Thus Spake Zuska

I have a friend. She has a daughter. While in college, the daughter was covered on the parents’ health insurance policy.

Well, sorta. As part of her college program, the daughter had to do an internship. Hey, that’s great! Great experience, maybe a great chance to get a permanent job! Except, as it turns out, the internship does not count as being a full time student for the purposes of health insurance.

My friends, being responsible parents, and additionally being parents with enough disposable income to afford it, took out a health insurance policy for their daughter. They thought they were doing the right and responsible thing for her. They did not want her to be without coverage should some unexpected and catastrophic event befall her (you know, like some sick fuck walks in to your fitness club….)

Well, as it turns out, they could have just saved their cash. My friend’s daughter was unfortunately stricken with a completely unexpected, though non-life-threatening, medical condition. You might think this is the kind of thing that your health insurance would help you deal with, but you would be wrong.

The coverage my friends were able to purchase for their daughter was a 180 day policy. The terms of the policy required that, if they wanted to “renew” it, in effect, they had to reapply for it all over again. At which time, the insurance company was free to take into account any “pre-existing conditions” as a cause for denying coverage. “Pre-existing conditions”, in this case, included any conditions for which the policy holder sought treatment for during the 180 days of coverage for which they had paid for.

Does this not seem, shall we say, somewhat vaguely Kafka-esque????? Or is “vaguely” being too polite?

I will sell you insurance coverage, with the option to “renew” said insurance coverage. If, however, you actually use your insurance during the time of paid insurance coverage, any condition for which you use the insurance coverage, can be used as a pre-existing condition for which we will deny you insurance coverage. Thank you, and please make out the rather large check to “Fuck You Very Much Insurance Company of America”.

Even auto insurance companies just raise your premiums if you have the audacity to make a claim on your auto insurance – they don’t just tell you to piss off and have a good life.

But hey, let’s not go all SOCIALIST and all, and insist that young people ought to have health insurance, or that we ought to get picky with health insurance companies about their pre-existing conditions requirements. I mean, they need to make profits and all! And what could be more important? What are you, some kind of socialist commie librul???


  1. #1 Lab Rat
    August 27, 2009

    This is why I love the NHS. OK it’s slow sometimes, and frustratingly beurocratic sometimes but at least it’s *there*. if something goes wrong, you don’t have to be rich, or lucky, or under the right what-the-hell-ever plan, so just have to find some way of stumbling into a hospital.

  2. #2 Kat
    August 27, 2009

    I am young and thankfully healthy – I was unlucky enough to fall over while out running, but I am lucky enough to live in the UK. I am extremely grateful to the NHS for stitching my wound, for giving me enough dressings to take home, for free painkillers, and also for taking the stitches out again. Also in the past six months, my housemate has had a broken ankle set in plaster, and is now receiving regular physiotherapy – all on the NHS. It’s not “free” (I pay taxes for it) and it’s not perfect. But every time I read your posts I am thankful to live in a country with socialised healthcare – it sounds like a never-ending nightmare.

  3. #3 DRK
    August 27, 2009

    We purchased a high-deductible catastrophic health insurance policy for my young, fit, nonsmoking son after college, which turned out to be a good thing the day he suddenly developed spontaneous pneumothorax and had to have surgery. Because the kid had well-off parents, waking up with a collapsed lung did not land him with tens of thousand of dollars worth of medical bills. But what of the post college people without family resources? If a generation of twenty-to sixty somethings puts off needed health care because their jobs, if they’re lucky enough to have them, do not come with health insurance, what happens to their long-term life expectancy? All these old people on Medicare railing against socialized medicine (while benefiting hugely from it) –who do they think is going to pay for their Medicare if the younger people are too sick and unhealthy to work?

  4. #4 SharonC
    August 27, 2009

    I am forever grateful that we have the NHS. It’s not perfect, but the vast majority of treatments needed are covered. We don’t have to negotiate with insurance companies. We don’t even know what the terms “co-pay” or “deductible” mean.

  5. #5 kt
    August 27, 2009

    I went to high school with this young woman, who just passed away…

    Short version: had no insurance or insurance with a high deductible, didn’t go to doctor because of cost, ended up having cancer, fought to qualify for state aid when unemployed due to said cancer, died at age 27.

  6. #6 Nico
    August 27, 2009

    I love my canadian universal care. for less in tax per month than the average american private premium, my health care coverage has been uninterrupted, non pre existing, non rationed and quite expedient. It’s saved the lives,( cancer, chrohns, a brain abcess and a friend with long standing liver issues, hardly sniffles.) and jobs of many close friends. I have freedom to pick a GP, a specialist, and I never have to worry. When we get pregnant or sick, our medical care system covers us, from the start, to mat leave and rehabilitation for injuries.

    We may not have the flashiest hospitals ( kids hospitals aside)but we do a very good job, providing efficient, affordable care.

    If I had to move, I wouldn’t dream of living anywhere that doesn’t do this for citizens.

    I have asthma and over my years ( much less so in the last decade)i racked up over 300 hospitalizations and ER visits, and never once did my mom have a worry over how to afford this. I wouldn’t BE here were it not for our system.

  7. #7 Erik
    August 28, 2009

    I agree, there is something comforting in being watched over by an ever present government regulated health system. It would also be nice if the government provided us with food, housing, and employment. It would be wonderful if I never had to worry about these life-essential necessities again. The question is whether or not this is the best way to organize a society? Is this the most efficient way, the most cost-effective, the most sustainable way? I don’t think it is. The reason the costs of our wonderfully advancing technologies is continually falling is because of competition, innovation, and consumer choice. With a less prominent role of government and less interference and regulation on its part, I think medical costs will naturally fall.

  8. #8 Dorothy
    August 28, 2009

    Here are a case where no insurance will help !

  9. #9 natural cynic
    August 28, 2009

    The reason the costs of our wonderfully advancing technologies is continually falling is because of competition, innovation, and consumer choice.

    Electronics? yes. Health care? Wake up!

    With a less prominent role of government and less interference and regulation on its part, I think medical costs will naturally fall.

    In the country with the least government “interference” in health care, the costs are, by far, the highest. Gee, that does not seem to fit in with your libertard ideas.

  10. #10 Schlupp
    August 28, 2009

    Erik, the usual axioms that make markets effective are not fulfilled in health care, because one partner is not in a position to rationally choose the best option. On account of being ill and possibly in pain. So we end up with one side in the bargain much more powerful than the other and exactly what makes markets effective on most circumstance is switched off.

  11. #11 Nico
    August 28, 2009

    Erik: My government doesn’t ensure we all have food, they do provide low income housing ( well, some), and I don’t feel babysat or coddled or watched over.

    I do feel an element of security in knowing whatever job I take, I’m covered, or lack of, as is the case at the moment. While working, I’m not tied to immmense insurance payments, and so I can turn that income to education, food, or whatever strikes my fancy.

    In a couple weeks I’ll return to working, but the spectre of health insurance is not there.

    Since more and more US employers don’t offer it, or keep staff below the FT mark for providing it, well, I’m not sure how workable a situation this is going to be long term.

    I am free to work, provide for myself, I’ve yet to understand how it is I’m not free. If I chose to smoke and drink and live off sticks of butter, and wrestle bears, I’d still be covered. Someone MIGHT have a discussion about my lifestyle choice with me in that case, but any medical care as a result is still covered.

    Government doesn’t dictate here what I eat, do, think. They do provide efficient, affordable healthcare, with the underlying hope we use it smartly. Most of us do. A vast majority do.

    No one has been able to enlighten me as a canadian how it is I’m not “free”, or in control. Truth be said, my government has very little direct influence in my life.

  12. #12 Dr. Kate
    August 28, 2009

    “With a less prominent role of government and less interference and regulation on its part, I think medical costs will naturally fall.”

    You are entitled to your opinion; if you want to think that a company whose sole goal is making as much profit as possible is going to ever reduce costs, that’s fine. However, if you’d like to convince anyone else that your ideas have merit, you will need to provide that pesky little thing called evidence.

    US healthcare regulations have, as far as I understand, actually gotten FEWER in the last several decades. Still waiting for those “naturally falling” medical costs you believe in.

  13. #13 cass_m
    August 28, 2009

    While in my late 20s, I had 3 illnesses requiring surgery. Due to the universal health care available in Canada, the only thing I had to worry about was arranging the time off with my employer. And yes I did get a second opinion and choose doctors.

    We have extra coverage supplied by our employer and I am quite happy not to rely on it. In spite of getting less and less benefits and higher deductibles, our premiums keep going up. And we have the lower end coverage.

  14. #14 llewelly
    August 28, 2009

    I’ll repeat (more or less )what I wrote over on Ed Brayton’s blog:

    When the waiter at your favorite lunch spot, the cashier at your regular gas station, or the poor children your kids play with at school catches an infectious disease, you and your loved ones are promptly at risk, regardless of how much choice your health insurance grants you, or how good it is for the economy, or whether or not it is socialist.

    For every infectious disease which has been defeated or controlled in any significant region, the successful strategy relied on protecting everyone. Not just the wealthy, or those with good jobs, or whatever – but everyone. Polio, smallpox, measles, mumps, rubella, whooping cough, malaria – all of them – proved to be most vulnerable to strategies that sought to protect everyone.

    Universal care is what works. Anything else is a half-assed failure. Health care only for those who can afford it amounts to denialism of the germ theory of disease.

  15. #15 Size
    August 29, 2009

    I guess I’ll just never understand the “argument from inefficiency” (to coin a rhetorical phrase?). I keep hearing people claim that government-run health care will be as bureaucratic as the much-dreaded post office! (Not to mention that I, personally, have always found the USPS service to be outstanding, but never mind)

    How many of Zuska’s posts about health care insurance does a body have to read before realizing that America already has an incredibly bad health care bureaucracy? One based around granting access rather than denying it can only be an improvement!

    I think part of the problem is that there are just too many people working for large corporations, state gov’ts, etc. which have used group insurance to get the “just show your card and you’re taken care of”, which is great for them, but there is no impetus to improve things for anyone else, and they probably don’t realize what a headache health care is for anyone who doesn’t have one of these sweet deals.

  16. #16 Julia
    September 3, 2009

    Ugh, this is so evil and infuriating! People have the nerve to bash the NHS for limitations and beaurocracy, as though dealing with HMOs weren’t a nightmare of forms and waiting lists and claim denials, for patients and for doctors alike. (On the last point, docs in the US hire full-time office staff just to fill out insurance claims, because one uncrossed T renders their reimbursment forms invalid. Don’t think doctors are getting a great break here, either. My dad had a hernia operation, and his general surgeon was a family friend. He’s got US Federal government health insurance, so his operation was covered, but he got the forty page bill and was appalled to find that after the tens of thousands of dollars billed, the surgeon saw a grand total of about $1000 dollars for the six hours he was on the operating table with complications. My mom had to stop him from writing the surgeon a personal check.)
    Furthermore, the pre-existing conditions bullshit is what stops my mother from changing from the ridiculously stressful and overworking job she has to one with more reasonable hours and duties for a woman over sixty – because since she is a breast cancer survivor, there is no way she’d be able to afford or even qualify for a new insurance plan.
    And then there’s the issue of preventative medicine saving countless lives and treatment-dollars, e.g. regular dental cleanings ($100 a pop) versus emergency root canals ($8000), mammograms and colonoscopies versus late-stage tumors, yearly bloodwork versus untreated diabetes, etc.
    The system is not just broken, it’s FUCKED.

  17. #17 anon
    September 5, 2009

    “… the surgeon saw a grand total of about $1000 dollars for the six hours he was on the operating table with complications…”

    Wow, poor surgeon. That was only miserable $166.67/hour.

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