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.

Sunday, October 04, 2009

The Failure of the Free Market Health Care System

Our national health care debate has included numerous anecdotal accounts of the failures of government-run health care policies. From the blogosphere to the mainstream media – and unfortunately today that includes the Fox network – people have come forward to recount how their relative in Canada, Great Britain, Germany and even Norway suffered illness and eventually died.

The fault is, of course, "socialized health care." Never mind that all of the countries named above have widely different systems of providing health insurance to their citizens. Disregard that not all of these countries practice "socialized health care."

Most of all ignore the fact that under any system, sick people will die and bereaved relatives will be offended and will find fault. Sometimes the faultfinding is justified. Many times grief clouds judgment.

What follows is an account where no one is sick, no one dies. It is anecdotal. Nevertheless, it is a true representation of what happens under the free market capitalist system of health care in the United States of America

A worker for a small concern purchases a high-deductible plan that is combined with a health saving account (HSA). It is the dream plan of the Republican Party. Contributions to the HSA are tax-deductible. Funds from the HSA can be used for the high deductible and health care costs not covered by the health care plan.

It is nice that health care savings are tax-deductible. The worker, however, works for a small firm and has an income that is congruent with working for a small firm. Contributions to the HSA necessarily come after paying for daily living expenses. Then there are the health care costs that drain the HSA even while the worker is trying to build this account with tax-deductible contributions.

This system requires constant vigilance.

Happily, the worker is healthy. The worker has healthy habits. The worker exercises regularly. The worker has a healthy diet. The worker is no athlete, and is not young. The worker is responsible and takes full advantage of the yearly physical examinations and screening tests covered by the high-deductible plan.

The worker pays the premiums of the high-deductible plan for two years, during which time the premiums increase no less than three times.

This is where the tale gets interesting.

After the first examination, a condition is revealed which in and of itself is not life-threatening, but could be serious. There are no symptoms of illness. There is only the possibility of illness.

The premiums for the high-deductible health plan go up again. The worker applies for a lower premium plan from another company. The worker's income has never gone up to meet the increase of the premiums.

The healthy worker is denied coverage by the alternate company because of the non-life-threatening condition revealed in the earlier examination. The worker is stuck with paying a higher premium.

The Republican Party has advocated that the free market system offers workers the freedom to make choices congruent with their income. Citizens can choose their health care providers. They can choose their doctors. They can control costs.

The Republican Party needs to return to planet earth.

The only freedom the present system provides is the freedom of heath care insurers to deny coverage and increase profits.

Anyone who is otherwise healthy will have a "pre-existing" condition simply because they have some existence.

The present system of health care provides no freedom for those who have employer-based insurance. It tethers them to their employer. The present system of health care provides no freedom to those who do not have employer-based insurance. They are at the mercy of companies who can deny coverage for the least reason. The present system provides no freedom for the 45 million who are uninsured. They ignore their symptoms until they need the emergency room. Or they die.

The citizens of the United States are at the mercy of so-called health care insurance providers whose motive is profit and not health care.

Read this essay again. It is not the tale of a sick person needing health care. It is the tale of a healthy person trying to pay for health care in this so-called free market and finding no freedom at all.

This is not my story. I have no health care insurance. I have too many pre-existing conditions. I will probably die before there is a civilized health care system in this greatest country the world has known.