The New York Times


March 21, 2010
Op-Ed Columnist

Is Any Illness Covered?

By NICHOLAS D. KRISTOF

Health care is etched on my mind these days not only because of the Capitol Cacophony but also because a husband and wife I know, my former neighbors, are undergoing the kind of heartbreak no family should endure.

Zack Liu and Jan Li, along with their two young daughters, lived a few doors away from me. Then a couple of years ago they moved to Hong Kong, and paid $4,500 per year for a health insurance policy for Jan and the girls (Zack was covered through his job).

Last April 24, their world collapsed: Jan was diagnosed with late-stage stomach cancer.

Opponents of the reform proposals argue: If you like the Department of Motor Vehicles, you’ll love Obamacare. But as the drama of Zack and Jan shows, the only bureaucrats more obdurate than those at the D.M.V. are the ones working for insurance companies. The existing system is preposterous: we rely on insurance companies whose business model is based on accepting premiums from healthy people and devising ways to exclude from coverage those who most desperately need medical care.

Jan’s stomach was removed, and she underwent extensive chemotherapy. Then in October, her doctors discovered that the cancer had spread to her intestines. She has been hospitalized ever since.

The insurance company is InterGlobal, based in London, and the policy ostensibly covered up to $1.7 million in costs. But, according to Zack, the company said the policy allowed it to cut Jan off because she suffered from a “chronic condition.” It stopped paying her bills in January, Zack says.

I reached Sophie Walker, the group head of claims for InterGlobal. She said she couldn’t talk about an individual case. But she explained in an e-mail message that with a “chronic condition” the policies can have a much lower limit, $85,000, on lifetime claims. That’s the limit that Jan ran into in January, Zack says.

Then Ms. Walker gave me the company’s definition of “chronic” (you couldn’t make this up):

“Chronic means a medical condition which has at least one of the following characteristics: has no known cure; is likely to recur; requires palliative treatment; needs prolonged monitoring/ treatment; is permanent; requires specialist training/rehabilitation; is caused by changes to the body that cannot be reversed.”

That sounds like a spoof from “The Daily Show.” To translate: We’ll pay for care unless you get sick with just about anything that might be expensive. Then we’ll cut you off at the knees.

I asked InterGlobal if this was an accurate translation. I noted that by its definition, cancer, heart disease, strokes, diabetes, tennis elbow and even athlete’s foot seemed to be “chronic.” I also asked InterGlobal to name any serious disease that it did not consider “chronic.”

The next e-mail message came back from the company’s chief executive, Stephen Hartigan, who sent his “kind regards” but added that because he was “disappointed” at the tone of my inquiries, the company would have no further comment.

Zack and Jan are a special case in the health care arena: although they and their daughters are all American citizens, they’re living abroad and struggling with an overseas-based insurance company. But their plight underscores the fundamental weakness of any system that leaves us dependent on the magnanimity of for-profit insurance companies.

Those opposing reform argue that emergency rooms are always available as a backstop for those without insurance. That rings hollow for a woman with, say, stomach cancer. More broadly, E.R.’s simply cannot solve the larger health needs of the roughly 75 million Americans who are either uninsured or underinsured.

The conundrum is this: It’s in the interest of insurance companies to exclude people who are sick, while it’s in our national interest to see them covered. Plus, it’s the right thing to do.

As the Institute of Medicine, a branch of the National Academy of Sciences, declared in a landmark report last year, “The absence of health insurance is hazardous to your health.” Among the many studies that demonstrate that is one conducted in Kentucky that found cancers are detected later in women who have no insurance than in women who do — so those without are 44 percent more likely to die of breast cancer.

Another study found that for American adults ages 55 to 64, lack of insurance is “third on a list of leading causes of death for this age group, behind only heart disease and cancer.” All told, depending on who does the math, 20,000 to 45,000 Americans die each year for lack of health insurance.

So that’s what’s at stake. Far too many Americans must wrestle simultaneously with mortality and insurance companies, as Zack and Jan are. That must end.

I invite you to comment on this column on my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.