A Misnomer Called "Health Insurance"

This was some years ago. One of the three doyens of our community - all WW II veterans - was finally bidding farewell to the snowy upstate New York and leaving for the sunny beaches of Florida. Those three elderly gentlemen and their spouses were everything to everyone of us in our area, irrespective of our race, religion or financial status.

As witnesses to a serene America before the wars and the baby-boomer era, they obsessively believed each American was entitled to the same peaceful lives of their youth. Those three elders were almost like mayors of a two-block community that spanned either side of a two-mile street. Not even a cat could stir without their knowledge. Needless to say, youngsters felt suffocated by the overbearing presence and concern of the three seniors.

Now, one of those guardian angels was leaving. I too helped the couple pack their belongings before the moving truck came. Their basement was full of antiques and collectibles. One of the framed old prints was interesting. It showed a physician getting out of a horse buggy with his medicine chest and an anxious family waiting for him at the door of a home.

Though in black and white, the picture vividly portrayed the mixed feelings of the subjects - the comforting, assuring demeanor of the doctor, the anxiety-turning-to-relief faces of the family. One of the ladies in the picture was half-turned toward the interior of the house shouting something. I believe it should be "The Doc has come. The Doc is here."

Then that was the stature of a physician in our society in the past. A confidante and insider of every American family. And our forefathers knew the docs had to keep up a higher status in the society and made it a point to pay them nicely. Those who couldn't pay in cash, made it up in kind. The physicians, on their part, had no room for complaints about their reasonable remuneration.

No, I m not saying our present day docs should travel in horse buggies. I am talking about a bygone era where doctor-patient relationship was above the mundane levels of payment worries or malpractice suits.

Then, who broke up that beautiful relationship?

Sorry to say, doctors themselves started the vicious cycle. Not all of them, but a few of them.

Those were the days when insurance companies, on the lookout for greener pastures, unfortunately decided health industry was inviting enough to be grazed.

That move was against all principles of actuarial science. Insurance is provided against infrequent emergencies in our lives - be it home, car, accident or death. Not against frequent incidents like illness or sickness.

What sustains the insurance industry is the "infrequency" of covered conditions and situations because they are not allowed to invest their funds in risky, high-profit ventures.

Still over-smart insurance mavens started covering illnesses, conveniently ignoring the cardinal principles of actuarial science.

Insurance agents, under pressure to meet deadlines and targets, viewed health insurance and professionals on a par with the automobile insurance and auto mechanics respectively.

Soon a felonious nexus sprang up. A small coterie of medics and agents colluded in jacking up health insurance claims to ridiculous levels. Though only a handful of the professionals of that era were in this racket, that was enough to start a vicious cascade that finally mothballed into the present unmanageable mess.

As the racketeers and their families started flying Cessnas and Beechcrafts (some parked on airstrips hundreds of miles away from their homes), some jealous lawyers jumped into the fray with malpractice suits even if God created one member of your paired organs shorter than the other.

Medium- and small-sized insurance companies started folding up due to mounting losses from unscrupulous claims.

Finally, a handful of major players were left in the health insurance arena. Cheated by their own agents and by accredited professionals, they banded together to stomp out the mischief.

Thus were born today's confusing jumble of managed care: HPOs, PPOs, IPAs and all that jazz- all hooplas aimed at meeting less and less of the insurance industry's commitments to the society and to shortchange it.

Doctors, due to the dishonesty of a handful of their predecessors, thus lost control of their hospitals and their preeminent position in the society. Insurance companies and law firms started "lording" it over them - including diagnosis, therapy and prognosis.

Now a new group also entered the fray. The medical equipment manufacturers! In a hurry to recoup their R&D expenses within the first few months of sales, they started charging exorbitant prices to the hospitals. Their excuse is,"Why you bother, insurance will pay." But insurance doesn't pay full or pays nothing at all.

Today's young physicians may not believe that this quagmire was started by a few, unethical predecessors. The situation has worsened to such levels that soon a person with a high school diploma and a two-year certificate will be prescribing medicines and doing surgeries, so that insurance industry can save money.

Lazy insurance company staff found a new way to flog an already tired health industry. They didn't want to do the verification of the bills even when provided with fast computers; so, they created new categories of jobs for a circuitous way of verification - coding. I have no objection to the job of coders. The more our people have jobs, the better for the society.

But after passing the buck to the health care industry, if insurance is not paying the hospitals to maintain those jobs, the hospital system has no choice but to cave in under the weight of a disproportionately- bloated administrative section with the actual patient care section becoming leaner and leaner.

Self-serving ineptitude on the part of the insurance industry has rocketed premiums to astronomical levels that businesses can no more afford even group insurances for their employees.

Some health care bosses appoint sycophantic cronies to top posts ignoring the claims of hardworking personnel who have been serving the hospitals for decades.

Recently I heard a middle-level departmental head in one hospital lamenting the departure of a long-serving technician elsewhere. The tech quit after being ignored for promotion the sixth time. That guy seemed to be the only one (out of some twenty around) who could be depended on even in the dead of the night to repair one of their critical systems. The only one to do it right!

Silent hardworking staff get ignored, while vociferous lazy bums get promoted.

Some state-funded hospitals in New York City have already closed. Luckily, some hospitals in the suburbs have some funds left from grants bestowed by rich philanthropists. How long will that last? God alone knows.

I was elated when I heard on TV that some physicians in New Jersey and Kentucky are trying the old system of house visits bypassing the insurance system.

No, not on horse buggies.

A good beginning!

Anything to get rid of the middle men and to bring health care back to affordable levels is better than the present day denial of basic rights despite all the technological advances.