I am convinced that the healthcare system in this country is broken. And the onus falls in large measure on the insurance industry, which spends an inordinate amount of resources to influence legislation that allows companies to deny policies to those with preexisting conditions, refuse payment for certain medical procedures and, in all ways possible, to minimize their risk.
What is it that they don’t understand about the unfairness of people having to pay huge premiums to minimize their own risk of catastrophic medical bills that all too often lead to personal bankruptcy? With medical care costs rising well beyond the rate of inflation, the days of going bare-taking one’s chances, relying on emergency rooms and free clinics-are over.
Insurance industry lobbying efforts have produced a bill in Congress that would mandate mastectomies for breast cancer patients as outpatient procedures. Now, I believe it’s possible that some patients might prefer not to stay in hospital if they don’t absolutely need to. And a simple lumpectomy might be okay as an outpatient procedure, if the doctor and patient agree. But for a radical mastectomy, or a procedure that includes removal of lymph nodes, I don’t think so.
If this bill were to pass, insurance companies would not have to cover the surgery to the maximum benefit for those patients who need to remain in hospital for two days after surgery. This would include those who have pain requiring heavy medication, drain tubes, etc. It’s my understanding that most hospitals will not release a patient until 24 hours after receiving a morphine injection. But this legislation would make it difficult, if not impossible, for patients receiving morphine to get reimbursement for the required hospital stay.
Breast cancer traumatizes women in ways that exceed the risks and complications of the surgical procedure. They should receive all the counseling and care they need to make a full recovery.
Also up for debate in Congress is a competing bill, called the Breast Cancer Patient Protection Act, which would require insurance companies to cover a minimum 48-hour hospital stay for all patients undergoing mastectomy. Women could not be forced to go home just a few hours after surgery, groggy from anesthesia and against the advice of their doctors.
However, this bill also has its detractors. Dr. Janet Osuch, breast cancer surgeon and professor at Michigan State University, says although the bill would eliminate so called “drive-through mastectomies,” it may not be in the best interests of some patients. Those who don’t need the extra two days in hospital might benefit more with loving support at home, emotional counseling and perhaps a home nurse, she says. If insurance companies would use the money saved on hospital rooms to pay for home nursing, that would be great, she says. But only if it is the patient’s and doctor’s choice. As of now, insurers rarely cover home care even though it is almost always less costly than post-surgical care in hospital or nursing home.
Personally, I avoid hospitals and nursing homes at all cost. I’m more afraid of infections and medicinal mistakes rampant in those facilities than discomfort at home and the indignity of relying on relatives for care. However, my surgeon and Kaiser hospital overruled me after hip surgery a few years back. Being a nonprofit, Kaiser wasn’t interested in denying hospital benefits for the four days. They wouldn’t release me until at least 24 hours after the morphine injection that dropped my blood pressure to 77, causing severe dizziness. And until I’d had a blood transfusion they insisted I needed to prevent a heart attack. And until they were convinced that I could tolerate the anti-clotting drugs necessary after major surgery. I can only imagine how traumatic it would be to go through all that with the threat of an insurance company denying benefits.
During the presidential campaign already under way, we’ll be hearing from candidates about their plans for healthcare reform. So far, the proposals haven’t included reform of the health insurance industry. We can only hope that one of these hopefuls will come up with something that will work, that could pass and that might bring us on par with other industrialized nations.
Until then, it behooves us to pay attention, to the extent that’s possible, to pending legislation that would erode patients’ rights and allow the insurance industry to take even more advantage of us.
I know sometimes it’s a nuisance to contact our representatives in Congress on these measures, but for now, it’s all we have. The power of our votes.