Corporate Death Panels: Insurance Hoops

We all remember — how could we not — Sarah Palin’s alarmist fears about how the government would “ration” healthcare, leading nameless, faceless bureaucrats to make decisions that could kill off disfavored elements of the population, like sick children and the elderly. Palin’s li(n)e was always inflammatory, contributing to the climate of extremism Republicans apparently need to win elections, and it was always wrong.

But now, please consider this short anecdote on the rationing we already experience, with privately-held insurance companies.

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I have a friend with a mild medical… thing. It’s not a big deal, and it’s certainly not serious, but left uncared-for, it could prove “unfortunate.” The treatment regimen requires monthly medication — preferably on the 28-day mark — all of which is very expensive.

Prior to the effective date of this part of the Affordable Care Act, his insurer would pick and choose months to deny coverage, claiming it was a “pre-existing condition.” It isn’t. He’s been covered his whole life, and was diagnosed only in ninth grade. Also, it’s not a thing that could go away, absent some radical new medical therapy, a breakthrough in pluripotent stem cells, or (hey, why not) nanotechnology.

Maddeningly, the timing of the denials conclusively proved that the insurer’s goal was to harass its customers out of coverage — not to avoid genuine overcharges. According to his insurer, this monthly medication could be a “pre-existing condition” in April, but not in May; in June, but not in August.  Such arbitrariness doesn’t make sense, unless the insurer’s only goal is to make customers work for their coverage. Imagine an elderly, infirm couple, facing the same strategy: at what point do they just give up? Private insurers may not know, but given enough bad-faith denials, they expect some patients will.

Thankfully, “ObamaCare” made this type of harassment illegal. But here’s the new trick: my friend’s insurer switched to a new “specialty pharmacist,” who’s demanding proof that the treatment is still medically indicated, despite the fact that, as any doctor would know, his condition is permanent. He’s submitted proof to that effect, but the pharmacy & insurer are still stalling the approval. In the meantime, he’s already one week late for his treatment.

As stated, my friend’s condition isn’t serious. This delay isn’t good for him, but it certainly won’t kill him.

But what if it could? Where for-profit healthcare is concerned, the unrestrained free market just doesn’t work. Why do we pretend the private sector is always superior to the public?

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2 comments

  1. Well said. It won’t be the government that decides who lives and dies, it will be the insurance companies in the name of profit.

  2. Thanks! It’s a very frustrating process…

    On the flip side, the photos on your site are beautiful.

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