BUCKSPORT — As both physician and patient, and child of an academic physician who was deeply involved in American health care system planning, I have a long-term insider perspective. We have a miraculous, world-class, but flawed medical care system, particularly in insurance coverage. Many of the frustrating inefficiencies of our present system could easily be fixed with a little common sense.

But if Mr. So-Called trashes Medicare, and/or the Affordable Care Act, and triggers a “winner takes all” monopoly capitalism financial stampede in private health insurance, we will all experience a total community health care meltdown. It would affect most of our friends and neighbors, even if we personally can somehow scrape through our own emergencies. Lifetime health care payment caps and denial of coverage for pre-existing conditions will hurt the most vulnerable. Is breast cancer a pre-existing condition after decades of progressively abnormal mutations, when it finally evolves to become metastatic?

“Insurance” is not spending $5 to compensate someone from the vanishingly small risk that a $200 package is lost in the mail, and guarantee huge profits for someone. Insurance is meant to protect all American families from overwhelming fear of arbitrarily losing everything they have worked their whole lives for – to protect the American Dream we all grew up with.

That has happened many thousands of times as people all over America have exceeded arbitrary yearly and lifetime caps on their health insurance after they contracted an expensive or chronic medical condition, such as cancer, diabetes, heart disease or multiple sclerosis through no fault of their own. Thankfully, the Maine Legislature outlawed such behavior in this state in 2010, when it passed L.D. 1620, “An Act to Protect Health Care Consumers From Catastrophic Debt.”

I was terrified! It was Feb. 3, 2010, and I was officially testifying in favor of L.D. 1620 on behalf of the Maine Medical Association, and very confident that Maine Physicians for Social Responsibility and the Maine Chapter of the American College of Emergency Physicians also totally supported my testimony.

I told legislators that I’d undergone a heart transplant after catching a virus on the job in the Eastern Maine Medical Center ER, and had just spent a terrifying month trying to deal with my insurance company, which was telling me I might have reached such a lifetime maximum cap on my health care coverage.

I suddenly couldn’t get so-called “prior approval” for one of my life-saving miracle medications, though I had gotten many other reauthorizations with only one error. I couldn’t get through to anyone in “customer care” at my giant national “insurance” company who would tell me anything I needed to know to sort the problem out.

I couldn’t get a call back from my supposed hospital case manager, if I even had one. I got dumped from answering machine to answering machine with no return calls. I was told that I “did” and that I “did not” have insurance within five minutes, by two different people trying to put me off. I got the same inverted answers regarding my wife.

My pharmacist couldn’t get through for “prior authorization” for my life-saving medication, and my “benefits office” couldn’t get through to begin to get any answers. I could not get any help from the “practitioners” at Brigham and Women’s Hospital in Boston, who had assured me they had gotten “prior approval” for a $24,000 cardiac catheterization.

The procedure involved five or six people’s time for less than two hours, a few hundred dollars of medical supplies and a huge machine that took X-ray pictures of my heart. It was certainly worth a few thousand dollars, but I then got a full bill with a threatening invoice, obviously derived from the chargemaster.

I suspect that few reading this know what a “chargemaster” is. It is a secret book of fantasy “Medical Charges from Hell” that hospitals invent, official rates that are generally about three times the negotiated rates with insurance companies. It is secreted off campus and can be reviewed only with special permission. It is used to plea-bargain innocent Americans into paying financially lethal charges, while slowly bleeding out their families’ life savings.

No hardworking American, particularly our wounded or mentally disturbed combat veterans, should ever die homeless or without health care denied by “death panels.” I am sure I speak for most of the 100,000-plus patients I have been responsible for, many of them at the worst times of their lives, perhaps even for the majority of owners and executives of insurance companies – and their lawyers.

One thing is absolutely for sure: Americans should not be subject to arbitrary death by disease, death by neglect, death by bureaucracy or death by lawyer.

 

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