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an offer you can’t refuse

May 6, 2010

I am shopping for new health insurance.  This is motivated both by my family’s warning about the economic situation in general (i.e., have a backup plan ready to go in a hurry if something happens) and my upcoming aging-out of my folks’ plan (depending on when the new laws go into effect, this could be as soon as this fall).  Along the way, I’ve been doing a lot of legwork to figure out what my healthcare costs are these days and to use that to evaluate different plans, and I have made some interesting discoveries.

Let me rephrase that. “Interesting discoveries” in no way describes what I have learned. What I have learned is that the system is far, far more broken than even I thought. I had heard all sorts of stories about the healthcare industry, but there’s something about discovering a direct impact on myself and those I love that makes it hit home in a way it never had before. I think a better term than “interesting discoveries” might be “shattering revelations.”

I woke up this morning believing that the healthcare industry has done terrible things, and has indeed made profit-motivated decisions that have threatened people’s lives, but that these instances are the exception rather than the rule. I believed that for the most part, insurance companies want people to be healthy and pharmaceutical companies want to help people. Maybe that’s how the industry started, but it sure as hell ain’t the way it runs today. It turns out that these terrible things are the rule rather than the exception, and that my insurance company, which even before today I referred to as Evil Insurance, Inc., has taken profit-motivated actions that have directly threatened the health and quality of life of myself and my family, and worse, lied to us about it.

So what’d they do? You might remember a post of mine back in the winter griping about how they wanted to take me off of my most important asthma medication, and how they did the same to some of my family for their respective most important medications (you can read the post here). The changes to their formulary were pitched as a “cost control” measure – so, openly profit-motivated in a sense, but pitched in a warm-fuzzy “Look! We, just like you care about affordable healthcare, and this will help us minimize your overall plan costs!” way – but today I inadvertently ran across evidence that this is not at all the case.

They removed my primary asthma drug from their formulary under the “too expensive” ruse, but the fact of the matter is that the asking rate of my pharmacy for this drug is $100 less than my other asthma drug, one that they insisted I switch to (yeah, hard to switch to something you’re already taking). In terms of real cost to the insurance company – the rate they actually reimburse the pharmacy at – the one they were denying costs them half of what the other drug does. This stinks highly of a back-room deal with Evil Pharma, Inc. With hard data in front of me, I can now see that the only reason that they didn’t fight me when I started fighting them about it is that in terms of their costs, this drug is the second-cheapest drug I’m on, and it probably wasn’t worth the cost of the man-hours needed to argue with me (I have in the past proved myself to be a prolific user of their man-hours). My mother and father, unfortunately, have not been so lucky; they have both had to switch to other drugs. I’m not sure how this is working out in my dad’s case, but for my mother, this means a noticeable change in her quality of life. More alarming to me is the interim period without the original drugs or the substitutes, which it’s no exaggeration to say could have been life-threatening. Previous denials of care in my mother’s case for other stated reasons (who knows if these were true or not) have also had serious risks and consequences. If they had actually fought me, I would also be facing a major reduction in quality of life, and would be at a much higher risk of death from my respiratory problems.

All of this deserves a clear summary of what’s happening here: Evil Insurance, Inc. put my family’s lives at stake and seriously reduced our quality of life because of a deal they made with Evil Pharma, Inc. , and lied to us about the reason. The utterly routine way in which this was all handled makes it obvious to me that this happens all the time.

Say it with me now: the system is broken.

Not only that, but it’s broken in a way that leaves people utterly powerless over their healthcare. What’s the point of me seeing a doctor if the doctor ultimately has no power to decide what drugs I can go on? Sure, the system leaves me the option of paying my own way, as if paying out more than 2/3 of my income to cover my care is really an option (this is no lie, I did the calculations today as part of my insurance search). And I’m always entitled to the option of not getting healthcare at all, if you could consider that an option even on par with “paying out 2/3 of my income.” The system is completely, utterly broken, to the point where people’s very lives are put at risk all the time because of profit.

If this still doesn’t seem that bothersome to you, let’s project this scenario onto another industry. Say, the car industry. For example, if a hypothetical company was selling cars with a hypothetical problem that caused uncontrolled acceleration or threatened a driver’s ability to brake, citizens would surely demand action. “People are dying because the car company is too cheap to take action!” they’d cry. Congress would announce outrage, demand the problems be fixed, and punish the company responsible. No?

Clearly this hypothetical example is not so hypothetical after all. My question, then, is why does the healthcare industry get away with it on a daily basis?

My theory? Our system needs an overhaul on every level imaginable to stop this kind of abuse, and it’s just too big of a problem for people to want to tackle. Witness the recent healthcare reform debacle. It basically shut down the capitol to argue about reforms that are like shooting a spitball (an expensive spitball, mind you) to fend off a grizzly bear, and nobody has had the courage to even try to do that in two decades.

This whole mess just makes me feel hopeless. I honestly don’t know what to do. There’s nothing I can do, really. Learning all of this makes me certain that I don’t want to take part in this system at all, but removing myself would mean stopping my healthcare altogether (I’m counting paying the 2/3 of my income as still taking part, since it lets them bleed me dry financially). Thanks, but no thanks, I don’t want to end up dead. And herein lies another part of the problem: it’s impossible for millions of us to opt out. It’s truly an offer you can’t refuse.

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