Walter Carpenter: In hospital-insurance company fight, patients are helpless

This commentary is by Walter Carpenter of Montpelier, who works in Vermont’s tourist business and is a writer and health care activist.

By now it looks like the divorce proceedings between the University of Vermont Medical Center and UnitedHealthcare that threatened the lives of some 5,000 Vermonters is over.

Though they have reconciled for now, this could easily happen again and it could be more than 5,000 Vermonters suddenly placed at risk. In our health care sickness, we are all left vulnerable to these forces at any time.

The question we should be putting forth to ourselves and our business, cultural and political leaders is: Why do we allow our health care, and thus our lives, to be placed at the mercy of the shenanigans of buying and selling that we call a market ? Why?

I sympathize with those 5,000 Vermonters suddenly finding themselves forced to go elsewhere for treatment if they needed it because two market behemoths were having a spat.

To understand what this is like, you have to go through it. In 2005-06, it was my turn. I remember well that feeling of fear, of utter helplessness at someone else’s decision suddenly tossing my and my coworkers’ lives onto luck and our nation’s unique belief that this invisible entity called a market should decide the fate of our health care.

I was working at a Vermont company. Like so many companies are now in this age of mega-mergers and monopolies, this company was owned by another company. The parent company was out of state. We were part of a family of companies.

In 2005-06, they switched insurance companies. They did this without our input. We had no choice in the matter. It still makes me laugh when supporters of the status quo admonish me about “choices.”

The new company was United Healthcare. One CEO I knew in our parent company and who was high up in the corporate strata told me “United was probably the lowest bidder.” That would explain why what we got was so shoddy.

Before them, we were with BlueCross BlueShield of Vermont. While hardly great, it was at least local and we could complain about the inevitable games that for-profit health care inflicted on us — like the inevitable co-pay increases, claim or prior authorization denials, and so on — to the proper state agencies or our representatives.

Blue Cross once jacked up my co-pay from $50 to $250 after a procedure. They cited how their costs had increased. I cited how my wages did not rise to meet their added costs. They sympathized, but intimated that it was my tough luck. The representatives and state agency (BISCHA back then) replied that they would “look into it.” I heard nothing more of it.

With United, all of our medical providers were wiped out of the network in one stroke. We could use them if we wanted to, but only at the uninsured rates, far higher than the insured rates.

Back then, United had precious few “networked” physicians in Vermont. Their nearest doctor to me in Montpelier was in the Northeast Kingdom; the closest “networked” hospital was Dartmouth-Hitchcock in Leabanon, NH the hospital was just up the hill.

This had serious ramifications for me. The first symptoms of the liver disease (by natural causes) that almost killed me in late 2006 were forming up. Without a general practitioner, the gatekeeper in our managed care world, I could not get into the system and the symptoms had all the opportunities they needed to gather into a force strong enough to do the job.

When I finally found a general practitioner, my skin was changing into a sickly yellow hue, then it became a fight against time. I almost lost it.

Sixteen years later, we’re still going through this and with more crises piled on top of it — fantastic wait times, doctor and nurse shortages, always spiraling costs, outlandish CEO salaries, and all the others we are acutely familiar with by now. Covid only exacerbated these problems.

What is called “value-based care” has done nothing to alleviate them, despite the billions of our money we’ve fed into it. Like the HMOs, the PPOs, and all the other experiments tried before it, value-based blames and punishes us for these ills, instead of the corporate system that suddenly put the 5,000 Vermonters at risk and nearly killed me.

The journalist TR Reid put this into perspective in his book “The Healing of America,” published in 2009. He framed our dilemma as a moral question: “Should we guarantee medical treatment to everyone who needs it or should we let Americans die from a lack of access to health care?”

We are still grappling with Reid’s moral question. Why?

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Tags: medical treatment, UnitedHealthCare, UVM Medical Center, value-based care, Walter Carpenter

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