Last Word

April 22, 2005

There ought to be a law

We welcome new patients to our practice, but only if they're profitable.

When a new patient arrives, he's handed a form and asked to check off a rigid set of criteria, providing us with information about his health, habits, and present complaints. We have an unskilled and therefore efficiently remunerated-okay, she's underpaid-staffer whose job it is to review the completed forms and then accept or reject patients. We've instructed her to look closely at items on the profile that might affect the cost and convenience of having this particular individual seek medical care from our strictly for-profit practice. Some pre-existing conditions are red flags, making a patient high risk and less profitable. We also don't like to treat patients for conditions that might be overly time-consuming. That could eat into our profit margin. If in doubt, the clerk rejects the patient. We intend soon to computerize this patient selection process so we can dispense with the staffer.

Farfetched, right? We're not supposed to cherry pick patients. We're supposed to accept patients much like we take a spouse-for better or worse-although not until death do us part. Can you imagine refusing to accept a patient just because his case might not be financially rewarding? Okay, if a patient refuses to pay your fees or makes a nuisance of himself, that's a different matter. But can we reject him because he happens to have a time-consuming disease or an unfortunate history?

Imagine being one of these patients:

Connie, a new patient, has diabetes and no medical insurance.

"I can't get insured. Nobody will take me," she said. Not good for the profit margin, I guess.

Peter did have insurance, but not for cardiac conditions.

"I have a murmur," he said, "and they won't cover anything to do with my heart."

David also had insurance. "But not for my hypertension," he said. "That's a pre-existing condition, and they won't cover me for that until I've had the policy for a year."

It has to be devastating to have a serious medical condition and not be able to afford treatment, knowing full well that every day that goes by without treatment is harming you.

Should an insurance company be allowed to reduce its risk by picking and choosing beneficiaries? Isn't that what insurance is supposed to be all about-paying the company to take on risk?

If an expensive condition is something the patient should be able to correct, the company may have a case. A smoker or drinker can work on stopping. A motorcyclist can exercise caution and wear a helmet. A motorist can wear a seat belt. But the point is, people can't avoid getting diabetes or heart disease or cancer. Should they be penalized?

Medical insurance should be available to anyone who wants to buy it. A company shouldn't be allowed to exclude a patient just because he's high risk through no fault of his own. Couldn't the company raise premiums for the healthy patients in order to compensate for the cost of those less fortunate? The increase may not be appreciable, and its effect would be far less traumatic than that imposed on individuals who can't get sorely needed medical coverage.