Wednesday, October 07, 2009

Cherry-Picking in Health Care

Last month I wrote that there are two important facts that are ignored in our current health care debate.

Everyone gets sick.

Everyone dies.

These facts are not always ignored. For-profit health insurance companies do not ignore these facts. These facts affect their bottom line. Their response to these facts is to cherry-pick among their applicants. They pick those who are the healthiest and youngest.

The cherry-picking begins with the application for insurance.

I have before me an application. It has three and a half pages of intimidating, broadly worded health questions that must be answered before insurance is granted.

The intimidation works this way. The prospective client must answer all the questions with full honesty, or eligibility will be denied. On the other hand, the prospective client, out of reasonable self-interest, will not want to overstate any health issue or problem, or eligibility will be denied.

In addition, if the prospective client neglects to reveal any condition because it is deemed trivial, or for some reason irrelevant, or the prospective client simply forgets, then the company reserves the right to rescind coverage even after granting the policy.

In three and a half pages, the prospective client must reveal the intimate details of his visits to the doctor with the knowledge that everything stated and unstated will be used against him in the event the for-profit insurance company decides that a claim for coverage should be denied. It is nothing less than three and a half pages of self-incrimination on the applicant's permanent record.

Forget what you have heard about "Washington" getting between you and your doctor. The intrusion of the for-profit insurance company is now much worse. The for-profit insurance company now intrudes, accepts premiums, and then reserves the right to use its intrusive, intimidating health history questionnaire to deny coverage.

The first use of the questionnaire, however, is to cherry-pick. Only the young and healthy will qualify.

In my previous post, I recounted the efforts of a worker to purchase a lower premium high-deductible health savings account policy. The worker is healthy, has a healthy life-style that includes a good diet and regular exercise. The worker has made full use of the preventative exams offered by the worker's current health care plan to stay healthy.

The exams, which should be part of any responsible person's health care, revealed two non-life-threatening conditions.

One condition was revealed by advanced medical technology. A few decades ago, I doubt that it would have been a matter of concern at all. The worker is grateful that the condition is being monitored, but has been told by medical professionals that there is no reason for concern. Simple prudence requires a modest amount of monitoring. (Readers will note that I am protecting the privacy of my source by not going into further details.)

The second condition is even more benign. Through the medical history questionnaire, the health care insurance company learned that the worker has a "History of Joint Pains."

Yes, the worker is closing in on sixty years of life. There have been "Joint Pains." There have been no tests, only the most cursory of examinations, and no prescription medicines. There may be a need for more serious care ten or twenty years from now – or not. Now the worker has some discomfort because the worker is closer to sixty than fifty – the pains are just part of getting older.

"History of Joint Pains" is how this company cherry-picks the young and healthy and excludes the rest. The "History of Joint Pains" preceded the worker's current health care plan, and did not resulted in one dime of claims under that plan. The "History of Joint Pains," however, does preclude the worker from getting a cheaper plan.

This worker is healthy. This worker is being denied cheaper health care under the current free market health care system. The practice of cherry-picking is denying healthy workers affordable health care insurance because our so-called free market system grants freedom only to the for-profit health care insurance companies for the benefit of their stockholders.

It is high time to admit it. The United States of America does not have a "health care system." The United States of America has a market where for-profit companies feed upon the facts that everyone gets sick, everyone dies.

Our worker is fortunate. Our worker for now has high-deductible coverage. The premiums have repeatedly gone up, but for now, the worker will manage to cover them.

This will not last. Moreover, there are others less fortunate than our worker.

Forget the public option. Anything less than single payer universal coverage is less than what is needed. Anything less is a shame in the greatest country this world has known.


O'Young said...

You are correct, America does not have a healthcare system - we have a health insurance system. A healthcare system would imply proactive, preventative care, rather we have a reactive problem resolving system.

Obama's healthcare reform is first and foremost insurance reform. There is a lot of other reform going on behind the scenes for hospitals (present-on-admission tracking, reduction of 30 day readmissions, reduction of hospital acquired conditions and infections, reduction in complications, etc.). This is good stuff and is needed and will not going away, even if the health insurance reforms are thrown out, but this is still not preventative, upstream reform. People are still stupid and make foolish health choices, such that the cost of healthcare continues to go up. Wake up America and exercise that sense of responsibilty people like to point to for enabled behaviors.

Lance Brown said...

Without quibbling over details or pointing to counter examples, I would say that your description of the business of health insurance is mostly accurate. And the comment from O'Young is not without merit. Hospitals need a lot of reform. However, it should be noted that ObamaCare is driving private practices out of business and pushing more care into big hospitals.

I do not think the solution to the evils of insurance is to put the Federal Government in charge (albeit indirectly) through a complicated scheme administered by people who continue to demonstrate their incompetence. You're right, we have a health INSURANCE system that has taken over and corrupted health CARE. The solution is not more of the same.

The solution is to make people see and feel the connection between their choices and what they pay. The solution is to have people pay more of their own health care costs directly and to be able to negotiate prices. The solution is to address the behaviors in our society that are contributing to increasing health costs (an area where Michelle Obama actually has a point). The solution is more competition and personal responsibility. The solution is to have insurance be less important in everyday health care. And the solution is to make health care less expensive.