Friday, August 14, 2009

Why's Wayne Worried?

Talked to a friend the other day whose father, who we'll call Wayne, is still a bit on the fence about significant national health care reform -- he doesn't want to lose his current insurance. I think he's probably representative of a good portion of the lukewarm opposition to a public option -- it'll be hard and expensive to make a big switch, learn a new system, and he's doing fine now.

One of the reasons that this kind of attitude can persist is that health insurance companies hide costs and show benefits -- your health insurance payments don't appear, itemized, on your paycheck, so you're often not exactly sure how much your employer's paying per year. Plus, a good portion of insurance company cost-saving measures (abandoning paying customers -- rescission -- and refusing to cover drugs and procedures because of the costs) are hidden, and blamed on the customers and the drugs, respectively. This means that the customer who develops an expensive, life-threatening condition is found, by some slight of hand, to be at fault, and expensive treatments are labeled as 'insufficiently tested' or 'unnecessary'. There is currently no way to measure or compare how, and how much, insurance companies use these methods. So we don't really know how much we're paying, and we don't really know what we're getting.

What we do see is that when we go to the doctor's, our insurance coverage knocks off a significant amount of the price -- my doctor's visit goes from $80 to $10. That feels like a great benefit. But if you're paying $2400 a year (and that'd be a pretty cheap policy), it's nothing -- you'd need to go to the doctor's 32 times in a year to break even, which is a little more than once every other week. What you're paying for is what happens if you get very sick. Brain scans and protracted physical therapy and hospital stays, etc. etc. Wayne's never gotten that sick: he doesn't know how quickly the insurance company turns from a no-hassle discount into a tight-fisted adversary.

That's why there's this immense flood of stories of people who have been heartlessly screwed by their insurance companies. We are promised that we will be covered, and then we're not -- and it's shocking (note the family in the last link that is dropped from their insurance provider of 35 years), and we are surprised, and we want to tell someone.

Because of the system, though, this will happen over and over again -- until Wayne hears enough stories to realize that this can and will happen to him unless he works hard to ensure a public option for himself and his family.

PS: I also have found one person who got screwed by our health care system and then fell in love with it later -- but I think he's more or less one-of-a-kind.


  1. Just came over here from

    I was diagnosed with AIDS in 1995, and was frankly on my way out when drugs called protease inhibitors (PIs) began to reach the market. In the spring of 1996 I probably had less than six months to live, so my doctors wanted to put me on Crixivan, one of the first PIs. At the time I was insured through Pacificare.

    They denied the application to pay for the drug, which was exorbitantly expensive ($40k a year if I recall correctly). Pacificare said that they would put the drug through their "assessment protocol" and, at the end of six months, would be able to make a determination whether or not the drug was one they should consider covering.

    The choice I was faced with was either force Pacificare to pay for this FDA-approved medicine, or simply die.

    I contacted the Los Angeles Times, which had just run a very critical series of articles on health insurance malfeasance, and one of their top columnists expressed interest in following what Pacificare was doing to me. I then contacted Pacificare Customer Relations, explained that they were going to find themselves in a public relations pickle pretty soon, and the guy at the other end of the phone actually laughed at me.

    So I found out who the president of Pacificare was, and got hold of his office number, then BESEIGED his office with calls and faxes demonstrating that I was perfectly serious about getting them to change their mind about Crixivan, and that if they didn't wanted to appear on the front page of the LA Times very soon in a very negative light, they had better listen to me. (I was able to cite the name of the columnist who was willing to take the story public.)

    Four days after I first called Pacificare, they issued a press release saying they had approved Crixivan as part of their formulary.

    A public option is not manna from heaven, but it is a toehold against the rapacity and evil of the insurance industry. With a clear public option on offer, along the Medicre model, private insurance with its waste and bulging profits will eventuallly wither away, as it ought to. But it will take time.

  2. I think I saw you on 538 as well. Nice post here. People just do not understand the realities of ScrewYouInc.

    Insurance is, was, and always will be a scam. You pay people to hold your money and then not give it to you.

  3. Thank you both for stopping by, especially Anonymous -- I have this odd feeling that if we all had your bravery and strength, maybe we could beat the insurance companies even while critically ill. I'm extremely glad we are getting the option to make that unnecessary, though -- that we have a chance now to make sure that nobody has to go through what you did. I dinged you in today's post, and thank you so much for sharing it.