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No one noticed CNN's top story two days ago, so I figured I would post about it. According to CNN, a cancer patient had their insurance rescinded because she had acne as a teen, and in the insurance company's eyes the acne made the cancer a pre-existing condition. The dermatologist asked the insurance company to grant a waiver.

The cancer patient then told a terribly sad, and disturbingly common, story to CNN:

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.

"I didn't know what to do. The hospital wanted a $30,000 deposit. I was by myself. I didn't have that kind of money," Beaton said through tears. "Can you imagine, having to walk around with cancer growing in your body? With no insurance. It's the most terrifying thing in the world to not have anybody to turn to or anywhere to go."

Beaton, who worked as a registered nurse for three decades, charged that the insurance company "searched high and low" to pull out anything on her so that they would not have to pay for her surgery.

Those of us who pay attention to health care reform have heard this before. I know of cases where surgeons have been faced to make an ethical choice when the phone rings in the middle of an operation--it's usually the hospital's Chief Financial Officer. The insurance company denied coverage for the surgery citing some bogus pre-existing condition like acne and the patient can't afford $50,000 out of pocket expenses for the surgery.

If the doctor thinks the patient has a high likelihood of dying unless the surgery is performed that day, the surgeon will almost always go ahead with the procedure and spend days fighting the insurance company later. If the patient can survive for a few weeks, the surgeon--as they did in the case cited by CNN--will usually put off the procedure.

While patients wait, their conditions deteriorate. Surgery is a risky business, and the less healthy a person is, the more likely it is that there will be complications. A two day hospital stay can turn into a 3 week hospital stay if an emaciated and frail patient comes down with MRSA or another hospital-acquired infection. If the cancer grows, and surgery can no longer eradicate the tumor, the patient must go through radiation therapy and chemotherapy.

In the end, the insurance company ends up paying far more than they would if they just approved the procedure in the first place. But insurance executives who control approvals and denials don't care about the long-term. They're worried about their company's quarterly report and its effect on stock options. Their bonuses are usually paid out in stock options, so a lower stock price means lower bonuses.

Besides, if a person gets sick enough, they will be forced to leave their employment. That means, due to outrageously high COBRA premiums set by insurance companies, they'll lose their health insurance. By delaying and denying medically needed treatments, health insurance bureaucrats can weasel out of their responsibility to pay for the medical care of enrollees by forcing them to become sicker, lose their job, lose their health insurance, and end up in hospitals on the government's dime. And for doing such a bad job, they probably get rewarded with a six or seven figure stock option plan at the end of the year.

It's little wonder that 30% of all health care spending happens in the last year of a patient's life. Our system makes it very expensive, and very difficult, to get better after a person develops a serious illness. It also makes it basically impossible for a person with a history of cancer, or some other terrible disease, to get a job which provides health insurance after their treatments put the disease into remission. It's little wonder that, despite Republican claims that our health care system is the "best in the world," the World Health Organization ranks it 37th, behind such economic powerhouses as Morocco, Colombia, Cyprus, and Costa Rica.

We have a chance to change that this year. We need a health care reform plan which takes power away from insurance bureaucrats who stand between us and our doctors. We need to put the power of medical decision making back into the hands of patients and doctors. We need some real competition from either a public option or non-profit co-ops that will force insurance companies to treat their enrollees as customers instead of mere pawns to be used in the objective of obtaining a higher stock price on those options the executives got last Christmas. And we need to ban the practice of compensating employees of health insurance companies and for-profit hospitals with stock options.  

Originally posted to The Bagof Health and Politics on Thu Jun 18, 2009 at 09:13 AM PDT.

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