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Insurance company profits are destroying health care

This Web only Speakout has not been edited.

Jeanette Oxelson

Published January 28, 2008 at 6 a.m.

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Brian Schwartz’ letter (Politically Controlled Insurance is a Disease, 1/17/08) concerning politically controlled medical insurance was right on the money but didn’t go quite far enough. I will never understand why something everyone must have or possibly die without is being run by for-profit companies. At best, this would seem to cause severe conflicts of interest; at worst, it’s simply legalized extortion.

A friend with Type I diabetes was put on an insulin pump by his doctor. This required a different type of insulin for the pump to work at maximum efficiency. But the insurance company decided he didn’t need the change, despite several letters to the contrary from his doctor. (It was a couple dollars more than the old insulin.) Plus, using their “one-size-fits-all” mentality, they told him he was using too many test strips and would only pay for half what he needed (again, per his doctor) to keep his blood sugar at acceptable levels.

I know a 93-year-old lady in a nursing home who was put on oxygen by her doctor. Again, using their “everyone-is-the-same” standard, the insurance company required she be given physical therapy to supposedly wean her off the oxygen. She couldn’t tolerate the PT, every session left her gasping for air and requiring more oxygen. So the insurance company refused to pay for any of her oxygen at all. She’s 93! She’ll never be able to get off her need for oxygen. Their policy would only cause her to die more quickly.

Several years ago I had to drop my insurance completely. Since I’m self-employed, the only policy I could afford had a $5000 deductible. Consequently, I was paying $350 monthly for the insurance and then paying all my own medical expenses anyway. In five years I had paid them $21,000 and, despite a couple of broken bones and a bout of asthma, I received absolutely nothing back.

So, thanks to the insurance companies, here’s what passes for health care in this country: (1) Non-medically-educated personnel deciding whether our own doctors are capable of correct diagnoses or simply arbitrarily asking for expensive treatments.

Luckily for my diabetic friend, he changed jobs and consequently insurance companies. He is using the insulin prescribed by his doctor and designed for his pump and is doing much better managing his disease. He’ll remain healthier thanks to his doctor, not his insurance company. (2) Insurance companies develop their guidelines based on averages. If your needs are outside those guidelines you’re out of luck. If you get sicker, or die, using their standards, that would seem to be your fault, not theirs.

(3) Can’t afford insurance? Soon you’ll be completely out of luck if you aren’t already. Doctors and hospitals are finding it harder and harder to treat the non-insured because of their own rising insurance costs. During the last few years I’ve been without insurance, I’ve seen my non-emergency medical costs quadruple.

Weren’t insurance companies originally supposed to help people manage their medical expenses? Wasn’t their purpose to give people a way to put aside money for unseen, and necessary, medical procedures? When did insurance turn into windfall profits for the benefit of insurance companies alone? How long will they be allowed to continue to take our money and give absolutely nothing in return? To paraphrase Mr. Schwartz’ last statement: Profit-based medical insurance is a disease masquerading as its own cure.

Jeanette Oxelson is a resident of Denver.

Comments

  • January 28, 2008

    6:36 a.m.

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    vudumom writes:

    So what is the answer?We already have Medicaid and Medicare that is falling apart. The 93 year old woman is not on medicare?
    There are many Dr's who won't take Medicaid or Medicare patients because the government has decided what they wil pay for medical care. The paperwork has bogged down Dr.'s billing offices.They don't get paid in a timely manner.The Dr's also are scrutinized by the government run Medicaid and Medicare.
    They are in the business of saving money and not paying Dr's in a timely manner.
    The pool of Dr's is shrinking who take government back prograns because of their inefficiency.

    So again I ask the question,What is the answer?

  • January 28, 2008

    7:39 a.m.

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    p_myers661 writes:

    I would suggest that the gentleman needing a special insulin could have quite easily filed a complaint with the state. That usually produces an instant approval as the fines for that type of denial are draconian.

    The elderly woman is a victim of Medicare, a government managed program. The "one size fits all" mentality is straight from the government. There is little appeal from this. That is the reason we need to make changes.

    As for the writer's situation with insurance, it is obvious that a Health Savings Account would have provided $21000 in that account while the insurance policy would have covered catastrophic circumstances for far less. The availability of such accounts has been limited by the combination of insurance companies and politicians. Insurance companies don't want to lose the revenue that individuals will have to spend on care with such accounts. Government doesn't want to lose the power.

    The problem with health care is that the government is a sugar daddy with no real oversight so Medicaid and Medicare go on and on setting prices for payment without dealing with the market.

    Health Savings Accounts for all, excepting the elderly who prefer to remain on Medicare, would return the market to the picture and the power to the individual. Nothing else will work. Just ask the Canadian politician who came here for treatment for her breast cancer. Free in Canada with a wait. She chose to pay money instead of her life. The choice for us is whether or not we will choose to let the same people who make such wonderful decisions for the post office and the DMV to set the limits for health care. There is a 93 year old woman out there who could tell you why that's a bad idea. (My mother is on Medicare and oxygen. She is not required to go to physical therapy and has never been charged a dime for her oxygen. She does have a supplemental policy. I tend to doubt the accuracy of the claim above being due only to the insurance company. Is it possible there is a nursing home or other facility putting a hand in the revenue stream?)

  • January 28, 2008

    7:50 a.m.

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    Art writes:

    Why exempt the elderly from Health Savings Accounts? They have needs too that are not covered by Medicare. These medical needs could be covered with HSA funds if they were to have them. HSAs are very restrictive and insurance companies are reluctant to provide the insurance that allows one to get an HSA. I know, I have tried. The costs for these types of policies have gone up faster than any other types. Perhaps this is because the insurance companies realize that people want them and will pay more for them than anyone can possibly save by having one. At any rate HSAs should be allowed for everyone, no exclusions due to age, race, religion or sexual orientation.

  • January 28, 2008

    1:05 p.m.

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    dpfrichard writes:

    Alot of people are talking about competition and shopping around, but unfortunately that won't work since I have yet to find a listing of prices for any procedures in any hospital.

    So you need your appendix removed and you try to shop around. Did the price quoted include the operating room, the surgeon, support staff, supplies? Your probability of getting an accurate estimate is about the same as Senate passing a balanced budget next year. Which brings me to the next issue of lawsuits.

    Lawsuits in healthcare are WAY out of control and are the reason why healthcare costs this much. Given that suing is a zero sum game, the net results are that only lawyers win and everybody else loses. I have a couple of friends who are doctors and they say that of the amount they charge, 80%+ is due to liability insurance. They also say that there is no money in it today due to the overhead of insurance, liability and health, so they are telling their kids to chose other professions.

  • January 29, 2008

    11:10 a.m.

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    gary writes:

    So again I ask the question,What is the answer?

    The answer....

    Let us go back to the basics. Throw out all of the insurance companies,thier HMOs, and the government. All of us got a long just fine with a private health care system and NO INSURANCE companies involved for hundreds of years. The mess in health care is insurance companies and the government.

    The cure... all of us need to cancel our health insurance, everyone of us. What would the insurance companies do then?? Maybe try to be competitive?? HA... let them go out of the health insurance business and let doctors go back into private practice for the American public and not be ruled by insurance companies. Yea, yea, you will all say that it will not work. But it did in the past and it would work today. So go ahead everyone, tell me how great the insurance companies are and how great a socialized program run by the government would be. Well, you are wrong...
    Back to basics will work and is the solution.
    Nuff Said!!

  • January 29, 2008

    4:34 p.m.

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    annie143 writes:

    I cannot get private health insurance because 30 years ago I had a nervous breakdown from stress and over the years I have had occasion to take an mild anti depressant. You will never get private insurance with a history of depression, period.

    We are self employed so group plans were not available. That is the only thing I could get coverage under.

    HSA are provided under private insurance and we had one provider in the state of Florida offering them. I could not get private insurance.

    We paid 1,500 a month for a few years for coverage, until we could no longer pay it.

    My regular doctor continued to provide limited treatment for me. 3 1/2 years ago, just prior to dropping our health coverage, I complained of lower back pain and he ordered an MRI (very expensive). My whole back was looked at and an incidental problem was noted that I had plaque buildup starting in my groin artery, but nothing else was found.

    In September of this year, I complained again and he sent me for an ultrasound, then a catscan. They found a 14 cm tumor in my pelvic area.My doctor said there was nothing on the original MRI to indicate it and when I requested a copy of the file reading, the incidential finding was not on the report and it appeared as though the MRI only went to my waist. Fancy that. It even said on the report, LOWER back pain.

    I did find a surgeon to operate and thank God it wasnt cancer. Unfortunately, we have had to take out a mortgage on our house to the tune of $50,000 to pay for the operation. We are hurtin'. And till the day I die, I will believe that tumor was overlooked by the radiologist and it was covered up. Doctors can be bad too.

  • January 30, 2008

    7:19 a.m.

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    vudumom writes:

    Don't even get me started on Doctor's.I have horror stories that would keep you from going to the emergency room with a gunshot wound.You would be better of removing the bullet yourself.Well that was a overdramatization,but you get my point.

  • February 4, 2009

    11:05 a.m.

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    Lulululu writes:

    Living in this country, with all the bad and insufficient service and greedy people who only think about money, makes me feel so unsecured. I have been living in the States only for a year but I feel like I am going to die in my own bed before I even get to the ER just because I cannot afford insurance.
    Not only that, even though I have insurance, knowing that medically uneducated people work for the insurance companies only worsens the situation. They have no idea about diagnosis and treatment, and yet they're the ones to decide who should get treated and how.
    I went to a hospital in Philadelphia last year. I went to the ER, but they made me wait for at least 1 and a half hour to get the paper work done before I was hospitalized. I was suffering so much from abdominal pain but it was obvious that no one cared. At the end, I stayed at the hospital at least for 6 hours and they could neither diagnose, nor treat me. If the healthcare system and insurance companies continue working the way they are working now, everything is just gonna crash down at one point. I still can't believe why people are accepting and accommodating with this situation.