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INSURANCE: Bleeding Edge Benefits And Who’s Going To Pay?



April 10th, 2007
by Ellen Ficklen

The sentiment “if it ain’t broke, don’t fix it” has a strong foothold in the United States, as does the thought that it takes a whole lot to prove that something’s “broke.” Nonetheless, Americans are increasingly declaring that health insurance in this country is very badly broken. The reality, many say, is that insurance coverage often is nonexistent for preventive care, is slight for regular office visits, and peters out during catastrophic situations and hospitalizations. Additionally, because there is no organized health care system in the United States, there are always complicated questions about the specifics of insurance benefits.

Health Affairs recently published two personal essays on questions sparked by encounters with the health system and insurance restrictions. The essays are free access and appear in the Narrative Matters section of the journal. This ongoing section features the narrative, or personal story, side of the impact of health care policy.

Jay Himmelstein, a professor and a director of a health policy center at the University of Massachusetts Medical School, discovers the frustrations of insurance limitations first-hand when his graduate student niece, Emily, is diagnosed with an aggressive form of cancer. Worried about her health, her mounting treatment bills, and the limitations of her school insurance policy, Emily wonders whether declaring bankruptcy might be the only solution.

Health economist Phil Musgrove gets an up-close-and-personal view of American health care and its emphasis on insurance when he rushes a stranger to an emergency room and gets a “paper first, people second” reception.

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3 Responses to “INSURANCE: Bleeding Edge Benefits And Who’s Going To Pay?”

  1. Ellen Ficklen Says:

    From the administrator: Ms. Ficken’s comment below is in response to remarks left by “dneunabe.”

    Thanks for your thoughtful response to the two insurance-related Narrative Matters essays we posted. Thank you, too, for your supportive comments about the Narrative Matters column. As you note, the goal of our personal-essay column is to give a human context and first-person perspective to the policy deliberations in Health Affairs. Bo Diddly has pointed out, “We’re a nation of slow understanders.” But stories help us understand. Indeed, personal narratives often are instrumental in clarifying issues and suggesting what actions are needed.

    BTW: As a fan of the Narrative Matters column, I hope you’ve heard that Johns Hopkins University Press recently published a collection of 46 essays drawn from the column, titled “Narrative Matters: The Power of the Personal Essay in Health Policy.” Details about the book are in the Press’s catalog (http://www.press.jhu.edu/books/title_pages/9190.html), and the book can be ordered through the Press or from Amazon.com. I think it’s a stunning, thought-provoking compilation of some of our best first-person stories–but as one of its editors, I would, wouldn’t I? I’d love to hear what you think about it. .

  2. Neil Gardner Says:

    INSURANCE: Bleeding Edge Benefits And Who’s Going To Pay?

    Let’s see now. 47 million uninsured, and yet the two biggest NON-PROFIT (Supposedly) health insurance companies in PA have at least 650 million dollars sitting around to use to try and entice state officials to let them merge into one gigantic health insurance company that can them screw millions more Pennsylvanians out of more money. What is wrong with this picture from a health delivery system mission (Mission, what’s that??).

    Check this out and ask yourself if this sounds like a system with any defined public health improvement mission.

    Blue Cross offer to spend $650M on uninsured piques state interest
    Highmark, Independence pitch plan with merger

    “http://pittsburgh.bizjournals.com/pittsburgh/stories/2007/04/09/story8.html?t=printable”

  3. dneunabe Says:

    As a provider (we don’t have doctors, nurses, PTs, etc.; we’ve all been deemed “providers” by the insurance industry), I too have experienced these problems first hand. David Mechanic has written about the dehumanizing shift from “person to patient” when we enter the system, and it never ceases to amaze me when it happens. If you are looking for more examples, you won’t have to look far.

    I’ve been the recipient of: doctors not introducing themselves, not telling informing me of the diagnosis or plan, spending far too little time to do a fair workup (even in the hospital). I’ve witnessed this every time a family member is hospitalized. Unless I need to, I don’t tell them I am a colleague. I want to see what happens under the “business as usual” scenario. So, I don’t intervene unless I think they are doing something obviously wrong. When I do tell people I am a doctor, I’m sometimes met with deference and /or defensiveness. In my opinion, when it comes to care my family, we have far too often received marginal (but I wouldn’t say harmful) care. For example, my wife was recently admitted to a local hospital with an acute labrynthitis. She was initially very ill. We are of an age where stroke is not unheard of, and because she is adopted, my wife has no family history on which to rely. When I was summoned to the ED from my office in the attached Medical Office Building, the urgency with which my son (a university chemist), called me to the ED was curiously lacking. It was truly “paper first, people second.” To which I would add, “SLOW paper first, people second.” I spent 20 minutes completing insurance verification before I knew anything about her status, and this is in a facility in which I work. In her four day hospitalization, her physician visits were brief–we now joke that she was seen for a total of fifteen minutes. And, she was misdiagnosed with benign positional vertigo—which if they had just asked, was neither benign nor positional. Additionally, and ENT consult was not done, probably because of the pressure on hospitalists to keep length of stay low. Of course, we had a good idea of what to do, and I was on the phone with my ENT friend immediately after her admission. They stabilized well enough her in the hospital, and then I took it upon myself to get the proper consults, etc. once she was discharged. Unfortunately, because the ENT was not consulted during her inpatient stay, he needed to repeat MRI (done days before in the hospital) to visualize the proper structures. Physical therapy, based on the wrongly diagnosed positional vertigo diagnosis, was expensive and useless. This is not to say that I tthink the facility is filled with incompetence, and everywhere there were compassionate and caring people. But in the role of patient, you are vulnerable, vigilant, and concerned that everyone involved is both watchful and caring.

    I’m not giving these details simply to rant about quality of care. Frankly, I did not expect anything better than “business as usual.” I’m sure my wife looked fine on all standard indicators of hospital care. But, my heart goes out to those people who don’t have the experience and resources I’ve been fortunate to have. I essentially had to become my wife’s primary care doctor/case manager. All of the problems I note above could have been avoided if each professional had spent a bit more time with her, or asked me if I had something useful to add. So, is the health insurance industry broken? I’d say it is. But other things are broken too. It doesn’t take that much more time to be thorough, to explain things, to elicit comments and opinions from patients. I often ask why more time isn’t taken, and the most heartfelt answer is that “the insurance company requires….” And God save those without insurance. Not everyone has a tale with a good outcome.

    It is sad that we don’t seem to pay much attention to our health insurance (or lack thereof ) until weneed it. I’m glad you saw fit to post a blog about the first person narratives from Health Affairs, which are a a nice balancing touch to the sometimes mind numbing–but important–quantitative analyses you publish. I return to a comment I once heard by Professor Uwe Reinhardt, in a podcast on the University channel (paraphrased here): “Do we Americans have the stomach to fix the problem? I don’t think so.”

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