Rationed Health Care Is Already Here
by Clarence Page

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Rationed Health Care Is Already Here

Vocal Protests at town hall meetings about health care reform
(c) William Brown

"Rationing" is one of the scariest words in the current health care debate.

It conjures up apocalyptic nightmare images from "Soylent Green," the sci-fi thriller about a future in which the old and weak are quietly lured into early extinction for the sake of future generations.

What the scaremongers don't like to talk about is how much our private insurers ration now -- mostly for the sake of their own profits.

They're clever enough to avoid using the R-word. They use other words, like "Read the fine print on your policy."

My friend Sarah Wildman learned the hard way. She's the new mom with what she calls a "$20,000 baby."

That's how much she and her husband had to pay out of their own pockets after her insurer decided her baby was a "pre-existing condition."

Self-employed, Sarah and her husband fall into the individual insurance market, which the American Medical Association estimates to be as high as 27 million people.

Falling between the fully covered and the uncovered, their numbers have grown faster as thousands of Americans lose their job-based insurance every day.

Some of them are women who discover the hard way, as Sarah did, that if you bought maternity coverage after the pregnancy began, the fetus is viewed as an uncovered "pre-existing condition."

The Pregnancy Discrimination Act of 1978 requires employers with more than 15 workers to include maternity benefits in their insurance packages. But only 14 states require maternity coverage in policies sold on the individual market, according to the Kaiser Family Foundation.

And a report last fall by the National Women's Law Center found only 12 percent of 3,500 individual insurance policies included comprehensive maternity coverage. Another 20 percent offered it with a rider that cost as much as $1,100 a month. Others required a two-year waiting period.

Fortunately Sarah's story had a happy ending. She's a freelance writer for magazines like The New Republic, The New York Times, The American Prospect and the online publication Slate.

When she told the company's press rep she was going to write about their "crappy" maternity policy, "I got kicked up the food chain."

In the end, she reports, she was able to get 90 percent of her hospital costs paid by the company, which also promised to adjust claims paid to some similarly situated women.

After she wrote about her horror story in Double XX, a woman-oriented Slate spinoff, she heard from numerous fellow sufferers, some with hospital bills bigger than hers. Last Thursday she testified before the House Joint Economic Committee, which released a report that found women more economically vulnerable than men to high medical costs and related bankruptcy.

She also has received the inevitable scolding in today's heated blogosphere from opponents of national health insurance reform. It's her own fault, some said; she should have read the fine print. Right. As if everybody reads the fine print on their insurance policies -- and understands it.

And she hears the fears of those who suspect national reform will lead to government rationing of health care. I'm old enough to remember how similar fears were vented when Medicare was born in the 1960s. It is now so popular that President Obama and others have heard satisfied, if a little confused, constituents say, "Keep your government hands off my Medicare," even though Medicare is a federal program.

Left unsaid by those who raise fears of rationing by any "government-run" or government-related health care is how much rationing the insurance industry does now.

For decades, experts writing in the New England Journal of Medicine and elsewhere have concluded that we do "ration" health care. We just do it through gross disparities in race, sex, age, regions, income and education.

And, although Sarah's insurer may deny it, we also ration it to those who are lucky enough to have access to the big soapbox that she happened to have.

If anything, social conservatives should be on her side. By penalizing mothers in this way, the private insurance industry throws more barriers in the way of parents and prospective parents than the government does.

Under pressure, the private insurance industry has come to the table. A spokesman for the insurance industry recently responded to congressional criticism by listing concessions that the industry has offered as alternatives to a publicly funded option.

The industry has proposed "guaranteed coverage for pre-existing conditions, discontinuing rating based on a person's health status or gender, and a personal coverage requirement to get everyone into the system," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.

Sounds great. But why wait? Insurers don't need the government's permission to reform themselves. Just do it.

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