If we are to believe a report by Lisa Girion in today's Los Angeles Times, the battle for health care reform is now being pursued energetically on two fronts, both of which involve questionable, if not abusive, practices within the health insurance industry:
New York Atty. Gen. Andrew Cuomo said the nation's largest health insurers have rigged rates they pay for physician visits, leaving patients with higher medical bills.
In Los Angeles, City Atty. Rocky Delgadillo has assembled a team of investigators and prosecutors to probe industry practices such as canceling patients' coverage after they get sick. Today he is set to unveil a first-of-its-kind website to solicit information about insurance cancellations and delays and denials of treatment.
The announcements follow a yearlong string of fines and citations against insurers in California. Just last month, amid widening state probes, state Insurance Commissioner Steve Poizner decided to seek as much as $1.3 billion in penalties from Cypress-based PacifiCare as a result of widespread claim problems.
"Our healthcare system is broken, and it's going to take a team effort to fix it," Delgadillo said. "Through our combined efforts, and the efforts of other prosecutors throughout this nation, we can make a real difference in stamping out fraud and abuse, and secure for American consumers the protection they deserve."
This is a step in the right direction, particularly in light of the commitment of our country's Constitution to "promote the General Welfare." At the very least it reminds us that, where health care is concerned (as I have previously observed), every American citizen deserves the same quality of treatment that is offered to every member of Congress. However, if we pay too much attention to only one of the players that puts business interests ahead of health interests, we may lose sight of a very disheartening big picture.
In reviewing David Rieff's memoir of the death of his mother, Susan Sontag, Diane Johnson and John F. Murray used The New York Review to bring to light what may be the most "inconvenient truth" about the very nature of health:
Sontag's [highly expensive medical] experience reminds us that today, exactly as in centuries past, the most powerful determinant of health—whether measured in life expectancy, maternal mortality, childhood survival, or the incidence of tuberculosis—is wealth: the rich always fare better than the poor, even in countries where—unlike the United States—there are high-quality health care services available to everyone.
I see this as a reflection of a point I made about a week ago that the very nature of health derives as much (if not more so) from proper maintenance as it does from quality treatment of maladies. In light of the current efforts in New York and California, this raises the question of whether or not providing adequate (or incentivizing) reimbursement for acts of health maintenance (such as regular check-ups) is as important as providing adequate coverage for treatment procedures. As I observed last week, this is a difficult question to confront in a society that sees actions easily regarded as paternalistic as a threat to personal freedoms. However, it becomes even more difficult when we consider the poor.
Consider the role of diet in health maintenance. Not only to we get lots of information about the connection; but also we see large chains like Safeway putting more emphasis of stocking their shelves and bins with "healthy alternatives." The only problem is that those "healthy alternatives" almost always cost more; or, viewed from the other end of the telescope, the affordable offerings are less likely to be the healthy ones. This is important to a family that has to figure out how much it can afford to spend on food each week and still pay the rent. It is all very well and good to talk about providing incentives for better health maintenance; but what good will those incentives do if they are "off the radar" of the day-to-day problems faced by the poor?
Thus, the real "inconvenient truth" is that the battle over health care may turn into yet another front in that ongoing war against the poor that continues to rage with so much energy. This makes salvos such as a $25,000 chocolate sundae or an entire floor of Saks Fifth Avenue for designer shoes look relatively petty, because the reform of health care will ultimately be a matter of playing with the lives of those poor who have been deprived by circumstance of playing for themselves. Yet we still do not hear very much about the poor in either the rhetoric or the actions of health care reform. It is certainly hard to see any consideration for the poor in our Government's approach to "economic stimulus;" so why should we expect them to get better recognition where their health is concerned?