News & Politics
Hey Obama, Here’s What You Should Say Tonight
Tell our stories of health care disaster.
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My health insurance doesn’t really protect me, but like a lot of people out there, according to recent polls, I’m afraid to lose it. Despite my fear that speaking out might end up costing my family our coverage, I wrote about our knock-down-drag-out battle with insurance on DoubleX, spoke about it on NPR, and testified about it before Congress. But my case is unusual—because there was a beginning, middle, and resolution to it, and because I was willing to complain at all.
There is a near pact of silence among those of us with major insurance company woes. People simply don’t speak out. That shyness hasn’t boded well for the Democrats who assumed that all people who hate their insurance would get out there in town halls and on the airwaves to champion health care reform. Instead, collective reticence, combined with the inability of the Democrats to harness the most compelling of our stories effectively, means that a question remains in the minds of a lot of Americans about why exactly we need a health care overhaul. That is making Obama’s job of selling reform that much more difficult as he heads into his address to Congress on Wednesday.
At the beginning of the summer, proponents of health care reform seemed to believe that this debate would be won or lost on rational policy positions, rather than political atmospherics. Advocates for reform outside the administration tell me Hill staffers and the White House didn’t much pursue or push personal “real life” tales like mine. They feared individual stories would be seen as individual problems, rather than a pattern calling out for a systemic solution. In other words, the Democrats got lost in the math game of the health care debate. As a result, they haven’t used personal narrative nearly enough, or nearly as well, as they might have. And that, as much as anything else, left them vulnerable to an attack from the other side based on mythical granny killings.
Part of the Democrats’ trouble might have been anticipated. A new study by Mark Schlesinger of Yale and Brian Elbel of New York University, appearing this month in the health policy journal Milbank Quarterly, finds that most consumers do not formally complain or quit their health plans, even when they have had big problems with their policies, ranging from unexpectedly paying more than $1,000 out of pocket to being declined for services. Almost no one even writes in to her health insurance company, let alone to state insurance commissioners, asking for a review of denied claims. Overall, the study found, barely 3 percent of people with major health insurance problems file a formal complaint with their insurance companies when their health plans screw them over. “The [insurance] industry is quick to say ‘90 percent of people are happy with their coverage,’ but this research shows that people are not satisfied. They just don’t complain,” says Karen Pollitz, project director at Georgetown University’s Health Policy Institute.
She is surely right that silence doesn’t equal happiness. In the wave of response to my article, I heard many more stories like mine or worse. (Until my piece ran, Care First Blue Cross Blue Shield denied coverage for the labor and delivery of my baby even though I’d purchased, in advance, a supplementary maternity package meant to pad our basic insurance with promised routine prenatal care and hospital services.) One woman who wrote to me got a bill for $20,000 after labor and delivery. (She offered to give the kid back.) Another woman was told her previous cesarean section meant she was eligible for a policy with $15,000 in deductibles or no maternity coverage at all. A man wrote in about how he’d been mugged and taken to the medical school side of a university hospital emergency room, making his care “out of network” for his health insurance company. He had to shell out $6,000; his insurance paid nothing.
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