Wednesday, August 5, 2009

Excellent Read: Unconscionable Math

Taunter Media has an excellent essay, Unconscionable Math, describing the position of for profit health insurance companies from a mathematician's standpoint. The position is the for profit health care model is broken.
Everybody knows the fight was fixed,
The poor stay poor, the rich get rich.
That's how it goes.
--Leonard Cohen

For the record, I am in favor of eliminating for profit health care. I believe that it is impossible to both provide care to people and maximize profits for shareholders. At the end of the day, the shareholders are going to win, and the patients will suffer.

Ironically, I don't think that any of the horrors that the anti-public health prognosticators are espousing are any worse than our current system.

I have personally experienced the 'efficiency of the private insurers' and it's surprisingly similar to a bass ackward bureaucracy.

When I was a few years into my career as a software engineer, my dentist and a group of highly qualified specialists made a diagnosis that I had a Temporal Mandibular Joint (TMJ) issue that could be treated through a surgical procedure. My condition, when they diagnosed it contributed to severe headaches and issues chewing food. I could not close my mouth completely. Three independent qualified doctors agreed that my condition required treatment which included 2 years of orthodontics and a surgical procedure to be performed after a year of orthodontics.

I contacted my health insurer to verify that the surgical procedure would be covered. My health insurer at the time, Cigna, demonstrated some of the poorest customer service and responsiveness than any business I've ever dealt with while pre-certifying the operation. The first representative I spoke with said that no, they would not cover the operation without hearing any details. I tried to contact them again and improved the prognosis from a no to a maybe. For over 9 months Cigna did not give an answer. They contacted the oral surgeon's office and sat on the surgeon's reply for months. They promised me an answer at least three times and failed to deliver it. Finally, shortly before the surgery was to take place, they sent me a letter stating that they would not pay for the operation.

The cost of the surgery was estimated at just under $30,000. I had nowhere near that much money available and I had no idea how I would cover the cost if I had to pay for it myself. The stress, worry, and depression from waiting put me in a bad condition. My attitude towards my employer and my work became horrible. I felt betrayed by my insurer and my employer. I did my part as an employee and they ditched their responsibilities when I became inconvenient.

Why did they ditch me and deny me coverage? Was it outside of my policy? Nope. Was it unnecessary? I couldn't completely close my mouth. Was it efficient? In a way it was, but not for me. It is efficient in the sense that I didn't cost Cigna any money because they were able to avoid paying for the operation.

What was the total cost? As an employee I was not nearly as productive as I could have been. The lack of sleep, depression, and worry made it very difficult to focus on my work. The loyalty I felt towards my company was gone. Before the ordeal I thought nothing of working unpaid overtime and doing whatever it took to get the job down. I was punching a clock after the ordeal.

My insurer and my company also lost me as soon as I could find a company with a better policy that would hire me. I'm sure that whoever was hired to replace me cost much more than I did. Actually I was being paid about $30,000 a year under the market price for someone in my position. To save a one time cost of $30,000, my former employer traded up by paying it every year.

There's a huge difference between trying to cover costs and maximizing profits. It's ironic to me that I've heard health insurance companies describe the people they insure as having a sense of entitlement. The insurers lament that the people feel entitled to care that would improve their lifestyle like they are trying to cheat the system.

I think there's a different sense of entitlement and it comes from the private health insurance companies. They feel entitled to take our money and our quality of life. Under our current health care system, we're playing a rigged game. These companies have no concern for the quality or value of our lives. They only want us if they are going to make money off of not providing treatment to us.

If given a choice of a public system where I need to wait for my treatment, but instantly knowing that my treatment will be covered and the current American system of being able to wait less time for treatment but waiting much longer to eventually learn whether my treatment will be covered, I choose the former.

Health insurance companies are fighting hard to maintain the status quo and to slant the system more in their favor. They are trying to scare us into fearing a government health care system.

They use words like socialism and allude to waiting for health care. I'm sorry, has anyone ever not had to wait for health care under our system? Last time I went to see my doctor I waited well over an hour to see him after I waited three weeks to see him. That was for my annual physical.

There is a conflict of interests between providing life, i.e. health care, and maximizing profits. In our current system, the profits are winning out. Are we willing to trade life for profits?

2 comments:

Brian said...

Who is really here to be blamed? The Company that bought the cheap health insurance plan or the company that offered the cheap insurance plan? I've used Cigna before and have had better results than you. It was cheap for my employer but wasn't a great plan for employees. Then again my company spent the money they saved on health insurance to give me a job so I can't complain too much. I always ask what kind of benefits my employer offers before accepting a job offer.

Since your employer offered you low quality insurance then we should kill off tens of thousands of jobs and offer a single payer plan instead? Really all you are saying is you'd rather have lower quality health care as long as no one gets paid.

In the end it sounds like you think that people should not benefit from the fruits of their labor. Sad thing is I think that a slight majority of Americans feel this way. It goes against our constitution and the reasons our founding fathers started this country. It makes me question how much longer this union will survive.

Paul Wiedel said...

Who's to blame? There's plenty of fault to spread around.

A few points: the actual insurance that was offered when I was hired was stellar. It may have even been through Cigna. I don't think that there were even copays. It was also a big reason why I chose to work for that company.

The transition of going from that to a policy that denied treatment is why I felt betrayed. The price of that policy grew at a rate that outflanked inflation by a factor of 10.

I am not saying that I don't want people to get paid for their work. What I'm saying is that private corporations whose sole obligation is to provide a short term return to their shareholders is a system that has a conflict of interest with providing health care. The result of a corporation that weighs providing care to its customers with the bottom line is people who paid for coverage will not receive it, not so the insurance company can stay afloat, but so they can extend their profits.

In the Unconscionable Math essay, the author describes the rigged game of health insurance. It isn't a fair deal. It isn't about preventing the private insurers from going out of business or cutting jobs, it's about improving their profits.

I do feel that people should benefit from the fruits of their labor and I firmly believe that workers, you and I, are not because we have a broken system.

We get the regular coverage now, but insurance isn't just about regular and expected expenses. We'd be better off just budgeting our checkups and cutting the insurance out of the game. It's the catastrophic stuff that we get insurance. It's the stuff we can't foresee. I wonder what the point of getting the insurance is if the insurer may very well categorically deny their end of the deal.

Who's to be blamed? It's not about blaming, it's about getting people health care. Health care debts are the number 1 reason why people like you and me go bankrupt.

I know that people who identify themselves as conservatives claim to value the sanctity of life. Why is it that they don't seem to give a rip about the value of life when it comes to providing health care?

If I need to choose between someone's job and someone's life, I will choose the life. Are you saying that people who are not in a position to pay for health care do not deserve to live?

The thing I don't understand is why people feel that putting socialized medicine as an option for everyone is a bad thing. It seems to work for every developed nation in the world. We have other socialized services: education, fire protection, police, postal service.

Why should it matter if a public option is put on the table? It will definitely have an effect on the market. That effect is no different than say a Wal*Mart mandating that their vendors reduce their costs.

If the health insurance companies can't adapt, well I, for one, will not miss them.

Really all you are saying is you'd rather have lower quality health care as long as no one gets paid.

I don't think you understand how non-profit corporations work. People don't just volunteer for them. There are actually paid positions. The paid positions are regulated, so you don't see people making the ridiculous sums of money that you do in some of the other areas.

My current client is a non-profit corporation. All of the employees are treated very well and are well compensated.

If the private corporations are so good at creating jobs, why is it that they're paying out eight figure bonuses while cutting jobs?