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Commentary: Invitation to a colonoscopy, from a bureaucrat

This article first appeared in the St. Louis Beacon, Sept. 24, 2009 - Listen: Barack Obama has a plan. His not so hidden agenda would impact the lives of every living American and would fundamentally alter the basic character of the country. He wants you, your loved ones and yes, even your defenseless children, to have ... health insurance!

[Insert sinister chortle here: “Bwa-ha-ha-ha!”]

Luckily, right-minded citizens from sea to shining sea — fueled in no small part by an insurance industry anxious to maintain a very lucrative status quo — have rallied to the defense. They point out that his is a commie, atheistic, Muslim plot to deprive us of our God-given right to suffer and die from treatable diseases, as untold scores of our less fortunate predecessors have done for decades.

Meanwhile, the president takes to the air waves to advocate on behalf of reasoned discourse and sensible debate. It's enough to make you wonder if he really was born here. This is America, baby. We don't need no stinking reasoned discourse; we've got pistols!

OK, I exaggerate; but not to the extent that you may think. My mother, for instance, is convinced that the “public option” in health insurance would require her physician to euthanize her for reasons of economy. I try to explain that such a program would likely be unpopular with older voters but she remains unconvinced.

People are understandably wary of change — especially change that they perceive as being forced upon them. And citizens of a republic are well within their rights to challenge any proposed public policy. But some of the doomsday scenarios making the rounds are a bit over the top. After all, the effort is to increase access to health care, not eliminate it.

To put the matter into some kind of perspective, I thought it might be useful to take a look at the current state of affairs that so many are so passionate about preserving.

Like nearly 85 percent of Americans, I have health insurance. And like most people who are fortunate enough to have coverage, mine is provided through my employer. Since most of the concerns about reform revolve around issues of choice and privacy, I sought to evaluate how I'm doing on those terms under the current system.

Once a year, I have the option of changing my coverage. Back in the day, we were offered multiple plans from several different insurers. Over time, the options have dwindled. Today, one company offers a high and a low-option plan with corresponding higher or lower payroll deductions. That's it — take it or leave it. I have no say over which insurer my employer selects.

Because I'm lucky enough not to have any dreaded “pre-existing conditions,” I could always buy private insurance. However, as the employer contribution to my health insurance is part of my compensation package, I'd be taking a substantial pay cut by doing so.

I can go to any doctor I choose but if I seek care at an out-of-network medical facility, my coverage is reduced. A co-worker of mine recently wound up in a hospital on the east side (it's a long story) with a perforated appendix. He received excellent care, but ran up a bill totaling about $33,000, of which he was personally responsible for about $2,800.

Not bad: The insurance covered over 90 percent of the tab, but one reason the bill was so high in the first place is that the hospital transfers the cost of mandated treatment to the uninsured to those who can afford to pay.

Overall, then, I have no choice concerning my insurance carrier but currently enjoy wide discretion about the more important issue of care providers. This, of course, could change the next time my employer decides to change policies. For the moment, however, I'm covered. Privacy is another matter.

Under the Health Insurance Portability and Accountability Act (HIPAA), the privacy of my medical records is federally protected. Unfortunately, every time I go to a doctor, I have to sign a form waiving those rights to allow the physician to report my treatment to the insurance company. While it's understandable that the health insurer would want to know what it's paying for, I'm beginning to wonder just what it's doing with all this personal information.

Several months ago, I received a letter from my insurance carrier suggesting that I undergo a colonoscopy. No wine, no candlelight to set the mood — just an unsolicited form letter from total strangers proposing an intimate congress that they're willing to pay for.

I can only presume that the company was doing a little data mining and discovered that it had been a while since I’d had this particular exam. While the advice may have been reasonable and well-intentioned, I couldn't help but wonder just when insurance agents became licensed to practice medicine.

Then last week, the same outfit mailed me a brochure urging me to call a toll-free number should I be considering surgery. By doing so, one can have “a confidential discussion with an experienced nurse to help you understand your options.”

Excuse me? What happened to the doctor? A board-certified surgeon recommends a procedure for a serious health issue and I'm supposed to clear the recommended treatment protocol with the company nurse before proceeding? Is there anything wrong with this picture?

It is understandable that people don't want government bureaucrats interjecting themselves into the doctor-patient relationship. But it's hard to see how corporate bureaucrats are the better alternative. They, after all, are obliged to wring a profit from the transaction. At least we elect the people who run the government. When it comes to health care, most of us can't even choose the company we do business with.


M.W. Guzy is a retired St. Louis cop who currently works for the city Sheriff's Department. His column appears weekly in the Beacon.