December 9, 2014 6:29 AM

Third World America: Where insurance companies are allowed to kill patients without recourse

How far will a health-insurance company go to deny coverage when you are really sick? How willing are they to risk their customers’ health and possibly their lives? Well let me tell you my experience with Health Republic and its affiliate MagnaCare. For five months—ever since I was diagnosed with stage-four metastasized prostate cancer—they refused to pay my medical bills. On Oct. 20, a nurse with Health Republic overruled my oncologist and my primary-care physician and declared that a critical test to determine the progress of my cancer was unnecessary. It seems she was wrong. As a result, I am writing this from Lenox Hill Hospital, where I am undergoing emergency tests and treatments ordered by three prominent New York doctors who didn’t agree with that health-insurance nurse.

Conservatives are wont to expound at some length about how the American health care system is the best in the world. Bar none. You could advocate the truth of that- if you’re willing to ignore the lengths that some insurance companies will go to deny necessary health care in an effort to pad their bottom line.

The fact that the American health care system is held hostage by health insurance companies should be Exhibit A as to why our health care system- specifically the delivery of needed services- is something few Third World countries could be proud of. When an insurance company can directly and materially contribute to the death of a patient through the denial of treatment(s) deemed medically necessary by a trained physician…well, what you have is not a health care delivery system, but something sinister, perhaps even criminal.

The problem with our health care delivery system is very simple: doctors and health care providers, who are primarily concerned with saving lives, are beholden to insurance companies, who are primarily concerned with maximizing value for their shareholders. When human life comes into conflict with the Almighty Dollar, money is too often the victor. Because health care is treated as a service instead of a human right, it’s forced to deal with the same sort of realities any other service provider encounters, when nothing should be further from the truth…and it’s killing Americans.

Malcolm MacDougall, a prominent speechwriter and creative director, was unfortunate enough to have been diagnosed with prostate cancer earlier this year. He wrote this story five days before he died. It’s a very poignant and personal account, because it’s a chronicle of what happened to him…and his experience is by no means unique. Quite the contrary, in fact. A nurse (whose primary responsibility, I suspect, is keeping costs down) employed by Health Republic overruled MacDougall’s oncologist and his primary care physician, stating a test critical to determining the status of his cancer was unnecessary. As MacDougall says with no small amount of ironic understatement, it seems she was wrong.

For I know now how this company really feels about their customers. It was perfectly expressed in the letter I received last week when they tried to explain why they were turning down my oncologist’s request for that critical cancer test. It was, of course, a form letter. Very legal. “The request for outpatient medical services has been reviewed and has not been certified.”

But they gave themselves away with a very strange sentence—their only effort to acknowledge me as a human being. It read: “Member is over 85 year old and continues to smoke.”

So, that’s it. According to my insurers, I have already lived too long. And because, until recently, I enjoyed my two or three cigarettes a day, I am a bad boy who is not worth the cost of keeping alive. No wonder they won’t pay.

The role of an insurance company should not be to determine if someone has lived to long or engaged in habits that might be deleterious to their health. The only role of an insurance company should be to pay for medically necessary tests, treatments, and procedures. The problem is that because insurance companies control the purse strings, they essentially determine if a patients lives or dies. It’s as inhumane as it is criminal…yet this is how our health care delivery system works.

Money rules. People die.

There’s a simple two word solution available, a way this problem could be fixed and we could have a system in which nurses can’t overrule oncologists because they’re bonused for keeping costs down: single payer. No, it’s not a perfect solution…because there are none…but it would be a significant improvement over what we have now. When health care is held hostage to an insurance company’s bottom line, patients suffer…and too often die needlessly.

Malcolm MacDougall died at age 86. It’s likely that his cancer would have killed him eventually, so his case is not one of a nurse’s negligence and inhumanity ultimately killing MacDougall…but it’s possible he might have been able to live longer with less pain. By denying to pay for the test ordered for MacDougall, the unnamed nurse (who really should be named AND shamed) condemned him to a shortened life and a significantly more painful death.

The worst part about this is that the anonymous nurse will face no consequences, and in fact was likely engaging in behavior both sanctioned and rewarded by her employer.

The best health care system in the world? Yeah, right….

blog comments powered by Disqus

Technorati

Technorati search

» Blogs that link here

About this Entry

This page contains a single entry by Jack Cluth published on December 9, 2014 6:29 AM.

Narcissism and Christianity: More closely related than you might think was the previous entry in this blog.

What's on my bedside table these days is the next entry in this blog.

Find recent content on the main index or look in the archives to find all content.

Contact Me

Powered by Movable Type 6.0.2