Blue Cross Texas: More Lunacies

Businessman and KPFT radio commentator Leo Gold tells an amazing tale of how Blue Cross Texas rejected his medical coverage (and later found that the Texas health insurance risk pool assigned him to be insured by…the same company!).

I looked a little deeper at the Pool’s information, and to my surprise I discovered that the fulfillment arm of the Pool – the physician network, treatment management functions, and so forth – was contracted to an outside company, and lo and behold, that company is Blue Cross. The relationship between the Pool and Blue Cross is so intertwined that Blue Cross representatives regularly attend and participate in the Pool’s Board of Directors meetings. I’m not saying there’s anything illegal about this, but let’s consider the ironies: a Republican legislature, inveterately and philosophically opposed to government health care, writes legislation that allows insurance companies to exclude applicants who simply have a therapist, thereby ensuring that there will be a need for a government health insurance pool; and that government health insurance pool, because it does not have the resources to offer all elements of a health plan to its participants must contract with the very entity whose refusal of coverage resulted in the need for the pool in the first place. It’s no wonder that we Americans spend 15% of our GDP on health care, with all the inefficient bureaucracies, public and private, designed to pass people from entity to entity like hot potatoes.

I had a similarly bad experience with Blue Cross Texas two years ago. When I signed up, I made a similar mistake of being honest. I mentioned to the Blue Cross interviewer that my doctor offhandedly mentioned that I should have a freckle checked by a doctor. Blue Cross Texas turned me down for coverage…all because of a freckle! You see, Blue Cross Texas expected me to (pay to)  visit a dermatologist who would look at my freckle and perhaps remove it. Listen, I’ve had this thing since the time I was a teenager.  If Blue Cross Texas were willing to pay for me to visit a dermatologist, I might have consented, but the real problem is that the system penalizes honest disclosures.  This suggests the need for a system which does not depend on prescreening individuals.

Gold was using a psychotherapist for various reasons, and now Blue Cross is providing a perverse incentive not to seek alternative help unless sanctioned by Blue Cross itself.  That is an example of how health care privatization is removing choices–by forcing disclosures!

The question becomes: what restrictions should an individual agree to simply to receive discounts on medical care? Should the individual:

  • agree never to receive alternative care from an agency unless Blue Cross were notified?
  • promise to disclose every kind of visit that he has made to a health provider?
  • agree to disclose every kind of medicine he has ever taken?
  • promise to tell all future providers about any past care he has received?
  • have no choice but to visit health providers who promise to share medical records with the the health insurance provider?

Obviously Leo Gold is a healthy person and able to afford coverage (and so am I). But what about  people  like Esmin Green or Belinda Bach who couldn’t possibly  afford coverage? A company like Blue Cross Texas would easily and gleefully ignore them while at the same time issuing press release about its latest profitability. This is what we call "the American Way."



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