John Boyle is a friend who works as a writer at the Asheville Citizen-Times This is his column from April 8, 2012:
I just can’t imagine why we need to change a single thing about our health insurance system.
Are you crazy? Of course, the Supreme Court should throw out health reform in its entirety and let us rely on this wonderfully humane and efficient system that’s totally driven by patient-satisfying profit.
Sorry if I just busted the sarcasm meter.
I’m a little testy these days, what with a herniated disc in my neck and an insurance company, United Healthcare, that dragged its feet in approving the surgery my highly experienced surgeon recommended to relieve the constant pain and numbness.
Oh, and I did I mention I get to cover $6,000 or $7,000 in out-of-pocket costs, in addition to my premiums, while United Healthcare rakes in an annual profit of $5.1 billion and pays its CEO, Stephen Hemsley, $10.8 million annually?
As you read this, I’m recovering from surgery that repaired that herniated disc in my neck.
I’m grateful to have such skilled surgeons around as Dr. Eric Rhoton, and I have no problem with guys like him making a good living.
I’m not so enamored of United Healthcare, which dilly-dallied all week on “pre-certifying” the surgery. It was scheduled for Thursday morning, but we had to push that back to Friday.
What’s another day of pain, numbness and worry to them, though? They’ve got 5 billion reasons to be happy.
Here’s the kicker: I am one of the lucky Americans with a job and health insurance. I am grateful for this, trust me.
But I’m going to complain now — in what I hope is a constructive tone that illustrates why a for-profit health insurance industry is a nightmare for actual human beings.
I’ve paid about $3,600 a year in insurance for years now, which covers me and my two boys. The corporation I work for, Gannett, pays that much or more.
I’ve been here 17 years now, so I figure I’ve paid more than $50,000 in premiums and Gannett probably $60,000 or $70,000. I’ve had shoulder surgery, a colonoscopy and some other procedures that I’d estimate probably cost in the neighborhood of $35,000.
But I always have deductibles and the dreaded patient’s portion of the fees. So I’ve gotten some benefit from my insurance carriers (it used to be Blue Cross), but overall they’ve made a tidy little profit off me over the years.
For this neck surgery, I’ll have to pay the surgeon’s office more than $1,800 out of pocket and Mission Hospital $3,200. Physical therapy visits afterward cost me $60 each, out of pocket, while the co-pay to the surgeon’s office are $50 each.
The surgery alone is $13,000. The hospital is saying their charges will come in at about $16,000. Throw in some miscellaneous stuff and I’m sure it’ll hit $30,000 quickly.
When all is said and done, I’m estimating I’ll have to pay $7,000 out of pocket on $30,000 of care.
As I said, I’m lucky to have “good insurance.” A hundred years ago, I would’ve had to live with this pain and lost function in my arm. And if you have a major catastrophe in life, just imagine how high those medical bills would be without insurance.
But I don’t believe we have the best system in the world, primarily because it’s just wrong to tie insurance company’s massive profits to patients’ well-being, or more likely, their suffering.
In my case, United Healthcare denied an MRI that my family physician ordered and approved. So no MRI. My physician put me on physical therapy and meds, a combination that offered no relief. Then I started getting numbness and tingling down my right arm.
A good friend who is a nurse practitioner and had a disc problem in her neck that caused very similar symptoms to mine insisted I see a specialist — and get an MRI. She noted that you can get permanent nerve damage and loss of muscle function if you let such things go.
I mentioned that United Healthcare refused to let me get an MRI.
“You’ve got to have a picture to know what you’re looking at,” she said.
Once I got in with the Carolina Spine & Neurology, they got an MRI approved quickly. It showed a herniated disc, which means it’s bulging out, pushing into the nerve and causing all that pain, numbness and tingling.
The surgeon, who’s got 20 years’ experience, showed me the MRI. We talked a lot. I did the obligatory online research and talked to a lot of people.
It seemed very unlikely the disc would unherniate itself after three months of pain, and I was starting to lose some strength and function in my right hand. He recommended surgery to remove the offending disc and fuse the vertebrae above and below, which should relieve my pain and the numbness and restore me to a normal life.
It sounded pretty good, really, if that gives you any idea of the pain level.
We scheduled surgery for Thursday. United Healthcare, notified March 30 of this plan, did not precertify it, despite the diligent efforts of a Carolina Spine employee and a rather feisty call from my wife.
An employee actually told my wife I could go ahead and have the surgery without precertification and then file “an appeal” later to try to get United Healthcare to cover its portion. United Healthcare also said it had no time frame under which they have to approve this procedure.
For this I pay $3,600 a year in insurance premiums. I had to postpone the surgery until the diligent Carolina Spine employee finally got hold of a supervisor at United Healthcare.
All of this makes me think of the big picture of health care. I fully expect the U.S. Supreme Court to overturn the health care reform case it heard last week. As a country, we are strangely married to this for-profit insurance model. Some 50 million Americans don’t even have the frustrating level of coverage I have, the one that will leave me paying $7,000 out of pocket.
People die because they don’t have insurance. They skip health care and medicines they can’t afford. People lose homes, their life savings, limbs, functionality.
And yet, God forbid we change this almighty insurance system based on maximizing profit for shareholders.
Universal payer? “It’s socialism,” people say. One person held a sign up outside the Supreme Court saying, “Obamacare is immoral.”
Forcing people to buy insurance would not be my preferred method for universal coverage, but Obama basically had to take what he could get to cover everyone.
To call that immoral boggles my mind.
What’s immoral is the profit margins of major insurance companies, and their executive pay packages. Besides Hemsley, United pays Chief Financial Officer David Wichmann $4.6 million, Executive Vice President Gail Boudreaux $6.4 million and Executive Vice President William Munsell $5.7 million, according to Reuters financial reporting.
That’s $27.5 million a year for four people. Money culled from our premiums.
And yet, so many think it’s un-American to take the almighty profit incentive away from an insurance company. Yes, that same incentive that essentially encourages insurance companies to prevent patients from getting pesky medical procedures, like MRIs, that may allow their doctors to see what is wrong and fix the problem.
Sure, maybe we could improve the lives of actual human beings, but we’d infringe on the free market. A health insurance CEO might not be able to buy a fourth vacation home.
I know some folks are concerned about “socialized medicine.” I’m sure on sheer principle these folks do not or will not accept Medicare coverage at age 65. There’s simply no way around this: Medicare is socialized medicine.
Here’s another hot tip: Social Security is, well, socialism. When you agree not to take your Social Security, come talk to me about socialized medicine.
Like it or not, some socialist principles make sense within an industrialized, modern, democratic framework, especially when it comes to health care.
Maybe you oppose “universal coverage.” That’s what we have now, except we all pick up the outrageous emergency room tabs for people with no insurance who wait to see a doctor until they’re critically ill. It’s just really stupid, inefficient and expensive universal coverage.
Here’s what I think: We need a system where everyone pays into a health care fund — say the first 2 percent of whatever your salary is — and everyone has access to at least a standard minimum of care. And the entity administrating the coverage plan is not profit-driven.
It works in most industrialized nations, and it hasn’t led to communism. It’s led to a better quality of life.