you were an insurance company trying to cut your costs, how
would you do it? Emphasize prevention over cure? Cover birth
control? Allow coverage of cheaper alternatives, like in-home
care over nursing homes or examine ways to encourage use of
primary care providers over the emergency room?
Or perhaps you’d try to avoid paying for the treatment of
teens with eating disorders and then when you get sued, demand
that they give you their diaries, e-mails, and private MySpace
and Facebook posts to “prove” that the conditions were “emotionally
based” not “biologically based.”
In New Jersey, Horizon Blue Cross Blue Shield, may they receive
the corporate death penalty, has chosen the latter. Of course
they are enabled in this by an asinine New Jersey law that
says health insurers are only responsible for covering mental
illness when it’s “biologically based.”
Show me someone who says they understand enough about how
our brains work to clearly draw that line, and I’ll show you
someone with biologically based delusions of grandeur.
You can’t even draw it with so-called non-mental illness.
Emotions and health affect each other on macro and micro levels.
Should my broken leg not be coverable if I got it because
I wasn’t looking where I was going because I was ecstatic
about my first book being published? What if my diabetes is
attributable to my obesity, which is attributable to overeating,
which is attributable to grief at a loved one’s loss? Will
you not cover a doctor’s visit for the flu because I lowered
my immune system staying up late having a fight with my spouse?
How about crippling tension headaches or stress-related ulcers?
This is the slippery slope Horizon is heading down, since
it has the gall to think it should be off the hook for covering
a bulimia treatment if the sufferer was ever upset for any
reason other than weight before or during throwing up. (Does
it really think that large numbers of teens without eating
disorders are going to eating disorder clinics because they
had a bad week at school?) And Horizon’s lawyers think they
have the right to read personal documents (currently limited
to those that have been shared with at least one other person,
but originally they asked for everything) to “determine” this.
It’s like the Bush administration running your health-insurance
This attitude is similar to attitudes that only want to protect
victims of sexual assault who are virginal, meek, and dressed
in suitably “modest” garb. It harms many of the people who
are in the most need of help. Or, as one person commented
in an online mental-health forum: “Brain on the fritz because
of ‘no fault of your own’? OK, we’ll pay. Brain on the fritz
from years of abuse? Eh, we don’t cover that.”
Much like public safety and education, health happens in the
context of real life, which is messy, imperfect, and complicated.
Anyone who tries to make a change for the better in any of
those areas while ignoring that fact is going to spend a lot
of money, hurt a lot of people, and get not very far. Children
can’t learn while they’re hungry or suffering from PTSD or
being forced to sit sill for developmentally inappropriate
lengths of time. Factors from poverty to lead poisoning increase
crime. Illness and injury only rarely appear out of the clear
Which means, when you come down to it, that while I think
Horizon’s actions in New Jersey are heinous and unforgivable,
they do point to a tricky question: If someone is taking on
the responsibility to pay for health care, what constitutes
health care? If you mean literally that which cares for my
health, then most of what I spend on groceries, tea, exercise
classes, bike repairs, vitamins, water filters, posture-improving
shoes, allergen-blocking dust covers, vacations, relaxing
time with my family, books about baby sleep habits, and a
million other things I spend money on would count as health-care
expenditures just as much as a visit to the doctor (traditional
or “alternative”) and my asthma inhalers would. I don’t expect
a health insurance company to pay for all that, and
certainly don’t want them meddling in my choices about my
grocery bill. And yet, what they do choose to cover often
seems off base and counter productive—surgery, but not the
treatments that might make surgery unnecessary, for example.
Can we craft a health care system that encourages, values,
and spends energy on wellness and prevention, but doesn’t
sort the sick into the deserving innocent and the lazy lame-o’s
who don’t take care of themselves? Can we make a compassionate,
affordable health care system that also protects our privacy?
These are hard questions, and I don’t have the answers to
them, though I do have trouble imagining any a coherent long-term
discussion about them happening in any context other than
a national health insurance system. (Relieving people of the
strain of paying for health insurance would in itself help
them afford healthier, less stressed lives in the first place.)
In the meantime, you may want to think twice before blogging
about your health.