Tuesday, December 23, 2008

New Year Wishes

My wishes for the New Year are modest. I'm not wishing for world peace or an end to climate change, although these would be great things. But I want to be somewhat realistic.

My first wish has to be selfish: I wish I were no longer sick and could really do all the things I would like to do in life.

My second wish is semi-selfish: I wish my friends weren't sick or in pain, either.

My third and fourth wishes (in either order) are the meat of it. I wish everybody at an insurance company who denies claims for a living would get really, really sick, and everybody who works as a debt collector would get really, really broke. Not forever -- 6 months or so will do. Just long enough so they know how it feels.

Today, I got a call from Sallie Mae attempting to collect a student loan debt from a man with an inoperable brain tumor. We've already submitted enough medical information so they should have discharged the loan -- I don't know why they didn't. But when I told the collector that he is dying and has maybe 6 months to live, she didn't skip a beat -- she just kept saying she needs $267.68 this month in order to offer him the extended payment option. I just told the woman he's dying and she's talking about an EXTENDED payment option. Does this make any sense to anybody? Two days before Christmas. I guess she already has her gifts all wrapped pretty and under the tree, waiting for Santa Claus. I hope he brings her a lump of coal.

I don't mean to sound as nasty as these people are. But when an insurer denies coverage of a medication for a 14 month old baby with inflammatory bowel disease who's tried everything else, it makes me want to look the decisionmaker in the eye and ask "how could you?" A 33 year old woman with transverse myelitis needs a certain medication -- she's already tried the other two options and they didn't work -- but the insurance company denied coverage. How can it be? Transverse myelitis will paralyze her, and the longer you go without treatment, the less chance there is that the treatment will reverse the symptoms. What horrible person at an insurance company can deny coverage in a situation like this?

Yes, it's true that I see the worst of it. But I'm a patient, too. This year, I fought with my insurance company about how much they were going to pay my gastroenterologist for my endoscopies, and whether they were going to continue to pay for my Protonix, which is one of the meds that is keeping my gastroparesis in check -- which means I need it to live. So I know this happens to everyone. Or at least everyone who has insurance. But how do these people live with themselves?

I suppose they think it's a job like any other job. And I suppose if they never denied a claim or tried to collect a debt, they would lose that job, and there would be yet another person in trouble. I sort of get that. But someone has to be accountable. And really, if it were the last job on earth, would I actually be able to do that job? I don't know. I'd like to think I'd rather go hungry, but if those were my choices, would I have the strength of my convictions and turn down a job that results in misery for others?

Thankfully, I don't have to make that decision.

I remember when I was a lawyer for the state and I got assigned to defend a challenge to the first round of "welfare reform." It was a huge case -- my first really big case at the Attorney General's Office. I struggled over it. Should I ask to be removed from the case because I disagreed so strongly with the state's actions? My friend John Brittain said no, that I should hold onto the case because, even though I would be making arguments that could hurt people, I could do it with more tact and judgment and heart than other people in the Office. And so I argued that this was a legislative judgment rather than a judicial one -- never once arguing that it was a good idea to cut welfare. When you compare my briefs in this case to the briefs filed on behalf of the state in our big school desegregation case, in which the lawyers really did try to defend the state's provision of inferior educational opportunities to minority children, you can see the difference. Or at least that's what I tell myself.

I also know that I had such a hard time defending the state in individual cases in which we were denying Medicaid, for example, that it didn't take long before my supervisors realized that I really ought to be a plaintiff's lawyer because I'm lousy at defending decisions with which I disagree -- and I ended up settling all of my cases as a result.

I don't believe I could deny a 14 month old baby the medicine he needs, especially if he'd tried everything else. The insurer is arguing that this medication is not FDA approved for inflammatory bowel disease, but that ignores the fact that there are only two drugs that are FDA approved for IBD in children, and NONE for which there has been adequate evaluation of children of such a young age.

And I don't believe I could deny medication for a 33 year old woman who wakes up with new limitations every day, again, especially if she's tried everything else.

And I know that, if I were making a collection call, and the person on the other end of the phone told me that the debtor was dying of an inoperable brain tumor, I would apologize for bothering him and wish him the best of luck. Job or no job. I just know that I could not pretend not to have heard this.

So yeah, wishes three and four are on my list. Maybe, if the people who make these decisions had to suffer themselves for even a little time, they would find a little more charity in their hearts for others. Jennifer


  1. Happy Holidays and I like that you can express things I never would :-).

    Also on the Protonix, I'm supposed to take it also but I can't afford it right now. It makes a difference. I hope you were able to talk them down. I didn't know it helped with your condition.


  2. The student loan collector is probably on a quota, and probably will be out of a job if they don't make their quota on contacts. I've dealt with them, and I know my rights cold. They frequently don't. They lie, and lie, and lie to meet their quota. That said, I don't blame them. I blame the management that told them to be so aggressive and fed them the misinformation. And the thing is they spend so much money on collections only to get a few bucks off a disability check. $214.50 a week are protected from their garnishment efforts anyway.

    I think we'd probably be better off as a country if we moved towards the British model--no tuition, but 15% of your income for the first 15 working professional years of your life. I'd have no problem with that, and it'd eliminate the absurdity of bill collectors calling people on their death beds.