The latest faux outrage in the debate over health care reform has to do with the terrible way President Barack Obama has treated doctors. Over the weekend, Fox News Sunday commenter Bill Kristol declared that Obama was "an arrogant man" who feels "entitled to pass judgment on Cambridge cops or pediatricians." That all tied back to a comment Obama had made about doctors' judgments during last week's prime time presser:
So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out. Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies, maybe they have something else that would make a difference.
According to Fox News's Bret Baier, that made some doctors angried-up something terrible! He told Robert Gibbs, "I've talked to a lot of doctors who were offended by that language. One sent an e-mail that said, 'To think I spent forty years training and borrowed $150,000 to become a doctor so I can take out a kid's tonsils because it's good for my bottom line is demeaning. I'm appalled.'"
I know! How dare anyone suggest that the Hippocratic Oath has been in any way trumped by the profit motives, right? I guess Obama will have to spend the August recess having beers with doctors, putting everyone's liver at risk!
But Obama's tonsilectomy example aside, the most distressing way in which our supposedly "best health care in the world" gets truly bare knuckled with regards to profit motives lies not in cases where unnecessary treatments were provided, but where necessary treatments were withheld. And on this week's edition of This American Life, entitled "Fine Print," the show does an excellent job penetrating this story in ways that aren't going to come to life in a presidential press conference.
In the segment, TAL takes on insurance applications with language so obscure and difficult to follow that their entire basis for existence seems predicated on the notion that applicants will make enough of the right sorts of mistakes so as to later make it easier to withhold treatment or deny coverage. The episode can be downloaded here, and the segment begins at about the thirty-six minute mark. The segment describes a couple of health care horror stories, including a woman whose previous acne condition was cited as the basis for denying her cancer treatment. Talk about demeaning things that appall!
In addition, James Kwak, at the Baseline Scenario, has a good post up on both this TAL segment and the underlying issues that will really add value to the listen and is heartily recommended. Kwak asserts that This American Life's segment proves that "they can cover any topic they want better than anyone else in the media." For my money, I think Kwak himself has added value to the segment by deftly connecting the issue of health insurance rescission to the financial mess:
This reminded me of nothing so much as all of those "innovations" created by credit card companies, such as universal default, penalty rates, and double-cycle billing, which are really just ways to generate fees that you are unlikely to accurately estimate at the time you sign up for the card. It's legal; it makes more money for the insurer (or credit card issuer); once one company does it, other companies have to, or they won't be able to compete; it's disclosed in such a way that customers don't understand what they are getting into; it nails you when can least afford it; and it even has a plausible economic justification. Credit card issuers claim that their arsenal of hidden fees makes the cost of credit more closely reflect the riskiness of the borrower, and without the fees they would have to charge higher interest to everyone; health insurers claim that rescission is necessary to deter fraudulent applications, and presumably without it they would have to charge higher premiums to everyone.
The devil, as they say, is in the details.