As aging fighters face mounting medical costs, where does responsibility for their care lie?

Mark Coleman

Ask Mark Coleman now and he’ll tell you he always knew this was coming. Maybe not this exactly – not the plastic hip and the daily IV bags to treat infection and the donations from friends and fans and total strangers to help him pay for it all – but something.

All the things he did to his body as a wrestler and a professional fighter, surely there would be some price to pay. He knew that much even when he was just another college wrestler, looking up at the heroes of his sport.

“I grew up watching my idols, and most of them were walking a little crooked,” Coleman told MMAjunkie. “I figured that if I wasn’t walking crooked at their age then obviously I didn’t work hard enough or train hard enough. I fully expected it.”

Still, it’s one thing to expect it to happen to some hypothetical future version of yourself. It’s another thing when the pain and the suffering belongs to present-day you. And the physical part of it? That’s only one aspect for the 50-year-old Coleman, who admits the cost of multiple hip surgeries, plus ongoing care and rehabilitation, may far exceed his ability to pay.

That’s what Coleman’s longtime friend and former training partner Wes Sims had in mind when, unbeknownst to Coleman, he set up a GoFundMe page to raise money for Coleman’s medical bills. To some, it offered a welcome opportunity to help. It also raised the question of what’s to become of MMA pioneers like Coleman, as well as many of those who followed him, who may very well face a steep bill for their exploits in the cage.

How are professional fighters – independent contractors, as far as their employers are concerned – supposed to pay for what could be ongoing health costs? And what do fans and promoters owe them once they can no longer make a living with their bodies?

A high premium

When he was with the UFC, Coleman said, he was covered under the promotion’s insurance. After that, he had health insurance through various companies he worked for, such as MMA-themed brands Cage Fighter and MMA Elite.

But when those relationships ended, he found himself on his own for medical care and its associated costs, which only seemed to grow as the damage he’d sustained earlier in life began to catch up with him.

“You pay a pretty high (health insurance) premium when you’re self-employed,” Coleman said. “Even with insurance, I’ve got people coming over to give me IV bags and stuff. The costs are going to add up, and the fact is I can’t really do nothing to earn any money right now. That’s killing me.”

Coleman may be the latest fighter to face these issues, but he almost certainly won’t be the only one. As the first generation of career MMA fighters slides past middle-age, more and more will likely confront questions of medical costs. Thus do those who were pioneers of this sport inside the cage also become the first to figure out how to handle life after MMA, when the fight purses are all gone and the old injuries come back to haunt them.

For many fighters, retirement brings with it some difficult financial choices. While fighters under contract with the UFC are covered both by fight night insurance and a separate health insurance policy, instituted in 2011, that covers them for injuries, illnesses, and accidents suffered even outside of official competition, that policy only lasts as long as their contracts.

For those in other promotions, such supplemental coverage usually doesn’t exist at all beyond that for injuries sustained in the fight itself.

That leaves many fighters to decide for themselves when and how to acquire medical coverage, which often doesn’t come cheap for people who have to list “professional fighter” as their occupation.

Retired former UFC lightweight Mac Danzig, 35, said he simply does without health insurance, since the cost is too great.

“I can’t afford to see a doctor,” said Danzig, “so unless it’s an emergency, I don’t go.”

Danzig injured his knee in November, he said, and has “just had to deal with it.” He also still has pain from a hip injury he suffered during a unanimous decision loss to Clay Guida at UFC Fight Night 15 in 2008.

“It bothers me pretty bad,” Danzig said. “Still, it’s all good though. I never had insurance before the UFC. There are no guarantees, you know.”

Former UFC and Bellator lightweight Rich Clementi, 37, who also recently retired, said he purchased his own health insurance later in his career after learning some hard lessons about the limits of fight night insurance.

“I had an incident where I tore my knee in the first round, and it was a minimal insurance policy that was in place,” Clementi said. “But what was crazy was when I went in to get my knee surgery, it was a workman’s comp claim. Basically, the facility fee wound up absorbing my whole policy amount. I still owed everything for the physician, the rehab, and all that other stuff. It took me a little while to pay some of that back.”

These days there’s not a day that goes by where Clementi isn’t reminded of the physical cost of a life spent in MMA. He works in medical sales, a field he became interested in after his own struggles with pain forced him to learn how best to manage his newfound physical limitations, and he considers himself lucky that he has the financial means to pay for the care he needs.

“But I understand how it is for a fighter just coming up, where buying your own health insurance might run you $400-600 a month,” Clementi said. “For a guy who’s solely competing for a living, once you start chopping up your purse – training fees, management fees, diet, all that – you throw another $500 a month on there, that adds up, especially for the younger fighters.”

That’s why longtime fighter manager Monte Cox generally doesn’t advise fighters to spend the money on health insurance until they’re further along in their careers.

The fighters he managed who stuck around long enough in the sport to begin feeling the effects – guys like Matt Hughes, Rich Franklin, and Tim Sylvia – “they’re all financially OK,” Cox said, “so they can afford to do what needs to be done now.”

Cox’s younger fighters, such as Bellator lightweight champion Will Brooks, will have to think about carrying their own insurance soon, but Cox said he isn’t sure if the expense is justified while they’re still young and healthy.

“(Brooks) is 28 years old, but he’s in perfect health,” Cox said. “When he gets to be 34, 35, that’s a good time to start thinking about that. That’s when you start to worry about things falling apart.”

Accepting the risks

But what about for the fighters who are past the point of worrying about things falling off, and well into the reality of trying to piece them back together?

That’s where Coleman is, and maybe where he’s been for the last few years. He had his hip replaced for the first time two years ago, but even before that, such as when he beat Stephan Bonnar at UFC 100 at the age of 44, “my hip was already shot,” he said, “but I didn’t care.”

“I was getting therapy for the pain,” Coleman said. “I was able to work through it and beat Bonnar. It made me think I was going to keep going for another five, 10 years. But the fact is that the clock will get you eventually. You need to protect yourself, but when you sign up for this sport, you’ve got to anticipate some stuff getting ripped apart. I think everybody accepts that.”

It’s a sentiment echoed by Clementi, who admitted that he struggles with the question of whether the spoils are worth the sacrifice now that his son is competing in combat sports like wrestling and jiu-jitsu.

“At the same time, the lessons I learned through this are irreplaceable,” Clementi said. “They made me the man I am today. You almost have to willingly go in there just knowing that this stuff is going to happen to your body. When you get the guys like me and Coleman, guys who have been through the gauntlet of competing for 20 years or so, the results are starting to show.”

The thorniest issue, it seems, might be deciding what those fighters are owed, and who owes it to them once they reach the later stages of physical decline.

The UFC does a stellar job of caring for fighters under contract, according to Cox, who said he’s heard no complaints from fighters about the health care or insurance policy they get while they’re with the organization.

“The UFC giving the fighters health insurance just when they’re training, that was something nobody ever thought would happen,” Cox said. “That, in itself, was kind of amazing. Now a guy who tears his ACL in training, he’s covered. In the past that was a killer. He’d have to pay for the surgery himself and miss the fight. He’d never make that up.”

But what about when that same injury starts giving the fighter problems five years after he’s been cut? What about a former champion like Coleman, who has to turn to crowdfunding just to pay the costs of medical procedures to address injuries he suffered for the entertainment of fans and for the profit of various MMA promoters?

How much should both fans and promoters feel obliged to help him now? What do we owe to the people who sacrificed their bodies for the sake of the sport?

That’s a question Clementi keeps coming back to, especially when he thinks about the various revenue streams the UFC created for itself using fighters’ likenesses. A friend of his who wrestled in the WWE still gets tens of thousands of dollars a year in residual checks for video games he appeared in, Clementi said, while he gets nothing for sales of UFC video games that featured him as a playable character.

“If you reached a certain level where they can still make money off your likeness, and they aren’t willing to set up some kind of revenue stream, then they should at least step up and do something long-term with regards to fighter care,” Clementi said. “And hell, I’m sure Mark was in a video game somewhere along the line, but still his friend has to set up a GoFundMe for a damn hip replacement. It’s disgusting, to be honest.”

But then, as Cox pointed out, it’s not only in the UFC that fighters do lasting damage to their bodies, though it is usually the UFC who fans and fighters look to when it comes time to write a check. Requiring all promoters to pay into a fund for ongoing health care would be nice, Cox said, “but the only promoters who could afford it would be Bellator and the UFC.”

“It would be ideal, but I don’t know where the responsibility ultimately lies,” Cox said. “What business works that way? Once you’re released or fired, how long are they supposed to take care of you?”

‘The clock’s ticking’

Ask Coleman and he’ll tell you that he has no complaints about his treatment or his pay during his time with the UFC. If anything, he said, he only wishes things like the UFC’s so-called “fighter summit,” where experts from various fields explain things like taxes and money management to every fighter on the roster, had been around back in his hey day.

“I didn’t make the kind of money a lot of these guys are making now,” Coleman said, “I was in the old school days, but I did make decent money. I didn’t do what I should with it. I probably invested wrong. And I did feel like I was going to be able to fight forever. That’s not the case. The clock’s ticking for all these young guys. You need to put your money aside and think about your future. I didn’t do that, but nobody owes me nothing.”

As for the support he’s received via GoFundMe, which included donations ranging from $5,000 from UFC heavyweight Mark Hunt to $100 from Clementi, not to mention dozens of smaller donations from fans and complete strangers, Coleman admits he gets a little emotionally overwhelmed just thinking about it.

He never planned to be here, he explained, even if he may not have explicitly planned how not to be here. He’s the first to admit that he “didn’t always follow the protocol” after his hip replacement two years ago.

When he signed on as a coach for Season 19 of “The Ultimate Fighter,” for instance, he knew his hip probably wasn’t up to getting on the mats and shooting takedowns with the young guys.

“But I guess I couldn’t resist,” Coleman said. “It’s not the first time I haven’t listened as well as I should have.”

Accepting charity doesn’t come easy to him now, he admitted. Certainly it wasn’t what he had in mind when he chased wrestling championships and MMA titles. At the same time, he finds himself in a position where he can only cope with the reality as it is, rather than as he thought or hoped it would be.

“I’m not looking for sympathy,” Coleman said. “I don’t really enjoy how much help I need right now. But at this point, I have no other choice but to accept it.”