I try not to talk politics on this blog, because it’s really about the experience of living with a disability like mine and a service dog. However, a combination of the recent health care reform bill to pass and my experience dealing with health insurance companies has pushed me to post.
I’m talking about exactly one part of the bill, and I’m not opening the floor here to debating the whole thing.
One of the things that the new bill insists on is that every person must have health insurance. For people within 400% of the poverty line – which would include about 1/2 of households in the US, I believe – the government will provide a subsidy towards paying those health insurance premiums.
Now here’s the problem: we’ve created a system where taxpayer dollars will go indirectly into health care. They’ll be paid to health insurance companies. Now, what’s the purpose of a health insurance company? Well, it’s the same as any other company – to make a profit by providing a service. That means they want to maximize what they’re being paid and minimize what they’re paying out.
In short, the health insurance companies want to make sure that the least services possible are paid for while they get the highest premiums possible.
I think, in the end, it may have been more fiscally effective to expand either medicaid or medicare coverage and reform the process of medicaid and medicare than to throw all this money at health insurance companies. Set up something administered by people who aren’t making a profit off of the money the federal government is paying out.
Health insurance companies force doctors and patients to make choices that are less than ideal for their health because they’re less expensive.
I’ve just been forced through such a choice. My primary source of pain relief is a fentanyl patch that is applied every 72 hours. Fentanyl is an opioid, so it’s a drug that you expect to eventually develop a tolerance to and require a higher dose for effective relief.
Now, one of the problems with the fentanyl patch is that it theoretically lasts for 72 hours, but in practice wears off a fair amount quicker than that. In my case, it slowly starts being less effective around 48 hours, but comes to the point where it is noticibly (painfully!) less effective around 60 hours in.
My doctor wanted me to switch to using the same dose, but changing the patch every 48 hours. This would mean that instead of using 10 patches a month, I’d use 15.
The insurance company denied the greater number.
Because of that, my doctor has had to change my dosage. I’m now on twice as much fentanyl as I was before. This is emphatically not a good thing. When you take opioids long term, you do it with the understanding that they will slowly lose effectiveness, and you’ll need to increase the dosage. However, the body can only take so much opioid safely. You really don’t want to increase dosages until it’s absolutely necessary.
And so, my health insurance has made my doctor choose a less-than-optimal path for me. Why? Because the optimal path is more expensive. My insurance will pay for ER visits, and MRIs and other expensive tests, but they will not pay $80/month more for my medications, even though it is what my doctor believes is best.
Thus, there are 2 parts to what is wrong with leaving public health care in the hands of health insurance companies, both having to do with profit. First, health insurance companies will try to avoid paying for treatments, tests, and medications because the more things they can deny payment for, the greater their profits. Second, health insurance companies dictate treatment choices, and doctors are forced to obey even when it is counter to what they believe is best for their patients.
I think the better option would have been to create single-payer health care for those under a certain percentage of the poverty line. That would mean sending the same number of tax dollars into a system that does not make a profit, meaning one fewer group of people who are paid out of the same dollars. And if no one is making a profit, more money can actually go to treating patients.