health and (Un)WElfare

I have just been to see the movie “Sicko” by Michael Moore and a more frightening movie I can not name at this moment. Thank god I live above the 39th parallel! I have always known that the American health system was not the same as ours, known that they pay for many services we do not. However in this movie, an admittedly biased portrait, it paints a picture where health care is for profit and if you don’t pay, then you die and if you do pay then you probably die too. The HMO’s as they are called find every hint of a reason they can to deny giving you health insurance, find more reasons not to pay your claim and even more reasons to reverse the claim and collect back the payout.

Now supposing you have the cash, then you can have the very best, most modern, mosyt up to the minute care that your money can buy. MRI,s xray’s surgeries, anything you like can be purchased for enough cash. However if you are a working middle class (is there such a thing anymore?) who may need Interferon to forestall the onslaught of cancer well that’s probably considered too experimental and won’t be covered by your HMO, and so you must sell your house, car and dog to get it. Can’t raise the cash? Oh I am sorry, please go away then and suffer quietly as we wouldn’t want you to disturb the other patients.

In one scene of this film a man is given a choice between two fingers (previously cut of by an accident with a saw), he can reattach the middle finger for a price of $60000 or the ring finger for $12000. In another we see a woman who had been at an HMO hospital being let out (pushed out?) of a cab in front of a Mission building, still in her hospital robes carrying a plastic bags with her clothes in it. She was dumped there by the hospital because she couldn’t pay the bill. In yet another scene we listen as a mother describes going to a hospital with her colicky baby, finding out her HMO won’t pay for the treatment and subsequently begging the hospital staff to treat her baby as they steadfastly refuse suggesting she go to a different and more distant (HMO) hospital. By the time she gets to this alternate hospital, all is too late and the baby passes away.

What sort of system, what sort of person can possibly put a price on health? On basic human care? How can it be that any system, any group of people can deny services, delay services, even dump people on the sidewalk for lack of a dollar? It’s just unfathomable!

All is not rosy up here of course, our system is not perfect. We frequently have to wait long months for elective surgeries, my dental plan at work does not cover all my dental costs and I have never been to an emergency room and failed to wait less than an hour to be seen. Oh yes there one time, I had shattered my elbow in a fall, got driven to a hospital and was seen within minutes of arrival. No one asked me about my HMO, my cash flow or my credit card. Several operations later, after rehab physio and many doctors’ visits my arm is quite healthy. It didn’t cost me a hundred grand, my house, my car or anything in fact. OHIP, the Ontario Health Insurance Plan covered the bill.

In a similar situation about 10 years ago now, my wife was diagnosed with breast cancer and required a mastectomy. Well after many many doctors visits, a number of operations, extended hospital stays and a ton of medicines my wife is cancer free and has lived for many years and will for many more. The bill? Naught.
I have traveled to the US many times, never once thought overly much about health insurance or problems I might have (health related) during my stay there. Driven to Florida, flown to Denver, Las Vegas and San Francisco, never with a thought or worry about health and health insurance. Those days have evaporated forever with the viewing of this film. I will have to consider very carefully any trip made south of the border very carefully, purchase bullet proof medical insurance guaranteed to cover me during my stay, check and insure that my health is excellent with no hidden, sleeping health concerns. Even then you are at risk, a fall, a traffic accident, even a cut from glass or some other accident could cost many thousands of dollars.

Speaking of insurance, here’s the kicker, is the “Blue Cross”, “Aetna” ro other health/travel insurance I purchase here a Canadian company or a subsidiary of the big American health insurance companies? If it is the former I may have some hope of getting an insurance claim should I need it (although I am no fool and fully realize that no insurance company wants to pay claims) while if it is the latter I can expect to (almost) never get an insurance claim paid and possibly even be denied the life saving services I may need. It seems that these HMO insurance conglomerates have thought this out very carefully to maximize profits (in the billions) and minimize payouts. You see they can claim that you had a pre-existing condition, that the treatments are experimental, cosmetic or discounted for some other reason, that you did not correctly authorize, notarize and sign the consent forms (even though you were unconscious at the time) and thereby deny your claim. Even when none of these apply, they can claim the “Prudent Person Pre-existing Condition” clause which states that if you had some pre-existing condition but didn’t go to a doctor to have it diagnosed (because it cost too much?) as some prudent person would have, then your claim is disqualified.

So my lasting impression from this movie is that if you live in the US (or visit) and you have had anything (flu, mumps, measles, cold, yeast infection) then you don’t qualify for health insurance, if you do get health insurance but you have ever had an unhealthy day in your life, then they won’t pay your claim and if you have no insurance, oh well. In any case only money (and lots of it) will buy you any standard of health care.

Now if you’ll excuse me, I have to run my latest prescription down to Costco for filling, should cost me about $5 at most as my medical plan at work covers the rest of the cost (no forms, no claims, no waiting).


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