The Des Moines Register recently reported that Wellmark Blue Cross Blue Shield has been accused of violating federal HIPAA privacy regulations in the case of a patient with severe hemophilia. (See link to Register article below.) As reported, a representative of Wellmark was discussing the high cost of health insurance at a Rotary Club meeting last March. She gave an example of an extreme case that was costing $1 million per month. (ACA – Obamacare – prohibits insurance companies from placing any limit on the amount it will pay for patients.) She did not identify the patient by name, but described him as a 17 year old male with hemophilia. Maybe she should not have mentioned the age or sex of the patient, but that information alone did not identify who the specific patient was, and should not be considered a violation of federal privacy regulations.
Wellmark and other insurance companies must be able to cite specific high cost cases that are causing health insurance premiums to rise to unaffordable amounts. How can we openly debate ways to contain health care costs if we don’t know what is causing the high costs? Can we really afford to require insurance companies to pay out unlimited amounts for any patient? I recently heard that the last remaining company to offer individual health insurance policies in Iowa may charge more than $30,000 per year next year for a couple who are 55 years old. Health care wants are unlimited. Our ability to pay is not. We need to debate whether or not government should prohibit health insurance policies from having limits on how much they pay out for individual patients.
In The Des Moines Regiser’s report about Wellmark getting out of the health insurance market for individual policies under the Affordable Care Act (ACA), they reported, “Forsythe (CEO of Wellmark) cited a single Wellmark customer who has a rare genetic disease that is costing more than $1 million per month to treat.” One person – A million dollars a month. (See link to article below.)
One of the fatal provision of the ACA is the requirement that there be no limit in health insurance policies on how much can be paid for any individual’s care. No limit. Should we really expect others (society) to pay a million dollars a month for the care of ourselves or our family members? If you help to pay that much for someone else, then won’t you expect the same to be paid for you if you have the need? How can that be sustainable? Who gets to makes decisions regarding who we pay for and who we don’t? Unfortunate as it may be, it is a reality of life that we cannot afford, even as a society, to pay for everything we want. To the extent that those decisions, including limits on health insurance policies, can be made privately and voluntarily, we will have a more just, civil, and sustainable society.