Columns 2009

Don’t call it health care insurance… it’s not

America’s current health care system should really be called our sick care system because health is simply not its primary objective.

Preventive care, which would actually be caring for your health, is all too often not covered. For instance, the state of Alaska’s retiree health insurance plan will not pay for an annual breast exam if you no longer have a uterus. I have never quite understood the connection but the shortsighted nature of this policy is obvious to anyone who looks at the cost of caring for someone with advanced breast cancer as opposed to someone who catches it early.

Our current system seems to reward illness, not attempts to stay healthy – unless, of course, you are a man and need “help” to stay active. You can understand how some women might resent how quickly “male enhancement” drugs were mandated for coverage while some women are still fighting to get birth control prescriptions covered by their plans.

Many plans still do not cover something as simple as immunization shots, which once again leads to the question of whether it’s cheaper to pay for someone to get immunized or to pay for that person to spend a week dying in a hospital that is charging $300 per box of tissue used.

I find it absolutely appalling that my doctor can tell me that getting a flu shot is my best bet at not getting ill this winter but my insurance plan won’t cover that shot. How can health insurance not cover something so very basic to your health?

Here’s what I think is happening. I think health insurance companies are simply gambling on people dropping dead while waiting for approval of doctor recommended treatments and preventive care procedures. This means more money to put into their executive bonuses. Maybe that’s a short sighted way to look at things, but I don’t think long range planning has ever really been what the profit motive encouraged. If you can make a million today and walk away to spend it on a beach in the Bahamas, why worry about profit tomorrow when it will be someone else’s concern.

I think it has to be pretty obvious to anyone looking seriously as the state of health care coverage in America today that for so long as there are people who can profit from other people’s deaths, the health of those insured is not going to be of paramount importance when choosing which procedures and treatments recommended by medical personnel will be covered.  A much more gripping motive is how much money they can make from premiums without returning any benefits. Anyone who has ever sat on hold while an insurance clerk checked with their supervisor on why your doctor’s recommended treatment would not be covered knows that the ultimate decision on health care is made by anyone but the doctor and patient.

It seems that in America today, no one or thing is more important than the bonuses and dividends given out by insurance companies to their executives and shareholders. I get the impression they think I’m just being selfish to assume that their primary focus should be helping me stay healthy and fight illness or actually treating me as recommended by my doctor when illness strikes.

It’s not that you won’t eventually win the battle over some things with your insurance company. If you have the guts, stamina and stomach to stay the course through innumerable phone calls, letters and information requests to your doctor, you might actually win one occasionally. That is, if you haven’t dropped dead along the way and thus handed an automatic win to the insurance company’s executive suite.

America’s “health” insurance is really illness insurance with people making decisions on treatment based on how big their year end bonus can potentially be. It’s not right that we have an entire industry in this country that makes money on your death while purporting to be about your health.

Whatever else may or may not pass when it comes to health care reform, let’s at least take the profit motive out of the health insurance industry and mandate they become non-profits who actually put their clients’ needs first.

It’s a radical thought but one whose time has come.