trapeze artists uninsured

The LA Times online has revealed that most of the big health insurers in the state of California have lists of occupations that may make it impossible for workers in those fields to purchase an individual health insurance policy. Yes, you can imagine that the occupations listed in these health plans’ underwriting guidelines could mean you are at risk for injuries or illnesses related to your work.

Some of the occupations listed are obvious candidates for exclusion if you want to avoid expensive injuries, such as war reporting and stunt work. Others are less so: air traffic control (they probably need treatments for stress) and circus or carnival work (unless you are on a trapeze or working with the lions. It is not clear to me that you will be a high utilizer of healthcare services).

These plans’ underwriting guidelines also have lists of medications that could preclude you from getting insurance. The lists include eight of the twenty top-selling prescription drugs, such as cholesterol-lowering agents as well as medications for asthma, heartburn, and depression.


Cherry picking at scale

Jamie Court, President of the Foundation for Consumer and Taxpayer Rights, sums it up nicely when he says,

“This isn’t cherry picking: This is ignoring whole orchards of people.”

So what happens to these people who can’t get health insurance? They have a few options:

  1. Roll the dice. Hope for the best. If you get sick and run up big bills, you can always file for bankruptcy.
  2. Take a job that provides health insurance even if you hate it and aren’t particularly good at it.
  3. Use the ER. They usually aren’t very good at collecting the money.
  4. Go to a developing country for your big-ticket healthcare items, such as coronary artery bypass and hip replacement (google “Medical Tourism” to learn more).


How about “leaning” the insurers?

Insurers, including California’s non-profit Blue Shield of California, say they have to have these guidelines in place in order to be profitable. But is that really the case? What do we know about how well these companies are run? Do they have the appropriate efficiency measures in place? Or are they sloppily run because they know that when they need more money, they can just raise premiums. Do they spend more money on efforts to avoid paying a claim than the claim was worth in the first place? Do they have solid evidence-based mechanisms to manage costs and root out fraud and abuse? Are their executives appropriately paid or are they overpaid for the value they bring to the company and their customers? I don’t know. Do you?

As more and more people find themselves not only uninsured but unable to buy insurance regardless of the price, my hope is that they will exert political pressure so that we can finally get to national health reform. We tried this in the early 90s, but industry forces that benefit from the status quo effectively squelched change (remember Harry and Louise?).

Without significant reform, it is not going to get better. The “system” is sick and getting sicker. You might say the whole industry is in a death spiral.


We need everyone in the insurance pool

We need laws and regulations that will put everyone back into the insurance pool again…and I mean everyone, regardless of whether they work for a circus or take a cholesterol-lowering medication. If that means a single-payer system, so be it. It has to be better than the mess we have gotten ourselves into with the hodge-podge of insurance offerings we have in place today. Just ask any of your friends who are uninsured and quaking in their boots lest some illness or injury forces them to seek medical care.