This great line, from Lisa See’s Lady Tan’s Circle of Women, struck me as important. Set in 15th century China, the book takes inspiration from a female physician of that time. I immediately wondered how someone could have asserted this idea back then when now, so many years later, it remains unsupported by western medicine. Oh, the idea bounces around here and there, but it’s a farce. How do I know this? Mainly because health insurance seems to have nothing to do with health.

No matter how much preventative care I practice, unlike with my car insurance where I get discounts for accident-free years, all I get with health insurance is an annual premium increase. For the past five years, my premium has increased at an average of 10% each year and I saw a percentage decrease after my cancer diagnosis and subsequent surgery. How does this make sense?

Shouldn’t the state of my health have something to do with it? Shouldn’t my health insurance company want me to take less medication and use diagnostic tools to decrease terminal illness risk factors where I can? Wouldn’t maintaining my good health cost them less long term? Are they not making enough money to include preventative healthcare with my already very expensive premium?

Know What Your Plan Covers

But wait, doesn’t my plan include wellness visits? Yes, my plan says it covers annual adult wellness visits with a family physician and a specialist with no co-payment as well as a colonoscopy and a mammogram. Great, right? Um, well, my plan doesn’t really mean what it says. This week, I had three separate conversations that reinforced my thinking that prevention is not the priority of our current healthcare system or many employers.

1. I had the most enlightening discussion with a representative from my insurance company. I learned that my benefit depends on the codes the doctor uses for my visit. If my family physician finds something wrong with me, boom–I owe a co-payment. If I ask her a question about something she deems unrelated to an annual wellness physical, boom—I owe a co-payment. The only specialist covered with no co-payment is my gynecologist. Everyone else is $75 a pop. If I don’t see specialists and manage my health, I’m at risk for heart disease, diabetes, spine surgery, and skin cancer. I pay the $75, but many people don’t because they can’t afford it. The delightful representative completely agreed with me. Too bad we’re not in charge.
2. The radiologist technician I saw for an echocardiogram (follow-up from an issue found during pre-operation tests for cancer surgery) shared her opinion on how she thinks it is ridiculous that her insurance covers an annual gynecological exam although she felt fine and hadn’t been sexually active for the past two years. An echocardiogram, however, they do not cover. “It’s your heart,” she said, “why wouldn’t insurance cover a baseline echocardiogram for everyone before there was an issue?” Other examples: A heart calcium score scan helps my doctor better evaluate how to treat my high cholesterol. Not covered. Ultrasounds and breast MRIs are better diagnostic tools for dense breasts. Not covered. And don’t even get me started on alternative therapies, like acupuncture. Not covered.
3. When the receptionist at my physical therapy office commented that I had one of the highest co-pays she’s ever seen, I responded, yes—but after my deductible, they covered my entire colon cancer surgery, so I can’t really complain. I told her my story and encouraged her to get her colonoscopy (like I always do with strangers!). She said she had a polyp eight years ago and is overdue, but couldn’t afford to take the time off unpaid, so she’s been procrastinating making the appointment. I continued the conversation with my physical therapist, who also had health issues she couldn’t take care of because she didn’t have enough time off. She’s thinking about cutting back her hours so she could keep her benefits and have time for doctor’s appointments. She can’t afford the loss of income, she said, but her health must come first. These women are weighing paying their bills against their health.

Profit vs. People

I may never understand the health insurance business (and I don’t think they want me to), but as a human resource consultant, I know a lot about the value of benefits and employee retention. Every industry is different, but all employers should provide employees with the paid time off they need for their mental and physical health. When you don’t offer enough paid time off, you get employees coming to work sick and not prioritizing preventative care because they’d rather use that time off with friends and family. I get it—it seems impossible to find the right amount of paid time off that will satisfy everyone.

I’ve always reminded my clients that happy, healthy employees have a positive effect on profitability. If two of the employees at the PT company I visit talked with me about it on the same day, that company is clearly not meeting the needs of their very human employees. Unfortunately, I don’t think their story is uncommon.

Bad News

We have a healthcare system that prioritizes fixing health problems with pills and surgeries instead of maintenance. We have employers who don’t recognize the value of the wellness of their employees. I don’t know how to fix the system, but I’m very sure it’s broken.

Good News

We have access to more information than previous generations dreamed of, and we can educate ourselves. If you wait for someone else (your doctor) to tell you what to do, that can be too late. Yes, our world is too often concerned with profits instead of people. Until the government figures out the best way to fix it (I’m not holding my breath) I will speak out. I will not settle for situations that put my health in jeopardy. I will seek information to help myself. I’m simply suggesting you do the same.

Rant over.

Thanks, Lisa See, this is one great line.

If you’d like to read more about Lady Tan’s Circle of Women, click here.

If you’d like to read about me, click here.