic Four were all getting their big start. For kids who were into comics, it was a special time— the likes of which have never been repeated.
But Mantlo’s writing itself was also deeper than most other comic writing, especially for the time. Mantlo used comics as a form of social commentary, especially on topics that became flashpoints during the protest era of the 1960s. A comic series about an injured stuntman became an allegory for disabilities awareness. A space opera comic about a talking raccoon became an allegory for taking proper care of the mentally ill. A story about why the Incredible Hulk is powered by rage became an allegory about child abuse.
A lot of writers, including Claremont, did this sort of thing, but few did it as regularly or as effectively as Mantlo did.
The Boisterous One
By the mid-1980s, however, Mantlo’s writing assignments were dwindling. The days of lax deadline management were long gone, and most writers were doing their own fill-ins. Plus, Mantlo had locked horns enough with Shooter and Marvel top brass (including Stan Lee) that new editors were not particularly willing to work with him. Mantlo did not help matters with a failed attempt to unionize his fellow Marvel writers. He spoke his mind with such freedom and bluntness that he earned the nickname “Boisterous” Bill Mantlo, or merely, “The Boisterous One.”
Bill’s memory was shattered by the accident, though he was aware of what had happened to him, and he had a sense of how grievously he had been injured. Throughout his early rehabilitation, Mike says, Bill was consumed with rage, both at the state of his own health, and that whoever had hit him had successfully fled the scene. This made him combative during rehabilitative therapy sessions. He was still quite fit and strong enough to resist therapists physically, which became a problem and prevented Bill from making much progress.
Both Adam and Corinna visited their father regularly while he was at Gaylord, and they could see that he was becoming ever more angry and distraught at his condition. During one visit, Bill asked Adam and Corinna to kill him. After that, neither could bear to see their father in person again, confining contact to letters and telephone calls.
What happened next has become a major point of contention for both of Bill’s children. Having sole authority over Bill’s finances, and a need to spend Bill down to Medicaid eligibility as soon as possible, Mike systematically sold off nearly everything Bill owned, including an extensive toy and memorabilia collection. Adam rankles over the loss of that, especially since it complimented his father’s extensive comic book collection, which his father had paid him to curate back during the Marvel years. The comic collection was more than just a trove of four-color pulp; it was Bill’s reference library for everything he ever wrote for Marvel. It was also Adam’s strongest connection to his father’s work, and to the time he shared with his father during long nights of writing and printing off scripts from a Daisy wheel printer housed in a hushbox so it would not wake up the rest of the family while it ran. Bill sold the comics, and paid Adam a commission on it, before the accident, when he stopped writing for Marvel. The rest of the collection, however, remained as a reminder of those times. That collection is now gone. Adam does not even know what Mike got for it.
For Corinna, the liquidation involved the sale of a small vacation cottage her parents owned in upstate New York, not far from Woodstock. When Bill and Karen divorced, the house was split between them and Bill bought Karen’s half from her. Before Karen could buy back the cottage, Mike sold it to someone outside of the family. For Corinna, the cottage was a storehouse of family memories, especially of her father. She feels the sale was somehow connected to bad blood between Karen and the rest of the Mantlo family that emerged during the divorce. She will not say for certain, except to note that she no longer is on speaking terms with her uncle because of it. Neither is Adam.
“There’s no doubt in my mind that CIGNA has a hard-dollar amount on every case that they cover,” Mike says. “They won’t always tell you what that limit is, but they have one. CIGNA deals with the facilities and the doctors. They don’t deal with the individual policyholders. And they never reveal those limits to the policyholders.”
Mike feels that what happened with Bill and CIGNA would have happened with any other health insurer, too. The way he sees it, insurers are bound to look at any health problem in terms of how much it will cost them. Policyholders are bound to look at it in terms of who is going to pay to make them better. What angers him is the power insurers have to deem what treatments are medically necessary when their motivations appear to be purely financial.
“It doesn’t seem helpful to speculate on what might have happened 20 years ago, or to create a hypothetical situation,” Barone says of CIGNA’s handling of Bill Mantlo. But she does cite the 2011 Payerview Performance Ranking—a study of some 47 million claims submitted to the payers of neatly 27,000 healthcare professionals—which gave CIGNA the No. 1 ranking nationwide for the lowest claim-denial rate among all health insurers in the United States. It is the second consecutive year CIGNA has earned the top spot in this survey, which is conducted by athenahealth, a provider of billing services for physician practices. Barone also cites the 2011 National Health Insurer Report Card, a study conducted by the American Medical Association that gives CIGNA top marks for its low number of denied claims, at less than 1% of total claims processed.
What is important to note is that Bill Mantlo’s case would not qualify as a denied claim. CIGNA did spend a several million dollars in just a few years caring for Mantlo. As with any medical claim, there is an actuarial decision to be made, and eventually, almost every claimant reaches a point where the insurer considers its contractual obligations fulfilled. By declaring that Bill Mantlo could make no further rehabilitative progress, and that any additional rehabilitation would not be medically necessary, CIGNA freed itself from paying any more into a potentially lifelong, multi-million-dollar medical tab. But did CIGNA act prematurely on the issue of Bill’s actual need for rehabilitation? That question remains unanswered.
Translation: The Bill Mantlos of tomorrow are even more likely to end up in Queens-Nassau than they were before. During the long national debate that led to the passage of PPACA, stories like Bill’s were spun into a larger narrative of how patients with persistent and expensive medical needs were routinely cut loose by a health insurance industry more interested in profit than anything else. It was a primary reason behind the first and second provisions of PPACA—the elimination of lifetime or annual coverage caps, and the prohibition of policy recissions. On both of those counts, when compared to cases like Bill’s, PPACA has been an abject failure.
If Bill Mantlo had been hit today instead of in 1992, his downward transit through the healthcare system would have been no different than it was, and he would have ended up in the same place, in the same condition. PPACA does nothing to help him. It was never intended to, amounting to a gaping blind spot in the reform package’s mission to improve access and quality of healthcare for all.