My post on insurance-company-driven health-care-rationing-by-waiting drew a comment from Paul Krugman, which in turn drew a link from Matt Yglesias.
I’m happy to have the attention, but on one key point my writing proved unclear.
Krugman quotes me as saying:
It was only later that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to “Tier II,” which would have meant higher co-payments.
and adds, reasonably,
To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs.
To be clear: I didn’t, and don’t, imagine that there was some insurance company bureaucrat deliberately stalling my approvals in particular in hopes that I would (in the industry jargon) “go Tier II.” I did and do believe that the approval process was deliberately made slow and clumsy, with no “out” for time-sensitive tests, in order to create an incentive for patients to opt for Tier II coverage to jump the approval queue.
In my case, it would have worked, except that no one told me about the option until it was too late. Of course I should have found out on my own. After all, it was my life that was at stake.
But it’s worth remembering that I was deathly ill at the time, and probably not at the top of my decision-making form. That’s a fact about health care finance I haven’t seen much reference to in the literature: what seems like at least a marginally reasonable process if you imagine a healthy well-educated person dealing with it becomes less reasonable if the person is poorly educated or elderly and frail or, like many patients, very sick.