Not to get political
Healthcare
I was talking to my neighbor the other morning. We ran into each other walking our dogs. My fiancé and her both share a history of cancer. My fiancé currently has stage IV metastatic breast cancer. We found out less than a year ago. My neighbor knows this and was asking how she was. All things considered, she’s doing pretty great. But it launched us into a conversation about healthcare.
My neighbor’s new insurance doesn’t cover preventative PET scans, a very effective form of diagnostic imaging that could detect cancerous cells throughout the body. So she told me she’d first have to be diagnosed with cancer, again, for a third time, before her insurance would cover a scan. By which point it could be spread to multiple locations throughout her body. The best chance of survival when it comes to cancer is early detection. Which makes this policy insanely dangerous and stupid.
Its backwards policies such as these that leave the patient out in the cold that caused me to leave a successful career in healthcare after nearly a decade. I could no longer be an accomplice to such crimes.
My neighbors husband it turns out left for similar reasons. He was working for an insurance company that celebrated when they got above a certain threshold of claims denials. The more claims they deny, the less services they pay for, and the more money that goes to their bottom line. The more of a chance that treatable diseases, like cancer, are missed, and people like my neighbor or my fiancé suffer.
One of my responsibilities at work was to fight the insurance companies for erroneously denying claims, and for what we called short pays (the health insurer is contracted to pay $90 for a service but they only pay $60). We had a whole department dedicated to this one function of recovering money we were owed, a large percentage of which was owed to the doctors we managed. We routinely negotiated multi-million dollar settlements ($30 x thousands of claims = millions of dollars). Wasting hours of our time, and never getting 100 percent of the money owed to us. The reason a doctor spends only 10 - 15 minutes with each patient is not just because of the low level of reimbursement they are receiving, but because sometimes they aren’t being reimbursed at all, and they need to make up for it with volume.
These are the very real games that health insurance companies play, and get away with. Sometimes the doctor pays for it. Sometimes the patient does. But the insurance companies always seem to walk away unscathed. Healthcare in this country is a business. And business, particularly in a capitalist society, is driven solely by profit. And when patient outcomes are pushed aside in favor of more profit, you end up with a nation of chronically sick individuals.