‘Health care reform?’ Hush! You’ll anger the Insurance Gods!

By BRAD WARTHEN
EDITORIAL PAGE EDITOR
EVERYWHERE YOU GO in South Carolina, if there is a presidential candidate nearby (and they do seem to be everywhere), you’ll see people in red T-shirts that say “Divided We Fail.”
    That’s the AARP’s way of drawing the candidates’, and everyone else’s, attention to the organization’s belief that “All Americans should have access to affordable health care, including prescription drugs, and these costs should not burden future generations.”
    You’ve heard about how one in seven Americans, or some such awful number, has no health insurance. But I’m not here to talk about that. Today, I’m talking about the other six of us who have coverage. If routine — not even catastrophic, but routine — health care is “affordable” for those of us with insurance, then somebody redefined the word while my brain was imploding from trying to figure out which health plan to pick for next year.
    As AARP’s Web site notes, “Whether we have good health benefits or not, it seems that insurance premiums, deductibles, and co-payments always seem to rise faster than our paychecks.”
    Not that I’m complaining! I love my benefits, and I love the job that provides me with them — love it love it love it. I’ll never, ever leave it, or even threaten to. I will pay no attention to that same AARP article when it moans that “Too many Americans are locked into jobs or stopped from opening their own businesses because of worries about affording or maintaining health insurance.” Hah! “Opening their own businesses?” I’ll let the saps who don’t have families and think they’ll never get sick engage in such crazy entrepreneurial tricks as that.
    To complain about our health insurance is to risk offending the Insurance Gods, and their ways are mysterious and terrifying.
    Just the other day I went to my allergist’s office to get the results of my first skin tests in 20 years. I’d been getting allergy shots based on the old tests all that time, and my allergist, being a highly trained professional, thought it might be a good idea to see if I was still allergic to the same stuff. Actually, I can’t tell you for sure that the shots ever helped. So why get them? Because my insurance pays for allergy shots, but won’t pay any more for me to take Zyrtec, which I know relieved my symptoms. The Insurance Gods say I don’t need Zyrtec.
    Anyway, at the end of my visit I went to pay my $50 copay, and the lady at the counter — one of those ladies who is neither a doctor nor a nurse, but one of the army of priestesses every doctor employs to perform arcane rituals all day aimed at appeasing the Insurance Gods — told me that I had a credit on my account, so today I only had to pay $17.45 cents. Timidly, I asked why I had a credit when I hadn’t paid anything lately. She shrugged and said she and her colleagues never ask, because no one understands why insurance does what it does.
    But ... come a little closer so I can say this softly... there are times when the Insurance Gods are not so kind. For instance:
    Earlier this year, after surgery worked only briefly to relieve head-pounding sinus pain, my surgeon gave me a prescription for Allegra. I started to protest adding yet another drug to the 11 I was already taking, counting the prednisone he was putting me on, but then he said it was the generic version, so I said OK. My copay is only like $10 on generics; the Insurance Gods say generics are good.
    Then my pharmacy said my copay for my 30 generic pills would be $81.95. Stunned, I asked why? They shrugged and said no one knew; the Insurance Gods just said so. I shut up and paid it, even though it meant delaying paying on my mortgage or my electricity bill or some other frill. I think the pills helped, but I certainly wasn’t going to get a refill.
    I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and copays. My premiums in the coming year — we’re going to a new plan — will be $274.42 on every biweekly check, not counting dental or vision care. And I’m lucky to have it. I know that, compared to most, I’ve got a sweet deal!
    I’m in the top income quintile in the U.S. population, and we can’t afford cable TV, we’ve never taken a European vacation or done anything crazy like that, we haven’t bought a new car since 1986, and aside from the 401(k) I can’t touch until I retire (if I can ever afford to retire), we have no savings.
    Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital.
    Speaking of hospitals, I recently heard Mike Biediger, CEO of Lexington Medical Center, marveling that when he started in the business, health care soaked up 7 percent of the U.S. economy, and no one thought it could go higher. Now, he said, it’s 16 percent, and climbing.
    That’s why so many physicians and corporate CEOs who once would have bellowed in rage at the sound of “socialized medicine” now believe we’ve got to do something as a nation to get this mess under control. So we’re going to do something, right? Don’t bet on it. What I’ve seen from presidential candidates thus far seems very timid, and disturbingly deferential toward the Insurance Gods (who once got very angry at one of them), and the Big Pharma Gods as well.
    Mr. Biediger pointed me to a recent piece in the New England Journal of Medicine that explained that “no matter how much momentum it seems to have, no matter how many signs point to change, there is nothing inevitable about health care reform in the United States. In U.S. health policy, the status quo is deeply entrenched and, despite all its failings, the system is remarkably resistant to change, in part because many constituencies profit from it.”
    And there’s not a lot we can do about it — except maybe get one of those red T-shirts, and show up every time a presidential candidate comes to town. They’ve got boxes full of them at AARP headquarters, and they’ll give you one for free.