Medicynic

Another article on inadequate health insurance coverage, this from the NY Times.

As noted in previous posts, the U.S. health care non-system is unique in the industrialized world. First, it’s does not provide for universal coverage. Furthermore, it allows, no it encourages, private for profit insurance companies to eliminate people who need coverage (the sick) from their roles.

I say encourages because the first responsibility of a private corporation is to make money. Having these people provide “health” insurance is an unstated sanction for them to cull their rolls of, or otherwise scam beneficiaries, particularly those who are sick and use health care. A paradox? No, it’s simply how insurers make money!

From the Times:

“Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.””

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.”

Also:

“He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care – the expenses incurred in the operating room, for example, and the cost of any medication he received.”

Medicynical Note: The mythical free market in health care has never existed. And given the complexity of health care, the myriad conflicts of interest among the participants (patients, docs, institutions, patent holders, insurers), a so-called “free market”would never work to decrease costs. The proponents of such schemes inexplicably omit addressing the issues of the poor, the working poor, the sick and the asymmetry of information available (costs, options, outcomes) that would tend to distort such a “new” “free market” system.

So, if we are to reform health care coverage, we are left with what must be a highly regulated insurance scheme. Insurers would offering some standard government mandated clearly defined package of coverage using community rates (as opposed to individual ratings) with extra options at extra costs. They would compete with each other on price and service. To keep these people honest a competing public insurance program would provide an objective benchmark from which to rate the value of the private company’s offerings.

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This today in the Seattle Times emphasizes the holes in todays health insurance policies. Insurers, particularly the for profit ones, are not about financing care but about assuring profits. What’s happens when you really are sick? Where can we draw the line on care?

“”It’s not just the uninsured. It’s people who have insurance that doesn’t protect them” who are fueling the hunger for reform, said Sara Collins, an economist and a vice president at The Commonwealth Fund, a private health-care foundation in New York.”

“Until about a year ago, Moody and Krull lived comfortably on her earnings as an associate broker for Windermere Real Estate. But despite their income and his seemingly gold-plated coverage, he can’t get either a second organ transplant or an expensive drug that might eradicate his hepatitis C without risking financial peril.”

:When she first enrolled in a Premera plan in 1995 after a di”vorce, she remembers that it cost only a few hundred dollars a month.:

“In 2000, she married Moody and added him to her policy. Though affordable at first, their premiums kept rising sharply. Their combined monthly premiums now total $1,746.”

Read the article to get the full flavor of their predicament. These are not the working poor or the uninsured.

Medicynical note: It is ironic that the goal of health insurers is to limit services to those who need health care most.

Forcing people onto the individual market (as opposed to providing group based rates) is the first step. Individuals have no leverage and are rated by their medical need. Premiums are routinely raised to exorbitant levels. As noted in the article people who need the most services are offered policies with unrealistically low limits and find their premiums raised to unaffordable levels (in the case cited over $1700/month).

Any new system should require community ratings. and a standardized coverage structure. both of which are anathema to the private insurance crowd or alternatively mandate a government sponsored program that will offer same.

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In many instances whether a person opts for treatment or not the outcome will be the same.

Hodgkin’s disease, a type of lymphoma, is different. Treatment will cure the great majority of patients. Without it the disease is almost always fatal.

The story of the child in Minnesota, Daniel Hauser, with Hodgkins disease illustrates a parent making a bad decision based on faith, and fear. Hopefully the mother who is hiding somewhere with the child will come to her senses and give the child the best chance he has for cure, which is conventional chemotherapy and/or radiation.

The management of Hodgkin’s disease is one of the great successes of oncology and denying someone access to treatment is indeed criminal. Amazing that this should be happening in a modern country.

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