Monday, March 29, 2010

Insanity from the world of health insurance

Here's some insanity from the world of health insurance: a couple who can't afford insurance for themselves, but who buys it for their children, is told by the company they can't buy insurance for their unborn child until he is born. Then, when he's born with a heart defect, they tell the couple their son can't be insured--because he has a preexisting condition:

At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.

Instantly, Doug Tracy knew something was wrong with his son.

"He wasn't turning pink fast enough," Tracy said. "When they listened to his chest, they realized he had an issue."

That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.

Surgery would correct it, but within days of Houston's birth March 15, Tracy learned that his application for health insurance to cover his son had been denied. The reason: a pre-existing condition.

"How can he have a pre-existing condition if the baby didn't exist until now?" Tracy asked.

New federal legislation that will prevent insurance companies from denying children coverage based on a pre-existing condition comes too late for the Tracys. The legislation, passed by Congress and signed by President Barack Obama this week, won't go into effect until September.

But Houston, who is hospitalized at Cook Children's Medical Center in Fort Worth, needs coverage now.

Of course, little Houston did indeed exist before he was born, but our pro-abortion laws don't recognize his existence as a person before his birth. Luckily, he has had the life-saving surgery he needed, but it won't be paid for by insurance, and thus far he has continued to be denied coverage.

This story does highlight one of the major problems with insurance--yet the fix may end up being worse than the cure. Since the new law is supposed to prevent people with preexisting conditions from being denied coverage, there's no incentive for people to buy coverage until they need it--and the insurance model depends on healthy people paying into the pool to minimize the costs of those who need expensive treatments, surgeries, etc.

I'm not one of those people who thinks that the government's expanded role in health insurance is going to be as helpful as people hope it will. But I'm also not one of those who thinks that things were perfect as they were. The insanity of denying an unborn child coverage only to insist that his heart defect present at birth is a "preexisting condition" is hard to fathom, yet the twisted and strange world of health insurance contains many such irrationalities. The worst thing is that adding an overlay of government bureaucracy to these already serpentine rules and regulations may end up doing worse than no good--yet it's clear that reform, sensible, targeted reform, was needed a long time ago.


Anonymous said...

This is an absolute travesty! However, I do have to point out that had he been born in Canada, or any of the other 32 countries with some form of universal healthcare, we would not be seeing this kind of drama play out.

Thankfully the young lad received the surgery and has an excellent chance of full recovery. None of that thanks, however, should go to the insurance company.

Anonymous said...

Frankly, I am glad to hear people are outraged about this extreme example of 'pre-existing' conditions. It happens all the time in different forms. People interested in nit-pickity details and who's to blame merely thought the 'victim' should be 'blamed' under the current system, and were quite ready to dismiss involvement in any government support of righting a wrong perpetuated by the private megalomanic insurance industry.

I was under the impression that healthy people would be required to purchase insurance in establishing new programs. It is one of the underlying tenets of 'insurance', otherwise the matter would be that of any other healthcare purveyance--many people had discounted the idea of a 'government' option.

Call the new plan whatever one wills, a country-wide group-purchasing plan with clout to provide health care in sickness and health; a Medicare for those of us under the age of 65, whatever.

It was never 'right' that the benign tumor requiring intensive surgery with NO sequelae when I was 17 should prevent me from obtaining costly insurance when I was by myself, nor impact the take-home pay I could provide for my family!


Rebecca said...

I agree that things have been a mess, and I don't see that increasing central gov't control will seems to me that the insurance companies doing things like convincing hospitals to require doctors to have malpractice insurance are what has mainly contributed to the massive inflation of costs and then the need for everyone to buy insurance for ordinary care. Insurance used to be about catastrophic circumstances, but now people can't afford even ordinary care.

Red, I wonder if you have any thoughts about these Christian sharing plans, such as Samaritan ministries, which aren't strictly insurance. The members pay a certain amount per month and pledge to help one another with medical costs when necessary, and nothing like contraception or abortion is covered. Apparently this is an exception to the individual mandate of the health care bill, so you could do this instead of insurance.

Siarlys Jenkins said...

How sad that our congress dithered and dallied for over a year getting a rathern ungainly health care reform bill together, then finally passed what was politically expedient (i.e. enough votes could be cobbled together) rather than what was thoughtful, flexible, and best for the patients. If it had been done right, done swiftly, and done without thought for political expediency or earmarked reservations, perhaps this child would already be protected.

It also seems that a challenge could be made on the ground that if the child wasn't eligible for insurance prior to birth, then delivery in such a condition is part and parcel of his mother's pregnancy, and if she's covered, so is this operation. It would be worth asking an attorney if they could make it stick.

Catholic Momma said...

Okay, if his parents would have had insurance, the baby would have been covered. They didn't seek insurance until after his birth. While terrible, it's hardly fair that people don't want to pay into a system until they need the benefits.