Cutting Costs or Cutting Services

I just read a really interesting article in the New York Times about how the nation’s major health insurers are reporting record profits for the third year in a row and I thought to myself “Wow, how do they sleep at night?” After considering it for a while, I came to the conclusion that maybe they’re suffering some kind of mass hypnosis where they actually believe they’re not doing anything wrong. It’s a stretch, but in my most compassionate moments, its something I considered anyway.

What the NY Times also mentioned in that article was that people are generally cutting down on their visits to doctors, prevention, and other health care because they are economically compromised. So when the economy is bad, they let illnesses
that can be taken care of easily at the beginning – for example a bronchitis – wait until it turns into a pneumonia for which they have to go to the Emergency Room and get x-rays etc. Which, of course, costs all of us because then the insurance companies raise their premiums.

But do our policy makers consider what happens to their family and the community in the meantime? While one or two people are not being treated, they are spreading their disease to many others. Even if we don’t want to consider the moral or ethical issues of human suffering, doesn’t it cost more to treat a village than a person?

Another area that people are cutting down is in their medication. They’re not taking blood pressure medication, for example, or their asthma medication because they need to eat and they can’t afford both. Those illnesses, left untreated, can cause stroke and other more severe disabilities that cost much more to treat in advanced states than taking blood pressure medication or buying an asthma inhaler.

The next tricky concept invented by insurance companies, of course, is the dreaded “Insurance Company Formulary,” which includes the only drugs an insurance company covers or considers even as they calculate “out of pocket expenses.” This in itself can be dangerous.

For many of us who have been taking certain brand name drugs for years, and found them effective in regulating our “symptoms,” that choice is no longer available to us. Now we have to settle for generic equivalents or generic alternatives which are other medications that are carried in the insurance company’s formulary. They contain the same “active” ingredients but different fillers or dyes and are often manufactured under different standards. Many of them are outsourced and not monitored by the FDA in the same ways as Brand Name drugs. Who chooses the medication to include in the formulary? Who knows? I don’t, and that’s not for lack of research on my part. I’m still trying to find out!

Medicine as an art is no longer practiced in America except by our rare conscious service oriented doctors. Why? Our doctors have been compromised in the practice of medicine for they can no longer prescribe the medication they prefer or order the tests they can order to properly diagnose. Even after years of trial and error prescribing medications that worked for their patients, they are forced to prescribe new generic medications that cause side effects, because the insurance company regularly refuses to pay for those older medications. If the doctors are willing to fight for brand name drugs, they have to hire a staff and raise prices just to do the paperwork the insurance company requires.
Now Congress justifies this excessive profit-making by pharmaceutical houses or insurance companies by calling it free enterprise and Capitalism? They threaten us not to allow government to control our relationship with our doctors or fix the prices of pharmaceuticals. Why would they rather have big business- who has a profit motive-control that relationship?

Why is it that we call ourselves a progressive society? I don’t get it. But then maybe someday when I can drink the same crazy potion, and then I will. Who knows?