The "Little Guy's" Right to Lie
Much to the horror of doctors nationwide, Blue Cross of California (BCC) recently requested California physicians to confirm the accuracy of new BCC applicants’ “pre-existing medical conditions” claims. In letters to these primary care providers, BCC included prospective policy members' applications, asking the providers to review their patients' applications and to "identify medical omissions…that may be considered pre-existing." Any discrepancies were to be immediately reported to Blue Cross of California.
Many doctors are upset by BCC’s request, alleging that compliance would violate the privacy of doctor-patient relationships and inhibit patients from disclosing ailments to their physicians. As reported in the Los Angeles Times, doctors are "'…outraged that they [BCC] are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality.'" This according to Dr. Richard Frankenstein, president of the California Medical Assn.
At first blush, Dr. Frankenstein's statement seems reasonable. Health insurance applicants probably would be disinclined to share important medical information with their physicians if they feared that their pre-existing conditions claims would later be debunked. This fear could lead to serious diseases going undiagnosed, as patients hide their conditions in hopes of procuring health coverage for expensive operations and treatments.
Let’s explore a scenario where a patient is spared the fear of such accountability and therefore confidently falsifies his health history to a health insurance provider.
"Bob" is concerned that he needs surgery for a particular ailment, or alternatively requires an expensive long-term prescription medication. "Bob" is not presently paying for health insurance because of the significant strain it would place on his finances, and accordingly he is not covered for whatever malady he may have. "Bob" knows he requires surgery or prescription medication because he has made several visits to his doctor's office and has been told so by his physician. However, realizing his inability to personally pay for these necessary medical expenses, "Bob" applies for health insurance and purposefully does not include his ailment on the insurance provider's "pre-existing conditions" disclosure form. "Bob" is confident he can poker-face his way through any telephone or in-person screener interview, and if "Bob" is the only resource the insurance provider can tap for “Bob’s” health history, how can his application be denied?
As far as “Bob” is concerned, the above scenario represents savlation from a potential lifetime of financial ruin. He is very willing to lie a little to preserve his own skin. After all, don’t the insurance companies owe affordable healthcare to everyone? “Bob’s” health condition presents an insurmountable debt to himself, but an inurance company would count the bill as a day’s pocket change. And doesn’t everyone try to beat “the system,” especially if there are no accountability checks to prevent success? It’s almost un-American not to lie in a situation like “Bob’s,” right?
It seems that many who are presently taking issue with Blue Cross of California are fighting for the "little guy's" right to lie and get away with it. “Privacy” is the mantra, but in my experience a health insurance applicant must explicitly authorize his health history to be shared with the insurance provider when completing the application. Assuming that BCC includes such a provision in its applications, why are doctors doing battle for applicants who have lied about their pre-existing medical conditions? I can understand a doctor’s reluctance to involve himself in these situations, both for time’s sake and for the sake of his relationships with his patients. But to express outrage that an insurance company wants to verify the veracity of its applicants’ health history claims, alleging violation of privacy by the insurer, seems disingenuous.
BCC wants to protect itself from the “Bobs” who hope to leverage boldfaced deception into financial windfalls. Knowing the propensity of our culture to lie for personal gain, why should BCC rely solely upon the "good word" of a prospective member who stands to significantly benefit from lying to BCC? What bank approves someone for a loan just because the want-to-be debtor says he is worthy of the bank's trust? What self-respecting home inspector issues a certificate of occupancy merely because the homeowner says the house merits one? Similarly, why should a health insurance company be restricted to considering only the "good word" of an applicant when reviewing a health insurance application?
As reported by ABC News, Dr. Joanna Cain, director of the Center for Women’s Health at Oregon Health and Science University in Portland, said of Blue Cross of California’s recent letters:
“This so simply and succinctly exposes what health care 'insurance' in the United States is: a business.”Very fair. For-profit health insurance companies do indeed operate as businesses, charging their members a mutually agreed-upon fee for a mutually agreed-upon service. Auto insurers also operate as businesses in like fashion. Should auto insurers pay for the repairs of previously damaged vehicles belonging to new members? If not, why not?
Why is Blue Cross of California's verification request to doctors such an issue in a free society? No one is required to apply to BCC for healthcare coverage, just as BCC should not be required to pay for the treatment of new members' pre-existing medical conditions. Such an across-the-board requirement for BCC would astronomically increase the insurance rates of current BCC members, which members have no expectation to retroactively cover the healthcare costs of new members. Just as the U.S. taxpayer ultimately pays for the numerous programs of the "benevolent" United States federal government, so do health insurance company members' premiums pay for the company's healthcare coverage costs. If coverage costs rise, so do the premiums.
The socialists are winning. Today our society believes that universal healthcare is an inherent, unalienable right, conferred upon our generation by America's visionary founding fathers within a soon-to-be-found penumbra of our ever-evolving U. S. Constitution. Accordingly, any for-profit health insurance company that does not recognize its obligation to take upon itself the physical (and financial) cares of the world is selfish, greedy, and evil. In this vein, no applicant should be denied coverage merely because he already has the problem (and financial burden) he wants to insure against, and if a health insurance company does seek to deny coverage to such an applicant it should do so based solely upon the testimony of the applicant; no third-party accountability measure are allowed.
I do not write this post in defense of health insurance companies. We live in a fallen world where most men seek their own interests at the expense of others, and I do not ascribe undue “purity of heart” to Blue Cross of California or any other health insurer. In fact, I am not commenting at all upon BCC's merits as a company. Nor am I addressing the many reasons behind rising healthcare costs, which is another issue all its own. Rather, I am questioning the "new normal" that a private, for-profit company is expected to function as a charity provider to all. Such a perspective destroys the very notion of free enterprise and belongs to the realm of socialism.
Blue Cross of California today put an end to this controversy. Public outcry from private citizens, doctors, BCC members, and politicians was loud enough to cause BCC’s termination of its years-old application verification practice, effective immediately. I am curious how new BCC applicants will now be screened for pre-existing medical conditions, but that is not my burden to bear. It is, however, the burden of current BCC members who will have to cover the cost of any and all new applicants who falsify their health histories and thereby gain access to BCC membership.
“Welcome to Blue Cross of California. What you don’t tell us won’t hurt you.”















