Tuesday, March 23, 2010

Yes, we need reform

Nicholas Kristof wrote in the New York Times about some neighbors of his who ran into a health insurance snafu. The wife got sick with metastatic stomach cancer; they turned to their insurance, which had a $1.7 million policy cap. Even with inflated health care costs, they were kicked off long before they reached that point. Here's an excerpt from his column:
I reached Sophie Walker, the group head of claims for InterGlobal. She said she couldn’t talk about an individual case. But she explained in an e-mail message that with a “chronic condition” the policies can have a much lower limit, $85,000, on lifetime claims. That’s the limit that Jan ran into in January, Zack says.
Then Ms. Walker gave me the company’s definition of “chronic” (you couldn’t make this up):
“Chronic means a medical condition which has at least one of the following characteristics: has no known cure; is likely to recur; requires palliative treatment; needs prolonged monitoring/ treatment; is permanent; requires specialist training/rehabilitation; is caused by changes to the body that cannot be reversed.”
That sounds like a spoof from “The Daily Show.” To translate: We’ll pay for care unless you get sick with just about anything that might be expensive. Then we’ll cut you off at the knees.
I asked InterGlobal if this was an accurate translation. I noted that by its definition, cancer, heart disease, strokes, diabetes, tennis elbow and even athlete’s foot seemed to be “chronic.” I also asked InterGlobal to name any serious disease that it did not consider “chronic.”
My first thought was that the company's policy on lowering the limit for those with chronic conditions is utterly absurd. Basically, I as a healthy person can have a $1.7 million limit, which I will never reach, because I am healthy, but were I to be diagnosed with cancer, heart disease or even arthritis and there is a need for that, I could not use it because I am sick. Anybody else reading between the lines and hearing a whole lot of nonsense here?
Building off that point, this is why people need health insurance, really. Yes, it's nice to get discounts on prescriptions and to pay a small copay for a doctor's visit and to not worry about a bill for an X-ray or a minor procedure, but we all have insurance so we're not saddled with the bone-crushing bills from a lengthy ICU visit after an unexpected heart attack and quadruple bypass surgery, cancer or a premature child who spends her first six months in the hospital. We buy the insurance because it has a $1.7 million cap, not expecting the company to lower that cap as soon as we need it.
Maybe it's not illegal. But what insurance companies are doing is incredibly unethical, and I think all reform needs to take a hard look at these companies' practices and end the predatory ones. Maybe only nonprofit agencies should be in the insurance business. Maybe insurance companies should not be allowed to make more than a certain percentage of profit.
There are a lot of things wrong with the system right now. There are a lot of things wrong with the reform bill signed this week. I don't have a whole lot of faith in the government to fix any of that, because I don't know that government fixes much of anything it gets its hands on, but I will stand up and agree with anyone who is willing to fix the system instead of put a Band-Aid over the problems.

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