America; Heal Thyself II

 Second Part in a Series 
We Don't Insure a Burning House

I clearly recall the interview that I heard on NPR prior to the 2008 presidential election.  A woman described her efforts to find insurance when she was pregnant.  The charming response from one agent was, "We don't insure a burning house."  By good fortune or the grace of God, her job transferred her to Germany where she immediately was accepted into the health care system and received prenatal and postnatal care.

In my last post I described the opinions of some influential Americans; politicians, candidates, pundits and media personalities, on the subject of health care.  All oppose a national health care system and support the idea of keeping health insurance in the hands of private insurance companies.  And while some of these folks have been eliminated from the electoral contest their opinions and ideas live on. 

I referenced statements by these individuals expressing opinions; that insurance companies should be allowed to charge for preexisting conditions or even completely deny coverage for preexisting conditions; that compare health insurance to auto and homeowners insurance; that people in America don’t die for lack of insurance; and that everyone has access to health care in the form of the emergency room.

What is so striking about all of the statements by these individuals is that they reveal a broad disconnect with mainstream America and a shocking disdain for their fellow citizens.  

Rick Santorum’s patronizing comments comparing health insurance to car insurance reveals a man who is clearly out of touch with the realities of the middle class.  In comparing auto insurance to health insurance he suggested that people not charge routine bills to insurance; if you charge your oil change and gas bills to auto insurance you’ll pay higher premiums just as you would if you claim well baby visits.  Well Mr. Santorum, if I submitted a 40 dollar oil change bill or my gas receipt to State Farm they would invite me to, as my dad used to say, go whistle down a well, because as we all know, car insurance doesn’t cover maintenance; it is for, so called catastrophic incidents.  Health insurance does and should cover routine visits.  It encourages routine visits because routine checkups reduce the chance of catastrophic illness and their much higher costs down the road – it’s good business.  It seems that Mr. Santorum has never had to cheapen himself by having to use an HMO because he clearly doesn't know how they work.  HMOs don't give you the option of what you pay for and what you claim.  Your plan determines what services you pay for and how much you pay.  For instance, when a condition that I had required weekly blood draws I was not charged for these visits; they were part of the plan.  The good folks at Kaiser wouldn’t have taken my money even at my insistence.  We can only assume that Mr. Santorum has a lackey to handle all of the irksome plebian details that he can’t be troubled with and apparently doesn’t understand. The problem with that assumption is that it's wrong and this is what's troubling.  Rick Sanotorum knows full well how auto insurance works and how an HMO functions; he isn't an idiot.  He simply thinks that the people who's votes he was courting are idiots.     

Santorum “is okay” with paying extra for his child’s preexisting condition.  I’ve no doubt of that since he is worth over a million dollars and largely due to his status as a former senator has no trouble securing lucrative speaking engagements and high paying jobs.  Mr. Santorum couldn’t relate at all to my friend Scott who has had severe back problems for decades that have required major spinal surgeries; a preexisting condition if there ever was one.  Scott has no illusions of ever being able to retire.  Whatever money he has in the bank is being inexorably consumed to pay insurance coverage that rivals his monthly rent. Being bled dry he is finding that he may no longer be able to live in the Bay Area where he has spent nearly his entire life.  And so in middle age he finds himself nearly disabled and faced with the probablility of having to relocate and start all over again. 

And while Santorum thinks insurance companies should charge extra for preexisting conditions, Mike Huckabee thinks insurance companies should be able to deny coverage for people with preexisting conditions.  While Santorum compared human health to cars, Huckabee comparison of people to possessions was to compare health insurance to home insurance; as in why would an insurance company cover a home that has burned down.

So what is a preexisting condition?  A preexisting condition is inscrutable; its a mystery; a ghost.  I asked some family and friends to describe a preexisting condition.  My wife offered her bouts with cancer.  Someone else mentioned diabetes. Another mentioned emphysema.  I would say my past episodes of atrial fibrillation.  All of these seem like reasonable definitions of preexisting conditions.  The problem is that there is no definition of a preexisting condition.  In case you didn’t get that let me put it this way; an insurance company can determine anything to be a preexisting condition. So in theory a trip to the dermatologist for a case of adolescent acne could haunt you some years later.   

When she was in high school, my friend Scott’s daughter went to the family physician complaining of minor knee pain.  Nothing ever came of it except that now as a healthy young woman in her mid-twenties she has been denied coverage for a preexisting knee condition. I have a number of friends who are runners; healthy folks with excellent blood pressure, heart rates in the 50’s and great lung capacities.  They’ve probably also had a few visits to the orthopedist for anything from mild knee pain (see Scott’s daughter above) to shin splints, to tendonitis to stress fractures; all potential preexisting conditions that could preclude them from getting coverage if they ever have to get insurance on their own.  These runners, folks who pride themselves on their healthy habit could conceivably have reams of preexisting condition files as thick as those of a lifelong smoker.  I can imagine very few people who don’t have something in their medical history that can be described as preexisting.  Think about it.  Do you have a skeleton in your health closet that broke a bone once upon a time?

In a sorry, ironic sense Santorum's and Huckabee's comparisons carry some validity.  How many of us have decided against making a claim against our homeowner's insurance because we were afraid that we might get dropped?  Or just leave that dent on the front fender so the auto rate won't get raised.   And so when we realize that anything can be a preexisting condition do we limp around on that swollen ankle instead of having the doctor look at it for fear that it might put a flag in the medical files?  As my wife often asks rhetorically, "Why do we even have insurance if we're afraid to file a claim?" 

According to the website Health Care.gov, “There is no one definition of a pre-existing condition.  Health insurance issuers and employer plans use different definitions.  Depending upon your condition, you may be denied coverage or charged a higher premium.  Some plans consider acne, asthma or high blood pressure a pre-existing condition.  Others narrow the definition of pre-existing conditions to cancer or diabetes.  Sometimes you might have totally recovered from a condition – like a past bout with depression – and it will still count against you.”

And so let's extrapolate Huckabee’s analogy to home owner’s insurance and the fact that anything can be a preesisting condition.  I suppose that you might understand if a carrier refused to cover your burned out hulk of a home, but you would probably find yourself flabbergasted if that carrier refused to insure your home because of a creaky door or a running toilet; your home’s preexisting conditions.  What exactly does Mr. Huckabee think that people with preexisting health conditions are supposed to do?  Put into action his idea leaves the diabetic without insulin and as a result leaves him with no choice but to die; and decrease the surplus population.  And to think that this man is supposed to be a minister.