Why do insurance companies balk at paying for MRIs?
The softball was a useful reminder that hardballs are
available: If the congressional GOP, allied with insurer-dominated interest
groups, succeeds in stonewalling comprehensive legislation on health care, the
White House and Congress can at the very least fall back on the single step of
expanding Medicare. That would be a stroke-of-a-pen “public option,” the very
public option that the insurance industry is hell-bent on preventing, to the
tune of an average $1.4 million per day in lobbying Capitol Hill in 2009.
It is highly unlikely that the GOP alone has enough power
to serve its corporate donors adequately at this point. Congressional
Republicans did manage temporarily to disrupt hearings yesterday—by moving to
adjourn (Congress), forcing members engaged in substantive hearings to exit for
the House floor. Waxman kept the Energy and Commerce Committee hearing going as
members left to vote.
The hearing on the draft of the health care reform bill was also
interrupted when a young woman intern fainted, falling in the risers where
members were seated and hitting her head. Several people including Rep. Michael
Burgess (R-Tex.), a physician, hurried to her aid; after several minutes she
was led out, shaky but on her feet. A Committee spokeswoman says today that she
is perfectly fine, and “thank you very much for asking.”
Fortunately this incident seems to have been minor,
leading only to predictable doctor-in-the-House smiles. (No one called out, “Is
there a . . .?”) Head injuries, however, are no joke. As dramatized in the
headlines—the death of Natasha Richardson following a skiing
accident—and in fiction--a plot point in John Grisham’s recent novel The Appeal--the full extent of a head injury
often does not manifest itself until well after the incident that caused the
injury.
One woman I know personally suffered almost the full
consequences of a fall and head injury—almost. By nearly a miracle, the woman—a
successful and diligent businesswoman, name omitted here for privacy
reasons—escaped death (“I guess I’m just hard to kill”). She had a freak fall at
home, over a low railing, hit her head; had medical attention and seemed okay
afterward. Some time later—boiling this narrative down—she collapsed with
severe symptoms threatening major organ failure. Net result: Recovery achieved,
but at the price of a near-death experience, a lengthy hospital stay, lengthy
recuperation, weeks of work missed stretching into months (I, among other
customers, certainly missed her), and—along with the human cost to family and
friends—considerable lost productivity.
One factor determining this chain of events—which only by
a fluke, and family concern, did not result in a fatal outcome—was that her
insurance company declined to provide an MRI. Not to boost any single medical technique
as miracle cure, still, magnetic resonance imaging here would have upped the
relevant information necessary to informed medical judgment.
So why—given our insurance industry’s oft-iterated wish
to reduce health care costs (by eliminating malpractice litigation, etc)—would
an insurance company not want to pay
for MRI in a head-injury case? An ounce of prevention is worth a pound of cure;
medical research, like common sense, reaffirms that with head injuries as with
heart attacks, getting prompt help to the patient is crucial; delay creates
complications far more costly down the road than imaging at the time of the
incident would have been. Life is full of hard questions. This is not one of
them.
As Sebelius pointed out in the hearing, for all the
arguments about ‘rationing’ health care under proposed reforms, rationing
health care happens under our current system every day—often by private
insurers, making decisions that come between doctors and patients.
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