Wednesday, August 26, 2009

The Perversity of Our Current Health Care System

Read this gripping story of one family's struggle with the health care system as it currently operates. If this story is, by itself alone, not a clarion call for immediate and substantive reform, I don't know what is.

There are many things I would call "perverse" about what this family has had to go through to keep their daughter alive, but the most perverse is that, in order for this family to get the health care their daughter needs, they are incentivized to live below the poverty level. Read this and marvel at it:

Since SoonerCare is the only insurance that will accept Sophie, we have to meet their financial criteria, which means living at or below the poverty level. I have had to quit wonderful jobs because I made too much money to qualify for SoonerCare. At this point I can only work either part-time, or for a very small salary, because we CANNOT afford to lose Sophie's healthcare coverage. It's the most important thing in our lives. We structure every single financial and professional decision we make around staying eligible for SoonerCare.

And while we'll gladly continue to live at the poverty level in order to provide our daughter with the healthcare that keeps her alive, we SHOULDN'T HAVE TO. We would happily pay outrageous premiums and co-pays, and do whatever else it took to get Sophie covered by regular health insurance. But you know what they all tell us?
She has to go two years with no pulmonary medications and no doctor's visits because of respiratory problems before anyone will accept her. Sophie can't go two DAYS without her medications, let alone two years.
Hat Tip: Andrew Sullivan.


Eric said...

What I find perverse is the incredible irresponsibility of this poor girl's parents, who with a modicum of planning and forethought could have prevented this entire mess by not allowing their insurance coverage to lapse when changing plans, knowing full well their daughter had been plagued in the past with a chronic respiratory problem.

Yes, it would be nice if our insurance system had better options for people with pre-existing conditions (and while I'm not one who agrees, I think there is a lot of bipartisan support for disallowing insurers to deny coverage in cases like these). But it would also be nice if people who can afford insurance were a bit more careful about making such high stakes decisions, especially where their kids are involved.

Do you not see ANY culpability here on the parents' part, huck? Would you let your insurance lapse on your family if you switched plans?

Huck said...

Yes, Eric, I would say that the family bears some responsibility, but I think the situation that put them into this predicament is not all that out of the ordinary. This is what the mother wrote:

"There was a week long gap between the policies - something that we didn't think anything of, because we simply did not know better."

While perhaps the parents should have known better, having a week-long gap between the end of one coverage plan and the start of another is not that much out of the ordinary for peoples' experiences with such transitions.

The real question to me is whether such an innnocent oversight then condemns the little girl and the family to the kind of outcome that they experienced.

Eric said...

Huck, we are in agreement that the consequences of their oversight are incredibly harsh. I do think insurance companies should have an obligation to warn departing customers about not cancelling coverage until they have secured and reviewed a new policy. I believe most insurance agents already do warn customers about this (ours did when we switched from Blue Cross to United Health a few years ago, in fact, we were warned against cancelling our old coverage at muliple points throughout the sign up process). People who ignore these warnings do so at their own risk, and the consequences can be devastating, but ANYTIME you go with out insurance, for a day, an hour, a month, or a year, you run this risk. I might not be opposed to a law mandating a 30-day grace period where your previous insurer must give you the ability to reinstate your policy according to the terms you had when you cancelled it, but I guarantee if such a law passed we would still be reading about stories like this.

Huck said...

All that said, Eric, the system that makes a citizen with the education, skills, and desire to be a productive member of society, and who even wants to pay outrageous premiums that come with obtaining a private health insurance plan, forced to live a life of poverty to save her daughter because she can't get private health insurance coverage, is sure evidence of a broken system. You know who's paying for this little girl's treatment, Eric? Not the larger pool of national members of United Healthcare, for instance, but the citizens of Oklahoma. You are paying for her care, Eric. Not I. If this family were able actually to get coverage by United Healthcare, we both (as well as the family itself) would be helping to pay for her care by our premium payments. Something is just not right in a health care delivery system when saving a life requires the conscious choice to be poor and foists the costs of that care on the backs of taxpayers without expecting anything from the family other than being poor. That's just perverse, Eric.