I am not a "dog." That's what health insurance executives called me because I have a disease. I'm also not a "trainwreck," another term they used for members like me.
Soon after I was born in 1972, I was diagnosed with muscular dystrophy. By the time I was six years old, I was confined to a wheelchair. Doctors doubted I would survive, but I inherited my parents' determination, and I proved them wrong.
I was the first wheelchair-bound student "mainstreamed" in the schools of Broward County, Florida. I became a poster child for the Muscular Dystrophy Association and president of my high school class. I entered college in 1990 with plans to work in politics and patient advocacy, but at 19, I had a severe setback and I was confronted with a stark choice. My survival would require a machine to breathe and round-the-clock nursing care.
A breathing machine usually means life in a nursing facility. But my father's small business had health insurance from Guardian Life Insurance Co., which promised "Solutions for Life." The health policy had no lifetime benefit cap and covered home nursing care. Relying on that contract with a 149-year-old company, I decided to go on a mechanical ventilator for the rest of my life.
Since then, I've endured life-threatening medical complications and long hospitalizations. I've lost my privacy and ability to travel. But I never regretted my decision to live, to continue to learn and write, and to share in the lives of family and friends.
After decades of medical emergencies, we still weren't prepared for the latest crisis -- this one created by the same insurance company that once saved my life. Guardian abruptly withdrew our health plan from all policyholders in New York where my father's business is based. Guardian offered a 'replacement' plan with low benefits and no home nursing benefits. They knew that I would never survive with such a plan, but they didn't care.
Suspecting that this action was related to the high cost of my care, we filed a lawsuit and have asked the U.S. Department of Health and Human Services to enforce existing federal laws and require Guardian to continue my health plan. Without federal intervention, I will lose this insurance, and that would be a death sentence.
Our lawsuit uncovered insurance company documents that confirmed my suspicion that I'm a target of discrimination. The documents revealed Guardian had compiled a "hit list" of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as "dogs" and "trainwrecks," and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.
Although my medical costs constituted a minuscule fraction of Guardian's profits, the company had been trying for 15 years to sidestep its obligations to me. The insurer hired private investigators who searched in vain for evidence to justify canceling the policy. Guardian had similarly targeted the other "dogs" without success. Finally, Guardian launched the unprecedented strategy of withdrawing an established plan throughout an entire state in order to discontinue a few costly members.
When we checked the private insurance market to see my options, we discovered that benefits covering the care I need to survive are no longer available to small businesses. We learned that the insurance industry has replaced risk management with risk elimination, offering only benefits that guarantee permanent profitability. The human toll is not a factor in their calculations.
While all this was going on, Guardian reported $7.5 billion revenue, net income of $437 million, and available capital of $4.3 billion in 2008. Unlike small businesses, Guardian's financial strength remained unscathed by the economic downturn.
The health insurance industry remains unchecked, unaccountable and uninterested in the health needs of Americans. Nothing is more important than profit.
Don't think what happened to me was unusual. Insurance companies regard everyone as potential dogs and trainwrecks. They won't hesitate to use similar tactics to avoid your claims if someone in your family suffers a catastrophic illness. Insurers don't like it when sick people live too long and cost too much.
I know firsthand that America's health care system has the capacity to provide incomparable, life-saving care. But I am living proof that insurance-company "death squads" meeting behind closed doors routinely make life-sustaining benefits vanish.
Without stricter enforcement of existing laws and the creation of a public health insurance option to keep private insurers honest, it's only a matter of time before you or someone you love will become the next victim.
Now, while I truly feel that Ian Pearl and his family deserve the best care, I also feel that private insurance is not the way to go for them. Why not apply for Medicaid and/or Medicare? Disability like this would virtually guarantee state and federal benefits.
Another point I would like to make is that Guardian agreed to pay Mr. Pearl's medical care even though the product is not offered in NY any longer.
It is simply appalling. The only words I can think of are not suitable for children.
I cannot for the life of my understand why we don't outlaw privately held insurance companies who provide dental, medical, vision, and home owners insurance.
Why would we want to give ANY company the opportunity to make a profit on other peoples misfortunes? I mean com'on. I'm for capitalism but that's just nuts and inhumane.
I'm against the current health reforms because I'd be mandated to buy private insurance. For people like me it's cheaper not to have insurance -- but I'm mostly against it because of what your company has said about me. Knowing they'll do everything to make my life hell given what they think of me makes me not want to be forced into buying private insurance. And yet I'm not eligible for public anything. I'm surprised private insurance companies don't use their lobbying powers to force that, surely they don't want any more dogs... Then again I'd be paying them gooood money and they'd surely find a way not to cover me.
mark.finguerra@gmail.com
Also, how does one become a writer here? I too desire to get on the record about my experience with Guardian.
Although I am relatively healthy at the moment, I am 50 years old and anything can happen. The current health care system would certainly find a way to get rid of me as well. I feel as though I am one surgery away from having no health care, losing my job and losing my home. Some American dream huh?
Hang in there and I hope you win your lawsuit.
While we wait for a public option I'd like to see healthcare providers of every stripe break away from the insurance companies and offer services at affordable prices. It can be done. It's the way healthcare was provided for decades. I'm thinking of running an ad to see if I can find a physician willng to work with me.
Why should we need insurance to see a doctor, dentist or get our eyes examined? A woman who got dental help at a recent Remote Area Medical event said she didn't have dental insurance and couldn't afford to get her abcessed tooth treated. Why aren't there dentists and doctors willing to work with patients on a non-credit card payment plan?
I wish you well Mr. Pearl and hope our legislators and Congress have developed the spine to see you continue to recieve the medical benefits you need to survive.
As they pretend to debate and drag this out, people are dying and descending into abject poverty. The 30 Senators who voted against Sen. Franken's bill and in favor of corrupt coporations could not look up as they tried to defend their positions. In the case of ACORN they were loud and clear with their outrage. KBR has been bilking the Gov for years and not for a couple of million dollars, but Billions.
Pull the funding from KBR, shut down these two disasterous wars,and use those Trillions of dollars to take care of the taxpaying American citizens. There propblem solved.
May you live many more years. The world would be a lesser place without you.
Please keep us posted as to your situation. Your struggle is our struggle.
Sincerely JRT
Capitalism on "Main Street" practiced by small entrepenuers was at one time what made this country great. War has been declared on them and their destruction emminent by the huge conglomerates that strive to crush all "mom and pop" businesses. Capitalism has failed in that predatory monster corporations have been allowed to thrive unchecked by corrupt legislators who always have their hands out for "free" money and still not realizing they had to sell their souls for it.
Mr. Pearl's care is expensive. But doing everything we can to help Mr. Pearl along the way gives doctors experience and insight to help him and the next person -- that is, if the doctors are allowed to do what they think gets the best outcome instead of constantly doing what the insurers will allow. The way the insurance companies control medical practice actually impedes the advancement of medicine. In particular, they have incentives to avoid quality of life care altogether, and to avoid paying for life-extending care for people who would die without it. As a society, we benefit if people have better quality of life, if we are constantly honing quality-of-life-improving care (and technology), if people who would otherwise die are able to be productive, if we constantly improve life-saving medical care. Insurance companies benefit from obstructing it all.
Allowing Mr. Pearl to spend his time being as productive as possible -- instead of fighting insurers -- would also benefit our society, that is clear from his essay.
I'm sure their answer would be, "But that's different!" That much is obvious.
This needs to be on the front page of every newspaper in the country.
Bless you Ian and keep up the good fight.
There are many more caring people in this Country, than people like Mr. Manning and company.
If more people knew that these heartless insurance companies take such actions to deny coverage, they would demand change.
(Think of the most sarcastic, dry-witted person you know and imagine the above in that person's voice.)
If that is the case, then please contact your Republican representative and Senator as well, and demand they stop try to roadblock any and all attempts at reforming our current system.
Whether you find it unpleasant or not, your party leaders have embraced the role of defender of the status quo... a status quo that would make a cold, calculating business decision to terminate care for anyone that cuts into the bottom line.