I really want to support Barack Obama. I voted for him. I want his proposals to succeed. I also think one component of his health care plan — a public option to private insurance — may be the only way this country will ever join the rest of the industrialized world and create a tax supported national health plan that will provide quality health care — at much less cost — to all. But I am very, very worried about some of the polices and assumptions upon which he founds his health care proposal. His plan, for example, continues our reliance on the employment -linked, private, voluntary, for-profit, insurance industry. Obama tries to reassure people that if they like their current health insurance they can keep it. The assumption here seems to be that everyone who has health insurance coverage is just mad about it. Mad, i.e. happy. I think most people who have insurance in this poorly regulated, for-profit insurance market are mad all right. As in angry, and frustrated with their insurance company not thrilled and delighted with it. This is particularly true for anyone who gets sick or needs expensive services. Folks who aren’t sick and rely on their insurance for small routine things may feel just fine. But the moment you start needing expensive care, that’s when the industry reveals its true colors. The fact is, insurance companies rely on people staying health, that’s how they make their profits. Once you get sick, then all bets and promises are off.
Consider a typical case. My husband’s. He went to visit our daughter who was doing volunteer work in El Salvador. Before leaving he checked in at the travel clinic at the hospital that also houses our primary care practice — Mount Auburn Hospital in Cambridge, Mass. The doctor offered to give him one rabies shot as a precaution, a prophylactic, in case he encountered a rabid dog. The doctor said it probably wasn’t necessary because my husband was only staying in El Salvador for a week. So to save money, and be a responsible health care consumer my husband said no. Well, with the health insurance industry no good deed goes unpunished. He went on his journey and guess what, on day four, he got bitten by a dog. He didn’t worry too much about it because it wasn’t a serious bite. But just to make sure, when he returned home he called his primary care doctor and the doctor said, this is a no-brainer, you need to get a series of ten rabies shots and pronto. The shots weren’t given in the PCP’s office but back in the travel clinic. So my husband got his ten painful shots and the hospital submitted the bill for $1000 to Blue Cross Blue Shield. We also thought this was an insurance no brainer. Dumb us! My husband soon gets a call from the hospital saying the the insurance company has denied payment because the shots were coded as “not medically necessary,’ as if someone would get ten rabies shots just for fun. They’d confused the one shot, which wasn’t medically necessary, with the ten that were. So back and forth he goes with the hospital and the insurer. The diagnosis has to be changed. But who will change it, the PCP or the doc in the travel clinic? Finally, it’s correctly coded, and the insurance company finds another reason to deny payment. They will only pay for shots given in a doctor’s office or clinic but not in a hospital. More calls to explain that my husband was not checked into the Mount Auburn Hospital -but was in the hospital –as in inside its walls — because both the travel clinic and the PCP’s offices are in the hospital. No luck. Finally, my husband has to call his employer’s human relations department to get them to intervene. Meanwhile, the hospital has given the bill to not one but two bill collectors who are also dunning my husband. After months of phone calls, letters, emails, the insurance company finally pays the bill. But just yesterday, my husband received another bill from the bill collector.
So what’s the moral of this story. This is what happens when your health care system is run by prviate, for-profit insurers whose focus is only on the short-term, quarterly bottom line and for whom care of the sick or vulnerable is part of what the industry terms the “medical loss ratio”, i.e you get sick, we lose. This is one of millions of stories that could be told about our dysfunctional system, which, in the long-term, is completely irrational. Imagine, for example, how much the insurance company would have had to pay if my husband hadn’t had those rabies shots, and in a year or two developed rabies, which is invariably fatal. Of course, from their point of view, it’s better for enrollees to pay and then die. But his death would not have been instantaneous but prolonged and quite expensive. And imagine how much money was spent on all the letters, phone calls and time trying to deny the bill.
When I hear or relate stories like this, I’m reminded of a comedy routine that Boston comedian Jimmy Tingle often performs. It goes like this. We want health insurance to protect us when we’re sick but the industry only wants to deal with us when we’re healthy. It’s as if, he says, you called the police because someone was trying to break into your house and the officer on the other end of the line replied, “I’m sorry Madame but we only deal with the well-behaved.”