It is not clear what message Frontline wanted to deliver in last night’s Sick Around America documentary. The show, conceived as a sequel to its acclaimed Sick Around the World special, was a limp, flat journalistic effort that did nothing to help the public understand the current politics of health reform. It both demagogued the insurance industry and then sent valentines their way, making me wonder if the show’s bad cop/good cop portrayal was a deliberate attempt to reflect the nation’s schizophrenic attitude toward the industry. In the end, it just made for a confusing and unfulfilling hour of television, and made me think that Frontline missed an opportunity to say something meaningful and new about the topic at hand.
The first half of the show piled on anecdote after anecdote about individuals’ experiences with health insurance. It was all familiar territory. We hear about a Microsoft employee whose super insurance paid a million dollars to help his premature infant survive. Then there was Paul Stevens, once a manager at a telecommunications company in Houston, who was in his late fifties when he lost his job. Stevens found COBRA too expensive and had to venture into the individual health insurance market where his diabetes disqualified him from coverage. When he had his heart attack, he had no insurance and got stuck with bills totaling more than $200,000. The Texas high risk pool was out of the question because it, too, was expensive and required a long wait for coverage. Stevens says he is trying to live long enough to get coverage from Medicare. But there was no talk of what problems await him once he gets there.
Interspersed among the stories are lessons about how the individual market works—sort of an actuarial primer for the public about medical underwriting. That’s the process of weeding out sick applicants for coverage. We hear about hundreds of people who declare bankruptcy each year, partly because of medical bills, and that others are hurt by a practice called rescission, where insurance companies drop those people whose applications failed to disclose all their medical conditions. The producer focused on California, where Los Angeles Times reporter Lisa Girion has written extensively about this subject. In Sicko, Michael Moore made the same point with a different carrier. Not much new territory here.
The documentary progressed to a discussion of consumer-directed health plans that, it said, were “loaded with caveats.” No kidding! Deductibles of $7500 or more and 40 percent coinsurance (that means you pay 40 percent of the medical bill) pinch the pocketbook, as Patricia Campbell of San Diego found out. OK, nothing new here either, as Campaign Desk has noted.
When the documentary addressed the subject of health insurance for everyone, it began by serving up a lot of confusion about health insurance provided through social insurance, as in Europe, and that provided by private carriers, as in the U.S. The narrator noted that many experts believe that a fairer system would cover everyone, just as all the other developed countries do for their citizens. He said that was “what insurers call guaranteed issue.” That’s a new one on me—referring to other countries’ social insurance systems as guaranteed issue. (When private insurers offer to guarantee coverage, they are saying they will do so generally without evaluating their applicants’ medical conditions.) Since there’s little private insurance in most of those countries, the concept doesn’t seem to track. There was no discussion of how social insurance works—that everyone pays taxes to fund health care; that everyone is guaranteed care as a matter of right; and that the national health systems pay for medical services in most cases, not private insurance companies.
The program did mention five states that have guaranteed issue coverage—that is, they require that insurance companies offer a policy to everyone, sick or well. But then it featured experts who talked about the problems with that approach. One said that the premiums were three times higher in those states because sick people often fall into the insurers’ risk pool because they may have waited to sign up for a policy until they are sick. FYI: It’s also true that they may have been in the pool all along and then got sick.