Monday, September 21, 2009

Death Panels? Yes, The Insurance Companies

I got a phone call from my oldest friend yesterday. We've been friends since nursery school, stayed best friends in grade school, high school, college and beyond. We were the kind of friends that had hundreds of "in jokes" and we passed notes and talked on the phone more than we should have, and drove our parents crazy.

We survived Mrs. Nemchek's geometry class together. We liked the same music. Neither of us were the "popular" girls, but we didn't want to be. We marched to our own drummer. We had each other, and we made each other laugh and we were always there for each other without reservation. We got a kick out of the fact that people would routinely ask us if we were sisters, when we looked absolutely nothing alike.

So, it wasn't unusual to get a call from her. There are times when we talk every other day. Sometimes we seem to go for weeks without a call, but we're always there in spirit.
"I need to tell you something," she said. I wasn't sure whether this was going to be good or bad, but "I need to tell you something" is always important. "I went to the doctor, and there's something wrong with my heart."
I wasn't expecting that one.

My friend has had a series of health problems -- a bad car accident resulting in two painful spinal surgeries, asthma, a breast cancer scare, but this was different. Her matter-of-fact tone quickly dissolved into tears of fear and vulnerability. "I can't believe this. I'm only 43!" This wasn't supposed to happen.

After her breast cancer scare, the doctor recommended a preventative regimen of tamoxifen, a drug which would help ward off the risk of cancer that her condition indicated might be a problem. But before they started her on the potent drug, they wanted to make sure she had a good healthy heart. A family history of heart disease put her in a high risk group, so the cardiologist insisted on a stress test.

She's been living through multiple problems with her insurance provider, Horizon Blue Cross/Blue Shield, so she wasn't surprised when they refused to pay for the test. She was surprised when the doctor decided to call the insurance company himself. He explained why it was important, and that he felt very strongly and in no uncertain terms that it needed to be done. They still refused to pay for the test. And then the cardiologist did an amazing thing. Outraged at the insurance company, he said that he would pay for the test himself, out of his own pocket. It was important, too important to cow to the insurance company representative whose job it was to deny claims just to increase the profits for the company.

My friend wasn't even able to complete the stress test. After a few minutes on the treadmill, they stopped it and wouldn't allow her to continue. Shortness of breath. Chest pain. She'd been experiencing these symptoms lately. She was mowing the lawn this week, and had to stop half way through because she couldn't catch her breath. She chalked it off to asthma. But it was, in fact, a coronary blockage that was keeping one of the chambers of her heart from getting enough oxygen.

So, instead of starting a regimen of tamoxifen next week, she will be getting a stent in her heart tomorrow. She's home right now, trying to "do nothing," and trying not to get too stressed out by the thought that she'll be in surgery in just a few hours, and never even knew anything was wrong.

If her insurance company had gotten its way, she would never have had that test. The next time she was out mowing the lawn, it could have killed her. "He saved my life," she said, just as I was thinking the same thing. Yes, doctors are in the business of saving lives from disease, and illness and injury, but they shouldn't have to be in the business of saving lives from business. "He saved my life from the insurance company, she continued. "The insurance company... there's your Death Panel."

I didn't even ask her his name, but I'm grateful to that cardiologist in the kind of way it's difficult to express in words. He saved a wonderful, beautiful life. But how many people are not so lucky? A recent study found out that 45,000 people every year die because they are uninsured. And each one of those 45,000 has a story, too. They are someone's husband, or wife, or parent, or best friend since nursery school.

But my friend has health insurance. She pays $600 every month for it, and yet her coverage denied a test that saved her life. How many fully-insured Americans die every year because we allow the insurance industry to be a for-profit enterprise, making money off of people's lives? How many die because our current system says that the money made for salaries and bonuses for insurance company executives is more important than they are? More important than your mother. More important than your son. More important than my friend. How long will we accept the harsh reality that the insurance company looks at human beings and sees nothing but a spreadsheet?
"We need a revolution in the health care industry," my friend agreed. "We should not allow them to profit from our own illness."

Until then, if you have insurance, get in line. Because whatever you are paying them, it's only a matter of time before your number is up, and it's you or someone you love that gets to stand in front of the Death Panel and plead your case. And guess what? They'd much rather pay politicians than pay to save your life.

It's cheaper.

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