Thursday, May 11, 2006

Health Insurance Rant

The world's best healthcare system will implode in our lifetime. No one expected to witness the breakup of Ma Bell, the collapse of the Soviet Union, the fall of the Berlin Wall, or the transformattion of China into the world's biggest capitalist consumer. (Favorite line: It doesn't matter what color the cat is as long as it catches mice.) And so it should come as no surprise when we look around one morning and find that the whole damned infrastructure that we call healthcare wil be prostrate in a quivering heap, like a patient in a gurney bound for therapy, because what has been passing as insurance is, in fact, exactly the opposite: UNinsurance.

In the same way that "going public" is a sure way for a great company to lower its product quality or performance to merely okay or good, the notion of insurance is slowly but surely morphing into a community of incestuous connections all conspiring to squeeze the greatest profits possible from a shrinking population of healthy clients, while at the same time weaning off those who most need insurance by denying their claims for one reason or another.

When Hillary Clinton launched her ill-fated effort to nationalize health care about fifteen years ago the number of uninsured Americans was in the high twenty percentile. Last I heard the number is up to about forty percent and rising. And the reasons are as plain as the king's new clothes. I imagine that everyone reading this either has personal experience or knows someone who does with a nightmare story about health insurance.

Life insurance is another matter. Because the "insured" is either dead or alive, life insurance is the checkers board game of the industry. Health (hospitalization) insurance, on the other hand, is more like chess but without standing rules. Lacking a binding agreement, as with life insurance, health care arrangements are apt to shift wildly according to a vartiety of diseases, treatments and opinions.

But at the core of the problem is one simple reality. Insurance arrangements are not conceived to insure but to generate profits. The only way to maximize profits is to minimize payouts. And the best way to accomplish that is to collect premiums from as many healthy people as possible, shifting their care to another insurer if they start making claims or clipping them off in a quagmire of rules and restrictions.

I am experiencing a personal challenge involving health insurance, but I am not free to discuss the details. The gist of the problem is that neither the provider nor the insurer has any meaningful mechanism to serve as an advocate for the so-called insured. As long as I don't get sick or stick to the basics, everything is okay. But if I seek more specialized treatment options and don't know the ropes, I have full personal responsibility for all charges, not because they should not be covered, but because some technicality or another may not be done correctly. When there is a group officially referred to as a reconsideration committee is scheduled to convene weekly, that is an indicator that speaks for itself.

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