Thursday, December 22, 2011

The Fiction of Insurance

She was in the wrong place at the wrong time. My neighbor, who I knew only in passing, had stopped in the lobby of our building to chat with my wife. She was talking of a recent medical treatment as I happened by. She discussed, very matter of factly, that the cost of this care had not been covered by her insurance. That was all the opening I needed to launch into an extended, impassioned dissertation on the fallacy of "protection".

While up to 50 million of our citizens live in the unspeakably inappropriate universe where medical care must be paid for on your own dime, if you have one, the rest of us scramble to find the morsels of protection we have paid enormous sums to obtain.

With the coming of yet another dreaded insurance anniversary, my latest bill recently arrived, containing another double digit increase in my premium. How is it that in my legal practice I find myself almost begging to receive payment of fees that look like I am stuck in the 1970's, but in this alternate reality enormous annual cost escalation is a given? And how  would my clients react if I informed them that with their money they had obtained less than all of my services?

And yet, here, half a loaf is deemed better than none. We speak of deductibles, and co-pays, out of network and uncovered. We don't go to this doctor because he doesn't accept our plan, or worse, doesn't accept any insurance payments.

I read this morning of a nurse who was forced to use whatever power of persuasion she possessed so that a dying woman could receive insurance coverage and appropriate care in the last days of her existence("Looking for a Place to Die"). She wrote in detail of the challenges she faced in making this happen, and the possible truths she was required to invent to make an otherwise square peg fit into a round hole. Which brings me back to my neighbor.

I challenged her, in a rhetorical manner, to advise as to what our dollars really did buy. It was I  emphatically suggested,  merely a security blanket against catastrophe. While many of the everyday costs would fall on our shoulders, and while we would have to fight through mountains of paperwork and rhetoric to try to obtain coverage for this treatment or that, at least in our darkest days, we could be certain that our carrier would be there to comfort and protect.  And then we read stories like the one that this nurse relates, where even then, even when the worst is upon us, even then nothing is clear.

The next time my neighbor sees me coming, she will surely avert her eyes, find something that is of import on the other side of my universe, and head there. For she knows not what might trigger my next discourse on what ails us all. Or what should make us sick, like the fiction of insurance.

1 comment:

Bruce Egert said...

I've advised people, many times, that you cannot afford to get sick, so do not get sick.

The latest fight in Congress (which will end the payroll tax reduction) will, ironically,help further fund social security. Had they extended it there would come a time to end the reduction, but would not be able to, because it would be called a tax increase. This, would defund social security.

I have also advised my friends to make sure that they have a minimum of $100,000 on hand for medical expenses--drugs, co-pays, uncovered procedures, surgeries and therapies.

As for nursing home care--forget about it. You cannot afford it and the long term care policies now being sold will be unable to pay out in 10+ years due to oversale.