The Business of Health Care
When Helene Jorgensen, CAS/PhD ’96, went hiking in the Montanan woods in 2003, a tick bit her behind her ear. When she discovered it, she promptly removed it from her skin, flushed it down the toilet, and forgot about it.
But Jorgensen was forced to remember when she was diagnosed with Lyme disease two weeks later. Jorgensen’s disease left her bedridden and exhausted, and affected her vision and memory. But after seeking diagnosis and treatment, Jorgensen realized her disease wasn’t her only problem. “I had good health insurance, but when I got sick, I realized that my health insurance wasn’t really there for me,” she says.
Being an economist, Jorgensen is trained to analyze costs, benefits, and incentives. She began examining her own bills and statements of benefits from her insurance company and recording the thousands of dollars that she was spending on health care out-of-pocket, even though she had insurance. Eventually, Jorgensen compiled her findings into a book, Sick and Tired: How America’s Health Care System Fails Its Patients, which PoliPoint Press published in March. The book received a starred review in a February issue of Publisher’s Weekly.
In Sick and Tired, Jorgensen used her personal experiences, as well as surveys and government statistics, to frame her economic analysis of the health care system, arguing that insurance companies in the United States value financial incentives over providing quality services to their customers. Though a plan may look good on paper, insurance companies often avoid reimbursing claims. Jorgensen says that her insurance had restrictions on prescription drugs and only covered 10 days out of a month’s worth of some pills. At times, her claims would be denied for vague or unspecified reasons, and she would have to scramble to find the information in time to re-file.
“They care about making money,” says Jorgensen. “They care about the bottom line. They make it as hard as possible for you to get reimbursed, and they hope you’re either too sick to deal with it, too confused, or you’ll think your illness is not covered and you won’t pursue [a claim].”
Jorgensen further argues that patients’ well-being isn’t always doctors’ primary interest, either. When referred to an infectious disease specialist for the first time, Jorgensen assumed his main concern would be to diagnose her correctly, but found that this wasn’t the case. “It’s more complicated than that,” says Jorgensen. “You have pharmaceutical companies in the exam room trying to promote the latest and most expensive drugs. You have insurance companies setting all sorts of restrictions on care. You have conflicts of interest, such as consultant arrangements with insurance and pharmaceutical companies.”
Jorgensen has several suggestions to help fix the health care system and make it work for patients. However, her first suggestion is addressed to patients. “You have doctors who really take offense if you start asking questions or they just don’t want to deal with it,” she says. “Then you have doctors that encourage you to bring your family, read up on your condition, and so on. Those are good doctors. Those are the ones that you want to find.”