#586 Musings Beyond the Bunker (Friday February 17)
Good morning,
Starting today with a remembrance…
REST IN PEACE RAQUEL
Raquel Welch died this week. I don’t think I gave much thought to her in decades. Learning of her death, however, brought a wave of memories of this iconic “sex symbol” and actress. While she acted in many movies and TV shows (she once auditioned to play Mary Ann in Gilligan’s Island!), I recall two most vividly. The first is One Million Years B.C. I don’t remember the plot at all, nor do I recall it being a particularly good film. But the “one sheet” for the movie of Raquel is unforgettable, arms by her sides, staring up in hope. That one sheet that became a poster on who-knows-how-many college dorm room walls!
The second movie is one that was, for many of us, a seminal film about a hopeful future in which seemingly anything was possible. In this first of many movies adapted from a Michael Crichton novel, the audience went on a journey through the human body. In the future, a technology was developed that could shrink human beings and their submarine, injecting them into a human body in order to attack an otherwise incurable tumor. The adventurers confront a series of biological “enemies” along the way. We haven’t learned how to navigate the systems of the human body as the intrepid travelers did in Fantastic Voyage, and never will. The movie, which came out in 1966, offered quite a tour of the wonders of the human body and highlighted the endless possibilities the future might hold. I suspect the timing of this story was not an accident, coming after the eradication of polio, the successes in fighting childhood diseases (yes, folks, there was a time we believed in vaccinations!) and other medical advances of the time.
As I continue to digress, many will recall that Disney got in on the action of shrinking people down in order to experience the microscopic world with the ride Monsanto's Adventures In Inner Space, where the current Star Tours ride is located. Some may also recall that it was one of the first “dark” rides at Disneyland, offering a cozy journey with one’s date…
As the celebrities from our childhood drop, one by one, we increasingly are reminded that we should treasure those who are still with us, as we also are reminded of our own mentality.
A SIMPLE SOLUTION TO AN IMPOSSIBLE PROBLEM?
A friend related to me that they had heard about the biggest, most elaborate, over-the-top dinner thrown at a convention. The host was a medical insurance company.
It is pretty clear to many of us that the insurance companies have manipulated their way over the years into the indispensible “middle men” in our sorry national healthcare industry. They have successfully orchestrated monopolies and oligopolies in most states, avoid having to compete for customers, and press doctors to accept payments that barely cover their expenses, all while being the ultimate arbiter of the acceptability of medical care.
Most insidious is that insurance companies have the power to approve or deny drugs, operations, and therapies that can save or prolong lives. Looking at the system from afar, it is absurd that licensed medical professionals caring for patients are bound to accept a third party looking over their shoulders to determine the efficacy of a particular treatment. The judgments are not based upon a particular patient or the physician’s long history of caring for that patient. Rather, the judgments are based upon some theoretical actuarial table and the cost of the treatment. The underlying assumption is that the physicians don’t know what’s best and their judgment cannot be individualized for the particular patient. Rather, a profit-making entity, always seeking to cut costs, will decide. The judgment of these insurance companies—judgments often made by people with no medical training—is near final. When they approve a payment, for which the insured must pay a deductible, or when they choose to apply only a portion of a deductible, it is seemingly done by fiat. Sure, an insured can appeal a decision, but it is a long, cumbersome process in which the insurance company is its own appeals court.
A number of election cycles ago there was a brouhaha about panels that would determine whether certain therapies might be eligible for Medicare coverage. The blowback was talk of “death panels” that would relegate us to premature death merely due to cost. Well, I have news for people—these death panels are alive and well, producing huge profits for insurance companies, while denying treatments that people’s own physicians judge necessary or advisable.
How insurance companies are allowed to be monopolists who decide the magnitude and the extent of medical coverage is beyond me. We would never allow a company to rate its own bonds. We would never allow a contractor to act as its own building inspector. And we shouldn’t allow insurance companies to decide what should be covered and what should not. The more times they deny coverage, the more profitable they become. Determining the efficacy of a doctor’s chosen course of action should be in the hands of medical professionals who are not part of a corporation invested in denying coverage. And the “close calls” should be decided in favor of the physician. After all, the presumption of professional expertise and decision-making should rest with those closest to the patient.
LET’S CALL OUT THE FLAW IN REASONING
It would seem there is a simple solution here. The insurance companies claim an interest in ensuring control of healthcare costs. They claim there are physicians prescribing drugs and procedures unnecessarily. Assuming these worthy goals, they can be achieved more easily and fairly. There should be third-party arbiters of these matters. Whether it is paid for by the government, the insureds, the insurance companies, or a combination of all three, the decision of determining insurance company responsibility to pay for procedures deemed medically necessary should be in the hands of professions whose primary duty is not to profit motive, but service to patients.
I CAN’T WAIT FOR THE GEICO COMMERCIALS FOR MEDICAL INSURANCE
While I suspect a single payer system ultimately is the right resolution, as is done in most European countries, I’m ready to accept the next best thing, which is creating an open market to sell insurance product. Companies should compete with each other, as they do for homeowner’s insurance or car insurance. Let’s let the competitive market determine the price to be paid for the risk being undertaken by the insurance companies.
WHY IT PROBABLY WON’T FLY
When presenting this idea to a friend, he indicated there was one fatal flaw in my reasoning and this idea. “It can’t work,” he said. “It won’t work because the lobbyists won’t allow it to happen.” And there, sadly, is a commentary about the inability to make even minimal progress on bringing healthcare costs in line and insurance benefits available to those who need them.
QUALITY OF LIFE AND ITS UNNECESSARY PROLONGATION
After writing about people’s right to receive no further care in their last days, a friend noted the distinction between long lives with purpose and those without:
“In some areas of health care, there have been remarkable advances that have extended lifespans without sacrificing quality of life. I am thinking of heart disease. My Dad, who never exercised and loved his (albeit lean) pastrami sandwiches, had bypass surgery and lived until 93 with a very high quality of life.
On the other hand, curing cancer is obviously a challenge. The spouse of a friend was diagnosed with pancreatic cancer, usually a death sentence, and became a vegan. He lived a relatively normal life for a few years.
To me the issue is quality of life especially if you believe that you have had a high quality of life prior to the ‘diagnosis.’ One time [I] visited a client in a nursing home. At that point he had dementia and, when we arrived, he was eating his liquified dinner of lamb and peas through a large straw. What was the point?”
Have a great day,
Glenn