First, let me say that this is primarily a letter to President Obama and that ultimately, until let down completely in the march towards health care reform, I still have his back. I tend to think there's still a master plan to toughen the current legislation and nail the insurance lobby. I just finished Obama's book "Dreams From My Father" and the man that penned those words simply could not have made such an ideological leap in such a short period of time that he would now be bought and paid for by big business. Maybe he's more cautious and crafty but there's a heart and mind behind his decisions. I have to believe that or America is done.
But, that leaves me with an ethical dilemma that is extremely pertinent to the current debate and my situation in many ways is a valuable talking point in this discussion.
I am one of the hundreds of millions of Americans who have health insurance through their employer (small business) but, because of the horrific and greedy practices of those insurance providers and the costs the health care providers are having to push down because of their mandate to provide for the uninsured, I am among the ranks of the grossly under-insured. Should conditions present themselves properly, I can be responsible within a year for tens of thousands of dollars in hospital costs for me and my children. Just a mere decade ago my insurance plan would have left me with only small co-pays for any procedures.
With one of those boys going to college in a state that is piss-poor in educational funding and another beginning in a few years, I simply do not have tens of thousands of dollars in reserve for such an eventuality.
Last year one of my sons was diagnosed with a hernia. It was first found by our primary care physician, an able and caring doctor. It was confirmed by the surgeon who also seemed caring and skilled and we of course scheduled the surgery as any parent would do. The children's hospital where the operation was performed was well-run and all the staff were courteous and kind. Everything went fine, no problems with anesthesia or complications but, we were told in complete honesty by the surgeon afterward that he could find no hernia and that perhaps they were fooled by a tiny fatty mass. In effect it was a misdiagnosis and the surgery was unnecessary.
Also part of the news that day was that this procedure, although completely authorized by our primary care physician and done by doctors and facilities aligned with our insurance, fell beyond the norm enough that our per person deductible (per calendar year) kicked in to the tune of $750. Now we had never known what the deductible meant but had assumed it to be involved more with work done outside the normal network of providers. Later we'd find out that the deductible was not the only thing we were responsible for. They also have this concept of co-insurance which doesn't mean you have other insurance that can kick in to cover some of the costs but instead means that every procedure has been negotiated with a part the insurance company pays and a part that the insured must pay. This kicked the bills up well over thousands of dollars. I went back and read the policy and it took me hours of legalese parsing before I could figure out they had us nailed. The deductible and this co-insurance part had nothing to do with one another in terms of one covering the other. That ethically at least seems fraudulent. The very definition of a deductible should be the maximum one should have to pay.
Now, because of our cluelessness about how much this could cost, we were unprepared for this expense. Our lifestyle, some decisions about the educational expenses for our children, purchases we had intended that could help aid our economy and local businesses, had to be altered or stopped. First step was putting off paying the bills coming from the health care providers for as long as possible including simply ignoring the bills until the threats began that could harm our credit status knowing those providers are largely impotent to act simply because of the volume of unpaid bills they face.
However, during all this, knowing I'd eventually own up to the obligations, my dark side voice kept whispering in my ear. We're paying thousands of dollars for an operation that never had to be performed. Despite my admiration for the skill and caring of the physicians who'd misdiagnosed my son, that little voice was telling me I could probably make this all go away by calling their offices and saying I had a legitimate malpractice claim. My first instinct was revulsion at the thought. These men had not acted out of greed to operate on my son. Certainly they profited from the office visits and their fees for that day but I knew in my heart that ultimately they did what they did to try to help. I had never believed a situation like this in any way entitled people to compensation.
Yet, my rationalization engine began. I'd not threaten a full malpractice suit with lawyers, only bring up casually the possibility. I'd simply go talk with the doctors and see if they could help with the costs some. I wake up each day with that temptation but ultimately have not acted. I'm not sure I could look at myself in a mirror after that.
So why is this a talking point in the health care debate? It's simple. I'm not sure we can win this argument by ourselves (just us normal peon customers of the system). We have little clout. However, the health care providers and physicians are ultimately the victims here of the insurance company greed and deception. We need their voices shouting for hard core competitive reform which includes a strong public plan or ultimately complete single-payer coverage, not because their rich asses believe ideologically in socialized medicine, but instead because their business model is failing miserably when their customers can't or won't pay and those customers look for any way out of their financial dilemma including the unthinkable of erroneous malpractice claims against them.
One of my rationalizations of going against these men to allay my unexpected financial burden is that ultimately irrational action may be required in order to fully break the system and force it into rehab. Maybe I'm looking at this too emotionally and my impulse to do something irrational needs to instead be expanded nationally. Perhaps our target has been wrong all along. We keep yelling at and trying to inflict harm on the insurance agencies who can easily deflect the criticism because their bottom line is guaranteed and instead stage a nationwide strike against paying our share to the providers. If any tiny thing was wrong during a visit or procedure, threaten a malpractice claim. Just all of us at once stop paying our exorbitant deductibles and co-pays and force panic from the health care industry. Europeans seem to understand the concept of national strikes and mass protests. Why can't we?
Our doctors and health care professionals are not the enemy here but I'm not seeing that they are allies either. That second part must change to get true reform. They are wealthy and powerful and yet, other than small groups, have been very silent in this debate.
At this time, unless other financial problems hit, I am resisting that visit to the men that misdiagnosed my son and will pay the obligations as slowly as I possibly can but it needs to be known that the same dilemma I face today is happening to lots of other under-insured Americans and often with much more dire consequences. They won't be so caring and resist the impulses I have if it means getting their bills taken care of through an unethical action which, if undertaken, might mean they can eat for another week.
President Obama, here's that foot in the door you so badly need. Our physicians and providers are wealthy and politically powerful but strangely silent in all of this. Perhaps it's time to let them know the dangers facing them in the financial collapse of our current system. Maybe it's time to scare the hell out of them a bit. The next time I'll listen to that little voice from the dark side.