Is there no sympathy for the Health Insurance industry?


By Josh Shepherd

Since beginning my work as a reporter for the Cynthiana Democrat, I come into the office each morning carrying a backpack that contains, among other items, a pair of sneakers, a t-shirt, and shorts. Every morning I tell myself that, after work, I’m going to head right out to Flat Run Veterans Park in downtown and spend at least a half-hour walking. Or maybe I’ll even run a bit … at least to the point where it hurts.
Those articles of clothing may well be the cleanest I own considering how often I actually follow through with my plans. So far, I have not had to pay the consequences for my inaction. At least … not yet.
For a good friend of mine in Michigan, though, the situation is much more serious. He’s not even 35 and, earlier this year, his doctor informed him that his obesity has put him in a pre-diabetic state. His physician has outlined a long-term plan which, if followed, will not only reduce my friend’s chances of adult-onset diabetes, but may prevent serious heart problems as well as a whole host of other avoidable health problems.
There are no guarantees, because life just isn’t like that, BUT IF my friend sticks to his prescribed health plan, he will not only improve his physical well-being, but reduce the costs associated with his personal health care.
For a lot of us, including me, that’s a big “BUT IF.”
The thing that I find most irritating about the debate surrounding the Patient Protection and Affordable Care Act (ACA) is the persistence on the part of nearly everyone to call this reform effort “Obamacare.”
That term implies that Barak Obama and his administration were the first to come up with these reform ideas, which is, of course, completely untrue and an insult to the people who have dedicated themselves to finding alternatives to our failing health care system.
Our failing health care system. This is not my opinion.
Over the last two years, it has been my privilege to write about the health care industry for The Lane Report. I have interviewed leaders at Humana, CEOs of the major hospital chains, researchers at the Kentucky Medical Association and the Kentucky Hospital Association, and private physicians including the current President of the American Medical Association, Ardis Hoven, MD, who also happens to be a practicing physician at the University of Kentucky.
Each of them has said basically the same thing:
1. The ACA is a deeply flawed piece of legislation and elements of that act have got to be changed.
2. Despite its serious flaws, the ACA is an improvement over the current heath care system. That system cannot be sustained.
3. Change has to happen.
I believe them.
However, there is something about the way we approach health insurance in this country that has always confused me.
The ultimate goal of the reform effort has always been to drive down the cost of health care. The general argument, as I have understood it, is that people with insurance, or with Medicaid, are more likely to schedule annual check-ups with their primary care provider (or dentist or eye doctor.)
If more people are scheduling annual physicals, it increases the likelihood that a serious disease can be detected early and, therefore, treated with less costly procedures that also have a greater chance for long-term success.
Obviously, this approach doesn’t work for everyone. There will always be people who suffer serious injuries or contract a disease that resists treatment. That’s just the way life is. But a lot of the health problems we go through later in life are avoidable.
There are incentives worked into the ACA to encourage medical centers and physicians to reduce patient re-admissions to the hospital for the same illness. Most of the time, however, re-admissions occur because the patient failed to follow through with a recovery plan. When  that happens, the system punishes the providers and the hospitals. There is very little, besides our personal health, to hold us, the patient, accountable for taking care of ourselves.
The insurance I have on my car is designed to protect me and my passengers in the event of a catastrophe, such as the time four years ago when an uninsured driver ran a red light on Sixth Street in Lexington and totaled my beloved Camry.
My insurance carrier arranged for a rental and helped replace the car.
But I never consider for one second asking my mechanic to bill my auto insurance for a regular oil change.
I had to get the transmission fixed in my car recently. I can only imagine the look on my Farm Bureau rep’s face if I asked for money to buy a new transmission when I failed to take care of the old one.
But I do exactly that when it comes to my health insurance.
When it comes to the care and maintenance of ourselves, the relationship we have with our health insurance carrier is different from any other organization. I can think of no other service than health insurance where we not only ask the organization to help us in times of catastrophe, but to chip in on our regular maintenance as well.
A couple of weeks ago, both U.S. Rep. Andy Barr and Sen. Mitch McConnell stated that young working people didn’t want health insurance. I can’t speak for anyone else, but I have wanted health benefits from every job I held since the moment I graduated college. Maybe I’m different, but I suffered no delusions in my 20s and 30s that I was indestructible or impervious to disease.
Even a person of less than average intelligence understands that there are going to be health consequences if they spend decades smoking a pack of cigarettes a day, gain 75 to 80 to 120 additional pounds, and considered a double burger with cheese, Funyons, and an Ale-8 from the Apple Market as a regular dinner.
But rather than taking steps to avoid those health consequences, we have systems in place that are willing to pay the larger part of the financial consequences of our lousy habits.
And people can’t argue that these are personal decisions because every time a person ignores warning signs, fails to take tests to detect a disease early, and gets diagnosed for an advanced case of a disease that requires a massive investment to treat – those costs get passed down.
Say what you will about the European style of health care, if what my hostdaughters tell me is true, people have their care costs covered ONLY IF they can show they have been getting regular check ups and have complied with their health care provider’s prescribed health plans.
That’s an oversimplification, but I’m running out of space.
I suffer no delusions about the current impasse in Washington. I am cynical enough to believe that the objections of legislators are based less on public concerns for health care reform and more on the concerns of the health insurance industry.
But knowing myself and my health habits, and those of my friends, I actually have a bit of sympathy for the industry.
A bit.

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