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 is one of them. At first glance, there is nothing to suggest that he is different from his fellow patients, nothing to suggest the unusually high-profile career he once had, the near-fatal car accident that ended it, or his tortuous transit through the healthcare system from the outside world to Queens-Nassau. And certainly nothing that would point out how his life’s remarkable reversal of fortune illustrates not only some of the worst deficiencies of modern healthcare, but of the effort to reform it, as well.
Bill is gaunt, almost skeletally so. His skin is pale and pasty, the product of getting very little time outside. His short hair is lank and unwashed. His teeth are yellow and have not been properly cleaned in some time. He turns 60 on Nov. 9, 2011, but he looks more like 80.
The victim of a closed-head brain injury from nearly 20 years before, Bill cannot move from his wheelchair to his bed without help, nor can he feed himself, go to the bathroom or conduct any other kind of normal physical activity unaided. He can move his arms, but the fine motor control in his hands is very poor. He needs someone else to put his glasses on for him, and when he wants to take them off, he can only drag his hands across his face and let the glasses clatter to the floor.
Bill can hear and recognize when people speak to him, but his own speech is slow, labored and typically consists of single words or very short sentences. Most times, he simply yells at anybody who enters his room. He has a history of lashing out violently at staff and patients, though in his current condition, the only person he is likely to hurt with a swing is himself.
His room is nearly empty. No television. No radio. No books, magazines or newspapers. No decorations on the walls. No mementos from previous visitors. Nothing at all to mark the individual who has lived here since 1995. A solitary prison cell has more personality than this, even though Bill is not prohibited from going anywhere. He just lacks mobility, and most times, the will. His average day consists of waking up, getting changed and cleaned by the morning shift nurses, and then a sit in his wheelchair, where he stares at nothing. When he has had enough, he is transferred back to his bed, where he closes his eyes and tries going back to sleep. At some point he will be fed, and after that, more sleep.
Today, however, he has a visitor. A man comes to his room, but immediately Bill wants no part of it.
“GO.” he shouts. “GOOO!”
Bill’s social worker is nearby, openly skeptical that this visit will do anything other than agitate Bill into a state that will make him difficult to handle for the rest of the day. But Bill’s nurse, Fatima, moves in and places a hand on his shoulder. For reasons the staff will not disclose, Bill is disturbed by the presence of any men in his room, which is why his nurses are female. Among them, Fatima has the best rapport with Bill and her words soothe him enough to listen.
“Now, Bill, you can’t talk to him like that,” Fatima says. “Do you know who that is?”
“Who?” Bill asks, genuinely perplexed.
“That’s your son.”
Bill’s head turns suddenly, fixing on his visitor. This is more than a surprise.
“Hi, Bill,” says the visitor, a 45-year-old man in a puffy red jacket. “It’s me, Adam.”
Tears come to Bill’s eyes. Then they come to Adam’s. It is the first time either one has seen the other in 17 years.
The Fill-In King
While most people would not know who Bill Mantlo is, comic book fans might. He was, for a time, one of the top writers for Marvel Comics, and to this day he still has a considerable fan base. When Greg Pak recently finished writing a string of issues of the Incredible Hulk, he dedicated the issue to Mantlo. Bill’s impact on the comic world is significant, but even his most ardent fans generally do not know that he has become defined by a cruel irony: Mantlo wrote superhero stories to inspire people to be good to each other, only to become an anguished man in a broken body, in desperate need of a hero himself.
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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.
Bill’s connection with Marvel went even deeper, as Jack Kirby was a neighbor of his. Bill often spent his teenage afternoons at “the King’s” house, picking up on drawing tips, geeking out on superheroes and talking about storytelling. It would prove to be a formative relationship for Bill.
After graduating from the Cooper Union School of Art in 1973, Bill scored an internship at Marvel. He started as a gofer and soon began working as a colorist, which was not glamorous, but it got him into the trade.
At that time, comics were produced on an assembly line: a writer wrote a 17-page script which went to a penciller, who would follow the script to draw the panels in light blue non-repro pencil. Then the pages went to an inker, who went over the initial art, cleaning it up and adding light and shadow with black ink. Then it went to a colorist, who would paint the panels and send the page to a letterer, who would hand-write every word of dialogue and exposition. As a rule, the process worked fairly well unless the writer missed the deadline, at which point the whole show would grind to a halt.
In the early 1970s, Marvel was plagued with writers who regularly missed deadlines. Comics rarely came out on time, often running a full month late (or more). This had become a huge problem for Marvel because at the same time, comic sales had shifted from general newsstands to direct-sales specialty shops that would order issues in advance. Not knowing when or if a certain issue would be in was cause to withhold orders, and Marvel was feeling the hurt in a big way from that.
Bill’s big writing break came in 1974, when a writer had missed his deadline for an issue of Deadly Hands of Kung-Fu. Bill offered to write the issue on the spot, and quickly turned in a script that saw publication and landed him a gig writing Deadly Hands full-time. Deadly Hands was a minor title on the verge of cancellation anyway, but Mantlo did not care, and he took the job, and its deadlines, seriously.
Shortly afterward, Marvel mandated that all ongoing titles would have fill-in stories written in advance and held in reserve just in case the regular writer blew a deadline. Many of these fill-in jobs went to Bill, who became known for his utter reliability and a knack for turning out stories quickly, even overnight. Most of the titles he worked with were minor ones, like Deadly Hands, but eventually he got a chance to work on larger titles, such as Marvel Team-Up, Iron Man and Peter Parker, the Spectacular Spider-Man. At the same time, he also became the go-to guy for writing stories for properties Marvel had licensed, such as movie and television adaptations.
One such title was the Micronauts, which was based on a line of science-fiction action figures already popular in Japan and introduced to the U.S. market in 1976. Bill himself suggested that Marvel license the toys so he could develop a comic around them. Marvel agreed and began publishing the Micronauts comic in 1979. The toy line had little in the way of backstory, metaplot or character development, but that did not stop Mantlo from building an entire universe around the toys, inventing numerous additional characters and even a fictitious alphabet for the setting. The toy line died in 1980, a casualty of pretty much any science fiction-themed brand that tried to compete with Star Wars merchandising. But by then, it did not matter. The Micronauts was a hit in its own right, popular enough with the fans that it won the 1979 Eagle Award for Favorite New Comic Title. The series continued until 1984, with Mantlo writing all but one of its nearly 60 issues, including spin-offs.
Also in 1979, Mantlo took on ROM the Spaceknight, also a licensed property based off a toy line. The toy was a talking cyborg doll produced by Parker Brothers, but sales were so poor, the toy was cancelled within a year of launch. Again, this failed to faze Mantlo, who had already written a detailed origin, backstory, setting and supporting cast for the title, which remained popular (and more importantly for Marvel, profitable) enough to merit publication for seven years, ending in 1986 after 75 issues.
During this time, Mantlo remained Marvel’s “fill-in king”, ultimately writing for nearly every title Marvel produced at the time. He had long runs on Peter Parker, the Spectacular Spider-Man, the Incredible Hulk and Alpha Flight. At his most prolific, Bill’s work would appear in as many as eight different Marvel titles a month, and his total output exceeded 500 issues.
“Bill was in a class of his own,” recalls Chris Claremont, a colleague and close friend of Mantlo. Claremont’s 17-year writing stint on the Uncanny X-Men and various spin-off titles, from 1975 to 1991, made him one of the most famous writers in modern comic book publishing. Mantlo was different, Claremont says, because he lacked the prima donna ego of most comic book writers. He did not mind sharing story-writing credit on any given issue, often making a point of thanking in the credits anyone who helped him with the script.
While Mantlo wrote certain titles for long stretches, he never bonded with them so deeply that it prevented him from writing other titles. Even when he was writing monthly scripts for Micronauts and ROM, Mantlo was still doing fill-ins. “You gave him the call, and 72 hours later, you’d have a story. That’s something the editors grew to depend on. It was natural to think of him as a go-to guy,” Claremont says.
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.
“He was one of the writers who thought that comics should be more than just guys in skin-tight suits hitting each other and saving the world,” Claremont says. “He was asking, ‘What kind of a world are we trying to save? What kind of lessons can we impart to our young and impressionable readership?’ The trick was to find a way to do it so that you’re not preaching, but you’re also telling a cracking good story that will make the reader turn the page and bring the reader back next issue so you can have an ongoing and more lasting effect. Bill did that.”
But Bill’s writing was not perfect, and nobody knew that better than Jim Shooter, Marvel’s editor-in-chief and the guy who worked most directly on overseeing Mantlo’s work. Shooter became a comic industry legend in his own right during his nearly 12-year stint with Marvel, from 1975 to 1987. More than any editor before him, Shooter worked to make every Marvel title inhabit the same overall setting, creating a universe of thematically linked titles in which characters and storylines could easily cross over from title to title. Fans often refer to Marvel comics produced under Shooter’s watch simply as the Shooter era. More than a few of them contend that the Shooter era is the high point of all Marvel publishing.
Shooter notes that back when he was first editing comics—and Mantlo was just beginning to write them—publishers paid writers by the page, and it was a pittance, at that. The job was so pathetic, Shooter recalls, that one only did it because they truly loved the medium or they had no other choice. Those who could make a living at it had to be very fast at what they did. And Mantlo was fast. But his work often required a great deal of editing, if not full rewriting.
“I think it amused him that I was staying up all night fixing his stuff and making him look better while he’s staying up all night cranking stuff out and making more money,” Shooter says. He kept a file that consisted of entirely rewritten Mantlo script pages. If a single word of Mantlo’s remained on the page, it did not make the file. At the end of a single year, Shooter recalls, he would have a ream of paper in the file.
There were other problems, too. Because he was writing so fast, and under tight deadlines, Mantlo was known to rehash stories that had already run in earlier issues, or crib an idea too closely from another source while searching for a storyline to develop. Mantlo was hardly the only Marvel writer to do this, but he was one of the few who caused some problems along the way. In one case, while scripting an issue of the Incredible Hulk, Mantlo borrowed from an Outer Limits episode written by Harlan Ellison. Ellison called Shooter to complain, and settled things for a standard writer’s payment for the issue, an acknowledgement in a later issue’s letters page, and a lifetime subscription to all Marvel comics.
In another case—and one that remains a point of debate within comic book fan circles—Mantlo was accused of plagiarizing an unfinished story treatment written by artist Barry Windsor-Smith, again for the Incredible Hulk. Shooter’s version of the story is that Windsor-Smith had brought to the Marvel office an unfinished treatment for a story explaining the origin of Bruce Banner, the Hulk’s mild-mannered, but easily enraged, alter ego. Shooter wanted to buy the story on the spot, but Windsor-Smith insisted on finishing it first, and he left rough drafts behind. Mantlo, while visiting the Marvel office, found Windsor-Smith’s work, figured it was open for use, and wrote a story off of it. The Incredible Hulk itself was between editors, and the story’s lineage was not noticed until the issue was in print. The story remains one of Mantlo’s most popular, and it was developed as a core element of the script for the 2003 film adaptation of the Hulk. Windsor-Smith never stopped holding a grudge over it.
“He did a tremendous amount of good work for us,” Shooter says, stressing that Mantlo’s good far outweighed his bad. “The nice thing about Bill was that other writers could be picky fanboys, but Bill would do anything. Book about a stuntman? Sure. Book on a toy? Sure. And he gave it a good effort, no matter what it was. He could do any job and he was always polite, always nice. You couldn’t help but like him.”
Where Shooter noticed this most was the ease and frequency with which Mantlo created new characters. Until Shooter got Marvel to implement a policy that gave writers a small percentage of any licensing for characters they created, any new intellectual property belonged to Marvel. While Shooter was working on that incentive, he told his writers to not create any new characters, to ensure they got a piece of whatever they would be worth. There was substantial money to be had once the incentive program was in place—$30,000 checks for the action figure rights on a single character were not unheard of. This is why Shooter had wanted the writers to hold off for a bit.
“Not Bill. Are you kidding? He was making characters like they were going out of style. He was irrepressible. He was a font of ideas. There was no limit to his creativity,” Shooter recalls. “I appreciated it on behalf of Marvel, but I felt bad for Bill that he had created these things that if he had waited a little while, he would have owned a piece of them. You know what his attitude was? ‘I’ll make more.’ I really admired that.”
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.”
In 1985, Mantlo took advantage of a tuition reimbursement program Marvel offered and put himself through law school, writing scripts by day and taking classes by night. In 1987, he passed the New York State Bar and while he still wrote the occasional comic book, as well as starting various novels and screenplays, he considered himself a full-time lawyer. He received a number of offers to work for real estate legal firms but he opted to work for the Legal Aid Society, a private not-for-profit that provides free criminal defense representation.
Mantlo made about $40,000 a year at Legal Aid, which was considerably less than he was making at Marvel. But that was almost the point: he became a lawyer mainly because he felt he had done all he could with comics to send messages about social causes. In law, he could help people more directly.
In court, Bill lived up to his reputation as the Boisterous One, earning numerous warnings from the bench for his fiery brand of delivery, especially while cross-examining police officers. As one justice recalled, Mantlo was the nicest person he ever had to hold in contempt of court. Once, Bill was arrested as part of a sweep against a sit-in by a local school union he was representing. He used his phone call not to arrange for bail, but to order pizza for himself and everybody else in the holding cell.
It was also at this time, however, that his marriage fell apart. Mantlo had married Karen Pocock years before when they were both working at Marvel (Pocock was a letterer). Pocock had a young son, Adam, from a previous marriage whom Mantlo accepted and raised as his own. In 1981, the couple had a daughter, Corinna. And when Bill entered law school, Karen left her own career as a photographer to become a teacher; their calling to help people had been a joint life change. But by 1988, he and Karen were bitterly divorcing. The experience was hard on both children. Adam, 21 years old and an accomplished bicycle mechanic, stayed far from home to distance himself from the emotional carnage. Corinna was only seven and stayed with her mother, but the stress of the divorce also had a long-lasting effect on her. To this day, she does not readily share details about it. Regardless, Bill, Adam and Corinna still saw each other regularly and maintained a close relationship. Both Adam and Corinna describe Bill as a great father.
Throughout his time at Marvel and at Legal Aid, Bill was an avid runner, biker and rollerblader, keeping himself in excellent shape. A favorite activity was to take Adam and Corinna dirt biking in Central Park. Bill always wore a helmet, and insisted that his kids did likewise. But when rollerblading, Mantlo did not wear any head protection, like many other early rollerbladers. It was an oversight that would destroy his life.
Hit and Run
On Friday, July 17, 1992, Bill left work early for the weekend, and made his usual three-mile rollerblade journey through Brooklyn traffic to his apartment near Morningside Park. Just four blocks from home, a car came around a corner and hit Bill. The left side of Bill’s head impacted the windshield. He rolled across the hood of the car, and the right side of his head impacted the pavement. The driver never stopped and was never identified.
The accident jostled Bill’s head so violently that his brain squashed against the inside of his skull, and his brain stem severed. This did not paralyze him, but it would make it very difficult for Bill’s body—particularly his extremities—to accurately receive and process electrical messages from his brain.
Bill spent the next two weeks in a coma at Saint Luke’s hospital in midtown Manhattan, after which he remained in critical care for another two months. During this time, he was still on a ventilator and a feeding tube, as his brain was too damaged to tell his body how to swallow or breathe.
The acute care needed to save Bill’s life cost more than $1 million, according to Bill’s brother Mike, who at the time was a dispatcher for FedEx. Mike became Bill’s legal guardian once Bill could no longer make decisions for himself. The Legal Aid Society had provided Bill with group health insurance through CIGNA—one of the country’s largest health insurers.
According to Mike, in October 1992, CIGNA declared that Bill’s immediate recovery was complete and that he would have to be moved to a rehabilitation facility for further recovery. CIGNA instructed Mike to find a facility for his brother, but offered no help in doing so. Mike researched and interviewed seven different facilities before settling on one in Pennsylvania that appeared to be ideally suited for handling patients with Bill’s particular problems. CIGNA approved the choice and told Mike to move Bill in. Mike had Bill transported to Pennsylvania but a week after Bill moved in, CIGNA told Mike that Bill would have to go somewhere else, as CIGNA no longer covered the facility. It would be the first of a number of unwelcome conversations between Mike and the insurance company.
Bill was moved to Gaylord Rehabilitation Hospital in Wallingford, Conn., best known at the time as the facility that had treated Tricia Meili, the “Central Park Jogger” who had suffered severe head injuries from an assault and rape in 1989. Gaylord was Mike’s second choice.
Bill stayed at Gaylord for nearly a year-and-a-half, during which time a number of disputes between Mike and CIGNA began over the continuation of Bill’s care. According to Bill’s policy wording, he was eligible for 90 days of rehabilitative care, after which he would have to show that he was making recuperative progress in order to justify further rehabilitation. This is where being the “Boisterous One” came back to haunt Bill when he could least afford it.
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.
Three months later, CIGNA declared there was nothing more to do and informed Mike coverage would cease. Mike argued that his brother was still progressively recovering, and that even though some of Gaylord’s therapists refused to work with Bill, the family was assisting with therapy. Mike would visit Gaylord every weekend. Bill’s mother Nancy would sit with him and go through speech therapy. Bill’s father William would visit three times a week to assist with physical therapy.
And the work was paying off. Mike recounts that by November 1992, Bill regained his ability to speak and could sit up in a wheelchair. He was no longer on a ventilator or a feeding tube, and his family could even take him out to dinner. Bill could now read a menu and place his own order, and it could be understood by the wait staff.
But it was not enough. On one occasion, Mike recalls, a staff psychologist pulled Mike aside and told him that Gaylord was being pressured by CIGNA to cut Bill off. Despite the progress being made by the family, if CIGNA saw that Bill was not working with facility therapists, the company would say that Bill did not need any further help. That is exactly what happened.
Mike successfully lobbied for another 90 days of rehabilitation coverage while he scrambled to find a new facility where he could move Bill. He found Whittier Rehabilitation Hospital in Westborough, Mass., an 88-bed facility that specialized in acute and specialized rehabilitation, including a memory clinic. CIGNA approved the transfer, but the problems that complicated Bill’s stay at Gaylord did the same at Whittier. At the end of his first 90 days there, CIGNA decided that Bill was resisting therapy and not showing signs of progress, so coverage would have to cease. At this point, the total cost of his care totaled more than $2 million, nearly half of which went to rehabilitative therapy.
Mike fought with CIGNA on this ruling as well, with some help from Whittier’s physicians. CIGNA reportedly turned up the heat, requesting updates every 30 days to determine if continued care was still medically necessary. “The primary physician was siding with me and was really fighting with CIGNA,” Mike says, adding that CIGNA eventually brought in its own physician, who examined Bill and filed a report to CIGNA stating that no further rehabilitation was medically necessary for Bill. Mike says he was never given a copy of the report.
Bill’s primary physician at Whittier protested the report with Whittier’s management itself, arguing that it could not allow the insurer to bring in its own medical personnel to reverse the medical opinion of a department head within the hospital. The doctor insisted Mantlo could still make progress, but he needed more intense therapy than what Whittier could provide.
“Thank God for him,” Mike says. “That guy did everything he could for Bill.”
Round three. Mike found the Meadowbrook Nursing Home in Tucker, Ga., about 15 miles northeast of downtown Atlanta. Although Mike was still working and living in Manhattan’s upper West Side, he could fly for free on FedEx cargo flights, which meant he could still visit Bill on the weekends.
Bill arrived at Meadowbrook in 1994. Mike describes it as a “very small, very intense” rehabilitation center where Bill made progress in both speech and vocational therapy during the first few months. Bill recovered to the point where he was able to type at a computer and maintain his concentration long enough to begin writing once more. He started keeping a journal in which he recorded random creative thoughts as well as some personal reflections. During one therapy session, he even produced a two-paragraph short story for one of his doctors about an invasion from Mars.
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Sensing an opportunity to advance Bill’s recovery even further, Bill’s treating physician informed Mike that she had a new medication she wanted to try on Bill that might produce radical rehabilitative results. Mike does not recall the name of the medication, just that he approved its use on his brother.
“She started him on a very low dose, half a milligram a day,” Mike says. In one day, Bill came back the furthest he had come in any of the facilities he had been in. He picked up the phone, dialed his parents and talked to them for an hour. “It was unbelievable. They were on Cloud Nine.”
To advance recovery even further, Bill’s dosage was doubled, which prompted a very negative reaction. Mike received a call at 10 p.m. from a watch nurse reporting that Bill was sitting on the floor, shaking uncontrollably and picking imaginary insects from his skin. He was taken off medication immediately, and the next day Bill slipped into a three-day coma.
“When he came out, he had lost everything he had gained up until that point,” Mike says. “He could barely speak. He was completely back to square one.”
After that, Mike recalls, CIGNA decided that Bill no longer needed rehabilitative care of any kind, and that he needed long-term respite care instead, which was not covered by Bill’s policy. CIGNA advised Mike that Bill’s disability payments alone would be insufficient to pay for any kind of permanent care, so all but $3,500 of Bill’s assets would have to be liquidated in order to qualify him for Medicaid.
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.
Both consider this to be collateral damage from Bill’s loss of his health insurance. “This tore our family apart,” Corinna says.
The money Mike raised from the liquidation went toward extant healthcare costs not covered by insurance. Bill had a $100,000 life insurance policy that was surrendered to pay for uncovered costs. All of that money is now gone. Bill is on Social Security, but it all goes toward his medical care. He is permitted to retain $50 per month off of his meager streams of income.
Because Bill was a New York resident, he had to go to a New York facility once he left Meadowbrook. Moreover, he had to go to a place that would accept him, knowing his history of aggressiveness and his status as a Medicaid case. The only facility Mike could locate was the Queens-Nassau Nursing Home, which was a geriatric nursing home that had just gotten into the head-injury rehabilitation business. By Mike’s reckoning, the staff training was poor, with little experience with head injuries. But it was the only place left for Bill to go.
In August of 1995, Mike had to fly Bill on a commercial flight from Atlanta to New York. The flight was the worst experience of Mike’s life, he says, because Bill was combative the entire way. CIGNA offered no help in transporting Bill, nor did Meadowbrook.
Once Bill arrived at Queens-Nassau, he made some minor gains but he has come nowhere near to the level of recovery he obtained at Gaylord, Whittier or Meadowbrook. He is currently reported to have almost no short-term memory.
Until his regression in Georgia, there was hope that with enough rehabilitation, Bill might one day return to his home, living with assistance but actually having something approaching a normal life. Now, that seems impossible.
“At this stage, there really isn’t much that he gets out of life,” Mike says. “He doesn’t like to eat. He doesn’t like to listen to music. He doesn’t like to watch TV. He doesn’t like to read. He doesn’t want to do anything. It’s very difficult.”
If a way could be found to get Bill in front of a computer, perhaps with dictation software, Mike feels that Bill could probably write a story. But that depends entirely on whether Bill could maintain his concentration long enough to form a creative thought. These days, it does not happen often.
Mike does not have a large collection of Bill’s writing. But he does have a printout of the computer journal Bill kept while he was at Meadowbrook. Many of the entries contain loose details that appear to be connected to his Martian invasion story. But there are personal notes interspersed that reflect Bill’s own anguish, and his resistance to the very treatments that were slowly returning him to normal.
“My name is Bill Mantlo,” he writes in his last personal entry. “I want to go home.”
Years after Bill moved to Queens-Nassau, there were a few efforts made to raise additional money for Bill’s care. One was through the Hero Initiative, which gives financial aid to comic book professionals who have fallen on hard times. Being sick and without health insurance is a common cause. Jim McLauchlin, who manages the administrative side of the HERO Project, has virtually no information on its effort to help Bill Mantlo, just that it dispersed approximately $2,000 to Mike Mantlo sometime in the early 2000s.
In December 2007, Jason Leivian, the owner of Floating World Comics in Portland, Ore., held Spacenite, a tribute to Bill Mantlo. Leivian gathered over 100 artists from around the world to produce artwork based on Mantlo’s best-known character, the spaceknight, ROM. The original artwork was auctioned off while digital prints of the art went on sale online. All told, the event delivered $2,000 to Mike Mantlo. A second Spacenite event was held in 2010.
The same year the first Spacenite event got under way (2007), Mike Mantlo collaborated with cartoonist David Yurkovich to write Mantlo: A Life in Comics, a biography. The book’s meager profits all go to Mike Mantlo for the stated aim of buying Bill clothing, food and haircuts.
Meanwhile, Corinna Mantlo has created the Bill Mantlo Project, a Facebook page where fans and colleagues can share their thoughts about Bill. The page is also Corinna’s launching pad for starting her own non-profit foundation that aims to raise money in Bill’s name to pay for young artists’ formal schooling.
Although Corinna and Adam are no longer in contact with Mike, all agree that had Bill stayed at Gaylord, Whittier or Meadowbrook, he would be in better condition today. All blame CIGNA for Bill’s current state of regression.
“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.
CIGNA, by all accounts, did not act abberantly or in contradiction with its own procedures. It abided by the contractual obligations of Bill’s policy language, even if it did appear to pursue its claims management aggressively. Everything Bill Mantlo went through, from his acute care through his various rehabilitations, reflect the inner workings of a healthcare delivery system that functioned according to its design. This is not a case of the system breaking down, Mike believes. It is a case of a system designed to deliver results not all feel are just.
“The only thing I can say to people in the industry is that I hope to God they never have to be in the same kind of situation,” Mike says. “All it would take is for the president of CIGNA or any other health insurer to be in this kind of situation to realize that what they are doing is not such a great thing.”
Wendell Potter feels very much as Mike Mantlo does. For 20 years, he handled public relations and corporate communications for health insurance companies, the last 15 of which were with CIGNA. He left CIGNA in 2008 and now speaks out against what he saw as a troubling disconnect between the health insurance industry’s desire to make a profit and people’s desire to recover fully from injury and illness. He is now a senior analyst at the Center for Public Integrity, a nonprofit that produces investigative journalism on issues of public concern. He is also a senior fellow on healthcare for the Center for Media and Democacy, a public interest organization that argues for the need to overhaul the American healthcare system. And he is one of the few independent consumer liaison representatives for the National Association of Insurance Commissioners, attending their meetings in order to advocate on behalf of insurance consumers.
In June 2009, Potter testified before the Senate Commerce, Science and Technology Committee in what would become a frequently cited argument for the need to reform healthcare. He said that in the case of insurers that are traded on the stock market—as CIGNA is—the need to meet Wall Street’s expectations far outweigh the need to help policyholders get better. As such, insurers regularly find ways to scrub policyholders from their rolls who have conditions that will take a long time and lots of money to treat. Policyholders like Bill Mantlo, for instance, whose brain injuries are serious enough to merit ongoing rehabilitation in order to restore his brain and motor function, but persistent enough that no amount of rehab will ever bring him back to where he was before his accident. For health insurers, a policyholder like Mantlo is a worst-case scenario.
After receiving the details of Mike’s struggle with CIGNA, Potter says that sounded consistent with how CIGNA typically handled such cases when he worked for the company. But he adds that CIGNA is hardly unique in this regard. If anything, how CIGNA deals with policyholders like Bill Mantlo is par for the course across the health insurance industry, Potter maintains.
“Medical directors in cases like this are under the gun to make sure they are keeping medical expenses to a minimum,” says Potter. “There is often a review of cases on a periodic basis by medical directors and they’ll look at the benefit plan and if there is any reason to reduce or deny coverage, they’ll do it.”
Potter notes that CIGNA also does this to small businesses deemed to have excessive medical costs, in a practice known as “purging.” The strategy is simple: identify those small business policyholders whose costs are too high and systematically increase their premiums until the businesses are forced to drop their coverage. By then, the business has a hard time finding coverage with another insurer because of its claims history. “This is a big reason why we have a dwindling number of small businesses that can offer coverage.”
Potter has no specific information on Mantlo’s policy, and he refers the matter to Gloria Barone, an ex-journalist who currently handles CIGNA’s corporate communications. “Gloria is a good person,” Potter says, adding that she probably will be unable to provide any helpful information on Mantlo’s case. Potter’s assessment proves correct on both counts.
As Barone listens to an account of Mantlo’s career, his accident and his descent into healthcare purgatory, her response is a human, sympathetic one. Every detail of Mantlo’s case seems to trouble her on the same personal level that it troubles almost anyone who learns of Mantlo’s condition.
Her professional reaction, however, is one of guarded pessimism. She says that for legal reasons, she is prohibited from disclosing the details of Mantlo’s coverage as provided by the Legal Aid Society. When told that Mike Mantlo is willing to sign a HIPAA waiver on his brother’s medical records, she later reveals that CIGNA no longer has the paperwork on Bill’s file. Moreover, nobody at CIGNA is willing to discuss Bill Mantlo on record. (In fact, CIGNA would not comment on any aspect of Bill’s medical history as described in this article.) Most of the people who handled his case, she says, are no longer with the company. She will not say who those people are.
Same for the Legal Aid Society. Nobody at the Society who worked there at the same time Mantlo did knew him very well, let alone could recall any details on his medical history. And like CIGNA, the Society no longer has any paperwork on Mantlo. On paper, it is as if Bill Mantlo was never even treated for a brain injury. His medical patient record has all but disappeared.
“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.
While critics such as Potter decry the methods and motivations of health insurers for handling cases like Mantlo’s in the way that they do, playing hardball on the medical necessity of brain rehabilitation is not illegal. However CIGNA parsed the language of its contract with Bill Mantlo, it does not appear to have acted unlawfully or tortiously. The Mantlo family has not pursued any legal action against CIGNA, nor does it intend to. CIGNA has not even broken a moral contract with Mantlo, as insurers uphold no Hippocratic oath, as physicians do. Physicians are bound to serve the health of the patient first. For-profit health insurers are risk financing operations whose stakeholders are not, in fact, medical patients. Herein lies the great disconnect that Potter described during his Senate testimony.
“The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a government-run system,” Potter said in 2009. “But what we have today…is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.”
PPACA’s Blind Spot
The Patient Protection and Affordable Care Act, which passed in March 2010 and was signed into law immediately afterward, was supposed to change all of this. By legislative standards, it was an enormous bill, the final version of which came in slightly north of 900 pages—enough paper to stop a speeding bullet. Among the Act’s many provisions are a prohibition on lifetime benefit caps and annual caps on medical coverage plans, a ban on excluding policyholders based on their prior medical history and guaranteed coverage to the children of policyholders up to age 26.
Even before PPACA was signed into law, it was a political battlefield, especially over its individual mandate, which requires everyone to purchase at least rudimentary health insurance.
The health insurance industry in general, and its primary political lobbying trade associations—The National Association of Health Underwriters (NAHU) and America’s Health Insurance Plans (AHIP)—got a lot out of healthcare reform, Potter says. At the top of the list is the individual mandate, which provides the industry with some 36 million new customers and a new revenue stream in the form of government subsidies for people who cannot afford to pay their healthcare premiums.
“They’re not opposed to the Affordable Care Act, per se,” Potter says. “What they are opposed to are the new regulations and consumer protections, and that is what the industry is trying to get rid of.”
Potter is referring to the ongoing strategy by the health insurance industry to see that PPACA is defanged before its full implementation is completed in 2014. According to Maplight.org, which tracks political funding, the health insurance industry was the largest collective contributor to representatives who voted in favor of repealing health reform. NAHU publicly applauded the repeal effort, as did CIGNA’s rank and file, going by how many of them appear to be NAHU members.
By the time the House of Representatives voted on H.R.2, Repealing the Job-Killing Healthcare Law Act, it became clear that PPACA would not be repealed outright. The Senate was not even interested in entertaining any legislation that would overturn healthcare reform, let alone in a position to pass a vote on it. Even if it did, President Obama, who signed PPACA into law the same day it passed the Senate, had his veto pen warmed up and at the ready. There was nowhere near the 2/3 majority in either the House or the Senate to overturn the veto, so PPACA’s fate as legislation was assured.
This became obvious before the vote on H.R.2, when even CIGNA CEO David Cordani publicly took a position against repeal the day after the GOP retook control of the House during the 2010 mid-term elections.
“I don’t think it’s in our society’s best interest to expend energy in repealing the law,” Cordani said at Reuthers Health Summit in New York on Nov. 9, 2010. “Our country expended over a year of sweat equity around the formation of it.”
AHIP spokesperson Robert Zirkelbach was even more oblique about the repeal effort. “I’ll let folks in the Hill make their judgments on what they were trying to accomplish with that.”
AHIP’s official reason for opposing PPACA is because it does not address the rising cost of healthcare itself. This is of questionable concern for the health insurance industry, Potter suggests, since it ultimately passes along those costs to the policyholder in the form of increased premiums.
What the industry really objects to, he adds, is the law’s medical loss ratio (MLR) provision, which requires that at least 80% of premium health insurance premium revenue go toward actual medical costs. Since health insurers have no intent on drawing down how much profit they take from their policies, this restriction in net profit will come out of agent commissions—which is a primary reason why the health agent sector so uniformly opposes PPACA and supports anything that will disarm it. The main effort so far has been an intense lobbying effort to the NAIC to exclude agent commissions from the MLR. It has not worked.
Another lobbying initiative is the formation of insurance exchanges. To make cheap healthcare readily available to all of those uninsured people who will have to get insured, PPACA requires every state to establish an online venue through which cheap insurance can be purchased. Critics have derided these exchanges as Travelocity for health insurance. Agents note that health insurance is too complicated a product to buy without the help of a professional intermediary, and have lobbied—unsuccessfully, so far—to have a formal role for themselves written into the exchange law.
“They have been lobbying the administration at the state and national level to make sure that the exchanges that are set up are as friendly to insurers as possible,” Potter says. “They want to make sure their monopolies in given markets are maintained, and that’s why they want to have positions on the exchange boards. It’s not to provide any necessary expertise that can’t be found elsewhere. It’s to protect their interests.”
This spring, the Supreme Court will begin hearing arguments on the Constitutionality of the individual mandate. If the mandate is overturned, it could encourage further defunding of PPACA itself, rendering it a hollow law by the time its final implementation date arrives. But if it is upheld, the industry will have to find a way to live with health reform, as many insurers have already begun to do anyway.
And here is where the irony sets in. Because insurers can no longer set annual or lifetime limits to healthcare policies, exclude policyholders based on their previous medical history, and must extend coverage for policyholder dependents up to age 26, they are that much more likely to find other ways to maintain profit margins.
“What concerns me is insurers will be looking at individual cases more aggressively for reasons to cancel coverage or to deny care and coverage for particular regressive treatments,” Potter says. “They’ll be more aggressive in that area to make up for profit margin loss elsewhere.”
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.
“Healthcare reform addresses the uninsured having healthcare coverage,” explains Denise Gott, national sales manager of LTC Financial Partners. “The healthcare plans themselves still require progress to recovery to remain in force; they are acute care designed to get you better. Healthcare plans have not changed to accommodate custodial care and the kind of round-the-clock care that Bill needs.”
Gott is also a board member of 3in4needmore.com, an advocacy group spreading the word about the need for long-term care (LTC) insurance. LTC is meant to cover people who require ongoing medical care that does not address acute recovery needs. CIGNA’s cessation of Bill’s coverage hinged on the level of 24/7 care Bill needs for basic human functions, like eating, getting changed, moving around and going to the bathroom. These are seen not as health insurance costs but as long-term care costs, and the industry very much wants people to buy both. In a scenario where Bill Mantlo’s rehab truly is unnecessary, then he becomes an LTC case. LTC is a relatively small sector because of its cost, however. Those who want it often cannot afford it, and those who need it cannot get coverage.
PPACA tried to address this, too with the Community Living Supports and Services (CLASS) Act, a provision that would basically grant people access to affordable LTC coverage through a payroll deduction. The Congressional Budget Office estimated that CLASS would save $2 billion in Medicaid spending over the first 10 years of the program.
On Oct. 21, however, the Obama administration declared that the CLASS Act would not be implemented, citing serious actuarial concerns with its design and benefit structure. CLASS never made it out of the gate.
Lost and Found
Today, Bill Mantlo is one of the comic book industry’s great “where are they now” stories. But for those who knew Bill at the time of his accident, strong feelings remain. “It was a nightmare. It just didn’t seem like it could be real,” Jim Shooter says of when he first heard that Bill had been injured. “The whole business was disturbed by it.”
For Chris Claremont, Bill is a tragic tale of what could have been. “The stupid reaction is, ‘Where is a superhero when you really need one?’”
It would not have surprised Claremont to have seen Bill running for City Council or Congress, he says. Such would have been in keeping with Bill’s “real goal” to help people and make the world a better place. His writing was good, but there was a very real sense of where Bill would go from there.
“He was barely getting started,” Claremont says, his voice heavy with emotion. “What a fucking waste.”
At Queens-Nassau, Adam Pocock leans over and embraces his father, who hugs him back. Bill Mantlo is smiling broadly, and cannot take his eyes off of his son. Bill is talking with Adam, but his speech is slow and labored. One gets the feeling that somewhere within his damaged brain, the “Boisterous One” is still there, trapped in a broken body that stands between him and the rest of the world.
When Adam mentions his bringing his sister Corinna to visit, Bill lights up once more. “Corinna?” he says. “Bring her. I miss her. I love her.”
Adam then turns on an iPad and scrolls through images of some of the covers to various comics Bill wrote. Bill smiles and points to each one, identifying them instantly. Each one is like a miniature reunion with a long-lost friend.
“ROM! The Micronauts! Cloak and Dagger! Rocket Raccoon! The Incredible Hulk!” Adam asks Bill if he would like him to bring by some printouts of the covers, as well as some old issues he wrote. Bill nods enthusiastically. “Yes,” he says. “I would like that.”
After a short visit, it is time for Adam to go. “I love you, Dad,” Adam says.
“I love you, too,” Bill says. “Can I get some ice cream? Vanilla.”
As Adam turns to leave, Bill smiles again and gives him a thumbs up. Adam departs, and once he is gone, Bill falls back to his bed. This is the most exciting day he has had in a long time, his nurses say. He rests his head on his pillow and closes his eyes. He is done for the day. It is 9:45 am.