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What’s Healthy?


If 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 company.

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 blue sky.

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.

—Miriam Axel-Lute

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