Wednesday, August 8, 2007

Maybe they should call it SICK insurance...

Much in the same way that life insurance isn't really life insurance--it's death insurance (but who wants to buy something called that?)--what we call health insurance is really sick insurance.

Case in point:
This morning I was reading an article in the AAP (American Academy of Pediatrics) News describing new obesity guidelines to be published later this year. Truthfully, there was little groundbreaking in this article: treat obesity as a chronic disease condition, assess if the family perceives a problem, encourage a sensible diet and one hour of exercise daily (that last one is a little surprising, and potentially problematic: yes, it's recommended, but how many obese kids will do that much? I fear many will hear of such a lofty goal and fuggedabudit. I know I don't have time to exercise an hour a day...though I admit I should...)

The guidelines will also recommend checking up on obese kids every few months. Ah-hah, I thought, another ivory-tower academic recommendation, out of touch with the real world. Who will pay for these visits? Many insurers specifically do not cover office visits that have a diagnosis of "obesity." That's a lot of free care they're expecting us to write off.

Well, just a few paragraphs later, my concerns about ivory-tower recommendations were (partially) rebuked. The article went on to say that insurers need to start paying for visits related to obesity. It added that many insurers do not pay for obesity because they feel it does not directly cause health problems.

To put it mildly, pshaw. That's no different from saying that high cholesterol does not directly cause illness. The association between cholesterol and heart disease is pretty well established--granted, not in the course of days, but certainly over years. (I guess I missed that episode of E.R. where the man came in with a hypercholesterolemic crisis..."get me niacin, NOW, and some statins, STAT!") Let's see an insurer just try to deny coverage for our modern cholesterol-lowering pharmaceuticals.

Of course, paying for doctor's visits to treat obesity ultimately benefits the insurer in the end. Unless they actually don't mind paying for later treatment for metabolic syndrome and diabetes, heart disease, hypertension, bone and joint problems, not to mention the "incidentals" such as arranging for a specialized or open MRI machine that can handle our extra-large patients, extra-sturdy wheelchairs and beds and similar...

The administrators of these companies can't be that stupid. But they're also not that patient. They can't afford to wait 20 or 30 years to reap the dividends of investment now. Because their shareholders want to reap dividends next quarter. Wall Street needs to know what next year's projected revenue will be, and doesn't give much of a hoot about 30-year projections.

Then there's also the fact that there isn't a powerful obesity lobby waging a public relations war on the insurers. It's pretty much just the primary care doctors. Whereas, if the insurers decided to cancel coverage for cholesterol, you'd have the rich cardiologists and the mighty AARP yelling at CEOs within six hours, and the decision reversed in another twelve.

The insurers will cut costs, and coverage, where they can. And preventive care is one of the easiest things to cut. But then, since "health" is most effectively (including cost-effectively) guaranteed through preventive care, don't try to call it "health insurance." At least be honest and call it "sick insurance." And certainly don't try to claim you're in the business of "health care." As was said before, insurers are in business to make money, and it just so happens that they do it in the health care sector. Any health benefits to you, the consumer-slash-patient, are purely incidental.

150 comments:

Dr. JK said...

Funny thing, Dr. S. I read the same article with pretty much the same response. Not much of reality going on there. Try getting folks to follow up monthly, be directed to change an entire family's life style, and pay for the pleasure of the visit. I don't think so. Meanwhile expecting the pediatrician to basically write off the visit. I wonder how many small practices have a nurse or nutritionist available to do the counseling? None that I know of. Careful my friend, you sound as cynical as I.

mumkeepingsane said...

I think it'll be difficult to convince the drug companies that it WILL benefit them in the end. How many families will go through and not follow recommendations nor get healthier and therefore not decrease the burden on the future healthcare system. I'm playing devil's advocate here since I belive obesity should be treated as a chronic disease condition but I wonder if the insurance companies will see it as having to pay twice...once for prevention that might not work and again later in life for all the following health problems.

More people will take a statin pill regularly than will change their eating, exercise more, and follow up monthly with a doctor.

Debera said...

MAybe they may change their policies in the upcoming years....

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