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When The Health Care Crisis Becomes Your Crisis

Just hours before President Obama kicks off the White House forum on health care, Time magazine is out with a cover article telling another heartbreaking, fury-inspiring tale about our health care system. But what makes the story poignant--and particularly revealing--is the author. It is Time senior writer Karen Tumulty.

The subject of the story is Karen's brother Patrick, who has been battling kidney disease. Karen (who is a friend) has been helping him to navigate the world of insurance. And that's given her a first-hand look at just how dysfunctional our system is.

You see, Patrick wasn't uninsured when he learned about the cancer. He had coverage, from Assurant. But, as Karen quickly learned, that didn't mean much:

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years--since losing the last job he had that provided medical coverage--Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."

Kidney failure would seem to be one of those disastrous "unexpected illnesses" that Pat thought he was insuring himself against. But apparently he was wrong. When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue. 

Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere. That's when I realized that the national crisis I'd written so much about had just hit home.

The previous four weeks had left my brother with more than $14,000 in bills from hospitals, doctors and labs. And that was just to figure out what was wrong with him. Actually treating his disease was going to be unimaginably more expensive. Patrick needed help quickly, and we didn't have a clue where or how to start looking for it.

That's a long excerpt and I don't want to spoil the rest. But suffice to say that Karen's experiences in the ensuing months, as she worked with her brother, exposed several key flaws in our health care system. And among them was the fact that, particularly in the individual insurance market, coverage frequently becomes least comprehensive and least reliable precisely when you need it most.

As Karen learns, even a well-educated professional can have great difficulty navigating the system--and this is very much by design. There's a reason the fine print in insurance contracts is so fine. The companies generally would prefer nobody dwell too long on all of the exceptions they've carved out for themselves--all the instances in which people who have paid their premiums and think they have solid coverage learn, just as they become gravely ill, they are out of luck.

Anyhow, it's a compelling and important article--really, the perfect way to prepare for this afternoon's events and the debate to come this year. I highly recommend reading it.

--Jonathan Cohn