Friday, February 27, 2009

Completely broken

There's a fundamental problem with a healthcare system that can and does refuse to offer healthcare to infants based on pre-existing conditions.

Nicholas Simon was just 34 days old when he received his first rejection letter.

"Dear Nicholas Simon," began the March 2008 letter. "We appreciate your interest in the Aetna Advantage Plans for Individuals and Families. After careful evaluation . . . we are unable to offer coverage and have declined your application."

Nicholas seemed unfazed by the news, slurping down his mother's milk, emitting a manly burp and drifting off into post-nursing bliss.

His great transgression was he had jaundice on his fifth day of life. The bilirubin count in his blood - a key measurement - was 13.9.

"At 5 days old," said his pediatrician, Herbert Cady, "anything under 15 is normal."

Aetna felt otherwise. "Over 12 can indicate an underlying liver condition," said Aetna's Cynthia Michener. "We couldn't price a policy in a range that anybody could actually pay for. If we can't price affordably, we don't accept."
Yes, because we all know that health insurers hate when people pay too much for health care. They exist to keep health care affordable, and are doing such a great job.

Note the lack of a medical degree in Michener's background. But in our health care system, that communications degree from Castleton State College makes her qualified to second guess the baby's doctor. And in our completely broken health care system, when people not remotely qualified to offer a medical opinion say a doctor is wrong, the unqualified opinion overrides the doctor's opinion, and the patient doesn't get coverage and loses access to care.

It's way past time to admit that the for-profit healthcare system isn't working. Health insurance companies are obsolete and any system that includes them is fundamentally flawed as a result.

Single-payer now!

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