Note: I apologize in advance for any misspelling, grammatical errors, or incorrect information. Please leave comments/suggestions, or email me at thecheesydoor@gmail.com. If I have misquoted or did not properly cite you, please feel free to let me know. Thank you. –Sreya Alladi
*
I am going to write on a topic that’s really prominent in our lives and, of course, is being ignored politically in favor of pointless debates about religion and the nit-picking mud-slingery that seems to be dominating the political discourse for now. (The disconnect between the political process and the American people still leaves me agog. Can we leave the pork-barrel bullshit for later?)
Michael Moore made one of his shock-you-mentaries, Sicko, about the failings of the Health Care system. Like many other representations of the industry, it’s often over-dramatic and is quick to advocate other options without understanding that those, too, have serious issues that need to be dealt with. However, the success of the documentary is certainly based on the fact that almost all the claims made by Mr. Moore are valid to a point, and this is that point: Our Health Care System Sucks. Please Fix It!
In my freshman year of college, I took a course on Public Health Economics with a Dr. W, and the very first thing that we covered was the fact that the concept of “insuring” health was itself a misnomer, because it is impossible to actually “insure” health the way that you would, say, insure your home. The likelihood that an individual will get sick or will otherwise require, for instance, is much greater than their home being flooded, their bathroom catching on fire, an eighteen-wheeler taking out their trunk door, etc. It is possible that someone might require doctors’ appointments, dentist appointments, and all sorts of specialists, who, if they’re are not covered some health insurance, will cost them a premium. These are actually health-protection payment plans, not insurance. Generally, one insures against an accident, not against the inevitable.
That being said, when a heath insurance company is operating under a profit motive (which they always are), they are looking for ways to make money while minimizing costs. This leads to loopholes, exclusions, having, in the case of Sicko, to choose one finger over the other. Insane numbers of people are hired to fact-check, to manufacture pre-existing conditions, to save companies money and from having to insure sick people.
In the case of the Health Net of California, the insurer gave undisclosed sums of money to employees as bonuses based on how many policies were cancelled. At first, the company denied this and when the State of California issued a probe, it was apparent that this system of bonuses did in fact exist.
You can read that article here: http://www.bizjournals.com/sacramento/stories/2007/11/12/daily57.html
Recently, a case involving fraudulent cancellations was investigated by the state Department of California against the California Blue Shield. The State’s insurance commissioner Steve Poizner is fining them 12.6 million dollars for unlawful retroactive cancellations and other violations.
Insurance companies are willing to make these violations as long as it saves them considerable amount of money. (We have established a profit motive, haven’t we?)
The reason for this is very obvious. Health care costs are incredibly expensive, and very few people can afford treatment for anything out-of-pocket. An example: My brother was hospitalized for one night because of a violent allergic reaction. The night would have cost us $13,000 out of pocket, a sum which, to me, makes absolutely no sense. My family is insured, of course, and my parents didn’t have to pay a fraction of that. There are hundreds of thousands of other examples out there.
And, as is the case with each example, what if my brother was one of the 45 million (and growing) uninsured population of the US? Or what if my brother was one of the millions more who are badly insured? (Here’s the real doozy for all you policy nuts out there: where does someone draw the line?)
At the risk of sounding very stupid, I’m wondering what control a consumer has over his own health. The out-of-pocket fees are insurmountable, so insurance is necessary. Then what? What control does the consumer then have in making sure that the insurance (again, a misnomer) will keep them healthy? With permissible retroactive policy cancellations and other possible ways of shortchanging competent service, how do we win?
Because of the sheer expense of healthcare costs, we have multi-national corporations like Walmart who are invoking their subrogation clauses, extracting money from clients who win in third-party lawsuits. There is the case of Deborah Shank, who sued the truck company responsible for her permanent brain damage and won, after legal and other fees, $417,000. http://online.wsj.com/public/article/SB119551952474798582.html
Walmart’s defense for its actions is that not collecting these lawsuits increases the premiums that they’d have to charge to others who were insured under their plan. (I think this would have made a $.40, but I can’t find that statistic again.) And yet, they waited three years to collect their sum of money. They exhausted her trust fund, and as her attorney stated, Walmart was entitled to a sum based on equity. Now she cannot afford to stay in a nursing home, her husband has had to stay back and look after her, and her son just died in Iraq.
What do we take from this, then? How do we, the consumer, save ourselves from the law? From loopholes and clauses? Should our health be this darned confusing and expensive? Now the quest for the Grecian ambrosia of permanent good health doesn’t seem like such a Quixotic idea!
Here’s another one:
http://www.chicagotribune.com/features/lifestyle/health/chi-suit_bddec23,1,5501959.story
The Philadelphia-based insurance provider, Cigna, refused to pay for Nataline Sarkisyan’s liver transplant after complications following a bone-marrow transplant. Nataline, a lukeimia patient, was suffering from kidney failure. Cigna denied her transplant, saying that it was experimental… after doctors told them that this procedure worked in cases like these, with a 65 percent survival rate! After protests and national attention, Cigna backed down, granting the transplant, when Nataline finally passed away, sans functioning kidney.
Why should a company decide whether I live or die? People tell me that there’s more to this, but when an insurance company’s information is pitted against that of a cadre of doctors, I’d take the guys who know what they’re doing. They didn’t seem to me like people who thought that this liver transplant was an experimental procedure.
This was clearly an abuse that occurs when the primary object is to make profit. I anticipate people flinging dung at the mention of socialism, but I don’t see reform happening when a company is trying to make money, because inevitably there is some suffering at the other end of the bargain.
Gov Schwarzenegger of California has introduced a universal health care plan (his will be the third, and the largest, state to do so if it does, indeed, get passed) in which it will be mandatory for everyone to get health care, (including illegal immigrants… look at what including illegal immigrants under a driver’s license plan did to poor Gov. Spitzer!), that insurance companies will be required to put 85 percent of its premiums toward covering its policyholders, and will require employers set aside 4 percent of the employer’s payroll towards their health insurance in a separate fund.
http://www.washingtonpost.com/wp-dyn/content/article/2007/01/08/AR2007010800865.html
As Ms. Geis and Mr. Lee say, Governor Schwarzenegger cannot afford NOT to do this. Though he is facing opposition from his own party, I commend him on this action and for realizing the problem and for dealing with it the most pragmatic way possible. Let not our fear for buzzwords like, “National Health Care”, “Socialism” and “Big Government” scare us out of doing the right thing: preventing insurance companies from playing games with our health by forcing them to act responsibly and in the best interest of the consumer.
(A side note: You people really should read ‘The customer is NEVER RIGHT’, by one of our greatest thinkers, Mr. SJ Perelman.)
Leave a Reply