Sorry Virginia, Insurance companies aren't Santa

It was the best of times, it was the worst of times..... It was the Christmas season and I was at a holiday gathering at one of my husband's work friends. I had finished working a 12-hour shift in the Pediatric ICU. I changed into something festive and was looking forward to a little break.

I didn't want to think about how much busier our unit would soon be after yet another local hospital shut down. You see, a huge insurance company had bought up a bunch of hospitals and was busy trying to make them more efficient. After about 18 months, they stated in the press that the costs were too high, and they had to close more hospitals because there just weren't enough funds to cover the cost of providing care. I thought I understood, I mean after all, MRIs, CAT scans and surgeries are expensive, but I wondered about the numbers of people paying their premiums and where all that money went. Boy was I surprised when I found out.

I'd been at the holiday party for about a half hour when I discovered that my husband's friend was married to one of the insurance company executives. Soon after, I heard him laughing when someone asked if the hospital closing meant that his wife would also be looking for a job."

"Are you kidding me?" he asked with a wide grin. "They all just got their holiday bonuses. Her check was for $60,000.00, and that's on top of the quarterly bonuses they all got. She'll be just fine. We're going to take the kids sailing in the Caribbean."

I was stunned. I felt like the 8 year old, who just heard from an older cousin that not only was there no Santa Claus, but I was an idiot to ever believe in the first place.

I'm not usually speechless, because I'm used to working in life and death situations, but I felt like I had the wind knocked out of me. That feeling lasted about a minute, but then the ICU nurse in me, the one with attitude, spoke up.

"Let me see if I get this straight," I asked, "You mean that Insurance company X doesn't have enough money to provide care to the people who've paid their premiums, but there's more than enough for bonuses for executives who close hospitals so those same people are left out in the cold. Is that what you're saying?"

And this was his answer, "Wake up. That's how the real world works." Then he asked me what I did for a living, which is when the real fireworks began.

I learned a lot that evening. I learned another lesson in human nature. At the hospital, I was privileged and honored to see the best in people. People who devoted their lives to perfecting pediatric heart transplants, and others who made certain that children could walk without a limp or live without pain.

I was around a lot of heroes, and in my naiveté, I forgot that while there are many who are in the business of helping people, there are others who are only in the business of helping themselves and lining their own pockets. Even if it hurts the folks they're supposed to be serving.

And that, Virginia, is the real truth.

 

 

Comments

[sociocanuck]

I have tons of respect for you, as someone who has had tons of experience (more than I wish to relate in numbers) in Intensive Care Units and other wards.

In Canada, though. It's worlds different.

[newtonma]

What my dear friend Ms. Dehn fails to mention is that this incident happened somewhere in the 1980s.

In the ‘80s I worked for one of the Big 8 accounting firms. Common practice then was for the audit team to have lavish post-audit dinner, which was billed to the client with a markup. Today I sit on the other side, the client side. Common practice now is be prepared for the client to scrutinize expense, and only bill those agreed to in advance and are defensible. Times change.

While in the hospital one night, I had troubles falling to sleep. Luckily I was awake when the night nurse came in and tried to give me the medication prescribed for the woman with a heart condition in the next bed. After a considerable discussion, the nurse checked the charts and realized her mistake. What should I conclude about nurses based on this experience? That they are incompetent? The answer is I should not conclude anything. It was one incident with one nurse. Generalizations are dangerous.

In no way am I defending insurance companies. I simple do not have enough facts to defend them. Nor do I have the facts to assume that all insurance executives fall into the bucket Ms. Dehn describes. I’m simply asking that we not rely on one incident that happened many years ago as the basis of our opinions on insurance companies and their executives.

Who knows, Virginia, maybe their really is a Santa Claus.

[TheIndependenceParty]

A Bad nurse can hurt only one patient at a time. A bad insurance executive, ... issuing a bad policy, ... can harm hundreds, whose faces she will never see.

It is caled scalability.

[cheeriogirl]

Try again, as this effort on your part was an epic fail. I am a health care professional as well. Insurance company executives do rob us ALL blind, by collecting huge premiums, while avoiding paying out claims in a proportional manner; many times simply denying coverage altogether!

Newtonma, don't pee on my leg and tell me its raining. I am much too intelligent for that, as are MOST Americans. We NEED and WANT health insurance reform in this country. G od be with us and our leaders as we try and work this out for the good of ALL of our citizens.

[PackyJ]

Ah, so it happened in the '80's," and of course, things are MUCH different now!

The lack of coverage is more egregious, and the bonuses are bigger.

[Oldchef]

Heck, my health care coverage in the '80s was fine. However by the 90s and especially after 2001, premiums were more than 3 times higher and denials many more times prevalent, until, after recovering from a bout with cancer, my premiums were too high, more than 1/2 of my take-home pay.
Seems to me things got even worse after the '80s so your post is disingenuous and misleading. The fact is, things are many times worse now.

[DannyDanson]

Sorry to inform you, but you are protecting insurance companies, I have worked in the Insurance industry and unfortunately this is the prevalent culture that I observed, the amount of waste and profit margins of these companies are unbelievable.

For example the company I worked for, whom I will not formally mention (cough...UHC) was audited and fined upwards of 2 million dollars for one employee violating HIPPA guidelines in regards to multiple customers, and there was no recourse, no write-up, no re-training requirements, and not even a slap on the wrist, this was common and happened every quarter, the company used claims data to steer members into coordinated care programs, sort of like internal tele-marketing marketing practices, the industry understands that for at risk members, coordinated care saves them in the long run, this is the exact same thing Obama speaks of in the the "Medical Best Practices and comparitive effectivness Council" The company realizes that this is the only way to control cost, and the fines pale in comparison to the savings they gain by passing health information between depts, the problem is that they only do it for chronically ill and costly members, when everyone could benefit from it, if you can lose 2 million and shrug it off like 2 dollars that's a symptom of a larger problem, this is about profit not efficiency period, healthcare is no important to be private only just like education

[mamalisa38]

For profit health insurance is immoral. The only way to maximize profits, and that's what Wall Street demands, is to raise premiums and deductibles and deny claims.

For American's to continue paying billions of dollars a year for obscene salaries, bonuses, perks and profits is unconscionable.

I never thought our elected officials would work so hard to destroy something that would help every single American. But, then again, why wouldn't they? They take millions of dollars from these companies. We arrest street walkers for taking far less than these clowns do.

Shame on them for putting money before the lives of their fellow human beings.

Single payer is the only answer to our health care crisis.

[longtalldrink]

So of course all those bonuses go poof if we had single payer or a civilized society. Because what I'm seeing is far from civilization. Our country does not care about its citizens. We do not want health care for all because some di*ks want to take their kids sailboating?

[cheeriogirl]

I think you've summed it up nicely.

[Egghead]

Good for you!

It burns me up when people lecture me on "the real world" when they're trying to make that real world as crummy as possible.

[silverball]

...great "inside" story and perspectiv­e....singl­e payer is what we really need...more WE, THE PEOPLE kind of governance...