Roadblocks in the private insurance maze
How U.S. Health System Can Fail Even the Insured
By John Carreyrou
The Wall Street Journal
November 16, 2007
Barbara Calder lives in nearly constant pain. Her limbs dislocate at the slightest movement, even when she turns over in bed at night. She wears her hair short because brushing it hurts too much.
Mrs. Calder suffers from Ehlers-Danlos Syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. But, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. Now Mrs. Calder says she is left wondering whether she’s going to die suddenly because she can’t get the test that would tell her whether she has the fatal form of the disease.
Mrs. Calder’s difficulties mirror those of millions of insured Americans who get lost in the U.S. health-care system’s giant maze. For many, the journey is frustrated by coverage limits, denied claims and impersonal service.
Polls show that health care has become Americans’ No. 1 domestic concern, thrusting it to the center of the presidential campaign. Every major candidate has introduced a health-care reform plan. But for the most part, these plans focus on providing coverage to the 45 million uninsured or reining in medical costs. They do little to address the myriad hurdles insured patients often encounter when they seek care.
Trying to navigate these obstacles can be especially maddening for patients like Mrs. Calder who have little-known genetic diseases. Insurers, for their part, argue that they are merely fulfilling employers’ demand to control medical costs.
http://online.wsj.com/article/SB119515792495794643.html
Comment:
By Don McCanne, MD
Although this article provides considerable detail, no attempt has been made here to extract from it some of the numerous barriers faced by Barbara Calder - barriers deliberately erected in our system of private insurance plans. Suffice it to say that our fragmented system resulted in “a year battling numerous roadblocks,” and her battle isn’t through.
Under ideal circumstances, rare disorders such as Ehlers-Danlos Syndrome create challenges for the health care delivery system. But other nations use their health care financing systems to enable better access to the care that people need, regardless of the complexity of their disorders. Yet our dysfunctional private insurance system is designed to impair access in a misdirected attempt to control medical spending.
As this WSJ article states, health care has been thrust to the center of the presidential campaign. But the leading proposed solutions, dependent on private health plans, “do little to address the myriad hurdles insured patients often encounter when they seek care.” The proposal to offer in addition a token public insurance option will be of little help since the public program surely will disintegrate under the death spiral of adverse selection.
The segregated risk pools of private and public programs have become a highly inequitable, inefficient and obsolete method of financing health care. We need a single, universal, efficiently-administered risk pool if we expect our financing system to assist us rather then hinder us in obtaining the health care that we need.