Insurance: It’s a Business, Stupid

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Today I received a much delayed notification in the mail that Blue Cross Blue Shield is going to deny my request for personal health insurance. This is actually good news in sort of a perverse way. Several professionals had warned me that there was no way I would be accepted for personal health insurance. In order to benefit from our government’s new Pre-Existing Condition Insurance Plan (PCIP), I must demonstrate that I have been rejected for a pre-existing condition (plus I must endure 6 months without health insurance). Without the PCIP plan, I would not be able to get health insurance.

What was my crime that disqualifies me from receiving health insurance and the resulting guarantee of health care? I had the audacity of being diagnosed with cancer in July, 2007. I was treated for cancer, and my prognosis is excellent. There is a very slim chance that my cancer will return.

I had health insurance when I got cancer, so an insurance company paid for a portion of the cost of my treatment. Based on my calculations, within five years that insurance company would have received enough money in premiums to completely repay every penny I had ever cost them. Similarly, I estimate that the insurance industry has received three times as much money in premiums paid by me than they have had to pay out for my benefit. And yet I am considered to be too much of a risk to deserve ANY coverage.

I learned from my rejection letter that it wasn’t just my cancer that they didn’t like. You see, in order to check that no cancer has returned, my doctors perform regular CT-scans. So far there has been nothing but good news from those scans. But Blue Cross Blue Shield looked at the same images and found much cause for concern. They were terrified by the presence of a schwannoma and hemangiomas in my liver, spleen, and both kidneys. Before you shed a tear for my imminent demise, you might want to look up these fancy terms up. You’ll learn that none of these are of any real concern.

So why are people with ANY anomalies whatsoever in their medical history denied insurance coverage? It’s because insurance is provided in America by for-profit financial institutions.  Keep in mind that regardless of claims to the contrary, the top priority for publicly traded companies is to provide a good return on investment for their stockholders.  The profit margin is much better for a business if it can figure out a way to ensure a continuous bounty of revenue while eliminating as many expenses as possible. Now of course, one expense is executive pay, but I doubt you will be surprised to learn that this is NOT an area that insurance companies aggressively try to reduce.

Instead, they figure they can take money from healthy people until they actually start needing their insurance. At that point, the insurance companies use every trick in the book to deny coverage for the needed treatment, and then they try to get rid of customers who have been defiled by disease altogether.  Keep in mind that they already get a bonus from Medicare: they no longer have to cover the medical expenses for anyone over 65. This is one reason why all that trumped up outrage over a “public option” conveniently ignored the fact that Medicare is a “public option”.

Our nation depends on private companies to provide people younger than 65 the means to afford healthcare.  This means that sometimes the government needs to step in to ensure that the objective of affordable healthcare is possible for all of its citizens.  After decades of trying, the government finally took a step in that direction with the Patient Protection and Affordable Care Act (PPACA).

Thanks to PPACA  I will be able to receive health insurance in six months.  The insurance industry, of course, would like to be able to operate without any interference, so they have always lobbied against health care reform. As a result of their money and efforts, many people misunderstand what this bill does. We have all sorts of people who don’t like it because it is “job-killing” or a “takeover of the healthcare industry.” If the insurance industry’s efforts are successful in repealing this law, then PCIP will disappear, and I will be back to the situation of not being able to get health insurance precisely because I might actually need it.

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  • Jim Wheeler  On January 19, 2011 at 3:16 pm

    An interesting and articulate account of a real-life situation regarding the ACA controversy. Thanks, John. You give us much to ponder.


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