When Insurance Companies Don’t Care About the Caregiver

Sick_book_coverA recent article in the Bangor Daily News has struck me deeply. It crystallizes so much of what is wrong with American health care.

It relates the story of Sandi Tucker Kennedy, a 38-year-old mother of four and a nurse at the Maine Medical Center, who is rapidly deteriorating from a degenerative neurological disorder. The presumed diagnosis is prion disease, an episodic occurrence of a “Mad Cow” variant. This is a diagnosis made by exclusion. It is always fatal.

Her sister-in-law, Denise Tucker, notes that the multiple diagnostic tests and hospitalizations have resulted in lost wages and “a great deal of medical costs as their insurance will cover only a portion of their medical expenses.” Lost wages is an understandable consequence of the tragedy of serious illness. Medical expenses “not covered by their insurance,” are not.

What makes this a crystallization of the tragedy of our health system failure is that Sandi appears to have been doing everything right. The tragedy of her illness will be further reflected on her family by the financial burden they will have to work through because some profit-making insurance company can deny undeniably appropriate care.

The administrative costs of our for-profit insurance companies have been 30 to 35 percent (think high executive salaries, among other things) whereas the administrative cost of Medicare is 3 percent. What service is her insurance company performing by taking her premiums and denying coverage of all her medical expenses?

More than 700,000 Americans went bankrupt last year because of medical expenses. According to T.R. Reid in The Healing of America, there are no medical bankruptcies in Britain, France, Germany, Japan, Holland, Switzerland and Canada. The reason is that their systems are less complex and the basic services are fulfilled by the government or not-for-profit insurance companies.

Granted, I have a soft spot for nurses. My mother was a nurse. Those in the trenches are overworked and underpaid. Nurses are the front line of medicine. How tragic that a caregiver will not get the care that she needs.

Image credit: cover of book by Jeffrey M. Lobosky, M.D.

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