The Great Health Insurance Debate.

Can we have an honest conversation?

Two weeks ago I received my yearly health insurance letter from Blue Cross Blue Shield (BCBS) explaining why my rates are headed up again in 2010.

They should stop using stock photography for their pieces and hire me instead.

Apparently BCBS is very concerned about my health and general well-being.  So much so that they are extending several value added benefits to my 2010 policy.  I wish they would have asked me first.

This is verbatim from the letter I received.  “You will be pleased to know that we are increasing the amount of Life Insurance included with your health plan from $5,000 to $10,000.”  I called the number BCBS provided in my letter to tell them I don’t want the life insurance “option,” since I already have a separate Life Insurance policy.  They told me it isn’t an option.

Wait.  There is more.  Again, copied directly from the letter.

“Additionally we have expanded your discount program to now include teeth whitening, Laski surgery, cosmetic and aesthetic services such as Botox, and facial hair removal, weight loss membership to NutriSystem® and Jenny Craig, and fitness membership at clubs like Gold’s Gym® and Curves.”

Botox and facial hair removal?  Seriously!  Laski surery?  Apparently BCBS didn’t proofread the letter before mailing.  Health club discounted memberships?  I ride my bike on average 3-4 times a week, do regular stretching, along with ab and core strength work.  I eat a balanced diet — low on sugars, with a healthy mix of carbs and veggies and a bit of protein in most every meal.  Now if they were to offer discounted chest hair removal I’m willing to listen.

How about this? If BCBS doesn't have to pay benefits for me in a given year, they refund 25% of my total yearly health insurance premium. Just a thought.

I believe the original missions of health care and health insurance have fallen rapidly from their noble mantels into a bottom line, profit driven quest.

Nothing in life prepares you for the phone call I received on a sunny afternoon in June 1999.

My wife had been experiencing severe headaches, numbness on one side of her face and loss of hearing in an ear.  Our family D.O. suggested I might want to sit down.  “Eli, the M.R.I. is showing that Kelly has a very rare brain tumor.  We believe it is an epidermoid tumor.  Less than 1% of all brain tumors are this type.”

It doesn’t matter what problems you are experiencing in life when receiving news like this.  Instantaneously everything else becomes unimportant.  At the time our kids were 10 and 7.  Kelly was 39 years old.

Kelly with our newborn daughter Rachel, November 1989. ©Eli Reichman, 2009. All Rights Reserved.

A prominent neurosurgeon with a background in this type of tumor removal practiced at nearby Saint Lukes Hospital here in Kansas City.  Time was of the essence and our D.O. had already scheduled an appointment for us.  We met Dr. Camarata two days later.  He explained the tumor was most likely a congenital birth defect growing in Kelly’s head while she herself was in utero.   In grave detail, he explained the complexity of the surgery.  It would be risky and there were no proven alternatives to extraction.  The tumor was extremely large, compressing and flattening her brain stem in half while pushing deep into the cerebellum.  The good news?  He was confident it was a benign tumor.  It was a simple matter of removing a large section of her skull, navigating past a few vital arteries (including the carotid, an especially vital artery), a plethora of nerves, then dissect and extract the tumor without killing or maiming her during the operation.  The entire procedure would be performed via microsurgery.  A piece of cake, right?  This experience gave the expression “it ain’t brain surgery” a new and profound meaning to me.

Since starting to freelance in 1986 I chose BCBS for health insurance.  They provided good coverage with affordable premiums.  At the time of Kelly’s surgery our family deductible was $1,000.00.  That’s when a deductible was applied to the entire family and not $1,000.00 per each individual within the family.  We’d never before experienced a coverage problem.  Not when our kids were born, nor when I severed my ACL playing basketball or broke my collarbone skiing.  BCBS had always been solid.  Not surprisingly I suppose, health insurance companies take a different look at matters when having to pay for a six figure, life saving surgery.

Soon after our consult with Camarata I was contacted by a BCBS representative who explained there may be a problem covering this procedure.  The initial diagnosis of the tumor being a congenital birth defect meant Kelly had a preexisting condition that we did not disclose on our joint health insurance application when we were married in 1987. They would continue to investigate and would be back in touch soon.  I was dumbfounded.

Immediately I called my attorney for advice.  You know the funny thing about attorneys?  When you need a good one, they’re invaluable.  Maybe they don’t deserve all the grief they receive after all.

I’ll spare you the sordid details, but rest assured BCBS did pay — though not without a fight.  Of course we did too.  Between attorney fees, hospital and doctor bills, we paid a large share of the “uncovered” insurance fee’s.  But, it’s hard to quantify what is an appropriate price tag when it comes to saving a life, isn’t it?  It was money well spent.

The entire procedure lasted a little more than 9 hours — 2 more than originally planned, but the results were better than anyone could have hoped for.  The tumor was completely removed, the headaches and numbness eventually went away and, as a bonus, the hearing in Kelly’s ear was restored,  leading me to believe a fine physician is worth their weight in gold.  Maybe more.

Though Kelly and I eventually went separate ways, our kids were given the gift of their mom who, because she had health insurance and skilled surgeons, was able to continue raising her children and see them grow into young adults.

Kelly, Sam and Rachel at Rachel's high school graduation. ©Eli Reichman, 2009.

Perhaps Congress, the pharmaceutical industry, lobbyists and financial investors should be required to have first person experience similar to ours before weighing in on this debate.  I believe there is a moral imperative to provide adequate health insurance and health care to every US citizen.  Our country was founded on Judeo-Christian beliefs.  Isn’t it appropriate to ask: are we not our brother’s keepers?

If we demand it accountants and actuarians can make health insurance affordable for everyone.  Undoubtedly it would mean anyone involved in the health care delivery system would make less money.  But, why shouldn’t every US citizen have access to the same health care insurance their members of Congress have?

Fear mongers have been spreading that nasty S word around when it comes to a public option.  Woooo, it’s a  government takeover of health care!  You’d better watch out.  That bad boogeyman is gonna get ya.  We’re all going to subjected to death panels.  This is an unconscionable lie, though some might argue health insurance companies are already complicit in this behavior.

If you believe we live in a pure capitalistic society then someone has cast a magic spell over you.  Or perhaps you are not willing to personally admit how you directly benefit from our current political and economic shell game.

The United States Armed Forces, the Interstate Highway System, the FAA and Social Security are just a few examples of government running an industry.  Public schools, local police and fire departments are all funded by the taxpayer.  Admittedly, all have varying degree’s of success.  However, I wouldn’t want to see any of these services provided by corporations whose ultimate motivation is driven solely by profit.

I’m not sure if it’s socialism or communism or some other “ism,” but when we’re allowed to write off the interest of a 1st and 2nd mortgage, or a “2nd” home, or those in the agricultural industry continue to receive government subsidies, or anyone writes off losses from the stock market, it sure isn’t pure capitalism either.  How about those multinational corporations and the Delaware tax haven?

Yet I don’t hear Congress talking about removing these services or tax benefits from our current system.  Are they?

When health insurance companies are not willing to offer coverage for life-saving procedures without legal intervention, yet will extend coverage and discounts for unnecessary procedures, I question their motivation to do what is best for the greater good.  Private health insurance companies need a competitor. A public option would create an institution dedicated to social well-being.  A competitor whose sole goal of providing the public all-inclusive insurance would force private companies to do the same or fear losing market share.

Hey Congress!  It’s time to put the ideological partisanship aside.  How about an honest health insurance compromise benefiting all Americans?  We deserve nothing less.

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