My darling boy will eat almost anything. He is rather great that way, if I do say so myself. Gnocchi, carrots, kung pao chicken, broccoli, brown rice, calamari, salmon - there isn’t much he won’t eat, let alone try. While this is great for us as parents, he didn’t seem to think it was so great in preschool. Nearly every day in his final year of preschool, he’d come home with a tale of some friend who was now allergic to dairy or soy, red food dye or peanuts. Several of our Muslim and Jewish friends don’t eat pork and since Husband is Hindu, he rarely, if ever, eats meat.
Darling boy felt very left out of all this “speciallyist” as he called it and decided he really must be allergic to something too. Although he never officially declared his food allergy, there was a time when he refused to eat anything red – especially if he had seen it on Husband’s plate. If it had been on Husband’s plate, that meant it was spicy and darling boy apparently decided he was allergic to anything spicy.
He’s since grown out of this phase and while not a huge fan of change, he does approach life as an adventure and is generally willing to head into new activities with a sense of enthusiasm. His only hard and fast rule is that he wants to get places quickly and he wants to get there without an airplane (this could have something to do with the fact that the first time we took him to India, it took us almost 32 hours to get there). He is just sure he can figure out a way to make that happen. His unwavering belief that if he can imagine it, he can do is one of his most endearing traits. If he had a motto, I’d say it was “Physics be damned!” At the end of our first trip to India, he just could not understand why we couldn’t live in India, and have his US based Grandma and Grandpa, aunt and uncle, and several friends come be with us on weekends. He had loved the month we spent with his Indian Grandparents, aunts and uncles and three cousins. They had showered him with love and he wanted to stay. More importantly, since US Grandma and Grandpa “didn’t have to work anymore”, they could come to India anytime they wanted to see him. He thought they should want to come at least once a week. In his mind, it was the grown-ups who couldn’t figure out how to make this work. He had his plan and he was sticking to it.
This is the point where I will draw my analogy to health insurance. You knew I’d get to it eventually, didn’t you? But I’ll start with insurance appeal information first. On Thursday, I received a letter from my health insurance company that provided the outcome of my appeals hearing from Monday. It took them three pages to say it but essentially, the message was “Sorry kid, your policy doesn’t cover you. We can’t do anything about it. Tough luck. You can pay for the treatment if you want to but you won’t be covered if anything goes wrong.”
Anger is inadequate to describe my sentiments upon reading that letter. However, the complexity of my emotions would fill several pages and none of us has the time or inclination to read all that. The lack of control I felt over my own life at that moment was truly overwhelming. Also at that moment, a sort of nauseating realization hit me - they don’t care if I die. Worse yet, I can understand why they don’t.
Health insurance is just that – insurance against ill health. Any kind of insurance – home, boat, car, life – you can hedge your bet and work towards never having to use your insurance. You can keep your home well maintained, you can keep your boat clean and well cared for, you can keep your car in good running order and you can keep your life by avoiding risky or stupid behavior. Insurance is meant to cover those times when there is an accident, when there really wasn’t anything you could have done to prevent the situation. One could argue that in a certain percentage of people, you could hedge your bet against ever needing your health insurance. Don’t smoke, get lots of exercise, limit your stress, etc. But your health insurance is there if an accident occurs – you break your leg playing soccer, you cut your hand opening a bottle of wine, you hurt your back raking leaves. When you are just covering for the accidents, this system works pretty well.
But what happens when there is a catastrophe? Insurance companies don’t do catastrophe. How many homeowners’ insurance firms went bankrupt trying to cover homeowner losses from the Northridge, CA Earthquake in 1994 or the storm related damage of Hurricanes Andrew, Rita or Katrina? The inevitable result is that most homeowners in California now find it extremely difficult to get earthquake insurance. New Orleans residents, years after their disastrous storms are still fighting with their insurance companies to get the coverage they paid for. Personally, I think insurance companies really need to set up their headquarters on the Las Vegas strip. It would make for a very visible reminder of what insurance really is – legalized gambling. Casino, insurance company – the odds are the same because the house always wins and they’ll never play when the odds aren’t in their favor.
And so it goes with health insurance. If it were up to the health insurance industry, I’d never, ever, ever be granted an insurance policy. And for their business model, that is reasonable – I completely screw up their cost\benefit ratio. They would need to have many, many healthy people who never use their insurance to make up for having one of me in their system. Is it fair that those other people pay for me? Not really. However, is it fair for me to have spend nearly $8500 a month to care for a body that didn't want to work when I was only ten years old – especially given that I have little to no control over those monthly costs?
This is where my darling boy and I are similar. The emotional, humanist side of me says that the health insurance company just needs to understand that this is about my LIFE. Pay for the surgery already, damn it! Allow me the luxury of thinking that I am worth saving. Let me get on with living! From this standpoint, I would argue that the cost for the surgery is minimal compared to the contribution I can make to society if I can go back to being productive in some way. Although incalculable in business dollars, the societal impact is immeasurably greater.
The rational capitalist side of me is like the grownups telling my young son that his plan to stay and have his family with him wasn’t possible. A sensible person would accept that the surgery will never be paid. And even if it were paid for, there could be complications, problems or issues that would require yet more money spent on a previously unsupported policy. One person’s medical care costs might be higher by not granting the surgery, that person’s life might even be ended through a lack of treatment, or worse yet, the patient’s family might file a lawsuit. However, the out of pocket costs of these potential scenarios is far less than the real possibility of having to grant exceptions to future health insurance users. The better business decision is not to pay for anything at all.
Darling boy’s plan for staying in India didn’t come to fruition. He was disappointed but as always, he immediately started drawing up a new plan, even before the plane had taken off. I’m not giving up either. While it might not be rational to expect a business to accept that my life is valuable enough to save, it is important enough to me to keep trying yet another plan.
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