Blue Fucking Cross

I'm in the Catch-22 of forking over thousands of dollars a year to company whose policies I hate - I mean really hate - and yet I probably can't stop paying them, because nobody else would accept my money.

I'm talking about health care.

nyceve points me to the story of Catherine Seipp, a conservative writer for National Review Online who, through her personal experience with Blue Cross of California, has come to understand just how severely broken the health care system is in this country. Since she's exactly the type of person you would expect to make COUNTER-ARGUMENTS to this on the basis of the glory of Free Market Jesus, I think this is a very important development. She writes:

Without me, Blue Cross' parent company, WellPoint, which reported a $2.5-billion profit last year, could have seen a profit of $2.5 billion plus about $50,000. I was diagnosed with advanced, inoperable lung cancer in 2002 and so now typically reach my $2,500 individual deductible by January and my out-of-pocket cap by February.

By law, insurance companies aren't allowed to adjust your monthly premiums just because you get sick. But they can raise the out-of-pocket cap for all of their members anytime they like, which amounts to the same thing because it affects only the unvalued sick members. (And, of course, getting sick means that even while one's medical costs go up, the ability to pay goes down — earnings potential is curbed when life becomes a series of treatment appointments.)

Lucky you, if you don't know what your out-of-pocket cap is. And if you're like every single healthy person I've queried, you probably don't. But you should know, because the out-of-pocket cap is the most important part of your policy, meant to stave off financial disaster in case of catastrophic medical expenses.

The worried well, however, tend to be remarkably ignorant about medical insurance. Policy wonks keep arguing about market competition and consumer choice. But healthcare for the sick isn't a market because choice disappears. You can't shop around for generic drugs when you have cancer. Whatever chemical treatment the doctor suggests, it almost certainly will be a brand name costing several thousand dollars a month.

That is such a vital point. You can't bring the powers of the free market to bear on health. There are no cut-rate AIDS drug treatments, or bargain MRIs. The collective action of the market is not wide enough to bring down fixed costs (unless you're talking about prescription drugs, in which case the US actually gave its bargaining power away in the 2003 Medicare bill). Such "choice" actually makes people sicker, since the one cost you can give up is preventive treatment, which leaves people ill-prepared for diseases that could have been caught earlier with regular checkups.

But here's the hammer blow:

My out-of-pocket cap is $7,500, which means that after I reach $7,500 in co-payments, Blue Cross pays 100% of my medical expenses for the rest of that year — except for the $30-per-brand-name prescription I have to pay the pharmacy after I reach my $500 annual deductible for drug coverage. According to the policy, it's supposed to be a $30 co-payment for a month's supply, but a new anti-nausea drug I was taking for weekly chemo costs $285 for just three pills, so Blue Cross made me go to the drugstore and fork over $30 every seven days.

Another thing working in insurance companies' favor is that cancer patients rarely have the energy to argue about such nickel-and-diming. I recently managed to spend a morning forcing my way through multiple disconnects and transfers on the Blue Cross 800 number, but I was eventually told that the company would probably reimburse me for the extra $90 a month I was paying for that weekly anti-nausea drug if I filled out the right forms. My far bigger worry is that out-of-pocket cap, which is essentially what insurance is for. To drastically raise it seems the definition of bad faith.

Or so I thought — until I began getting letters from Blue Cross in February announcing that it was retroactively disallowing the anti-cancer drug Avastin treatments it had been paying for since October, at $5,000 a pop every other week. It seems Blue Cross decided this new and expensive targeted therapy is experimental. (It looks as if Blue Cross is not asking to be repaid for my relatively unexperimental chemo, which had been costing about $2,500 every single week, but who knows?)

To decide after a therapy has proved beneficial that it's merely "investigational" and therefore should not be covered — that, actually, seems the definition of bad faith.

It's an unbelievable hazard to have for-profit companies making these life and death decisions. I'm not suggesting we abolish all insurance companies; they're there to pool risk. The problem arises when profits get in the way of managing that risk. We already know that Blue Cross of CA finds ways to terminate enrollees who file claims. Now they're retroactively charging customers for treatments their doctors prescribe. It's not like Seipp came up with using Avastin on a whim. And it worked.

The insurance racket is but one of the many facets to our medical nightmare in this country. Merck lost another case last week, as a jury awarded millions to the family of a man who died of heart complications after taking Vioxx. The FDA, our last line of defense against dangerous drug treatments, is routinely staffed by pharmaceutical company executives. The sellout Medicare bill of 2003 that I mentioned before has exceeded its enrollment goals, but rates are going up, the "doughnut hole" (money that all seniors in the prescription drug plan must pay out of pocket) is being enlarged, and thousands have received letters from insurance companies that they will be thrown off the plan because they have not paid (in fact it's just being mismanaged by the Medicate bureaucracy).

I'm very sorry for Seipp's troubles with Blue Fucking Cross. I hope people from all parts of the political spectrum can come together around this issue, and in fact I'm optimistic that they will. I think there's more of a chance to "reach" across the partisan divide on issues like this. The business community is coming around. They'll end up leading the crusade for universal health care. Everyone has a family. Everyone has this issue in their lives. That's why there's more of a chance to reach a moral consensus on it. You can pretend not to see the flag-draped coffins from Iraq, but you cannot duck the price tag on prescriptions, or letters such as the one Seipp received.

Of course, I'm not likely to drop Blue Cross of CA, where I am enrolled, because it'd be very unlikely that I could get an individual health plan with anyone else (my Achilles tendon surgery of a couple years ago clinched that), and I don't work in a business that really concerns itself with giving employees health care. So I'm stuck, paying money to a company whose activities I find abhorrent. Insurance companies only want you if you pay your premiums and don't ask for anything. In other words, the health care system only likes the healthy.