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The Deadly Algorithms of the Health insurance Industry

Why is Mitt Romney Trying to Kill Me?

by CLANCY SIGAL

Under the influence of the painkiller Dilaudid, and dog-tired after another day of fighting for my life with my private health insurance company, I glimpsed Mitt Romney and his running-mate, Paul Ryan, entering my Los Angeles hospital room dressed in surgical gowns with scalpels in their hands ready to fatally operate on me.

It was a drug-induced hallucination, of course. But the mirage made me sit bolt upright in bed and, fully awake, start to rethink my previous, bitterly dissenting view of Barack Obama.

For the past year, I’ve been in a death spiral without knowing it. The occasional fainting spell, sprawls on the street and a dramatic weight loss were shrugged off as merely a cost of doing a writer’s business. Denial is a most powerful analgesic. Even when paramedics first rushed me to the hospital, I angrily argued with the doctors.

But when a lightning-bolt sciatica pain, triggered by a car accident, brought me down like a bull under the matador’s sword, more or less paralyzing the left side of my body, the health gods decided it was time to shut down my hubris. Like something out of the TV’s “House” or “General Hospital”, suddenly there were midnight ambulances, emergency room traumas, drip feeds, oxygen tubes up my nose, renal failure, suspected meningitis, pneumonia and a minor heart attack.

Thankfully, working as a team at my local Cedars-Sinai hospital, whole platoons of neurosurgeons, cardiologists, nurses, infectious disease experts, radiologists, physical therapists, pulmonologists and hospitalists (whatever they are) dragged me back from the edge. Emergency surgery in a special spinal unit was successful, and today I’m back on my feet – I’m a product of American medicine at its best.

Ah, if only the doctors were free to do their jobs!

My private insurance company, a subsidiary of Wellpoint Inc – America’s largest “managed healthcare”, for-profit company – interfered at almost every stage of my treatment. They were aggressive and shameless. At my most vulnerable, with tubes sticking out of me, they phoned my hospital room – kicking my anxiety level sky-high – to let me know that Wellpoint’s profit-seeking radar had targeted me. The anonymous voice warned, with a kind of smiling threat, that they were on my case: meaning, some bureaucrat – was he or she even medically competent, or just an IT geek – in a far-off, distant corporate office believed that my treatment was violating a mysterious insurance algorithm.

Here in California, Wellpoint and its member plans are notorious, as Reuters reported, for “using a computer algorithm that automatically targeted [women] and every other policyholder recently diagnosed with breast cancer … the insurer then [allegedly] canceled their policies based on either erroneous or flimsy information.”

The practice is called rescission. To put it bluntly, the company collects your money when you’re healthy, but cancels if you get sick. In the case of another insurance company, Health Net Inc, employees were actually paid bonuses based on how many cancellations were carried out; at other insurers, like Wellpoint, staff were praised in performance reviews. Wellpoint’s California subsidiary, Anthem Blue Cross, has raised premiums capriciously by as much as 39%. Politically, Wellpoint is, in effect, a rightwing “political action group” that lobbies hard against healthcare reform – even calling upon employees to do their share. In other words, it’s the ogre in the medicine cabinet.

Perversely, none of the bad stuff would have come down if my primary insurance had been traditional, government-paid Medicare, the closest America has to a single payer. But a quirk in my union benefits put me in the sweaty hands of Wellpoint. I wasn’t threatened with recission, but almost daily, and sometimes several times daily, my doctors were interrogated about practically every measure they took to keep me alive. Again and again, I saw caregivers, even the most skilled and courageous, retreat with an embarrassed, impotent shrug of resignation that said, “what can I do; it’s ‘the system’?”

So I – and my courageous tiger wife – fought, wangled, yelled, protested until I ultimately squeezed past the algorithm. The surgeon of my choice skillfully removed the whatsit that was pressing on an inflamed nerve that had been beating up my spine, and I even won a little rehab time before the insurance computer forced my early discharge. Along the way, anguish over near-daily arguments with the faceless insurance hanging judges almost gave me another heart attack.

Need it be this way?

Obamacare – also known as the Affordable Health Care Act – isn’t medical heaven, or single payer, or anything like the “socialized” NHS that kept me well for the 30 years I lived in the UK. The new law, an obvious compromise with the corporate sickness industry, still keeps us in the hands of private insurance companies. But when the law fully kicks in for the first time, all Americans – regardless of income and “preexisting medical conditions” – must have health coverage. Individuals up to the age of 26 are covered by their parents’ plan. Low-income Americans will get subsidies to help them buy insurance, and doctors and hospitals will be paid for outcomes not “procedures”. Starting in 2014, insurers are forbidden to deny coverage to anyone who has no workplace – the jobless and freelancers will be able to get a government-mandated, insurance plan; indeed, they must or pay a “fine”. And under the new law, “federal parity” means mental healthcare will be more accessible to more people.

Granted, that all depends on this upcoming election day. If Romney and Ryan win – the latest polls tell us this is a real possibility – they, a vengeful Republican Congress and their insurance lobby allies have sworn to sabotage healthcare-for-all. As for repeal and replace, Mitt’s prescription for uninsured folks is that emergency room care is a good enough substitute:

“We do provide care for people who don’t have insurance … If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.”

Here and elsewhere, I have written bitterly attacking Obama’s serial betrayals. He’s no street-scrapper, our Barack. Prior to falling sick, I pined for a third-party candidate, and seriously thought about not voting. But a drug-induced vision of a Romney/Ryan medical hell changed my mind. On 6 November, I’m pulling the lever for Obama: my arrogant,self-sabotagingdrone-happycompromise-addicted war president.

I never want to see Dr Romney in my hospital room again. Damn it, I want to live.

CLANCY SIGAL is a novelist and screenwriter in Los Angeles. He can be reached at clancy@jsasoc.com

Exclusively in the new print issue of CounterPunch
THE ARAB SPRING AT A CROSSROADS — Esam Al-Amin surveys the new Middle East, from the revolutions in Egypt and Tunisia, to the aftermath of the overthrow of Qaddafi and the civil war in Syria, and outlines the economic and political challenges facing the fledgling Arab democracies; THE BI-PARTISAN PLAN TO GUT MEDICARE: Dave Lindorff digs beneath the rhetoric to expose the grim similarities in both Obama and Romney’s schemes to degrade Medicare by cutting spending, reducing eligibility and privatizing services. KAFKA IN SEATTLE: Kristian Williams details the surreal ordeal of Matthew Duran, thrown into federal prison even though prosecutors admit he committed no crime.