An story of how an insurance company failed this patient:
There has been no consequence to insurance companies for the poor service they provide. Jane’s insurer did not get sued. There was no investigation. It did not even lose Jane (or me) as customers. On the contrary, when the company denies care, it saves money.When a reputable insurance company argues that two broken arms are not a medical problem, all of us are vulnerable. Jane did not fall through the cracks. She fell into the Grand Canyon. We can do better. We can create a healthcare system that is efficient, transparent, complete and accountable.
Tragic to be sure. But would Medicare or a similar government-funded program (like the VA) have served this patient better?
While there are plenty of anecdotes of private insurers denying care or providing poor care, I’m not convinced that the alternatives that reformers propose would be any better for patients.
Related posts:
- The RUC, medical home and the specter of single-payer
- Medicare: The big asterisk
- Signing insurance contracts
- Medicare and denying access to drugs
- Why Medicare for all won’t work
- Some continue to think that health care is "free"
- Health insurance doesn’t automatically lead to health care
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“There was no investigation. It did not even lose Jane (or me) as customers.”
Jane is not the customer; Jane’s doctor is not the customer. Jane’s employer is the customer.
A system where — due to schizophrenic tax laws that are a throwback to World War II wage and price controls — a person does not simply earn money and then turn around and buy inusrance in a competitive market — is simply not a “market failure.” It is government failure, pure and simple. It is the government that has added this absurd layer of employer-provided health coverage that creates disconnects such as this.
If your auto insurance company displeases you, you can switch it. If your homeowners insurance company displeases you, you can switch it. But you are stuck, thanks to the government, with only those health insurance options your employers negotiate for you.
Remind me again which insurance industries are “the free market” and which one isn’t?
This is not tragic. It is somewhere between inconvenient and tragic. Tragic would be having both her arms amputated due to denial of needed treatment.
Lets be honest here. Having your ass wiped and being fed is not medical care. It is not treatment. It is not rehab. it is not diagnostic. It is custodial care. This illustrates an altogether different problem with health insurance than the original post meant to illustrate–that much of the increase in health care costs is due to shifting costs onto the healthcare system that used to not be on it. Why should I bear all the costs of burdens of keeping a wife and otherwise maintaining a network of people that I can count on when I need such care, and pay insurance premiums to fund her expense of her personal choices that leave her isolated without such help.
In my state’s Medicaid program, which I know intimately, the decision would have been the same with regard to any hospital or rehab care. They would have approved a short nursing home stay however–but she wouldn’t have liked it one bit.
She is perfectly free to buy a supplemental policy to pay for such custodial care if she so wishes.
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