2908

21 Oct 2010

A sad/interesting anecdote of an insurance officer not-so-gently questioning a doctor’s care of an elderly (and likely dying) woman:

So the medical officer called me and started asking pointed questions. “Why did you do that test? You know that she’s not been compliant. Are you sure you want to do that? I don’t think that’s a good idea.” In other words, this was not just a review of the case. This was an opportunity for the insurance company to intervene in the actual care of the patient.

Then the kicker: “Have you considered not doing anything and . . . just letting nature take its course?”

At first, I was stunned. “You mean let the patient die?”

Expressed in such blatant terms, while he was trying to be diplomatic, made him back down. “Well, uh, no, but she is a high-risk patient.”

Anyway, this was the first instance I’ve encountered in which the insurance company is not just in the business of reviewing a case, but actually trying to intervene during the hospital stay, to the point of making the ultimate healthcare cost savings: Letting the patient die.

I’m certainly in agreement that insurance bureaucrats have no place sticking their nose in the business of patient care, but just a quick note here: you know, it’s easy for the author (the doctor) here to get all high-and-mighty about her continued care while it’s the insurance companies (really, the payees) that are paying for it, but I don’t think his position entitles him to that much moral superiority. The problem here is merely yet another side-effect of the wrong economic model (insurance markets) being applied to what is not unexpected. Insurance works best for the unexpected: car accidents, fires, tornadoes, et al. It doesn’t make any sense for things you know are going to happen: the flu, doctor checkups, and, unfortunately.. dying. Dying currently happens to everyone, and the cost of preventing it is directly correlated to the time you want to buy.

No one likes to talk about the longevity of human life in terms of dollars, but that’s essentially what it boils down to. If we were employing a commodity market (pay for what you get), this elderly woman’s care would not be paid for by her insurance company. It would have to come out of her pocket. Would the doctor still be so gallantly altruistic in advocating for continued, rigorous (and expensive) tests and care if she couldn’t pay the bill (read: if he had to foot the bill)?

“Dying”, or the process of getting older – and requiring more expensive healthcare – is probably better served by social security-like models, where the current generation subsidizes a smaller subset of the surviving elderly, to guarantee a reasonable standard of health/survival through retirement, disability and death. I’m not saying it’s easy to dictate who gets what and for how long, but it makes more sense to me than an insurance model, where ongoing care (and cost) is left unchecked, save for the needling bean-counters of the insurance companies. Hard questions.