A Pearl of Great Price…

Written by Monkeybrad on October 21st, 2009

Pressure...

I do not normally engage in politically charged subjects here.  I like to keep this nice and light, a place for musings that hopefully spread a little joy and the occasional bit of wisdom, but I read something this week that I feel needs to be shared.  Since this is one of the few places where I can get away with saying anything I want, I am going to use it to help put a face on a problem our country currently faces.  I promise to go back to my usual pictures, recipes and homilies in my next post, but I beg your indulgence and your patience as I look a little deeper into an issue that I had honestly never considered until this week.

I take a lot of things for granted, I always have.  I have been blessed by place and circumstance and most of my troubles can be directly attributed to my own poor judgement, so I tend to forget just how good I have things.  It is easy to forget just how fortunate I am when dealing with life’s little foibles.  A couple of days ago while I actively putting off ride my bike and quietly moping to myself because the aches and pains of impending middle age, I ran across a link to an article that reminded me again just how lucky I am to be in relatively good health, all things considered.  Of course, I am living with diabetes and have to deal with those issues, but on the whole things are pretty good.  Maybe that is why this article hit me so hard, without a team of doctors and specialists and all of the wonders of modern medicine, how would I be doing?  Even worse, what if I did not have the great health insurance that helps me afford this care?  It makes you think, or at least it should.  So without further ado I ask that you take a moment to read this article and give it some thought.  I’ll be back after the break to make a few more comments and maybe even have a little Paul Harvey moment…

I Am Not a Dog

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.

Ian Pearl, October 19, 2009″

Pretty amazing, huh?  I have to be honest, I was genuinely shocked when I read this.  I guess I was not too surprised to hear that an insurance company was making a financial decision that would impact a person’s quality of life, that has to happen everyday, by necessity.  I was a little surprised to find the callous “dog” and “trainwreck” references, but once again this is something that has to happen for people to be able to live with these kinds of decisions.  Dehumanization of the subject is pretty routine when people have to make decisions that impact other people negatively, it is way easier to “trim the bottom line” than it is to put a single mother out of work.  The thing that really shocked, was that I cared.  Normally, I would read something like this and think to myself, “Man, that sucks” and move on, but I could not do that this time, you see, I know Ian.

I guess I should really say, I knew Ian, since we haven’t spoken in over 20 years, but in middle school we were good friends.  We hung out between classes, ate lunch together, visited each others homes and got into most of the trouble that preteen boys will.  After I moved away from South Florida, I kept tabs on him for a while through a mutual friend and I knew of his setbacks after high school, but the last time I asked there was no news, so I assumed the worst.  To see that he is still out there fighting amazed and inspired me, to also see that he is being flanked by the insurance companies while fighting his disease made me deeply angry.

I do not pretend to know what the answers are, to be honest I have not given it too much thought, since the system has been working for me.  There has to be some balance between quality care for everyone and a self-sustaining healthcare system and I am pretty sure that we can figure out some solutions if we will just try, but that is not why I come before you today.  I am writing in hopes that my experience here may help you.  It is so easy to not care, all you have to do is, literally, do nothing.  Caring is tough, because it makes us feel helpless to change things.  I am terribly frustrated because I see a situation that I know is wrong and I have no idea how to help.  All I know is that people matter, so when talk of “public options” and “death panels” and political BS reigns as we all watch the debates raging on the news, just remember.  Remember that for every statistic there is a person with a family that would give anything to see their “statistic” made well.  Remember that these “numbers” have names and that each has their story to tell and that there is nothing in this world more important than a person, any person.  What would you do if that “number” were a childhood friend?  So do this for me, remember what we are fighting for.  Remember Ian.

I Am Not a Dog was originally published on The Huffington Post.  Here is an article by the Washington Times for anyone interested in learning more about Ian’s situation and a video segment featuring Ian on CNN.

Update:

In a move that reminds us of the sly smile on Mr. Potter’s face, Guardian has reversed it’s decision.  In a statement, Guardian’s president Dennis Manning admitted the company was wrong,  “Insurance companies are comprised of human beings and sometimes we make mistakes. This was one of them, but we also learn from those mistakes and we seek to correct them.”  It just goes to prove that even when people do not want to do the right thing, they will do anything to keep other from thinking they are the kinds of people who would do the wrong thing.  Thank you to everyone out there who lent their voice to this cause, and Ian, you keep on fighting.

 

3 Comments so far ↓

  1. Cameron says:

    That is truly terrible that our lives can be reduced to numbers or
    statistics and I pray I never have to experience that first hand. Being a government employee I have witnessed it’s ability to turn people into numbers and stats as well. I’m afraid the answers to these problems can’t be answered by the government. I wish I had the answer.

  2. 6Lindseys says:

    Wow! I agree that too often I just think “That Sucks” but don’t really stop to think of the injustices or individuals being impacted. This story really makes me think of my own callousness. I am glad to see the update. I hope that that is not just the public spoken policy whilst Guardian figures out a legal way to shortchange Ian (and others) whom they deem a burdon on their multibillion dollar profits. Thank you for sharing this story, and in it, for reminding me to not be so indifferent when hearing about people and their struggles.

  3. Sandy says:

    This is awesome and touching story. Our life’s depends on numbers and statistics which is not a good sign

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