Whether the mandate stands or falls and takes the healthcare law with it, one thing that will not change is the fact that many Americans will remain dependent on insurance companies for how they pay for their healthcare.
Doctor Stewart Segal provides a healthy reminder about why this is not an ideal situation, and recounts the experience that two of his patients had attempting to get healthcare that is affordable for their chronic problems:
Patient #1 must stop taking the medication that is controlling his neurogenic pain. Pain produced by a malfunctioning nerve can be extremely severe. Patient #1 must go on an older version of his current medication. In its day, gabapentin was a good medication. Unfortunately, doses capable of relieving significant pain made people groggy. Patient #1 can save money and be groggy, suffer with pain, or pay out of pocket. I assume the insurer is betting that Patient #1 can’t afford to be groggy (he is employed and has a life to live) and will pay out of pocket rather than suffer in pain!
Patient #2 has a truly horrible history of heart disease. His cholesterol profile is just as horrible. He is on a high dose statin (for the control of HDL and LDL) and still has markedly elevated triglycerides (another dangerous fat in his blood stream). He has taken over-the-counter fish oil to no avail. His insurer denied my request for Lovaza, an FDA approved medication for the treatment of his disorder. In this case, there is no generic nor similar medication. There are other generic medications that treat high triglycerides, but they all have the potential to adversely interact with his statin. Patient #2 can either pay out of pocket for his Lovasa or risk a ride in an ambulance or hearse.
…As your doctor, I can only do so much. My staff fills out seemingly endless forms, only to get denials. As a patient, you have multiple recourses. Most patients fear insurers and will not challenge them. They simply pay up. Others go to their HR department and fight. Those who are self insured should contact their agents or brokers and fight for the right not to fail. Brokers make their living selling insurance and, when their livelihood is challenged, can accomplish what doctors and patients cannot.
Until the public demands value for their money, insurers will continue their plunder. Take control of your health. Do everything you can to maintain your body. It’s yours for a lifetime. The healthier you are, the less you will need insurers and medications.
A lot has been said about the 'onerous' infringement of liberty that takes place when people are forced to purchase insurance. Less has been said about how the practices of insurance companies themselves are hardly the most liberty-enhancing ones in the world.
