It’s a clinical name for an extraordinarily inhumane part of the health insurance system, one in which insurers dump someone retroactively from their rolls just when that person’s health needs are greatest.
It happened, reports Joanne Silberner of National Public Radio, to Jesus Gutierrez. the owner and chef of a Reno, Nev., mom and pop restaurant. He and his wife were paying $970 a month for a family health insurance policy. But when their infant daughter had surgery for a cleft palate, their insurer denied the medical bills. The reason: Their insurer called the condition pre-existing. They were left owing $98,000.
A Texas woman, Silberner reports, had her coverage by Blue Cross of Texas cancelled two days before a scheduled mastectomy. The ostensible reason: she had failed to inform her insurer of a pre-existing condition — acne.
And there are more cases — tens of thousands more.
Just how many in total, no one really knows. But in Congressional hearings last year, three large insurers acknowledged they had cancelled 20,000 policies retroactively within a five-year period, Silberner reports. Some of the people dropped from insurers’ rolls did intentionally mislead them. But others were dumped on a technicality; insurers look for legal ways to eliminate people from their rolls when they have the nerve to actually get sick.
It’s sort of like leaving someone bleeding beside the road because it’ll be too expensive to call an ambulance.
Rescission may be the most gruesome practice of the travesty we call health insurance. It even may be, as Silberner suggests, one practice that Republicans as well as Democrats are willing to end. But is that enough? Closing one loophole without requiring broader-based participation in insurance plans leaves the system with one of its biggest pitfalls: When only the more infirm buy health insurance, rates and care are more costly for all who are covered. Meanwhile those without coverage clog emergency rooms when something bad does happen — and the cost of their care in turn ultimately is passed on to those footing the insurance bill.
It’s a bad system and it’s going to get worse if Congress doesn’t act now, something the news media are slowly starting to understand.
Perhaps you are unconvinced. You think your health care plan is bulletproof, that you don’t need to worry about becoming the next Jesus Gutierrez, that you have better things to worry about than those unfortunate enough to choose poorly. It’s time to think again.
1. Another huge loophole in U.S. health care is insurers’ unwillingness to cover pre-existing health conditions. Let’s say a member of your family develops diabetes or a rarer condition — Parkinson’s disease, perhaps, or multiple sclerosis. If that happened, you can forget about changing jobs. And you’ll be cooked if for some reason you lose a job and — under the American system — your insurance with it. Why? Because U.S. health insurers are not required to cover “pre-existing conditions.” Good luck finding new coverage.
2. The number of uninsured Americans continues to grow. At last count it was 49 million people. Again, when these people get sick, someone ultimately gets passed the bill they can’t pay. That someone would be the insured. Without change, The New York Times reports in an article titled “The Cost of Doing Nothing,” the ranks of the uninsured will continue to swell. One estimate The Times’ cited suggests as many as 66 million Americans could be uninsured by the end of this decade.
3. Standing pat, economists of both political parties agree, isn’t an option. Health care costs are escalating — and have been — at a rate that far outpaces inflation. Typical family coverage now runs $13,000 a year, The Times reports. That could nearly double by this decade’s end, according to another estimate cited. And even if employers cover much of the increase, they are likely to siphon the money to do so from a pool set aside for raises.
Should you doubt The Times’ reporting, consider that the average proposed health insurance premium increase by California’s largest health insurer this year is 25 percent. Those paying for their own insurance are facing hikes of 39 percent from Anthem Blue Cross. Wow.
Reports The New York Times:
Health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.
“People think if we do, nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. “In fact what we will have is a substantial deterioration in what we have.”
Oh, and in case I forgot to mention this, more people will die as a result, more bleeding neighbors by the side of the road. Ron Pollack, the executive director of Families USA, a consumer advocacy group that The Times notes favors the Democrats’ plan, estimates that as many as 275,000 people “will die prematurely over the next 10 years because they don’t have insurance.”
But you don’t have to believe this figure to support health care reform. If you’re cold-hearted or merely highly skeptical, consider it this way. Leaving the insurance system unchanged isn’t just immoral. It’s bad economics, too, nationally and personally.