This column is not for the squeamish. There have been "death squads" in American health care now for over twenty-five years. I can bear witness to them.
I bear witness to a mother from the heartland seeing post-mortem pictures of her deceased eighteen- year- old son, who repeatedly sought hospitalization for his depression. Denied access to the hospital by his managed health care program, he eventually gave up, sat down in the bathtub and blew his brains out.
I bear witness to a mother of two young children who kept a journal of her pathetic pain- wracked efforts to find appropriate care for her depression through her managed care network. When she gave up hope and could no longer stand the pain, she took her father-in- law's shotgun, checked into a local motel, and shot herself to death leaving the children and a loving husband behind.
I bear witness to a young adolescent boy who told the facility where he was hospitalized that he was still very suicidal. He was discharged anyway because his managed care company refused to pay for more care. His father found him early one morning lying dead on the roof top of their home from a gunshot wound. The father now sleeps in the boy's small bed every day and has been unable to work. The mother has been treated with electric shock treatment, a last ditch effort to treat her depression.
I bear witness to a mother who went psychotic after her child was paralyzed at a school shooting. The mother was discharged prematurely from the hospital by her managed care company, bought a shotgun which she loaded right in the store, and shot herself in the head, leaving the family, already struggling with one tragedy, to face yet another horror.
I bear witness to a thirteen-year- old boy who was having difficulty coping with the death of his father. After engaging in some very high risk behavior he was hospitalized. On the first day of his hospitalization his psychiatrist and treatment team wrote a two-week inpatient treatment plan for him. On the very next day the same psychiatrist wrote in the treatment record that the boy had to be discharged immediately because he did not meet the managed health care's criteria for inpatient care. Ten days later the boy took his mother's car and crashed it into a concrete embankment splitting the car in half killing him instantly.
As a psychologist and lawyer these vignettes are all based on actual cases of people I have represented in courtrooms across America. I have seen a lot of human suffering, but there is nothing more oppressively heart-wrenching than an adolescent suicide in its effect on a family. And there is nothing more forlorn than a young child who has just lost his or her mother trying to hide their terror and make do with Daddy and Grandma, each of whom is struggling with their own devastating loss of wife and daughter.
I can list many more cases just like these, each with their own special horror. They are all people who were covered by private insurance managed care plans, as are most privately insured Americans. None of them were uninsured Americans.
There is just one fact Americans need to know about our current health care system. Private health insurance companies make more money if they don't provide care than if they do provide care. That is the most important difference between private health insurance and government run health insurance. Private health insurance companies are in a financial conflict of interest with their insureds. Government run plans are not.
This is the issue in health care reform, and it is what Democrats should be saying to the American people. It is not a complicated message to get across if all Democrats can stay on message repeating it like we hear Republicans and Fox News repeating their own mantras.
Of course, as we know, most Americans "like" their health insurance company. They will continue to like it until they need costly care. Only then will they find out, too late, that their insurance company has created a complex system of deception that lets them deny care that their insureds believed was covered in their policy.
For example, they will discover the insurance company defines "medical necessity," a reasonable sounding prerequisite to approval for treatment, in a way that is quite different from the way the medical community would have defined it. They will learn that the term "medical necessity" is just a contrivance of the insurance industry, a phrase that is a sleight of hand that lets the insurance company decide what care to give and what care not to give regardless of what benefits are listed in the policy.
Ironically, the term "medical necessity" preempts even their doctor's recommended treatment. If the doctor's recommendation does not comport with the managed care company's "medical necessity guidelines, the insurance does not cover. It is only when people are most vulnerable and least able to do battle with the insurance company that they discover where the real "death squads" are.
And how could a private system like the one we have now not lead to the results I have described above? It's the capitalist system working as it should. Maximize profits through holding down costs. The best way to hold down costs is deny care to sick people.
Oh, c'mon you say. If they do that and people die, the insurance companies will get sued. Not so. These are the cases the American public has been told are "frivolous lawsuits," leading to state "tort reform" that now make it very difficult for the average person to file litigation when they have been injured by corporate America including insurance companies. In addition, for many of the victims of managed health care abuse in particular, the Federal ERISA statute preempts state laws and provides no meaningful remedy for the managed care victims. In short, the financial incentives say don't treat and if the patient dies, in most cases, there is no legal consequence.
This is the problem with health care today. This is where most Americans are vulnerable and "underinsured.". Unfortunately, they don't understand it. And Democrats either do not understand it, or they are afraid to say it.
I am inclined to think they do not understand it and have not witnessed what I have witnessed. Otherwise they would not be promoting the "preexisting condition" issue as the major rationale for health care insurance reform. They tell the American people we need health insurance reform because they might "lose their coverage if they have preexisting conditions." But people who already have coverage typically do not "lose it" if they develop a health care condition. For the vast majority of Americans who already have health insurance, this preexisting coverage issue is an irrelevant powder puff counter-attack to the bogey man of government run health care raised by opponents of meaningful health care reform.
The preexisting condition problem is a serious one for people who are precluded from coverage because of pre-existing conditions. It does not affect enough people to counter the Republican scare tactic of "government run health care." Furthermore, we already tried to correct the preexisting condition problem in 1996 in the HIPAA legislation. The truth is because of self-selection issues you really cannot "fix" the preexisting condition problem in a private health care system.
What Democrats must do is help people understand that there are real death squads in their health care today. They do not "pull the plug on Granny" only because Granny is covered by the government's Medicare plan. Instead, they attack people in the prime of their lives, often people who are still very young. They attack people who are insured by the private sector.
If Health Care Reform does not end this system in which the decision maker is in a financial conflict of interest with the person needing the care, it is a failure.
I have born witness to this system for twenty-five years, and it is disgusting.
Bryant Welch is a clinical psychologist and attorney and is the author of State of Confusion: Political Manipulation and the Assault on the American Mind (St. Martins Press, 2008)