Frontline: Sick Around America

Millions of Americans do not have health coverage, or have inadequate coverage. As our economic challenges multiply, the problem of health care access grows.

— “The Costs of Inaction,” Health and Human Services Department Report, 29 March 2009

As he puts it, George Halvorson, Chairman and CEO of the Kaiser Foundation Health Plan, “I personally am uninsurable.” That is, if he lost his job and had to seek out insurance in the private market, he would not find a company willing to insure him. The same is true for Karen Ignani, President of America’s Health Insurance Plans. “I have a serious condition with respect to asthma,” she says, which would disqualify her for coverage by most private companies.

Both Halvorson and Ignani are well aware of the ironies in their situations. They believe the health care system in America needs to be repaired, if not wholly rebuilt. And both voice their concerns in Frontline‘s newest chapter, Sick Around America. Like its predecessor, 2008’s Sick Around the World, the show documents specific cases of things gone wrong in the “system” of health care, this time with a focus on insurance companies, where, most observers and insiders agree, the need for reform is most urgent.

Insurance companies operate with an eye to profits, meaning that the health care they are supposed to provide is usually the last priority. They regularly practice medical underwriting, that is, the systematic rejection of clients with preexisting conditions, in order to decrease the risk of payments. This is, observes narrator Will Lyman, “A good business model,” but, by definition, it makes life hard for “people with any sort of illness.” Take, for example, Paul Stevens, downsized in 2005, then unable to secure insurance because of a history of diabetes. Before this turn of events, he was “living comfortably,” in a house. Now, too rich for Medicaid and too young for Medicare, Stevens struggles to make ends meet. Following a heart attack, he has moved into his mother’s house and works odd jobs, none, of course, offering insurance plans. “I’m really rolling the dice until I’m 65 at this point,” he says, with two years more to go before he’ll be eligible for Medicare.

Stevens’ story is hardly unusual, though there are numerous ways individuals can be hurt by the health care industry. The dysfunctional system, says Karen Pollitz of Georgetown University’s Health Policy Institute, is “like having an airbag in your car that’s made out of tissue paper.” Insurers turn down applicants for all manner of reasons (including hay fever, acne, and bedwetting, she says), and even if someone is lucky enough to be able to afford and qualify for insurance that doesn’t come with a job, that policy might be subject to recision at any time, leaving patients with mounting bills during and after a medical emergency.

The rationale for recission is again economic. Private companies need to protect themselves against fraud and account for the fact that “people come in and out of that system when they need coverage.” A representative of Blue Cross of California explains, “It’s not a big part of what we do,” and further, even if they (or he) dislike the practice, they cannot be the only company that rejects it. “If we stopped doing it as a single company,” he smiles uncomfortably, “We’d go out of business.” No matter their rationales, however, many practices of the industry remain suspect. As Los Angeles Times reporter Lisa Girion uncovered in a series of recent articles, some companies encourage their agents to seek out policies to find cancel. She discovered cases where bonuses were paid “based in part on how many recissions” an employee had carried out in a given year.

Sick Around America posits one tragedy in particular as its climax, though again, the case of Nikki White is not unique. Diagnosed with lupus, while she was in college, White did her best to find jobs after graduating that would provide insurance. Her primary physician, Amylyn Crawford, recalls that White was an ideal patient, trying to “be responsible” for her condition and her coverage. Eventually, White was unable to keep such a job; those companies with good plans, like Microsoft, are decreasing in number, in part because of rising costs (see: the auto industry). She moved back in with her parents and sought out private coverage. In 2005, White received notice that she was no longer insurable, such that she was no longer able to control symptoms. An inevitable trip to the emergency room resulted in hundreds of thousands of dollars worth of intensive care, all too late. Crawford notes the absurdity of a system that won’t pay for preventative or maintenance care, then pays for crisis treatment. White died, Crawford concludes, “secondary to the complications of a failing health care system.”

Sick Around America outlines this system, and its many contradictions. If advancing technologies and the actual care offered in the U.S. are exemplary, these are only available to a select few. Unlike other developed countries, many of which offer universal health care, America sustains an illogical, costly health care system. While the show cites the reform urged by President Obama, it also notes the multiple difficulties and competing interests facing such an effort. Jeff Kang, CMO of Cigna Health Services, lists the many stakeholders in any system — doctors, hospitals, insurers, patents. “I haven’t met anybody,” he says, “who’s willing to take less.”