This week UnitedHealthcare told a stroke victim that her health insurance with them does not include the rehabilitation necessary for her to walk, eat, or speak again.
This "hip, young, vibrant and beautiful woman," as her sister described her to us, entered the hospital in December. After more than a month in recovery from a highly unusual massive cerebral stroke, her sister said that UnitedHealthcare has now "pulled the plug on her rehab and is sending her home with me."
The victim's sister, who prefers to remain anonymous, does not live in the same state; nor is she equipped to provide the care needed. "My sister cannot walk, stand, wash, toilet herself, count or read, and speaks only garbled phrases." The hospital insists that it will discharge her, or start to bill her sister daily, even though she has told them repeatedly that her "only current option is to take her to a handicapped-accessible motel room."
When insurance representatives were questioned on the wisdom -- or basic human decency -- of sending her incapacitated sister home with her to a motel, she was told, "This is a 'social problem' not a 'medical problem' and thus, the insurer has no duty to continue rehab."
Whoa, UnitedHealthcare! You think that's a "social problem?"
Denial of coverage for this young American woman who worked for and earned her health coverage is not a social problem. It's a "criminal problem." It's called stealing from the sick to feed the greed of the rich. Sadly, this is not an isolated case. In 2009, UnitedHealthcare in New York was investigated and found seriously wanting. Rather than go to court, UHC coughed up$350 million to settle the class-action suit. In 2007, UHC agreed to pay the largest settlement in the Nebraska Department of Insurance's history when UHC was found to have violated 18 Nebraska laws more than 800 times in a one-year period. Our conclusion is that UHC has a "criminal problem." But we'll let the lawyers and courts sort that one out.
However, we can tell you what definitely is a social problem: the fact that across America today there are thousands of people who have insurance, yet are denied care.
Another social problem is that our elected officials appear impotent in the face of health insurance companies' power and swagger. While we are glad for the tiny baby steps forward with the health-care reform legislation that we Americans achieved last year, this sad story shows how far we have yet to go.
For-profit health insurance companies, no matter what reforms or regulations we put in place, are not the answer. By their very definition, health insurance companies profit by denying sick people medical care.
That's the way insurance works. You pay the insurer, betting that at some point you will get sick and you will need care. The insurer takes your money but doesn't take care of you when you do get sick, at least if the insurer is UnitedHealthcare. As health care advocate Donna Smith said in a recent column, "Americans know that health insurance is not health care." In this case, UnitedHealthcare has once again made the point.
"Writing a check to Blue Cross or Humana or Aetna or Cigna or UnitedHealthcare," says Smith, "is not any guarantee at all of anything except that we've sent money to an insurance company. That's it. Armies of administrative people make sure they guard the gates to the actual delivery of health care. The generals who make sure those administrative soldiers hold the line are far behind the scenes in white coats and locked offices to make sure no insurgent patients without payment in place actually get near them. In the health-care delivery world, the disconnect between those who would give us care and those of us who need it is systemic and growing worse."
But back to our original point. Why does this make Jesus cry? Unquestionably one of Jesus' hallmark characteristics was his concern for and ministry with the sick. From healing the lepers and the woman with an issue of blood, to healing Jairus' daughter and the Roman soldier, Jesus publically called to account the levitical "health-care" system of his time.
The religious purity laws of the day -- what we might call "pre-existing conditions" -- created "a system of social boundaries," writes biblical scholar Richard Ascough, which served "to remove socioeconomically burdensome populations, and especially the chronically ill, from society." What the system said was just not possible to heal, Jesus showed was very possible with few resources and a little compassion. It wasn't that the system didn't have the ability or finances to heal the sick; it was that the system didn't care.
"I am enraged, bewildered, and powerless to take on the U.S. health-'care' system," this young woman's sister told us. She has left phone messages with her UHC "inpatient Care Manager," faxed letters requesting a written explanation for why coverage has been denied. To date, she has not heard back. "I want people to know what it means in basic human terms to watch a loved one sent home when medical help might give her back some minimum quality of life."
Somewhere tonight we're sure a UnitedHealthcare insurance representative is praying for forgiveness for what he or she has done to this young woman who is sick and needs support. We're equally sure that Jesus will offer that forgiveness -- but not without shedding a tear.
Rose Marie Berger, an associate editor at Sojourners, blogs at www.rosemarieberger.com. She's the author of Who Killed Donte Manning? The Story of an American Neighborhood available at store.sojo.net. Heidi Thompson is publisher of Sojourners magazine.