About Health Care Reform?

Nancy-Ann DeParle is Counselor to the President and Director of the White House Office of Health Reform. Some call her the Health Reform Czar. We have never met.

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Nancy-Ann, may I speak frankly? Thank you.

You just have to realize that there will never be meaningful health care reform in America as long as we see disease as a profit center. It would be nice to think that the whole AIG disaster was an isolated incident. And I realize that their Accident and Health division was small potatoes when compared to the biggies like WellPoint and UnitedHealth Group. But it doesn’t take a rocket scientist to figure out the business model of any insurance company – medical, car, home; they are all the same: revenue comes in when subscribers pay premiums. Money leaves when the company pays out on claims – those are expenses. You increase profits by reducing expenses – by denying claims.

Now, Nancy-Ann, we don’t know each other. And I certainly don’t know your medical history or experiences, but if you are still clinging to the notion that insurances companies place subscriber's well-being above profits . . . Well, I’ve got this bridge up in Brooklyn you might be interested in. Nifty new infrastructure project. More coffee?

Anyhow, let me tell you a story. A few years ago I had some problems with my back. All of my doctors agreed that a kytoplasty was the ideal treatment for me, and BCBS routinely approved the procedure in cases like mine. Only this time they didn’t. Thereafter followed a few months of medical mumbo-jumbo while BCBS tried to explain why a previously excellent procedure was now questionable. I tried to involve both my senators, Dole and Burr, in the dialogue. Their offices sent me nice little notes saying that this wasn’t their job. Finally, my congressional representative, David Price, intervened and miraculously my case was reassessed and the procedure approved. Unfortunately, my back had deteriorated further and a more invasive vertebroplasty had to be done.

I’m assuming you see the irony, Nancy-Ann. The tipping point was political, not medical. BCBS had obviously decided that this very effective procedure was simply too expensive so they made the business decision to deny the claims calling for the procedure despite its medical efficacy. My doc was able to place the time fairly precisely when kytoplasty went from a routine "yes" to a routine "no." I just raised such a fuss that they gave in – in one case. No doubt they still routinely deny the procedure increasing the pain and suffering of subscribers whose health they are supposedly guarding.

So the way I see it is that we are caught between endemic corporate greed and a past history of governmental incompetence. Even I am not wild about putting my health care in the hands of the folks who spend 800.00 dollars for toilet seats, build multi-million dollar bridges to nowhere, and spend billions of dollars and thousands of lives purging the Middle East of “highly illusive” weapons of mass destruction.

A solution? Would that I had one, dear lady. But I can suggest a few starting points. Any system needs to put medical decisions back into the hands of doctors and patients engaged in dialogue. I am blessed with a doctor who is also a friend. We talk about my issues. He then becomes my advocate to the increasingly complex network of providers necessary to affect my care. All my docs spent a lot of effort trying to turn BCBS on my back issue. The fact that only political pressure moved BCBS demonstrates why an insurance company, whose entire profit structure rests on withholding care, should never determine a patient’s course of treatment.

Balancing that rational decision-making process needs to be a method for controlling costs. I’m sure Big Pharma can explain in great detail why two identical pills separated by an imaginary line – let’s call it the US /Canadian border – vary vastly in price. The same “imaginary line phenomenon” can be observed between a bottle of aspirin purchased at WalMart and two aspirin dispensed at a hospital emergency room. Until the smoke and mirrors surrounding cost are banished, consumers will always assumed they are being gouged – even when they aren’t.

Finally, you need to put a plan in place that is user-friendly. Details are admittedly not my strong suit. But I do have a Ph.D and spend much of my life reading and writing with an eye toward clarity. Still, I probably spend 20 to 30 hours a month engaged in filing paperwork directly related to insurance companies. The stress and irritation is incredible as I fax a copy of a doctor’s bill to the administrators of my flexible medical spending account to prove to them that I am not stealing my money from me for purchases that my doctor says I need but are not covered by BCBS. Free Americans from the unpaid drudgery of that mandatory second job and we might well see domestic productivity skyrocket!

So that’s where I am on health care reform, Nancy-Ann. Thanks for listening. Oh, by the way, I love what you’ve done with the place.