Health Care Part 1: "At Anthem Blue Cross Life and Health Insurance Co., we offer full and fair consideration for our applicants"

So far, we’ve learned from this year’s presidential campaign that affordable health insurance is a big deal to most Americans. On the news there are stories about people driving 10-12 hours and staying outside all night to get an appointment with a traveling free clinic. Many of these are people who suspect they have breast cancer or diabetes but have gone without diagnosis, much less treatment, because they absolutely cannot afford it.

And we’ve also heard stories about horrible lapses in the hospital system, like the woman who lay writhing in pain and bleeding on the floor of a Los Angeles public hospital ER for 45 minutes, dying soon after from a perforated bowel (MSNBC). Senator Hillary Clinton had a good one for a while about the pregnant woman who was allegedly denied admittance to a hospital because she did not have health insurance (she actually did) and could not pay $100 (which actually wasn’t an admit fee, just an unpaid bill). Now, besides the fact that that ol’ Hillary didn’t check her facts, a practice so basic to journalism that even interns can be trusted to do it, the real tragedy of this story is that this woman and her baby died. More than that, it’s yet another vivid reminder of how the health insurance system in this country just doesn’t work for most people.

Many Americans are victims of the health care system but their stories don’t make the news. I’m one of them. Granted, my experiences are not nearly what others have faced, but they still illustrate some of the dysfunction, inefficiency and greed that are alive and well in our health care system.

Let’s start with the health insurance industry. Because I run my own business, I am one of many Californians currently seeking an individual health plan from Anthem Blue Cross, the 10,000 pound insurance gorilla out here whose decisions and policies are followed all of by the other individual insurers. If you didn’t already know this, it’s more difficult to get insurance if you’re not in an employee-sponsored group. According to a registered public health nurse I will call Mr. Ernst, this is because insuring a group of people lowers the odds that everyone you insure is going to get seriously ill. So right off the bat, individuals carry risky 1:1 odds. This makes health insurance companies much more wary of taking the gamble that you won’t get sick and they won’t have to pay much, which is all health insurance is really about anyways. Let’s be honest here-- as much as they deny it, these companies are in the business of saving themselves money. I gravely wonder if this is done “by any means necessary,” a concern regularly justified by sources in the news media, e.g. the Los Angeles Times.

I am in my early twenties, I’m an athlete (as you know), I’ve never broken a bone or had surgery, I’m not having babies anytime soon, so even for my age I’m healthy and in very good shape. You’d think I’d be low risk and fairly cheap in the eyes of Anthem Blue Cross, right? Wrong. I am apparently so high risk that my initial application and my “this is B.S.” appeal were both denied.

Here’s what’s so grievously wrong with me:

1. I possess prescription acne cream.

Whoa-- now this is a serious liability, even if half of all high school students probably have the same stuff in their medicine cabinets anyways. Apparently, it doesn’t matter that I only get them refilled every 5 years, just that I wrote it down. And if I wrote it down, it gets added to the list of ways I could cost money. Score 1 for Blue Cross.

2. Every six years, my jaw dislocates.

These dislocations are not the end of the world. I had a few episodes of it in high school and then, just my luck, one this January. More about that lovely experience later. But, despite how not fun this is, I don’t need surgery, I don’t wear a jaw brace and it’s just not an issue 99.9% of the time. Dislocating your jaw isn’t a walk in the park, but the worst that’s ever happened is me needing an IV muscle relaxant and a doctor to relocate my jaw at an hour when only the ERs are open. This ain’t no chronic heart condition.

Anthem BC considers these pre-existing conditions, a term usually applied to chronic illnesses that perpetually cost money like epilepsy, muscular sclerosis or Crone’s disease. That’s right—I’m in that pool. Sometimes I think the health insurance underwriters are actually untreated Attention Deficit Disorder patients, given how carefully they read my application. That’d work to Blue Cross’ advantage, eh? And maybe some healthy distraction while reading those applications will get you a nice Christmas bonus.

I put down every last doctor I’ve visited in the last ten years on my application, all the way back to a pediatrician who I visited for a sinus infection in ‘99. Why did I try so dearly to play by the rules? Because I read the L.A. Times; I know all about Blue Cross dropping people’s coverage when they get really sick, i.e. become expensive and the company says this is justified because the person “failed to disclose” that pertinent information on their application. Because, you know, there are all these people trying to abuse the benevolent health insurance companies.

I, for one, am truly beginning to understand why there’s a considerable movement for universal health care in this country. Many people contribute to or exacerbate their own health problems by not eating right, not exercising or going for check-ups, etc., but I did not cause this jaw condition. There’s just no way I could stop the problem from developing or reliably prevent my jaw from locking. And yet I’m being denied health insurance explicitly because of it, a fact Blue Cross clearly stated. Plus, if I do not get health insurance from a federal program and have a similar jaw locking episode, I’ll be getting a bill for $1400.

It seems that under this system it is okay to charge people at exorbitant rates for things that happen to them naturally. This would mean that some people are born into paying high health care costs and some people aren’t. There’s something definitely wrong with this picture. Isn’t segregation, in any form, supposed to be a huge no-no in our society? It’s completely unacceptable to segregate someone for being a certain race, gender, or anything else you’re born with and can’t change, right? Would we allow companies who earn profit from discriminating against Black people to grow into multibillion dollar industries?

It’s clear my experience brings up many controversial issues. For example, should people be denied health insurance for having ailments they cause? What about illnesses where we don’t know if or how much people are contributors? And yes, if you have universal health care it will let the people who mess up their own health off the hook.

Have we created a new -ism here?