Bio


View my bio

Now the Details

Media, ethics, and journalism. What works. What doesn't.


Jeffrey Dvorkin

Monday, December 21, 2009

My Own Personal Healthcare Reform Act: Leaving the USA



After twelve years living the United States, it was the absence of humane and comprehensive health care – more than any other single event - that drove me back to Canada.

I’m not demonizing the US system. My wife and I met some wonderful and caring practitioners. Nor am I idealizing Canada’s health care plans. There is rationing in Canada, much as Canadians refuse to admit it. But both systems have advantages and disappointments. In the end, it was the American approach – with its utter lack of any consideration other than a commercial one, and its ruthless corporate attitude that can only be describe as harassment – finally did it for me and my wife. In 2008, we had had enough and decided to leave.

Some background first: In Canada, all citizens are guaranteed health care through the federally mandated Canada Health Act. The Act is administered by each province while the funding comes from a combination of direct federal grants and provincial taxes.

In Ontario, it’s known as OHIP (Ontario Health Insurance Programme) and it covers all medical events. Prescriptions are separate and are often covered by employers in a public-private subsidy. It works pretty well, although Canadians generally complain about having to wait for non-emergency surgery and treatment.

I was hired by NPR to be VP of News and Information in 1997. My family and I were excited about the prospect of living in Washington DC, but nervous about dealing with the US healthcare system. Canadians love to point out the flaws in the US system and have exalted the Canadian system as another way of differentiating the two countries. But in truth, we benefited greatly from the US system – for a while anyway. At NPR, the company health care plan was with CIGNA and it worked for us. Whenever I needed to see a doctor or get a prescription filled, I would be promptly reimbursed, minus a small $10 deductible each time, known as a “co-pay.” Fortunately we had no serious pre-existing conditions that could have disqualified us.

I thought that with no major illnesses and a company plan, we had the best health care possible.

But once I left NPR and CIGNA in 2006, it got worse. A lot worse.

I took a career chance and left NPR to become the first executive director of a journalistic not-for-profit – the Committee of Concerned Journalists. At CCJ, health care was covered through the University of Missouri (a 25% stake holder in CCJ). The health care plan was run by a company known as UnitedHealth.

I won’t go into the now well-known details of how UnitedHealth has been ranked as the worst of all American insurance companies, how it came under investigation by the Securities and Exchange Commission for fraud and stock manipulation, how the SEC is still investigating. Or how in 2006, the CEO William McGuire was forced to resign and repay more than $400 million in bonuses (he received more than $1 billion from the board when he left the company). As an employee of the Missouri School of Journalism, I had no choice.

It was my own personal experiences with UnitedHealth care that were enough to drive me back into the arms of so-called “socialized” medicine in Canada.

An example: I would file a claim for Lipitor, a well-known cholesterol medicine when I was with CIGNA. Once with UnitedHealth, they refused to allow Lipitor. Instead there was a preferred list of other medications to be purchased from UnitedHealth’s own company. So much for freedom of choice.

My doctor wrote a letter to UnitedHealth saying that Lipitor was working well for me and other medicines often had side-effects including stroke and migraine. His letters were ignored. So I was forced to switch medications since staying with Lipitor would have been prohibitively expensive. Initially there were minor side effects, but over a few months they went away. But the concerns did not.

The harassment really began after I filed my claim with UnitedHealth and for a month, all seemed well.

When I filed a second time, I never heard from them, and no reimbursement arrived even though the website said I would receive a check within a week. So I would call to inquire and get trapped in their “telephone tree:” “Dial 1 if you are a UnitedHealth care customer. Dial 2 if you are not…”

When I finally found a way to speak to a human being, the routine was invariably the same. I would be told they had no record of me or my wife as being enrolled. My number issued by the University of Missouri was unknown to UnitedHealth. A call to the Missouri confirmed that indeed, we were registered.

Back to the phone tree: “But you paid me last month!” I would exclaim.

“One moment please,” as I would be put on hold. Then the line would go dead.

This would happen regularly and I was later told that insurance companies regularly resort to this technique since a "significant" percentage of callers abandon the process out of frustration.

This would happen every month and each time I would be spending anywhere from an hour to three hours trying to get some response from UnitedHealth.

Eventually I discovered on an Internet site that the best way to get results would be to threaten an “executive complaint.” An “EC” it seems, was a complaint that the insurance company must file with Congress – and the last thing they wanted was congressional oversight. That usually brought the required check within a few days.

After a year with CCJ, I resigned, as the position was not the perfect fit I had hoped for. I left to teach at Georgetown University as an adjunct (no benefits) and to do some consulting in and around public broadcasting.

As for health care, I entered into the “neverland” called COBRA – an ominous acronym that stands for The Consolidated Omnibus Budget Reconciliation Act. It gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice.

But COBRA is expensive. $1100 a month that came out of my pocket. And COBRA would only last for 18 months.

More disconcerting, and as bad as it was, UnitedHealth does not “handle” COBRA. Instead I was transferred to Great West Life and the same “phone tree” hell began again. After more promises of “executive complaints” I was given my own “insurance professional” who would process the claims. This person (quite helpful, by the way) was based in Tennessee and after a month or so, he went on stress leave and eventually left the company. I felt his pain.

The last straw was when Missouri finally ended its relationship with Great West and suddenly I was a “client” of Coventry Insurance – a company completely unfamiliar to me. The process started all over again.

That’s when my wife agreed that it was time to go. Dealing with American insurance companies was simply life-threatening. I was lucky: I could teach and consult from Toronto and not have to deal with this insanity again. It made complete sense. So despite a home we had made for ourselves with the expectation that we would be in the US for the rest of our lives, we moved back to Toronto in 2008.

As I read about the struggle to pass health insurance through Congress, I realize that timing is everything and my timing on this issue at least, was all wrong. A few years from now, Americans will look back and wonder why they listened to the scaremongering of Sarah Palin and Joe Lieberman (who really should be ashamed of himself).

An imperfect plan has passed the first hurdle in the Senate. It will be interesting to see how the lobbyists and their allies in the media try to sabotage whatever bill is finally passed. But watching the debate and listening to how the present system is defended, I am reminded of a comment told by a friend in Washington: "He died after a long struggle with Blue Cross and Blue Shield..."

I’ll come back to the US from time to time to see the people and places dear to me. But this is one US citizen (yes, I became one in 2005) who was forced to leave. I love America and Canada too, but I won’t miss dealing with insurance companies.

No comments:

Post a Comment