THE BLOG

American Healthcare: Frustration, Being Surgically Implanted

06/29/2007 04:07 pm ET | Updated Nov 17, 2011

Every time I drive by a billboard for United Healthcare that says, "Frustration, being surgically removed," I wonder if they're being sarcastic. My employer pays through the nose to cover my family with United Healthcare, and it's considered one of the more comprehensive plans. But they still work really hard to deny coverage. Last week my newborn came down with thrush. When I tried to get a refill of the prescription to treat him, the pharmacy told me that it was too soon to get a refill -- it could only be refilled after 15 days, even though the supply that they gave me the first time was only enough for 7.5 days. It was simple math: at the dosage they prescribed, the bottle would only last half as long as the insurance company seemed to think it should. It took about 10 phone calls to the insurance company, the doctor, the pharmacy, the insurance again, the pharmacy again, the insurance again, each time explaining the arithmetic, before I was able to obtain the refill. The prescription cost United Healthcare $9.99. The wages of the people I had to wrangle with over the phone probably cost them more than that, given all of the times I had to call.

I don't remember ever having such problems when I lived in Canada. I showed my card, got treatment, and that was it. Preventive care was available, and even encouraged. A single-payer system can reap the benefits of preventive care, since it reduces overall costs. One might think that private health insurance companies could also reap savings from paying for prevention but that's not true. They don't cover a large enough population to benefit from the overall improvements in health gleaned from providing more preventive measures like regular physicals. And they are able to deny coverage to those with existing conditions, which reduces the cost to them of chronic health problems and debilitating diseases. When everyone has to be covered, as in a universal single-payer system, existing conditions can't be excluded and that means the system has to cover them. There's no downside to allowing people access to low-cost drugs like my son's prescription. But what saves private insurance companies money? Denying coverage. So much for the "culture of life."

I haven't seen SiCKO yet, but I'm looking forward to it.