There are those who are convinced that COVID-19 is a hoax. They are welcomed to (forgive me) live or die on their principled hill. What I do know, is that according to the CDC by May 28, 2020, 300 healthcare workers died of the disease and 60,000 were infected. The numbers included physicians, nurses, paramedics and EMTs, technicians and other hospital personnel.
Hardly a day goes by that politicians, insurance company commercials, pharmaceutical houses fail to regale us with their praise of these frontline, essential workers. However, there appears to be a huge inconsistency – and it’s ethical.
Cutting My Pay as Reward?
With all of this praise, we might believe that Congress would want to reward healthcare service providers too, but in fact, the reverse is happening. Congress is doing its best to reduce payments to healthcare providers. It stems from well-meaning but poorly flawed programs that are dictating rates with regard to out-of-network coverage, and something referred to as “surprise medical billing.” Many of us have fallen prey to the surprises. Patients are in a sort of “no-man’s land” with such billing, as patients fall into disputes between providers and/or laboratories and their insurance providers.
For a patient with COVID-19, it is one thing when she or he is at home and becomes ill, and/or can’t get to an insurer-plan facility, but what happens to someone who falls ill and can’t get treated by their primary care physician or approved facility?
Patients have gone bankrupt trying to cover exorbitant, out-of-network bills. Insurance denial is a crushing blow for anyone, especially those on fixed incomes or in lower-paying jobs.
Who Wins?
Insurance companies squeeze both the person who is sick as well as the healthcare providers who are treating them. Congress is essentially subsidizing those insurers by keeping the rates paid to providers so low that the physicians either stop taking payments altogether or are forced to combine operations to such as extent that it takes away a lot of personal attention and turns it into a machine.
In the midst of this pandemic, with so many industries suffering, who is succeeding? No surprise, the health insurance companies are rocking. According to a recent Fox News article (August 4, 2020) reporting on the first half of the year:
“Three health insurance conglomerates have reported blockbuster earnings. UnitedHealth had its most profitable quarter in history. Anthem doubled its profit from Q2 in 2019. And Cigna beat Wall Street expectations.”
Common sense dictates that if the insured (most of us) keep paying our ever-higher premiums, and insurance companies limit coverage and cut reimbursement to healthcare providers they will pocket more of their money.
So, the reimbursements are declining, the service providers (doctors, nurses and so forth) are having their pay reduced because the hospitals are losing money at this time, and the government is insistent on setting reimbursement.
What ultimately happens? Hospitals close (especially in economically depressed or rural areas), healthcare providers “flee” and even services such as air ambulances are reduced.
The winners, pundits tell us are the insurers and the politicians on both sides of the aisle who support them.
According to the Fox News article:
“BlueCross BlueShield has contributed more than $2.6 million to Republicans and Democrats this cycle, and Cigna has kicked in another $1 million plus to their friends on Capitol Hill.”
Meanwhile Congress, seeing healthcare providers as demonic, I suppose, are intent on helping the insurance companies by allowing them to cut out-of-network rates.
Where are the ethics here? We might start by asking the politicians who get free healthcare – and for their spouses, and their families. Can they relate to a working person who is rushed to an out-of-network hospital?
While it is true (and I’ve written about it) that some unethical providers have gouged Medicare and other insurers, they are a drop in the bucket compared to the tens of billions of dollars the insurance companies are making, and their constant need to make more. I might add that the unethical providers wound up in jail cells and reimbursing the government with huge fines and restitution.
Who, at the insurance companies, reimburses the taxpayers for payments to lobbyists that make their way to politicians?
How can insurers and politicians alike rationalize their out-of-network policies on one hand, and their give-away, through lobbyists, to politicians on both sides of the aisle? Meanwhile, the insured are paying ever-increasing amounts for out-of-pocket expenses and healthcare providers are get paid less.
There are many stories of COVID-19 that have yet to be told. This in one of them.
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