What are we fighting for?

As the public debate over health care reform rages on, the private battles with health insurers for essential coverage continue on, as well. While some fight for political advantage, others fight for their lives. The triviality of the former should be obvious to even the most insensate, particularly when contrasted with the high stakes of the latter. Individually, each tale of medical hardship rends the heart and evokes sorrow and sympathy. Collectively, the tales make a compelling case for the desperate necessity of reform. Consider the following two stories:

Family Learns Pre-Existing Conditions Apply at Birth

Houston Tracy, a 12-day-old boy, has already survived a rare birth defect, a feeding tube and open heart surgery. Now his family is waiting to see how the battle with an insurance company will fare.

Last week, Houston’s parents found out that the term “pre-existing condition” can apply the moment someone is born.

“When he came out, he made one little cry and he didn’t really cry much,” said Houston’s father, Doug Tracy, 39, of Crowley, Texas.

Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife Kim Tracy, 36, could touch their son doctors got worried. “We could tell there was something wrong by the way they [the doctors] were acting,” Doug Tracy said.

Houston’s skin wasn’t turning a shade of pink like most newborns because, somehow, his blood wasn’t getting enough oxygen. Doctors rushed Houston, with Tracy riding by his side, in an ambulance to Cook Children’s Medical Center in Fort Worth, Texas.

Within hours the Tracy family would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the aorta and pulmonary artery are transposed where they should meet the heart. Doctors wanted to operate within days to save his life….

Houston was born on Monday, March 15. By Friday that week, doctors operated successfully….But by March 24, the Tracy family formally heard their son was denied health insurance.

“We don’t have health coverage on ourselves because it’s too expensive these days and because of the economy,” Doug Tracy said. The couple are small business owners and would have to buy individual policies, which they have for their other children Cooper, 4, and Jewel, 11.

Doug Tracy said the family had no idea there was something wrong with Houston before he was born.

“Prenatal, every doctor visit was perfect, his heart beat was fine,” he said. But Tracy said he called Blue Cross and Blue Shield of Texas twice in preparation of Houston’s birth, and he asked if they could get a policy on his son before he was born.

“They said we can’t do that because he wasn’t born yet, but as soon as the baby’s born go online and fill an application out,” he said. Doug Tracy applied for Houston’s insurance March 18, and the first month’s premium of $267 was charged to his credit card, he said.

“Wednesday, the 24, is when I got a letter of decline — they declined it the day after the [health insurance] bill was signed,” Doug Tracy said. [full article]

And about 1,000 miles away in Wisconsin:

Woman’s move triggers loss of coverage for cancer treatment

For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition.

Then Oertel did something she never imagined would jeopardize her good health. She moved. Less than 30 miles – from one county in Wisconsin to another.

The move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug. And the tumor returned within four months.

What happened to Oertel stunned her doctor, Mark Malkin. Nothing he learned in medical school prepared him for what now is too often a sad and frustrating part of his job as a cancer specialist: fighting Medicare and private insurance companies over life-or-death decisions.

Doctors aren’t supposed to get emotionally involved in the cases of their patients, but tears well up in Malkin’s eyes when he talks about Oertel, the 40-year-old Oshkosh woman he has been treating for several years.

“I wish Paula would have a second chance,” he said, choking up.

Oertel and Malkin are facing an ailment no drug can cure: a complex health insurance system that can overwhelm a seriously ill patient unequipped to deal with its complicated rules.

As America debates health care reform, cases such as Oertel’s illustrate how important decisions made between doctors and patients can be overruled, leaving patients with no options and the likelihood of dying in a matter of months. [full article]

Meanwhile, those who profit from a system that denies or restricts coverage are digging in their heels. The New York Times reports that, “just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.” Their stance is clear. They will resist change, to the detriment of us all. It’s sickening.

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2 thoughts on “What are we fighting for?

  1. These are two good examples of why ‘you can just go to the emergency room’ is not an answer. A baby who has been through so much needs excellent medical care, and insurance, government or otherwise, should not be overriding a doctor’s good judgment.
    I have a relative who had open heart surgery before he was a year old. He’s a big,healthy guy with grand-kids, and you would never know that a doctor at a well-baby visit saved his life.

  2. Sad about the baby who was denied coverage — I’m wondering why he would not be eligible for SCHIP state coverage, but it is probably because his parents earn too much — being hard working people who earn enough to live on is not always to your advantage when it comes to health insurance — another way that the system as it stands just does not work and hurts people.

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