Monday, August 10, 2009

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.


Kevin Robbins said...

I know less than nothing about health care reform, as well. That's what sucks about the idiot protesters. We can't honestly look at the flaws in it when there are people talking about "death panels."

magpie said...

Maybe you can....
I found this article, from the New York Times, a useful summary of the health care issues:

Leslie Parsley said...

quietmagpie: I just saw this article and am holding on it to address later. Looks to be a solid piece and one that maybe should be spread throughour the blogosphere by as many of us possible.

one L bill said...

My eye started really bothering me on Saturday afternoon. A multitude of flushings with Bausch & Lomb Advanced Eye Relief wasn't enough to curb the pain, so I went to bed, hoping it was a scratch that would heal overnight. I woke up yesterday with pain, so made a trip to the ER. Thankfully, not many people seem to be hurt on Sunday mornings and we got in and out very quickly. However, the trip resulted in the following:

1. A $150 copay.
2. Confirmation that I had a corneal abrasion.
3. Prescriptions of Bausch & Lomb eye drops and pain medication.
4. I never saw an actual MD.

And you're really downplaying your insomnia. I - like you - rarely get sick or have need for doctors, but I'd think that having trouble sleeping every night would get annoying. I'm assuming you've still not seen a doctor about it and I'm also assuming that cost is the primary reason.

Leslie Parsley said...

About 8-10 years ago I wrote a 2-part series on health care. In my research, which was extensive, I found: HMO's holding public info sessions - but always up a flight of stairs, so they could observe who was having trouble climbing & subsequently turning them down if they showed any difficulty; people with life-threatening diseases having their insurance coverage cut off, dying (remaining family would often sue & actually win in a surprising number of cases); people being denied treatment because it was new and unproven. And so many, many more but can't find the mags.

I do remember that SIGNA was and still is the worst. I did an SEC search and found that board members earned billions in compensation. This while people died from lack of treatment.

Anonymous said...

AHEFT shows African American health care has long been rationed by breeding us to limit our lives, so why should we pay for all those boomer pensions we will never benefit from? Afater all, it was the boomer pensions which caused the market to crash.

Leslie Parsley said...

How about CIGNA, not SIGNA? It's about my dyslexic brain.

JoeBama "Truth 101" Kelly said...

I spent time working for the Illinois Attorney General. Aetna complaints wore me out. The poor people that had to go through Aetna's review program went through a bureacratic nightmare. I had to tell them by law that they had to exhaust Aetna's complaint process before they could sue or I could do anything. Freaking nightmare.

JBW said...

Thanks for the link, quietmagpie. It's a fairly comprehensive article for whatever legislation has been agreed upon already but unfortunately that isn't very much at this point.

As I've said before, both sides of this debate have valid points and concerns but it still seems as if the bigger lies (exaggerations, if one prefers) are coming from the right. Having an honest discussion would help both sides, I think. Although it is Washington and these are politicians, so I'm not holding my breath.

JBW said...

Hope your eye feels better one L, and I hope you got some decent pain meds for what you shelled out. Yes, cost is one factor in my not going to a doctor for my insomnia but I've also researched the various prescription meds out there and they all seem too hardcore: fairly addictive, can not be taken with any amount of alcohol, etc. I just don't want to become dependent on anything so strong.

I'm looking at different holistic, OTC meds but I'm currently taking some GNC supplements that might not interact well with them so I'll have to wait to try them for now. The insomnia starts to become manageable when you stay on a regimented schedule of eating, sleeping and taking supplements but my life isn't quite that structured. We'll see, I guess.

JBW said...

Lesley and T101, I hear you both. It seems that the bureaucratic red tape set up by the insurance companies is one of the main obstacles to adequate patient care. It's also one of my concerns about a government-run program. I hope Obama can manage to streamline the process.

Vernon, I think you have a legitimate point about Boomer pensions but a quick perusal of the one post on your site makes me question your level-headedness. No offense and thanks for stopping by just the same.

Leslie Parsley said...

Consumer Reports just published a survey re HMOs and PPOs. Interestingly, the HMOs came out a little ahead of the PPOs - except for care when you're sick.

Leslie Parsley said...

Link to Consumer Reports survey:


Jack Reylan said...

I love it! Euthanize the boomers who deserted Iraq and Vietnam and whose pensions caused the crash. Divine Irony!