Existing as a pre-existent condition

Many apologies for the radio silence the past week, I’ve been tending to both personal matters and trying to deal with the creeping chest crud.  I’m still coughing like I have a two pack a day Lucky Strike habit, but I’m probably recovered enough to go back to my regular posting schedule.

I’ve been avoiding talking about health insurance reform here, mainly because I’m not sure there’s anything new and original I can bring to the discussion.  I support the public option, and it’s likely I’d be preaching to the choir here.  Not to mention the fact that it’s become such a polarizing issue, revealing a depressing, even frightening amount of racism, classism and intolerance at its core, that I’ve been avoiding much of the media surrounding it.  It just fills me with a profound sense of despair and anger, to the point where I hope that the next person I hear say something so stupid as “Keep government out of Medicare” has good health insurance, because I will stab him or her in the fucking face.

However, I felt this story could no go unremarked upon.  The next time your conservative grandfather or Libertarian co-worker claims that the health insurance crisis would be solved if people just got off their duffs and bought some proper health insurance, tell them about the provider that canceled a 17 year-old girl’s policy after designating her case of celiac disease as a pre-existing condition.

Their saga began in the summer of 2008 when Dale Rice lost his job as a business consultant. The family had group health insurance through his employer at the time, but decided continuing that coverage through COBRA was too expensive.

The couple consulted an insurance broker, who suggested Brianna apply for coverage with American Community. On Brianna’s application, the Rices noted no prior medical problems, and Brianna was granted coverage starting Nov. 1, with a monthly premium of about $130.

After the teen’s diagnosis in February, American Community reviewed her medical files and found reports of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough.

On May 12, the firm sent the Rices a letter saying it was rescinding coverage.

“The coverage you applied for would not have been issued for Brianna if we had known this medical history at the time of application,” the letter said.

Dale Rice said the insurance company cherry-picked from various doctors’ visits, and that none of his daughter’s health problems were ongoing. He attributed the dizziness to dehydration, the fatigue to his daughter staying up late surfing the Web, the elevated cholesterol to an inaccurate test, and said the cough is now gone.

None of the issues were serious medical problems, and none stuck out in his mind when he filled out the application, Rice said. He sent the Problem Solver a copy of Brianna’s July 2, 2008, physical, which showed no major health concerns.

“[Insurance companies] look for anything that they could say ‘you didn’t tell us about,’ ” Rice said. “They hope that people just lay down and die and don’t fight.”

Just to clarify, American Community, despite implying that the policy was canceled due to the Rices withholding information about Brianna’s medical condition, wouldn’t have covered the teenager in the first place, because she was allegedly already under a doctor’s care for a previously diagnosed illness.  This is what’s known as a “pre-existing condition,” and it’s a term that strikes fear in the hearts of anyone who deals with everything from irritable bowel syndrome to epilepsy when it comes to time to apply for new health insurance.  In the simplest terms, insurance companies don’t want to cover anything that was wrong with you before you came to them for coverage, even if it’s a condition that may only require an occasional visit to the doctor and some prescription painkillers.  Pre-existing conditions can cover anything from migraines to depression to obesity to fibromyalgia, and pretty much everything in between.  As I mentioned in a previous post, I was declined for health insurance coverage by a previous employer because I was pregnant.

It doesn’t just stop with medical issues, though–in some states it’s legal for health insurance providers to deny coverage to police officers, firefighters and construction workers, deeming their high risk professions as being too much potential for expensive payouts.  If you like that, you’re gonna love this: in eight states, plus Washington, DC, it’s legal for health insurance providers to deny coverage to victims of domestic violence.  I think that bears repeating, with some emphasis: in eight states, plus Washington, DC, health insurance providers have the right to deny coverage to someone if they have been a victim of domestic violence.  The reasoning is clear and cold as the proverbial witch’s tit: domestic violence victims go to the emergency room a lot.  Emergency room visits are expensive, and most health insurance providers bear the brunt of that cost.  Women and men who get beaten up by their partners cost insurance companies too much money.

One of the biggest myths of this debate is the notion that health insurance companies are benevolent beings whose job it is to help their customers in times of need, and how dare Obama and his band of merry socialists try to deprive us of that service?  Health insurance companies don’t exist to pay your medical bills.  They exist to not pay your medical bills, and they will use any loophole they can find to avoid paying them, even for something as minor as a misspelling on an application.  As insurance premiums increased an astonishing 131% in the past ten years, the restrictions on what policies will and will not cover become ever more limited.  It’s ludicrous to believe that health insurance companies are there to help.  They’re businesses, and businesses can’t exist if they don’t make a profit.  That profit comes from making decisions on whether or not someone will get medical care, or at least, be able to get it without getting stuck with hundreds, perhaps thousands of dollars in bills afterwards.  It’s someone’s job, and that someone’s expertise more likely lies in finance rather than medicine, to decide what procedures and treatments will get covered and what won’t, and it all comes down to how much money the company stands to earn or lose.  Occasionally, these decisions lead to someone not getting treatment they desperately need, and that person dies, such as 17 year-old Nataline Sarkisyan, who died after her health insurance provider declined coverage for a liver transplant.  Their reasoning? The procedure was “experimental,” with a low success rate.  In layman’s terms, they didn’t feel it was worth the cost, since she would have likely died anyway.

I probably shouldn’t paint all health insurance providers with the same tainted brush.  I’m sure there are some who are a bit more generous with their decisions.  My point is, these people who shout and raise their fists, claiming that Obama is going to kill their grandmothers and make people stand in line for hours at a time just to get some hemorrhoid cream are kidding themselves if they believe that health insurance companies are the “good guys.”  They’re part of the same big business that has always worked against the needs of the people, where we’re all just dollar signs, and our lives and well-being are measured in degrees of profit and gains.


5 Responses to “Existing as a pre-existent condition”

  1. I was just thinking that all junk food — chips, soda, ice cream, cookies — should be taxed. I see two things happening as a result of this:

    (1) low income families, who are currently having high rates of obesity, will probably avoid purchasing that kind of food in order to save money, thus reducing obesity, and

    (2) the tax revenues could be used to fund a public option for health care.

    What am I missing here? Why isn’t this the obvious solution?

  2. “17 year-old Nataline Sarkisyan, who died after her health insurance provider declined coverage for a liver transplant. Their reasoning? The procedure was “experimental,” with a low success rate. In layman’s terms, they didn’t feel it was worth the cost, since she would have likely died anyway.”

    I have to call you out on this one.

    Some facts you are omitting here include:

    1) The girl had leukemia. The liver transplant had a 65% chance of success for 6 months, and she was already weak from the leukemia treatments. On top of that she would have had to take anti-rejection drugs to lower her immune system. I know this kind of thing is uncomfortable for those who have nothing but emotions to guide them, but try to give thinking a chance. Organs are in constant shortage. If you have one organ and two patients, you have to decide based on some criteria who it should go to. It makes the most sense to give the organ to the person who can get the most use out of it. Harsh? Yes, but reality is our only option here. You don’t make it better by hiding from it or burying it under saccharine platitudes and brainless moralizing. You deal with what you’ve got.

    2) Transplant centers in San Fransisco and Dallas stated that they would not perform a surgery with such low odds.

    3) She was also suffering kidney failure.

    4) She was already in a vegetative state.

    5) The insurance company isn’t even to blame in this case. The plan this patient’s father had with his employer was an ASO plan, also known as self-funded. That means that the company he worked for funded a bank account from which CIGNA paid claims. The employer then chooses what will be covered and what won’t. Transplants were excluded under this plan by choice of the employer.

    6) And guess what, this evil insurance company you are so quick to vilify, which had no financial stake in the decision at all – it would not have been their money that paid for it, and they gained nothing by rejecting – decided to pay for the transplant out of the shareholders’ pcokets. That was not a profit/loss decision, because as I pointed out, CIGNA was not insuring anyone, they merely administered the employer’s insurance plan. If this company were so evil, why did they offer to pay for the surgery and the long-term follow-up care?

    I really get tired of all this brainless moralizing, the pitchforks, the screaming, the rage, the red-faced indignation, over things that are either not true or are riddled with half-truths and misinformation. In fact, I’d probably find the rest of the story on that other bloody-shirt anecdote of yours and discover it’s nothing like what it is presented to be. Just like the 50 million uninsured story that makes the rounds all the time (interestingly Obama lowered it to 30 million in his speech, a small step in the right direction, 22 million to go).

    As for benevolent beings, I have no idea why you think the government would be one when the insurance companies aren’t. Did we suddenly elect angels? The only thing that would happen if the govenrment had a larger role would be the politicization of health care. They would make the same exact cost/benefit decisions that the insurance companies do. In fact, the savings that are promised are premised on the notion that the government would make BETTER cost/benefit decisions than insurance companies, because the ICs often do pay for gray-area medicine where efficacy is not fully established (read: experimental), whereas the government would eliminate that.

  3. April: I am somewhat in agreement about taxing soda, but I say this while trying to rid myself of a nasty caffeine addiction. I don’t think such a tax will go through in a lot of areas, however, simply because it will at least be perceived as targeting lower income households, although people of all backgrounds enjoy junk food. But yeah, it does seem like it would eventually solve a number of problems.

    Brian: You know, I would have been perfectly happy to have a polite, even friendly discussion with you, but the fact that you peppered your well-written, thoughtful comment with insults basically proves my point that this is an issue that has moved past any notion of civilized debate. I refuse to get into an online shouting match with a stranger who makes assumptions about my intelligence and inability to act on anything but emotion by reading a whole two blog posts. Call me a wuss, but I doubt you really want any sort of debate, you want me to try to argue your points so you can fire off a few more insults and remind me of how the liberal media gets everything wrong. Sorry, when you can come into my place with some manners, then maybe we can talk.

  4. Ok, yes I did come come off a little harsh. But this is frustrating. Before I stumbled across your blog I had spent the better part of an hour trying to find some non-hysterical information about pre-existing conditions clauses. I must have passed over 80 or so Google search results pages, all saying the same exact thing, and most of the time, they were repeated verbatim. What is the source of this? I don’t know. There are apparently tens of thousands of people out there, all with their own websites, getting information from some single source and repeating it, without investigating the claims, without a hint of skepticism of its truth. And every one of them loaded up with the hysterics, the moralizing, brimming with the fire of righteous outrage. It’s tiresome.

    I stopped believing in the devil a long time ago. So try to understand my frustration when this whole debate is being driven by people who believe that the other side is the devil. And yes, I do mean that for both sides. There is a problem with the way we deliver health care in this country, that much is true. But few people, at least the loudest voices, really know why or how to solve it. They just have this idea that anyone who disagrees with them and their pet solution is acting on ugly motivations, that the only reason anyone would disagree is because they are evil, and so they completely shut out any valid criticism of their ideas; and because they view it as a titanic battle between good and evil it ends up reinforcing their belief that they are unquestionably on the side of pure good. And I imagine that is probably why that tragic story about that girl was repeated as gospel truth. Like the Virgin Mary on a grilled cheese sandwich, if you truly believe something, you will see evidence of it everywhere. This story is just that, it fits the template, confirms the bias.

    I just wish there was more skepticism in the world. True belief, of any kind, is dangerous.

    That said, I apologize for the rudeness. It’s born, as I said, of frustration. I do like this blog. Nice on the eyes, good design.

  5. Brian: I appreciate your apology, and your compliments on the blog. Glad you’re enjoying it, even if we don’t see eye to eye on a lot of things.

    In a way you’re sort of right, my stance on this issue probably is based more in emotion than logic. I grew up pretty poor, and didn’t have any sort of health insurance until I was well into my twenties. Since then, I and a lot of my friends and loved ones have had far too many negative experiences with health insurance, whether trying to get coverage or with the coverage we already had to be able to view the industry in a positive light. None of us are the bums or drains on society that conservatives portray supporters of the public option as being. We’re all just hardworking, regular people who needed coverage for issues that didn’t come from poor lifestyle choices, such as smoking or obesity, and yet for some reason it’s been an ordeal, either presently or in the past, to get that coverage.

    To be perfectly honest, part of my support of the public option comes from a naive belief that it will somehow solve the problem of proper health care for everybody, regardless of financial situation. However, I’m also cynical enough to know that it’s going to take a hell of a long time to see any real change take place. I expect that, in the end, money will still talk, and the rich will continue to get a better quality of care than the poor. But then again, even something is better than nothing.

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