Tuesday, December 25, 2012

Tiny Tim Gets Health Care In a Republican World

The Ghost of Christmas Future Relates How Child Health Care Works With Conservatives in Charge

[Editor’s Note:  Following are three short versions of the popular Christmas story, all telling what it would be like if Republicans implemented their plans for health care in the United States.]


Marley was dead.  Well of course he was dead.  He had used up his lifetime limit of Medicare benefits and when he went to the Emergency Room for treatment he was told he had to have three bids from health care providers before he could be treated.  Marley died after getting the second bid, his eyes closed up over the fine print in the contract that absolved the physician from all liability.

So Bob Cratchit went to the surving partner of the firm, Mr. Scrooge, and asked if there could now be some new health care plans.  Scrooge had recently undergone a transformation from greedy boss to benevolent supervisor.  “Of course my boy” said Scrooge, “we have this new program that will be completely paid for by  the firm of Marley and Scrooge.  It is, of course, a high deductible plan.”

The high deductible amount for the plan was a modest $225,000.  “We will cover everything after you pay the first $225,000” said Scrooge magnanimously.  “Bob, your only other costs will be the income tax you have to pay on the premium benefit we give you.”

Bob Cratchit left the offices speechless.  And not in a good way.


Marley was dead.  Well of course he was dead.  At the age of 72 he had not yet qualified for Medicare because Republicans had raised the age to 75, and his health insurance company had dropped him because in their words “you are likely to get sick and file a claim”.  After his heart attack the emergency room care was delayed while he mortgaged his house to pre-pay for the hospital stay, and right in the middle of the appraisal process he dropped dead.

So Bob Cratchit went to the surviving partner of the firm, Mr. Scrooge and asked about new health care plans.  “Oh my dear boy” said Scrooge, “of course we have plants that cover your family.  Now none of the plans will cover pre-existing conditions, so Tiny Tim will not receive any treatment for that leg disease that will eventually kill him, but any new ailments he develops will be covered.”

When Cratchit asked about deductibles Scrooge assured him there would be none, but Scrooge did inform his dedicated and loyal employee that the co-pay would be 124% of the bill, the extra amount being use to cover the profit requirement surcharge of the insurance company.

Bob Cratchit left the offices speechless.  And not in a good way.


Marley was dead.  Well of course he was dead.  After suffering from a debilitating disease he found out his insurance did not cover that particular ailment.  Marley was puzzled since the denial occurred before the ailment was diagnosed, but the insurance company explained that their coverage limitations were not based on a particular type of illness, but on the expected cost of treatment.  Before paying a claim the company required a total cost estimate from the health care provider, and if that cost was in excess of $575.00 the claim was automatically denied. 

So Bob Cratchit went to the surviving partner of the firm, Mr. Scrooge and asked about health care plans.  “Sorry said Scrooge, employers no longer provide health care insurance, but here is a list of companies that you can buy individual coverage from.  Good luck, let us know how it turns out.”

Cratchit found out that each application required about 11 hours to fill out, but since his son Tiny Tim was suffering a serious leg degenerative disease he took the time to apply to seven companies.  Six of the companies turned him down, and the seventh approved his application.  But subsequent investigation by that firm determined that Cratchit has committed insurance fraud, because he inadvertently listed the left leg of Tiny Tim as the one with the problem, when it was the right leg.

Because the insurance company found fraud in the application, Cratchit was denied eligibility for any coverage.  He took his case to an attorney, who for an upfront fee of $35,000 promised to pursue legal action to right this horrible wrong, and who predicted that after working its way through the court system Cratchit would be vindicated in about 9 years.  “We would expect compensation for pain and suffering also” said the attorney, “except that is no longer allowed”.

Bob Cratchit left the lawyer’s offices speechless.  And not in a good way. 

No comments:

Post a Comment