MS and Access to Healthcare

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I normally avoid writing anything that can be considered remotely political, but I’m making an exception in this case because living with a chronic condition, and having unfettered access to healthcare, is not a political issue. It’s a moral and ethical issue.

When efforts to “improve” the Affordable Care Act captured the spotlight earlier in the year, I could not believe Congress was seriously considering giving insurers the option of waiving the requirement that forced them to provide coverage for people with pre-existing conditions.

Don’t they know that treatment for something like MS can make the difference between living a productive life versus becoming dependent on Medicare disability or even Medicaid, which would cost taxpayers more long term?

Don’t they know that nobody chooses to be in this position, and how vulnerable we are to their political whims?

Don’t they know that even with good health insurance, the out of pocket costs for many of us can be daunting?

Don’t they know that one of the leading causes of personal bankruptcies are overwhelming healthcare bills?

Don’t they know that nobody, save for perhaps the very wealthy, can foot the bill for the treatment we need to halt or slow the progression of our condition?

Are they that blind? Even worse, are they that ignorant or mean-spirited?

Listen, I’m all for reigning in healthcare costs and government waste. I know there are a lot of people who feel government should not be intruding into people’s lives and dictate what they or businesses should or shouldn’t do. But I don’t think it is a stretch to say that anyone who feels that way would change their tune if they were in our position.

Quite frankly, if our elected officials in Washington all had chronic health conditions like MS, access to healthcare would not have strings attached. It would probably become law in a heartbeat.

Our treatments can be very expensive. Without health insurance, there is no way in the world I could get the care I’ve received over the last decade. Seriously, having to pay for one month of treatment would be disheartening. As it is, my yearly out of pocket medical expenses are significant, but what choice is there? Is it right to put someone in a position to make a choice between eating and getting the healthcare they need?

Health insurers will say otherwise, but their primary goal is to make the largest possible profit. They want their premiums, but they also want to pay as few claims as is legally possible. I admit to being biased about this, because I have worked in the healthcare revenue cycle arena for over thirty years. But I do know what I am talking about.

It’s complicated enough to get approval for treatment, and getting the bills paid. Insurers play games all the time, trying to avoid paying a claim or denying treatment that should be covered, often putting patients in the middle and causing undo stress in their lives. If you have doubts, someone who once worked for a large health insurance company, and was responsible for processing and paying medical claims, told me (he was out of the industry by then) he had a monthly denial quota to meet. In other words, his unit had to deny claims, regardless of whether the denial was valid, to hit his number.

I’ve endured a few of these games myself, and it took weeks of persistence on my part to get them to overturn a decision that was wrong to begin with. Fortunately, I had the knowledge to cut through the bullshit and run-around I was getting. And if that didn’t work, I knew who to contact in the state to intercede on my behalf. I can only imagine what it would have been like had that not been the case.

Healthcare is big business, and everyone wants their piece of the pie. The discussion over pre-existing conditions pissed me off because regardless of the rhetoric, this entire debate was about greed, not common sense.

This is not meant to be a commentary about how expensive healthcare is. I think everyone would agree the costs are insane. It is not a critique on what is wrong with the system (a lot), or who should pay for what. Nor is it a recommendation that everyone should be required to have healthcare coverage, although I do have a strong opinion about that. I am not advocating anyone should get a free ride either, because I don’t think we are entitled to anything.

What I am saying, is that if you give health insurers the choice of deciding who or is not eligible for coverage, and/or give them the option of pricing the coverage for those with chronic conditions, they will not do the right thing. Instead, they will either say you can’t be covered, or set their rates so high that nobody could afford them. So don’t put us in that position. The only thing we are entitled to is to have the same access to coverage, and the same financial obligations, as those who aren’t living with something like MS.

Fortunately, it appears that this storm has passed, but I don’t think the issue is dead. Each and every one of you should stay on top of it, and e-mail your senator and congressperson, letting them know how you feel on matters as they develop.

You voice could make a difference between getting access to the care you need, or be shit out of luck, unable to afford what you need, and left hoping your MS will be merciful and leave you alone.

I think we all know how that would work out.

Author: Steve Markesich

I am loving husband, a doting father, a Red Sox fanatic, an aspiring novelist and MS advocate

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