American Health “Care” Debacle

Health Care for America Now, Rally outside Sar...

Image by citizenactionny via Flickr

As I sit and read blogs this morning and as I am contemplating what to write next, my mind is turned invariably toward the American insurance industry. There is no such thing as American Health Care. It’s a misnomer that means whoever can afford it is guaranteed the finest. If you cannot afford it, you are urged to buy insurance. Since insurance is tied to the workforce, you are also limited by the insurances your company can afford to provide you, which in everyday speak means ‘not much.’ You are also limited by your work hours. My daughter, who works in retail is given between 20 to 39 hours a week to work. She is not salaried, so insurance is contingent on her maintaining 40 hours a week. Clever no? Her employer saves money by not giving every employee the hours they need to bank to provide their own coverage.

On the other hand, I have a salaried position and am paying $600 a month for group insurance after a long, long fight for it. Previously, I was covered under my husband’s insurance through his union. There was no interruption in coverage, in fact there was an overlap of almost a month. Yet, recently my insurance company denied a claim for a bone density scan claiming a preexistent condition. huh? What might that be? I will call them tomorrow, but an issue comes to the fore here. Why is the first inclination of an insurance company, who you pay thousands of dollars to, to deny your claim? I know why… profit. You see the insurance companies are not about health care. They are in this for one reason only, to make money. There is no other reason for insurance companies to exist. Don’t tell me it’s to “regulate” doctors or hospitals or to keep costs down. That’s just bullshit. America’s system is capitalism and that includes health care going to the highest bidder, not because they want their citizens to be healthy, but so that companies can make profits.

I was called back to get a second mammogram due to something they spotted the first time last week. I will call them tomorrow and see if they are going to cover this. If they aren’t, I’m not going. I can’t afford to. The bone density scan costs $350. I now will owe this somehow out of all my other bills and expenses. It sounds measly to some people, but $350 is almost a month’s groceries. It’s almost a car payment for me, or at least the kind of car that I can afford. As I wander the shops and watch everyone buying, buying, buying, I can’t help but wonder, “where do all these people get all this money?” $350 is a drop in the bucket for them. And another mammogram will be upwards of $600 or so. So, I will have to take the risk that what they saw on the first mammogram was a false reading and not go to the second. And I will tell the insurance company this when I call them and if they tell me they will refuse to pay for it. There is no alternative for people like me and millions more who make less than I do a month. Obama’s plan will try to redress this somewhat, but this won’t go into effect until 2014 and even then it will get huge opposition from whoever happens to be in office at the time. The insurance companies will retaliate by raising rates and we will be back to square 0.

So please, please, please, don’t call what we live with now health care. It’s more like health capitalism.

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3 thoughts on “American Health “Care” Debacle

  1. Even “health capitalism” is too charitable. I have spent hundreds of hours of my life dealing with insurance hassles. (It didn’t help that when my husband got cancer, we were overseas – still covered, but I had to document, translate, and fight for every dollar reimbursed.) Maybe “health scam” is more accurate?

    It seems to me that you ought to be able to fight this denial, assuming you can find the time and energy. Yes, you were born with those bones, and so they predate your insurance coverage. The same is true for any body part that can go awry (which is, basically, every part). If you didn’t have a diagnosis of osteoporosis or osteopenia when you joined that insurance group, I don’t see how they could rightly deny your claim.

    • Yes, I plan on calling the insurance company tomorrow. I’ve also deferred my follow-up mammogram until I hear from the insurance company. I will of course push the issue as far as I can. I will let you know how it turns out.

  2. As a side note on this, with reference to the British National Health Service (NHS), with such a long established American tradition for philanthropy and not-for-profit organisations, it seems strange to us Brits that the slightest suggestion that anything other than profit can properly be considered when discussing health care, immediately raises the spectre of the dread Socialism and the associated hysterical rhetoric among some Americans. I have some understanding of the deep seated antipathy to centralised state power in the American soul, and I have some sympathy with it. I’m not wild about state bureaucracy either, with its tendency towards top heavy administration and inefficiency. But if I have to choose between a bureaucracy whose primary function is its own profit, and a bureaucracy whose primary function is the admimistration of health care, I know which one I choose. The fact that, if you visit a hospital in the US, the first question you will be asked is whether you can afford treatment, not what is wrong with you, is quite simply outrageous in my opinion. The British system is not perfect of course, but its primary aim is the treatment of people who are ill or injured. It is not fronted by a medically unqualified door keeper, who seeks to deny treatment whenever possible.
    Resources are finite, and some form of rationing has to be imposed, especially as medical technology becomes ever more sophisticated and expensive. The British solutionis to throw these impossible questions at a non-governmental third party, the National Institute For Clinical Excellence (NICE). In a short discussion this morning, after
    “Bowel cancer charities have criticised a decision by the watchdog NICE to refuse NHS funding for a drug in England and Wales. Health economist Zack Cooper
    explains why the watchdog would reject the drug Avastin”.

    It is not pleasant to apply notions of cost effectiveness to questions of life and death – in the case of Avastin, is 6 more weeks of life worth £40000 per patient? Impossible questions for sure, but questions which have to be answered in the real world. I would rather such attempted, and inevitably fallible, answers came from a bunch of clinicians, rather than from a bunch of actuaries, whose first duty is to their shareholders.

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