Health Care and Profits Don't Mix

Let's repeat, all together now:

Health Care and Profits Don't Mix
Health Care and Profits Don't Mix
Health Care and Profits Don't Mix

That's my brief explanation for my non-American friends, who wonder why I'm so angry about the state of American health care and what exactly is wrong with it.

Profits, that's what's wrong.

Imagine that you are a decent, law-obeying and risk-averse American (ok, indulge me), which means that you have a health care insurance, either through your employer, or, if you are self-employed, like my husband and I, one you bought on your own -- and you get sick. (Knock on wood, but, you know, we biological beings are really fragile and susceptible to all kinds of microbes, accidents, protracted illnesses, and even death.)

Say (not that I wish any of that on you), you are diagnosed with cancer, or you are attacked by a bear that rips your face off, even though you manage to stay alive. Your first and foremost objective is to seek medical help and save your life. That's obvious so far, no?

But your insurance's first and foremost objective is to make money off of you. And because medical help costs money (a lot, in the US), your objective -- saving your life through seeking medical help -- and your insurance's objective -- making profit off you -- are incompatible. One could even say they are mutually exclusive.

But you paid your insurance premiums every month for years (and they were obscene, especially when you are self-employed), so your insurance is obligated now, according to your contract, to pay for your medical treatment. Right?


Insurance companies are not happy to part with their monies (and who is?), which can be spend so much more effectively on advertising campaigns, new and awesome shiny buildings (have you noticed that the tallest and spiffiest buildings in American cities belong to insurance companies? If you looked really closely, I'm sure you could see tears and maybe even blood running down their walls; but I digress), and ever-higher bonuses for their executives (those yachts ain't cheap, y'know).

A good executive has to show his company's growing profits each quarter or so, otherwise his head is on the chopping block (accessorized with a golden parachute, so don't shed your tears yet).

And if your insurance company really starts paying for your and everybody else's medical treatments, which in the US are obscenely expensive, as I mentioned above, there will be no profits. Hell, there'll be no money left for new yachts and summer houses at all!

So in the name of increasing its profits, your insurance will try to do whatever is inhumanely possible to get out of its obligation to pay for your medical treatment.

If you are the unfortunate victim of the bear encounter, for example, they will classify the multiple surgeries required to restore your face as "cosmetic procedures," which are frivolous and not covered under your (or any) plan.

Aha! It's your fault! You should have read the fine print when you signed your contract -- if you ever saw the contract to begin with -- and if your employer's responsible for your choice of health insurance, likely you had no say in it at all.

But anyway, had you looked closely -- very, very closely, using your telepathic powers -- you should have seen the "Bear Clause" in a tiny print somewhere, stating that if you are mauled by a bear, it is, first, your freaking fault (should have stayed home, damn it), and, second, cosmetic procedures post-bear-mauling -- like putting your face together 'n all -- are not "life saving" and your insurance clerks -- not your doctors, or, god forbid, a total ignoramus like you -- determine what's life saving and what's not. So you're out of luck.

Keep away from bears next time. Or better yet, never leave the house (thus avoiding what the Department of Environmental Conservation calls negative human-bear interactions). Well, now that you don't have a face, you won't anyway.

Now let's say you're diagnosed with cancer.

It's a very scary thing -- and extremely unpleasant for your insurer, because while you are thinking life-saving chemo and radiation, they are thinking, goddamn it, another money drain.

So again, they'll do what they do best: have Clerk X find reasons to curb the payments for your treatment or deny it altogether (they may classify it as "experimental," for example -- a kiss of death, for you).

It does not matter what you think and want (ha ha ha... you were still imagining that it does, no?) or what your doctors recommend. What matters is what Clerk X, under directives from his higher-ups, decides, in his calculating mind, is best for their company's bottom line.

You may be "lucky" enough to require cancer treatment that is not experimental and it is covered by your insurance. Yipee! you think, grateful and hopeful about your future.

Not so fast, my friend. I have mentioned that medical treatment in the US is very expensive, haven't I?

So if you have an insurance with high premiums and a high yearly deductible, first you have to pay thousands of dollars out of your pocket to meet that deductible (ten or twenty thousand a year, say -- and if your illness continues for more than a year, you'll have to pay the thousands of dollars again when the new year kicks in*) -- all that on top of the already obscenely high and ever-rising monthly premiums you have been paying for years.

And rest assured, if you can, now that you've been sick, your monthly premiums will rise to stratospheric levels, as if by magic -- read: insurance companies' calculations which make them dislike sick people, who are distinctly unprofitable.

It is quite probable that through the few courses of chemo and radiation, along with associated hospitalizations (which cost several thousands of dollars per day, yes), tests and other procedures you will exhaust your lifetime insurance benefits.

That's right, you have not misread it: you will exhaust your lifetime benefits, which may end at, say, one million dollars. And one million dollars is easy to exhaust in the US during cancer treatment. So guess what? You're out of luck. You're on your own. Left to die, or do whatever it is that sick and poor people do. (Yes, that still means die.)

You non-Americans may think, what's the big deal, go out and buy another insurance coverage, no?


First of all, with the prolonged cancer and its treatment, you probably have been unemployed (or underemployed) and lost your employer's coverage, if you had it at all. It also means that you have limited, if any, income. And if you insist on stubbornly clinging to life, you've probably lost your house and any other possessions by now, trying to pay for your treatment, and have had to file for bankruptcy. So you have no means to buy a new insurance policy.

Not that it matters, because...

Second, now you have a preexisting condition, which is a death sentence when it comes to finding insurance coverage. No insurance company will take you on -- what, you did not realize that yet?

Health insurance companies like young, healthy, happy people who don't get sick and die healthy after leaving a substantial portion of their life earnings in the pockets of health insurance companies.

Sickos, on the other hand, are costly and they whine a lot. Also like to bother insurance companies with useless calls begging for help. They are so totally no fun and disgustingly unprofitable. Insurance companies do not like sickos and avoid them like a plague (pun, I think, intended).

BTW, preexisting conditions may be anything: acne, allergies, migraines, heart palpitations, a moderate weight loss (happened to me), not to mention cancer or bear maulings.

When you look at an American street, and look really really closely, you'd see how many people walk around with the letters PC (almost) invisibly tattooed on their foreheads. (PC does not stand here for political correctness, mind you.) That's how insurance clerks and executives look at us -- they surely can spot those letters right away. Coverage denied.

And Republicans and/or those who oppose health care reform, come out with ads telling us that the best way to safeguard our health is through education and good life habits -- good food, exercise, etc. -- and, their favorite catch-phrase, personal responsibility.

This always makes me laugh -- how can one not find it funny, in the Beckett-ish, absurdist way?

Not that I have anything against personal responsibility, but personal responsibility, education and a good diet (which, BTW, are not available to the poor) have not shielded me from developing a brain tumor ($100,000.00+ for the hospital stay during the surgery, not counting the doctors' fees), nor do they have anything to do with the myriad illnesses that befall people left and right.

But maybe those ads are created with the old adage in mind that laughter is the best medicine. If that's the case, then their creators perform a valuable public service and should be commended for their efforts. It does not mean they should be taken seriously, of course. On the contrary.

If you have managed to read all this and happen to think, "This woman is so bitter it makes her crazy!" -- you're right, I am bitter.

Crazy? Not so much. Just wait till you see my next two posts.

*I should mention that's a deductible per person, so you better pray that no one else in your family gets sick. And if they do, well, you're screwed.

But you knew that already, didn't you.

AN UPDATE: for more insurance horror stories, check this and this and this and THIS. Also, talk to your relatives, friends and neighbors.

Cross posted at The Middle of Nowhere.


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