Wednesday, August 12, 2009


I'm afraid you've grossly underestimated the extent of the problem. While the uninsured are, of course, in deep doo doo, those of us 'lucky' enough to have "health insurance" (really just the 'illusion' of health insurance) in the US are, in some respects, even worse off.

My wife and I pay $364 a month for insurance through my job at Tulane university. For this, I receive the dubious privilege of arguing with United Healthcare about which part of which bill they may or may not bestir themselves to pay. The way it works is, I go to the doctor (first, of course, coughing up my $25 "co-pay" in front). He takes a look at me, and if that's all he does that's the end of it. If, however, he actually treats me in any manner, in about three weeks (although I have received them up to six MONTHS) I receive a calculation containing the actual cost of the procedure, minus whatever United has decided to pay. What's left is the "patient responsibility," which is mine to pay.

As near as I can tell, there is no sure way to ever determine what this will be. The insurance contract itself contains pages of meaningless, deliberatly misleading blather, all of it undecipherable, even by colleagues with degrees in higher mathematics. Their website is no help. I've even tried calling their 1-800 number while in the doctors office, only to receive an ultimate accounting wildly different (and always larger) than their representative's 'quote.' Imagine a healthcare system run along the lines of a shady used car dealership and you get the idea.

At a recent 'enrollment meeting" (don't ask) United asserted that they would now pay for a "routine colonoscopy" every five years for men over 50. After a morning spent wasted on the phone with a representative I now understand that the word "routine" means something very different in insurancespeak and that if I want fiber optics technology shoved up my ass this year I'll need to fork over $1800.

Then there's the "lifetime cap" for treatment. On most policies this is about a million dollars, which seems like a lot, until you get a load at what a couple of weeks in the ICU costs. Once you've exceeded that your family has a choice between letting the hospital kick you out on the street to die or bankrupting themselves paying out of pocket.

For a lot of people though, things never get that far due to a nifty process insurers call 'recission.' If you get sick and start costing them money, algorhythms in their computers red-flag your file and their team of adjusters go to work looking for egregious reasons to cancel your coverage; childhood asthma that you forgot to include on your original application, say, or a change in meds your doctor noted on your chart but forgot to inform you of.

Unfortunately even Obama's 'reforms' still leave private insurers in the catbird seat. The uninsured will receive government subsidies to assist them in buying private insurance (talk about "socialized medicine," only in this case the risk is socialized while the profits are privatized). The 'public option,' if it happens at all, will likely be so compromised and ineffectual that only the poorest and most disenfranchised will opt for it, reinforcing the notion that "government" can't do anything right.

I'm sad to say it, but this latest "health care reform" bill is looking more and more like a rearrangement of the deck chairs on the Titanic

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