August
2009
I was on a Death Panel
There’s a lot of talk from fear-mongering from the right against national health care these days. They’ve even sought to scare people by talking about how the government will have to decide who will live and who will die, all based on costs.
But if the fear is that someone other than the individual needing care will be making the decisions, the Republican faithful are a little late for the boat. You see, death panels have been around in this country for years. In fact, you could say that I was on one.
In the 1980′s I was a health benefit claims analyst for a major insurance company here in town. I was given guidelines on what to cover and what not to. If the procedure or the medicine wasn’t something that was done all the time, the orders that were given to me were to decline the claim.
And I was in charge of AIDS claims.
I dealt with people every day who had severe problems. In the 80′s, people didn’t live with AIDS for the most part, they died from it and it was my job to make sure that only those treatments that were approved and by the book were covered. I declined a lot of charges and sometimes customers would try to slide through treatments that were still, at that time, deemed experimental. But back then, AIDS was still pretty new and most anti-virals were experimental.
I denied a lot of claims.
I did what I could for people within the guidelines that I had to work for, but still, I was making decisions that would affect whether someone could get the medicine they needed. If I denied the claim, and the customer appealed, it advanced to the Claims Examiner. Sometimes it would then go to the doctor who was on staff. He had two degrees. He was both a doctor and a lawyer. His presence on the staff strengthened their ability to deny a claim.
We even had customers that would seek alternative ways of keeping their costs low. I can recall one customer who worked for a veterinarian and the drug he needed was also stocked at the vets clinic but at about 1/2 of the price he would have paid at a pharmacy. But because he got it dispensed to him at the vet clinic, I was instructed to deny it. Had he paid full price for that medicine we would have covered it at 80%. It was the same exact medicine at the same exact dosage that he needed.
Now if you really want to be precise about the whole thing, the real death panel wasn’t us folks making the day to day benefit decisions on what could be covered and what wasn’t going to be — it was the actuaries and the underwriters. They were the ones who made the decisions as to what type of procedures could be covered by each plan. They designed the plans and we carried out the marching orders. They weren’t making their decisions based on whether it would make sense to get people the care they needed. It was there job to maximize profitability.
So the next time you hear someone tell you that they’re afraid that nationalized health care will create a situation where we have death panels with people making decisions as to who lives or dies based on costs, remind them that we’ve had death panels for a very long time now — we just call them insurance companies.
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Jim McGuigan
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Thanks for this. I think it is really important to point out to people the many roles of insurance companies…like, they operate to make profits, not to ensure health care and good health outcomes.
And your denied claims were appealed and most likely overturned by a state board under the Commissioner of Insurance.
That board doesn’t hear Medicaid claim appeals.
Actually most people never ever appeal their claims.
As for medicaid appeals, I don’t know where those claims are appealed or if medicaid has a different approval process.
One thing is clear — the motivation for the insurance company was profit which isn’t a bad motivation for a business but there should be an option for consumer where the primary motivation isn’t just to provide profit.
The difference is that we can choose one plan or another right now. There is great danger when we put government in charge os such an important sector of the economy. Look, most of you libs thing repubs are evil bastards. You believe they are all homophobic scum. Imagine what they might do when they appoint the bureaucrats who make decisions regarding treatment for aids. Evil, right.
The purpose of government is to secure rights for the people, not to provide for them. Any government program siezes control from the free market and puts it in the hands of people who love control most of all. It cripples the natural desire for self reliance and freedom.
If you were freaked out about government going after terrorists under the patriot act, how can you turn around and give government the authority to scrutinize the most intimate details about yourself?
Our system was never designed to provide equal outcomes for all citizens because this is the opposite of freedom.
We really can’t choose one plan or another. I do not have a government option. My only option right now is the private sector.
As for your evil bastard comment, you’re mistaken. I have many Republican friends but I don’t look to them for solid ideas about public policy. That being said, most of my republican friends, like me, have a liberatarian bent so we tend to find some common ground. I have very few republican stateist friends even though most republicans tend to be stateists from my experience.
In my opinion it’s a little twisted to believe that government creates rights by decreasing availability of core services. And yes, I include health care in with fire services, police services, public transportation and roads in the same essential services category.
As for comparing the Patriot Act to a Public Health care option, I’d like to think you were kidding but let me put it this way — no one ever gave me the choice to opt out of the inappropriately named Patriot Act.
Jim:
I’ve never met a republican who was also a stateist. Republicans generally favor less government intrusion into private affairs and business. They do not promote smoking bans, forbid bartenders from drinking, prevent parents from offering a drink to their children in a supervised environment. Liberal democrats do these things then call republicans and conservatives prudes.
That being said, in some respects you are more libritarian and freedom loving that most liberals (like most people you seem to have a “chinese menue”, not an idiological checklist).
However, your fantasy that your privacy and freedom of choice might be better protected under Obamacare demonstrates a faith in government that is simply misplaced. No libritarian believes the role of government is to provide all things for all people. Libritarians understand that all government programs are by nature rationing programs with no need to keep the coustomer happy.
I heard John Stossel make an interesting point today about health care and Lasik surgery. People pay for this independent of insurance plans and therefore there is great competition and lower prices. It follows that we rely on all forms of health insurance too much and that keeps costs high. He suggested that you get a HSA and insurance policy for only catastrophy. Most doctors are willing, he suggested, to offer great reductions in costs for cash. My point is that there are other solutions to the health care problem than surrendering everything to stupid republican or democrat bureaucrats. That should appeal to your libritarian viewpoint. This would also free the resources of government to focus on caring for those in genuine need.