Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, February 28, 1992 TAG: 9202280400
SECTION: EDITORIAL PAGE: A-6 EDITION: METRO
SOURCE: LAWRENCE SHIELD
DATELINE: LENGTH: Medium
BLUE CROSS NOT OGRE IN SMUSZ CASE
WITH THE NATION'S attention focused on health care, the article (Feb. 9) on Frank Smusz's lobbying the legislature for state-mandated insurance coverage of experimental medical procedures ignored important elements of the controversy.The plight of Lorraine Smusz could not fail to move anyone with the tiniest seed of human compassion. But the painting of Blue Cross of Virginia as unfeeling corporate ogre is unfair, and fails to recognize how medical insurance is funded. Any stand that forces me to side with Blue Cross of Virginia causes me to question my opinion; but in this instance, the media coverage of the entire incident was one-sided.
Medical-insurance companies pay claims with funds collected through premium payments by subscribers. There is no magic money pot to draw from. Every penny paid in benefits to any single subscriber is collected from each of the other subscribers to the plan. When medical expenses for the subscriber pool outstrip the amount of money in the pool, rates must be raised to cover them.
Where I work, the employee contribution for family medical coverage has more than doubled in the past two years, from approximately $68 per month to more than $150 per month. An employee making $6 per hour now works more than three days just to pay this premium. At minimum wage, an employee must work more than 35 hours to pay the premium.
The cost of Lorraine Smusz's bone-marrow transplant was reported to be more than $180,000. If Blue Cross had paid for the procedure, the cost would have been passed on to each subscriber through a rate increase or a cut in benefits.
Multiply the cost of that single experimental procedure by a conservative 20 other like procedures statewide, and the cost to the insurance pool exceeds $3 million. The average worker cannot afford the cost, and Blue Cross properly exercised its fiduciary responsibility to conserve the assets of its subscribers.
If Blue Cross of Virginia is not the ogre in this unfortunate story, where does responsibility lie? It lies with the corruption of medical care and medical ethics rooted in the profit motive rampant in hospital care.
Since for-profit corporate hospitals have largely replaced the voluntary hospital system, health-care costs have soared. Today, hospital costs are calculated not on the actual cost of services delivered, but on how much third-party insurance carriers will pay. In fact, a profit center exists in modern hospitals, based on interest payments collected from patients unable to completely pay the already inflated bill.
The not-for-profit hospital groups similar to the Carilion Health System here in the valley are just as guilty. They may not distribute profits to shareholders as do HCA and Humana, but someone pays for the slick advertising campaigns used by Carilion management to attract paying customers.
What would the cost of an aspirin be to a patient if hospitals did not spend small fortunes telling us how lucky we are to be sick within their walls? What would the cost of a bone-marrow transplant be if all a hospital was interested in was curing the patient? If hospitals were more interested in healing and less interested in profit and publicity, the heart-rending images of Frank and Lorraine Smusz begging for donations would not be needed.
Lawrence Shield, who lives in Burnt Chimney and was a registered nurse, writes software for a local computer company.