Private health insurance is really no panacea
If two Albertans who went before a Calgary court Thursday to argue for lifting the ban on private health insurance win their case, theirs will be rather a pyrrhic victory.
Darcy Allen and Richard Cross spent thousands on surgery in the U.S., Allen for pain from a hockey injury and Cross for back pain. Their lawyer, John Carpay, argues that his clients and others like them should be able to have private insurance and buy health care here in Canada, including for cancer treatments and orthopedics.
However, doctors are unlikely to rush to switch to a private parallel system as the small number of patients who’d purchase insurance and use it wouldn’t make it worth the doctors’ while. Doctors can choose to opt out of the public system right now, but you rarely hear of any of them doing it.
Moreover, given Canadian doctors’ familiarity with how their counterparts in the U.S. are forced to hire phalanxes of full-time staff in the office to handle the mountains of insurance paperwork, the appetite for busy doctors here to increase their staffing costs or fill up their own time with insurance work is likely to be pretty small.
But the real mystery is why Allen, Cross and Carpay assume that private health insurance is a panacea. Insurance companies in the U.S. — the same ones that would move into the Canadian market, if they were ever allowed to — are notorious for taking people’s premiums and then finding ingenious ways to weasel out of paying claims.
Last year, in an article entitled The One Horror Story That’s Missing When Canadians Talk About Health Care, Dr. Jennifer Gunter, a Canadian who practises medicine in the U.S., wrote of her trip home to Manitoba and how people there talked to her about their medical problems. But the one horror story that was missing was insurance: “I heard nothing about copays, nothing about fighting with an insurance company to get a drug or procedure approved ...” she wrote.
Or as Los Angeles actress Terry Kaye wrote in The Huffington Post: “For-profit health insurance is an oxymoron: To maximize profit for shareholders, you must deny services to policyholders.” She said a delay in treatment, caused by her mother’s health insurance company, “directly led to the complication that ended her life.”
Kaye added: “For my mother to die of cancer at the age of 53 and have to spend the last months of her life ... arguing with insurance companies because they’re saying ... they don’t have to pay her treatment, there’s something fundamentally wrong with that.”
Kaye, who started a foundation to help women with cancer get the treatment they need when their insurance companies deny them, wrote, “If you or I practised medicine without a licence, we’d go to jail. Yet, we allow health insurance companies to do it every day.”
Her mother’s insurance company denied her a drug, despite personal appeals from her mom’s doctor. Her mother had endometrial cancer which was considered curable, and the bitter lesson Kaye learned was: “If you’re lucky enough to be diagnosed with a ‘curable’ cancer, but you aren’t cured, your treatment probably won’t be covered.”
So when Carpay says he wants “people to be able to obtain health care here in Canada,” via health insurance, he’s not reckoning with the caprices of insurance companies who find all kinds of ways to deny coverage, including pre-existing conditions, refusal to approve an expensive drug, incorrect procedure codes and other trivial administrative excuses. Wendell Potter, a consultant and columnist with the Washington, D.C.-based Center for Public Integrity, noted in The Huffington Post earlier this year: “One of the things you need to know about the private health insurance business is that insurers make a lot of money when they delay paying a claim ... the longer you can delay paying a claim, the more investment income you can make on the premiums you take in from your policyholders. And investment income ... contributes significantly to the bottom line.”
Potter reports that the California Nurses Association analyzed 2010 data from insurers and found that one company’s denial rate was almost 40 per cent.
The American Cancer Society has published guidelines advising cancer patients how to fight claim denials. Patients are advised to engage in lengthy appeal processes, launch litigation and demand an external review by the government. All this, while these patients are supposed to be fighting cancer.
Those in favour of health insurance for Canadians insist it’s not about having an American-style healthcare system in Canada. What makes them think that insurance companies will operate differently if they’re allowed to come into Canada?
Carpay and his clients are naive if they think private insurance will solve the woes of Canadians on long wait lists. All it will do is inflict on insured Canadians the same struggles with getting claims paid that insured Americans now have.
That is not to say that insurance companies always treat claimants unfairly. They don’t. But when you Google “health insurance horror stories” and it comes up with 3,330,000 results, we Canadians should be thankful for socialized medicine — and for the one horror story that’s missing north of the border.