Here's a personal story -- a single vignette out of countless others -- that shows why the United States needs to reform our screwed-up health care system, pronto.
Earlier I wrote about how we labored to fill out a lengthy on-line Regence BlueCross BlueShield of Oregon application: a request to change our individual coverage from Plus to Premier, since that seemed to fit our needs better.
Yesterday my wife and I got individual letters from Regence. Bottom line: denied. Here's how my letter started out.
After carefully reviewing your health application and any available claims history we find that we are unable to honor your request for a change in your coverage based on the following condition(s) and/or symptom(s):
History of enlarged prostate
Our inability to honor your request for a change is based on the medical history profile, which contains risk factors that fall outside our Individual plan underwriting guidelines. We apply our risk criteria fairly and consistently to all applications we receive for coverage.
Well, this must mean that Regence rejects almost everybody around my age (60) who just has a few minor medical problems, because I'm on the upper end of the healthy bell curve, for sure.
My dreaded "hyperlipidemia" consisted of a one-time total cholesterol reading four years ago of 212, which dropped instantly into the 160's after I started taking a generic low-dose statin, and now sits at 181.
So for one year, according to the American Heart Association, I was at a borderline-high risk level, and now I've settled into the desirable level by taking $10 per month lovastatin.
My other big risk factor, which also popped up in 2005, was a moderately enlarged prostate. At the time, I blogged about my family doctor finding evidence of this via the least enjoyable part of my physical exam.
Great. A prostate exam is the only time you don’t want to hear from a female who is inspecting your genital area that you’re larger than average. Maybe Flomax will get me nearer to normal.
Which, it did. Along with Avodart, a complimentary drug I started taking a few years later.
And that's the sum total of the medical problems that caused Regence BlueCross BlueShield of Oregon to deem me outside of their underwriting risk factors.
I feel sorry for the many people who are denied coverage completely because of pre-existing conditions, since I was only denied a change to another Regence plan. The ugly truth is this:
Health insurance companies don't want to insure people who aren't healthy.
That, of course, includes almost everyone at one time or another. In 2008, one in five Oregonians who applied for individual health insurance were rejected due to pre-existing conditions.
Crazy. The private sector of our health care system is dedicated to providing as little health care to people as it can get away with.
To a patient, health care fulfills a need. To the insurer, health care is a cost that detracts from profits.
A MSNBC piece, "When you are denied health insurance," explains that in the 1930s hospitals began offering insurance policies that were fair and affordable.
But commercial insurers, who joined the game in the 1950s, had another obligation: pleasing shareholders. The simplest way to make money was to try to attract healthy customers, who were less likely to rack up big medical bills. That way, insurers could charge lower premiums yet still clear a profit. Excluding sick people wasn't so easy when insurers agreed to cover the employees of a large corporation.
But denying coverage to risky prospects who sought coverage individually was simple. If an applicant had a history of illness, weighed too much or worked in a job that carried greater-than-usual physical risks such as mining or construction, the insurer would charge higher rates or simply refuse coverage. And once a few insurers started screening applicants, the others were forced to follow suit — or chance winding up with all the sickest people, a certain path to bankruptcy. Within a decade, such weeding out of the infirm or those likely to become so was common practice.
So that's how we've arrived at the insane situation where people who need health care, even if they have relatively minor problems, are rejected by private insurance companies. That keeps profit margins up.
And the United States' health ranking down. We spend more of our GNP on health care than any other country, yet the performance of our health system ranks 37th in the world.
People our age, over 60 but under 65, get particularly screwed if they're retired and couldn't continue with an employer-based insurance plan. Which describes us.
I'm suspecting that Regence is eager to get us onto Medicare and off our current policy. So they weren't going to approve our request to move to a different plan, since they'd prefer we didn't have any Regence plan but have to put up with us for another four to five years.
Tomorrow I'm planning to phone Regence and ask some questions about why I was rejected. Check the comments to this post for any updates to our story.