Everyone knows health insurance in this country has some profound problems. Where things differ is on how to resolve those problems. Liberals tend to favor approaches which make health care more generally available to everyone, approaches which tend to be more "socialized" (Oh the horror! Oh, the humanity!). Conservatives tend to preach the supposed efficiencies of the free market and capitalism.
A discussion I had this morning with Blue Cross/Blue Shield of Arizona just cemented for me why conservatives are simply wrong on this matter, and free market health care will never work to get everyone insured.
Someone I am close to suffers from severe depression, and has for the two decades I have known her. She goes through long periods of time where she has trouble getting out of bed, let alone getting out of the house. I can tell how well she is doing at any time by whether or not she is returning my phone calls when I leave messages -- if I get a call back in a day or two, she's doing well. No return call, she's doing poorly.
Fortunately for her, she and her family are relatively well off, to the extent she does not need to work if she doesn't wish to. She consistently does part-time work for various projects, but I don't think she's worked full time for several years. Which is fine - like I said, she doesn't need to.
She's been in therapy for her depression for a long time as well, and has tried various medications. One this past spring seemed to be working well. She was as happy and full of energy as I had seen her in over a decade. Unfortunately, it turned out to have some side-effects and she was taken off of it, and things aren't going well again.
In the midst of all this, she needs to get some individual health insurance. It's understood her depression would be a preexisting condition and not covered, but that's not a problem. All she's looking for is something in case she breaks a leg, or needs knee surgery because she slips and falls, something like that.
She's 39, decent health (other than depression). She doesn't smoke, doesn't do drugs, drinks rarely and not to excess. She has had no surgeries. Her family doesn't have a history of cancer or anything like that. She does have eyes which require eyeglasses or contact, but so do lots of folks.
Anyhow, because she's currently in a bad state of mind she asked me to look into what was necessary to get her insured. I spoke to BC/BS this morning and got the general information and rates, which I will call her with later today. However, the agent I spoke with mentioned that, depending on what medication she was on for her depression, she might be uninsurable.
Think about that for a moment. A person otherwise in good health, with no major health-affecting vices, no background of problems or family history, someone who can easily afford health insurance may not be able to get it at all. Not just no coverage for her depression (which is understood), but simply no insurance at all.
You have someone who wants health insurance, can pay for, is willing to pay for it, and it may simply not be available to her. The free market at work - all they want are the people who can pay but who won't actually make any claims. The incentives are to look for reasons to deny coverage, not provide it.
As long as we continue to insist on private health insurance, our health care system will continue to return underwhelming satisfaction and results at an inflate cost, while guaranteeing some (large) number of citizens will not have insurance at all, even some who can afford it. Additionally, people who otherwise wouldn't need (or want) to work full time will be forced to, simply to maintain health benefits.
That's obscene.
I didn't know what (if anything) her current medication was, but made arrangements to have an information packet and application form mailed out. We'll hope the insurers generously, graciously and benevolently acquiesce to insuring her.
Bastards.
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2 comments:
Sirocco,
There is a lot of political stuff that we could go into here, but I think we need to instead speak to the rule that you, as a technical guy, should be very familiar with.
When a matter is important, or the answers you get infuriating, NEVER trust front line support!
I would suspect that the person that you spoke with knows little about the actual details of what you discussed with him. In my case, I have a wife who has spent several years working as an office assistant in a medical setting so she can sniff this type of incompetence out right away. Others may not have this resource.
I would:
1. Call back and get another agent.
2. Ask to speak to a supervisor.
3. Use a third party broker to handle this for you. There are several in Tucson, and if you need some names, let me know.
Yeah it is terrible that HMOs often have untrained workers fielding calls. I wouldn't suspect that this would improve much if government took over, however.
Framer,
I bumped up from the person who answered the phone to an actual underwriter, so the info about possibly not "being eligible" or whatever term was used came from someone who actually signs off on these things.
I may end up going to a 3rd party broker -- that's a good suggestion actually, one I will keep in mind if it becomes necessary. Thanks for mentioning it. If it comes to it I will drop you an email.
The original point would still remain, however - it shouldn't be necessary to jump through such hoops. The incentives all point in the wrong direction.
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