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Five Reasons for Health Care Reform

Updated on October 9, 2009

A Personal Look at Healthcare Reform

Most of the talk concerning health care reform has centered on numbers – lots of numbers: nearly 50 million persons uninsured, expanding national debt figures, head-counting of votes etc. But something is missing in all of that talk. Those numbers are stand-ins for people . . . real people, the reasons that reform of our national health care system is needed in the first place. Here are four of those reasons to inform our thinking. Names have been changed to provide anonymity, but the facts are real.

Case #1 – Fred and Sally are the parents of two small children. Fred works at a hospital that also provides their family’s health insurance and pays part of the premiums. When their son was born – at that same hospital – Buddy was automatically enrolled for health care and his infant/child-care needs were covered, less deductibles.

Four years later a daughter, Bess, arrived, delivered at the same hospital. When her parents took her to the doctor later for her first post-natal check-up, however, they were presented with a bill for 100% of the cost! Why? That’s what Fred asked the people in the hospital’s insurance office the next day, and this was the reply: “We’ve changed the system. Now, you have to request coverage for a newborn in writing on a special form.”

Fred expressed shock. “Why wasn’t I told this,” he asked. “I work here. I never got a letter or phone call.”

“But we sent everyone an e-mail,” came the reply.

“And I don’t have a computer, and can’t check e-mails,” Fred said, “so I want our daughter enrolled and her first doctor’s appointment covered.”

“We can’t do that,” the office person said, “not until after her first birthday next January.”

The solution? Fred and Sally had to purchase private coverage for their newborn daughter at $79/month for the next nine months, a damaging amount from an already-meager paycheck [less than $10/hour] for a 40 hour week at a church-related hospital, no less!

Case #2 - Bruce and Anita are employed, one in construction and the other in education. They have one young son, now in school. When Bruce was injured on the job he was unable to work for eight months due to needed surgery on his shoulder. At the same time that year the construction company shifted its health insurance policy, increasing the deductible for a family from $500 to $1,500/ year.

In addition, the specialist who did the surgery would not accept the MRI that had been done initially and required a new test – a $1,200 fee Bruce’s insurance would not cover.

To add insult to injury – literally – Bruce’s disability income [only 60% of his normal wages] ran for six months, not eight – so he went for two months with no income AND the next year both he and his wife were laid off from work.

The result? Multiple missed car and mortgage payments, no health care, near foreclosure on their house and a lot of family stress (on relatives as well as their immediate family unit) and they’re still not out of debt and financial hardship.

Case #3 - Minnie, aged 63, needs a hysterectomy and a related procedure. She is referred to a surgeon by her family doctor and surgery is scheduled. Minnie goes into the hospital the week before to give blood, undergo pre-op tests and complete all the required forms for admission.

Early on the morning of surgery Minnie’s pastor pays her a visit in the hospital to offer comfort and prayer. Afterward, about a half hour before her scheduled surgery time, the surgeon comes in and says, “I have some bad news. We have to cancel your surgery.”

“Why?” asks Minnie.

“The insurance company only approved your hysterectomy, not the other procedure. We’ll have to re-file the request for surgery and reschedule, assuming permission is given later for the second part of the operation.”

Result? Minnie went back three weeks later for the same tests, same blood draws, same forms and then was readmitted for the same surgical procedures, now approved for insurance coverage. The financial cost for rescheduling? Immense. The emotional cost? How would you feel?

Case #4 – Ted needs a hernia repaired, so he sees a specialist at a major clinic who examines him and schedules outpatient surgery. Ted tells the surgeon, the nurses’ aides and anyone else who will listen that he gets deathly sick from anesthetics and requests something in advance to avoid vomiting. Everyone nods and assured Ted he’ll be fine and the surgery goes perfectly. Afterward, in recovery, Ted vomits repeatedly.

Three hours later he is discharged from the hospital. Ted and his wife retire to a Holiday Inn. Ted does fine until they go downstairs to get something to eat. Ted takes one Oxycontin tablet, prescribed by the surgeon, and thirty minutes later starts to vomit . . . and can’t stop. His wife tries to reach the surgeon, calls several offices and the ER and is advised to stay with Ted through the night and call in the morning if things haven’t improved.

At 10 a.m. the next day, after a twelve-mile drive Ted is admitted to the ER – after having to verbally supply his own personal and insurance info! Three hours later the vomiting stops and they drive ninety miles to their home.

Two years later, almost to the day, Ted needs a hernia repaired on the opposite side and sees the same surgeon, telling her about the previous experience with vomiting. “This time I want you to admit me to the hospital overnight as a precaution.”

“I can’t do that,” the surgeon says.

“Why not?” asks Ted.

“Insurance won’t allow it; hernia repair can only be classified as an outpatient procedure.”

Case #5 - Tom and Trudy have their first baby, a girl. The delivery goes well, but the baby is born with a cleft lip. Plastic surgery will be necessary in a few months.

A few weeks later an insurance agent shows up at the doorstep and explains that Tom’s parents have arranged to purchase a whole-life policy for their new granddaughter. Tom says he appreciates the thought, but doesn’t want it. The agent explains that his parents have already paid the first year’s premium - $300 – so Tom relents, invites the agent inside and with Trudy answers the routine questions the agent poses. The agent leaves, promising to come back within two weeks once the policy is issued.

Three weeks later an appointment is made, the agent returns, and Tom asks to see the policy. The agent hems and haws, then reluctantly explains that he doesn’t have the policy in hand . . . yet.

“Why not?” asks Tom.

Embarrassed, the agent says, “Well, I’ll be able to give you the policy, but not for a while.”

“When, exactly?” asks Tom.

“After your daughter’s surgery, or on her first birthday, whichever comes first.”

“So you mean to tell me you’re happy to take our premium money now and issue the policy once we’ve taken all the risk, is that it?”

“Well, I wouldn’t put it quite like that.”

“How would you put it?” Tom asks. Then he requests his parents’ check and their application form, and tears both up in front of the agent – before telling him to leave their house.”

These five case histories detail only some of the things that are wrong with our current health care system, and the power/control/greed of the insurance companies who dispense funds and collect premiums.

If these stories don’t convince you, dear reader, that something drastic needs to be done, then here’s one more tidbit to consider. I’m writing this in Germany while on a family holiday.

Last Monday evening my wife and I went to a meeting attended by ten German individuals and one person from Great Britain who’s lived and worked in Germany for many years and speaks fluent German.

The topic of health care arose, and the Brit said to us, “One thing I don’t understand is, what reasons are given by those who oppose health care reform in the U.S. In Great Britain we pay taxes and health care is provided to everyone – no waiting, no problems. Doctors are paid a salary, regardless of how many patients are seen and the care they need. As a result, only those procedures that are necessary are ordered. The welfare of the patient is the goal. What’s the logic behind opposition to this in your country?”

The response my wife and I gave him: “There is no logic to it.”

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