The Effects Of Rationing Health Care

A Daily Dish reader relates a recent bout with the insurance industry:

Our twins are preemies - born at 34 weeks. While there were no complications, it was cold-and-flu season when we brought them home. Their health was a very precarious affair. We were under strict orders to keep them in the house, to limit visitors, to always wash hands after coming back into the house, etc. When we went to the pediatrician, she scheduled us on on a Saturday afternoon when the office was empty in order to minimize potential contact with other sick children.

At our first visit, she recommended a vaccination for a common virus. This is a virus that everybody gets, and is generally mild. With preemies, however, it can be quite severe and commonly results in hospitalization and even death. It should have been done in the NICU, but it had been missed. She scheduled us for the following week. She had to order the vax since it was quite expensive (a total of about $16K.) Two days beforehand, she notified us that our insurance company had denied the coverage as too expensive.

We then proceeded to try to get the insurance company to cover the vax. Our doctor called. The NICU doctor called. We had conference calls with them and the insurance company. We worked up the chain of command at the insurance company. We had it done and paid out of pocket. What choice did we have? Finally, we pulled in a specialist and managed to get high enough up the chain to get it approved. By this point, it had become something of a crusade for the various doctors involved. Two weeks later, my company's health insurance premiums went up 30%.

Coincidence? Who knows. But when people talk about rationing under socialized medicine, I always think, "You know, we have rationing now, it just hasn't effected you. Yet." And mine was one of those highly-vaunted "gold-plated" private health insurance policies.

I personally am very fortunate in that I barely ever get sick and take no prescription medications so I rarely have cause to visit any kind of doctor. Subsequently, I've never had to go toe-to-toe with an insurance company in a situation wherein the very nature of the battle stacks the odds squarely against the patient but I nevertheless empathize with people in situations like this one. Their story is neither remarkable nor uncommon yet this is the manner in which the current health insurance system has been structured to operate since the introduction of the HMO (Health Maintenance Organization) Act 0f 1973 by then President Richard Nixon.

I don't know about you but having to come up with $16,000 without warning to ensure the safety of my (nonexistent) children's lives would be a fairly large yet obviously unavoidable speed bump in my life. Before the housing collapse and current economic downturn of the last couple years illness and/or medical bills contributed to nearly two thirds of all bankruptcies in this country. If something like this can so easily happen to someone with a "gold-plated" private health insurance policy then what can we expect for those 45 million of us without health care of any type whatsoever? As I always say, I don't know enough about this issue to claim to have all the answers but I do know that something definitely has to change. The lives of millions of Americans are depending on it.