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Saturday, July 19, 2008

Private Health Insurance at Work: Hassling Cystic Fibrosis Patients

Let's put health care in a real, personal context:

Deron Arnold, brother of one of my wife's old school friends, is 36, a pathologist in Minnesota. He has a wife, 3-year-old twin sons... and cystic fibrosis. That means, among other things, his body overproduces mucus, making it hard for his lungs to work.

Deron pays Blue Cross Blue Shield for his health coverage. Yesterday he got a letter from the Blue Cross Blue Shield saying that as of October 28, the company will no longer cover expenses at Fairview University Hospital in Minneapolis, where Deron plans to have his transplant. As of August 23, Blue Cross Blue Shield will stop covering physician expense at that hospital.

Deron, understandably, is in shock:

The implications of this are obviously potentially huge. I spent much of the morning on the phone in heated conversations with employees who knew about as much about it as I did. And had as much power and authority to change it. One Blue Cross employee even suggested transferring my care to Loyola...the nearest provider who could provide the same level of benefits. (For those of you who don't know, Loyola is in Chicago.) [Deron Arnold, "In Shock," Here in Time, 2008.07.18]

No accountability, no answers... doesn't sound like a very effective health coverage system to me.

So now, because of an inexplicable business decision, a man with an incurable, terminal illness, who could get a phone call at any moment saying, "We have a lung; get to the hospital now," has to devote precious time and energy to figuring out whether he can even afford to have his hospital do the operation.

Things like this don't happen in Canada.

Another example: another friend of ours with cystic fibrosis couldn't get her private insurer to cover the treatments that can keep cystic fibrosis in check while she attended grad school. She thus had to do what some of my readers tell me to do: leave the country. She went to Canada, to Regent College in Vancouver, British Columbia. Just like us during our stay in Canada, she paid her taxes and national health insurance premiums. Canada didn't kick her out, or tell her she had to go to Calgary instead of Vancouver. Our friend got her treatment, and her education... in Canada.

Cystic fibrosis is hard enough. Private insurers shouldn't make it harder. Countries with national health insurance don't make it harder.

7 comments:

  1. The more I ponder this issue, the more I suspect that the real problem lies in the way we Americans think. It's as if the very principles of our founders have turned, and are now working against us.

    As sensible and obvious as the Kucinich proposal seems to me (and I'd take it a little further by proposing a consolidation of all taxes), something in me says that it simply cannot work in America. But why?

    Maybe it's this: We as a people do not trust our government. In recent years we've lost our trust in just about everything. Maybe this is why Barack Obama is striking such a resonant note. We want to believe that he can bring back our trust in our government, in our corporations, and in each other.

    It's as if we need a brain transplant and we want to believe that Barack Obama is the surgeon who can do it. But of course he can't. We have to do it ourselves. Even Barack Obama does not go far enough with health care, anyway.

    The big question I have about socialized medicine (and let's face it, nothing short of that will really solve the problem) is this: How will we keep the big corporations from ripping the government off?

    If I were the CEO of, say, a manufacturer of essential medical equipment on the day before the beginning of the great medical-industrial revolution, there would be spirals in my eyes, and drool would be falling from my exposed fangs as I filed down my titanium claws for the kill. "Blank check from Uncle Sam!" I would howl at the full moon. And in my ecstasy, I would perhaps actually hear the moon howl back. Such would be the magnitude of my greed.

    You see, I would not be a French or Danish or Swedish CEO. I would be an American CEO. That is like the difference between a kitten and a tiger, or between a chameleon and Tyrannosaurus Rex.

    How will we prevent this sort of abuse, the equivalent of the ten thousand dollar monkey wrench we've all heard about, to the tenth power? And how will we punish violators?

    That is the sixty-four-trillion-dollar question.

    Please keep us informed about what happens to the folks in your post!

    ReplyDelete
  2. As usual, you get me thinking, Stan....

    A friend of mine in Canada would agree that the difference lies in the way we think. In a lot of the comments she reads here as well as other news coverage of American affairs, she sees an unhealthy individualism, a lack of genuiune concern for others. Could that be tied up with the distrust you mention?

    Keeping a check on greedy corporate profiteers requires the same sort of vigilance as keeping a check on a power-hungry or corrupt branch of government. And a lot of us (I know whereof I speak: this is how my immature political philosophy worked not so long ago) want to believe that we don't have to make an effort, that we can just have faith in the Invisible Hand to make everything work out right. If we all just mind our own business, let greed check greed in the marketplace, everything will work out fine.

    That may work in many areas, but it's not working in health care.

    It's funny: we're almost ready to buy socialized health coverage. We already recognize that none of us can afford health coverage individually, so we are willing to pay insurance premiums to pay for everyone else's medical bills (with the assumption, of course, that we'll get our money's worth at some unlucky point as well). And we'll grant socialized health coverage to old folks, soldiers, and poor kids. But we just can't bite the bullet and do it for all of our fellow citizens. That would be too jarring, perhaps, to our free market fundamentalism.

    People don't take hits to their worldivew kindly. They'll go to great lengths to protect those worldviews. Look how often folks like Guy and Phae say "socialized health coverage doesn't work" right after I've pointed them to a news article that says, "socialized health coverage works in ___ [fill in the blank with any industrialized nation other than the USA]." When worldview and reality don't square, too many people choose to cling to the worldview and deny reality.

    ReplyDelete
  3. "...she sees an unhealthy individualism, a lack of genuiune concern for others. Could that be tied up with the distrust you mention?"

    Yes, I think that's it. And I plead as guilty as anybody in that respect.

    The key word is "unhealthy." Individual initiative has its place and should not be unduly suppressed. But like any good thing, we can get too much of it.

    I think we're also failing to recognize that we reap what we sow, that what goes around comes around ... oh geez, my TriteScan® software is going cuckoo here.

    I suspect we Americans in general a visceral fear that "socialized" anything automatically entails a suppression of individual rights, a forced mediocrity, a bad social vector that would try to turn us all into robots. (I know that I have this unconscious fear, anyhow. I meditate! I have seen the Beast Within!) I get this vision from the way I was brought up: "socialism" means blank-faced hordes marching in lock-step, posterized flags or banners as large as football fields with faces on them (sort of like that prez of Enron who pasted his full-motion electronic mug on all those gigantic monitors as he addressed his "employees"), people crawling over barbed wire or tunneling under walls to get out of their oppressive regimes, relatives tattling on each other and getting their sisters and brothers and cousins sent off to the camps ... all of that comes to my mind like a bad movie when I think of "socialism."

    But it's only a movie! Although, alas, based to some extent on reality and history, as are all bad movies.

    I'm by no means a socialist. More like a libertarian, actually. But I do not share the libertarian view that the market, left all to itself, will always regulate itself properly. That is no more true than the notion that the human body can always cure its own illnesses without outside intervention.

    No -- I'm with you on this one, Cory, even though at times I will play the role of the devil's advocate. It's part of the engineering process, you know. Proactive troubleshooting.

    ReplyDelete
  4. Heh, so what you are saying is that because of bloated beaurocracy your friend couldn't get answers for why his insurance was stopping coverage at his hospital...and that this would NOT happen if he'd been calling a government agency.

    Sure.
    I did find out a little It doesn't answer what happens to Deron Arnold and others like him already approved for treatment there, just some explanation for what is going on. I don't think his case impugns US health coverage at all. His current hospital is just going to be out of network. He may not like Mayo as much but they saved my dad's life when he had about a 2% chance of survival. If he is not able to continue at Fairview it would be a big inconvenience but he wouldn't be getting denied 1st class treatment.

    If you are also saying that under Canadian Medicare nobody with an incurable terminal illness ever needs to worry about getting denied coverage you are just wrong.

    I would agree with you and Stan that a large part of the problem is in how America thinks. America seems to think the government or society is failing whenever people suffer. I seriously doubt that is how the founders thought. It is not more ethical to attempt the futile to make us feel better about ourselves, at the expense of others. It is just stupid.

    But that is just me clinging to my completely unsupported by facts worldview. :P

    ReplyDelete
  5. Great links, Phaedrus. The Libra part of me loves it. Dueling blogs.

    No easy solutions here!

    No, I don't take astrology seriously, except when it's convenient. ;-)

    ReplyDelete
  6. The Swift meat-packing plant in Worthington was just shut down for a day. The reason? Humane handling violation. While they were shut down, truckloads of hogs were unable to be delivered. Those hogs sat in the trailers for several hours, packed in and overheating. Not to mention the cost and difficulty for the truckers and farmers waiting to unload. (I'm sorry, I haven't learned how to put a link in here, but you can google Swift at keloland.com for the story).
    That kind of incompetence and idiocy and bureaucracy is what I expect from government-controlled health care.
    Yes, there are problems with our current system, but putting it in the hands of the government will make it worse, not better.
    How Cory can so despise the No Child Left Behind mess, and yet think the government will do wonders with health care, is beyond my understanding.

    DRK

    ReplyDelete
  7. Hey Cory,
    Thanks for visiting my blog and mentioning me in a post.

    As both a physician and a patient, I have been a long-time opponent of government involvement in healthcare.

    However, this current situation (as well as millions of others in this country) certainly leads me to rethink that position.

    ReplyDelete

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