An eroding model for health insurance

Working Americans once could rely on employer-based benefits. But more people are being forced into the individual market, where coverage is costly, bare-bones and precarious.

The health insurance system has become increasingly expensive and inaccessible. It leaves patients responsible for bills they understood would be covered, squeezes doctors and hospitals, and tries to avoid even minuscule risks, such as providing coverage to a newborn with no serious illness. Full Story »

Posted by Kaizar Campwala

See All Reviews »

Review

Michael Bugeja
4.0
by Michael Bugeja - Oct. 22, 2008

This is the first of three installments and, as such, my ratings might change as other segments are published, perhaps showing the physicians' side as well as cases where private insurers saved the health pool funds by exposing fraud. That said, the article lives up to the promise of its headline: The private health care system truly is eroding, both presidential candidates intend to maintain it, and consequences often spell financial or physical ruin for those who must rely on it. While the writing is engaging, personalizing the content with anecdotes, and while the subject is more pertinent than ever, the article suffers somewhat from lack of in-depth research connecting the dots so that readers can envision "the big picture." A case in point is the outsourcing of jobs--often so that companies can avoid medical coverage--and the effects of that from expendable income to the state of the economy (and technology's impact on both). After all, once technology blurred the line between home and work, this gave companies the occasion and excuse to outsource as many jobs as possible, increasing profits because they no longer had to pay medical coverage and retirement benefits. Moreover, as cases here show directly and indirectly, by turns, technology is being used by consumers to find the best and most affordable coverage ... and by insurers to pry into medication or prior treatments to expose pre-existing conditions, thus denying coverage once again. The answer, as this article suggests, is universal health coverage because the system no longer is operational.

In my first job for Blue Cross/Blue Shield in Newark, New Jersey, I was asked to revise a statement that read "You are ineligible for benefits 48 hours before surgery." My supervisor edited that to read: "You are ineligible for benefits 24 hours prior to the day before surgery." She said this would help the balance sheet because some would not understand it and others would file for benefits mistakenly. At that point, I decided to become a journalist.

Such cherry-picking tripped up Pam Munter when she applied for individual coverage two years ago. She had retired from a clinical psychology practice in Oregon and moved to California, where her insurance applications were rejected, one after another. The reason: She takes Prevacid for gastroesophageal reflux disease. It is a widely prescribed drug with annual sales exceeding $3 billion.

This is an example of how technology—what the pharmacist puts in her databank—can be used against consumers seeking coverage of benefits, only to learn that they do not qualify for them.

See All Reviews »

Michael's Rating

Overall
4.0

Good
from 22 answers
Quality
3.9
Facts
4.0
Fairness
4.0
Information
4.0
Insight
4.0
Sourcing
4.0
Style
4.0
Accuracy
4.0
Balance
3.0
Context
3.0
Depth
5.0
Enterprise
4.0
Expertise
4.0
Originality
3.0
Relevance
5.0
Transparency
4.0
Responsibility
5.0
Popularity
4.5
Recommendation
5.0
Credibility
4.0
More How our ratings work »