The Health Care Chamber of Horrors: Choose Your Bureaucrat!

By William Fisher

With their principles firmly focused on the 2010 elections, and juicy campaign contributions from the so-called health care industry, Republicans and some potentially endangered Democrats are furiously fulminating about “socialized medicine” and government bureaucrats who will “ration your health care” and “get between you and your doctor.”

Can Harry and Louise be far behind?

Well, government is not the only place where bureaucrats work. They are ubiquitous in those wonderful companies we pay to bring us our health insurance policies.

They aren’t big on “socialized medicine” – though not even economists dispute that universal health care is a social good.
But they’re regularly rewarded for rationing your health care and getting between you and your doctor.

Consider this mini-chamber of horrors, culled from a recent and highly dramatic House hearing chaired by Rep. Henry Waxman of California.

Robin Beaton, 59, found out last June she had an aggressive form of breast cancer and needed surgery -- immediately. But just days before her double mastectomy, she found out that her insurance provider would not cover the procedure. (In the industry, they call it “rescission.”) Why rescission? ?

In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.

Beaton's dermatologist begged her insurance provider to go ahead with the surgery.

"He said, 'This is a misunderstanding. This is not precancerous. All she has is acne.” Still, the insurance carrier decided to rescind her coverage. The company said it had reviewed her medical records and found out that she had misinformed them about some of her medical history.

Beaton had listed her weight incorrectly. She also didn't disclose medication she had taken for a pre-existing heart condition -- medicine she wasn't taking when she originally applied for coverage.

Another witness, Wittney Horton, said her coverage was canceled after her carrier said she did not disclose that she had taken a drug prescribed for weight loss and because of her irregular menstrual cycle. Her carrier sent her a letter saying they would not have accepted her had they known she had "polycystic ovaries," a condition she did not know she had.

And Peggy Raddatz testified on behalf of her late brother, who was diagnosed with stage four non-Hodgkin's type lymphoma. In the midst of his chemotherapy treatment, his coverage was cancelled and he was not able to receive the stem cell transplant needed to save his life.

Raddatz's brother was told his coverage was canceled for failing to disclose that, unknown to him, a doctor had once noted in his file that a CT scan showed a small aneurysm and some insignificant gallstones.

These are but a few of the thousands of people who thought their premiums entitled them to be treated. And if you think these are extraordinary cases, consider this:

Blue Cross of California, a subsidiary of WellPoint, encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses. One Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

Blue Cross of California and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period.

(Note to media watchers: When CNN reported this hearing, it conveniently ignored an inconvenient truth: the names of the errant insurers. Thanks to Karen Tumulty of TIME, we now know who they are: Wittney Horton and Robin Beaton were insured by Blue Cross. Peggy Raddatz’s brother, Otto, was insured by Fortis Insurance Company. Also, this riveting hearing got no airtime on the TV networks, nor did it appear in The New York Times or The Washington Post.)

At the risk of inviting my own “recission,” I invite you to examine my own health insurance history. I have several chronic ailments. But, over the last 15 years, Medicare – yes, that awful “socialized medicine” plan – has never denied me the treatment I needed. Ditto my Medigap insurance, purchased through AARP.

Bureaucrats abound in both the public and private sectors, and Lord knows, Medicare has more than its share of warts (is that a pre-existing condition?).

But, given my druthers, I’ll choose what’s now being called the public option.

It’s worth remembering that, through our votes and our letters and phone calls to our representatives in Congress, we have at least a fair shot at managing the public bureaucrats. The private sector is accountable only to the bottom line and the great invisible hand of the market.

Maybe you’d like to let the market perform your next surgery?