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Book of Matthew: Pre-existing cruelty

Published: September 18, 2009
Section: Opinions


Allow me to introduce you to Jane.

Jane is a victim of domestic violence. Not long ago, she was married to a physically abusive husband who made it his job to control every aspect of her life. He cut her off from her social circles and forced her to stay home like a “good housewife.” He became demanding, needy, at times deranged, giving her increasingly difficult orders to be carried out at once.

When Jane failed to do as he said, he beat her. Again and again.

For years Jane allowed herself to be convinced that this was all her fault; that somehow, she deserved to be punished. It is a mindset that too many victims fall into. But after several near-fatal beatings, she decided that she couldn’t take it anymore. She sought help from her family and the few friends she had left, and finally escaped from her marital prison. She was a lucky one.

Jane now lives with her sister in a small suburb just outside of a major American city. She has three part-time jobs at various small businesses downtown, and saves her money in the hope of someday getting her life back together. She is, in many ways, a success story.

Well, not quite.

Although she tries to hide it, Jane has painful shoulder and wrist injuries inflicted by her husband. Lately, they have made working increasingly difficult, and she worries that she may have to give up one of her jobs. And yet, Jane refuses to visit a doctor.

This is because she knows she could never afford medical attention. Jane does not have health insurance. The state where she currently resides allows insurance companies to deny coverage to victims of domestic violence. This leaves Jane with two options. She can go into debt trying to cover uninsured medical bills, or she can grit her teeth and hope that her condition doesn’t get any worse.

Actually, Jane won’t have to choose either option because she isn’t a real person. But she might as well be. Her story represents the real-life struggles of Americans who have fallen victim not only to domestic violence, but also to one of the insurance industry’s most powerful weapons: denial due to a pre-existing condition.

The term “pre-existing condition” has been getting a lot of airtime lately, thanks to the never-ending healthcare debate and prominent politicians who have finally figured out that publicly criticizing health industry practices is a good way to gain votes in midterm elections. But the idea itself is nothing new. A pre-existing condition is defined as an illness or condition that a person has before their health coverage begins. Insurance companies try to exclude people with such conditions from their plans, because too often including such people costs these companies more than they are willing to pay.

Allow me to explain. For-profit insurance companies make their money through a complicated process that can be summed up rather simply in three words: spreading the risk. “Risk” refers to a customer who is likely to require the company to cover his/her medical bills—an elderly person, for example, or a cancer patient. Since paying for too many of these bills does not bode well for the insurance company’s finances, the company will try to “spread the risk” by insuring as many healthy individuals as possible while making it difficult for those who are unhealthy to receive benefits, all while charging hefty premiums.

Many conservative economists and free-market hawks refuse to believe that insurance companies are so picky. They argue that private companies have to compete with each other, and in doing so they must offer good, affordable plans to attract customers.

Sounds good to me, but unfortunately, the magic of competition doesn’t apply to today’s insurance market. As President Obama pointed out in his recent (rudely interrupted) address to Congress, many parts of the country experience health insurance monopolies. In 34 states, 5 or fewer companies control 75 percent of the insurance market. A particularly troubling example is that of Alabama, in which Blue Cross Blue Shield controls a jaw-dropping 90 percent of the market.

In this case, insurance companies don’t have to try to serve the customer. They only have to serve their own wallets. It’s in their best interests to deny coverage to expensive cancer patients, diabetics, arthritics, and yes, domestic violence victims.

Which brings us back to Jane’s story. In seven states (Idaho, Mississippi, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming) and the District of Columbia, there is no law stopping insurance companies from denying coverage to someone like Jane. Think about the impact of this for a moment. It is especially detrimental to women, who statistically have a greater chance of being uninsured, and a far greater chance of being domestic violence victims. And on top of the victims who are being denied the coverage they seek, there are likely countless more who keep their abuse a secret, knowing that reporting the true cause of their injuries would mean losing the chance to affordably treat them.

Is this the country we live in? It reminds me of a bumper sticker I once saw that protested the Bush Administration. It read: “If you aren’t appalled, then you haven’t been paying attention.” Those words still hold true today. The problems we face haven’t changed.

While Congress spends the next few months debating the finer points of the various healthcare proposals that have been brought forth, its members should stop talking about the evils of the insurance industry and start acting. We need a strong, permanent Federal ban on insurance companies denying care based on any pre-existing conditions.

It’s about time we learned to take care of those in need.