Insurance industry puts money over logic

Published 10:27 pm Saturday, October 2, 2010

The so-called “Obamacare” may be the classic case of the cure being worse than the sickness, but it is hard to dispute that the current status quo of the health insurance industry is indicative of a system on life support.

The problems seem to arise when the bottom line becomes more powerful than common sense, when profit trumps logic.

Let me share a couple of recent examples with you.

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An individual I know went to a local family physician for a general checkup for the first time in several years.

Although he was in relatively good health the doctor wanted to check cholesterol, blood pressure, glucose and other general indicators of health or potential problems.

This individual had a good, middle-of-the-road health plan by a national provider.

Although it did pay for the bulk of the office visit, several hundred dollars in screenings were considered not-covered expenses. But upon further investigation it was revealed that this plan covers hospital stays and large portions of surgical procedures.

Say what? Yeah, that makes sense. The insurance company will shell out thousands of dollars to treat someone who is already sick but cannot spend a few hundred bucks for a little preventative care.

No wonder these geniuses have to charge exorbitant premiums just to make a profit.

Now, maybe there is more to it than I am aware of. Maybe my friend could have jumped through more paperwork hoops or put some mystical voodoo spell on the claim. but how many people would know to do this?

Here’s another example with a different friend.

This guy is a pretty good-sized fellow, likely looking at 350 in the rear-view mirror. His weight has caused or contributed to a variety of health problems over the years.

After a recent illness, he was ready to breakdown and go under the proverbial knife. Lap band and gastric bypass were both considered options.

Not so fast.

Apparently his particular insurance company, under the current plan, has determined that these are cosmetic or elective procedures.

Seriously? The goal wasn’t to look good in a Speedo but rather ensure that a quality and healthy life was maintained.

But that same insurance plan will happily pay for weeks of hospital stays, costing tens of thousands of dollars.

Of course this varies from case to case and depends on several variables.

The bottom line is that insurance companies seem to have lost their way.

The focus on making the almighty dollar has overtaken the desire to help those in need, while still making a reasonable profit.

“Obamacare” is scary because there are so many facets of the reform that are not fully understood and the long-term ramifications have not been truly analyzed.

Sadly, it may be the best solution because it will force changes in the insurance industry and in health care.

Now we just have to hope that the “solution” doesn’t become worse than the “problem.”

Michael Caldwell is publisher of The Tribune. To reach him, call (740) 532-1445 ext. 24 or by e-mail at mike.caldwell@irontontribune.com.