Wednesday, March 18, 2015

Sock puppets

Health insurance is all about limits. You can only see a chiropractor 20 times in a year. You can only pick up a 30-day supply of your prescribed medication. You can only see a specialist if you get a referral.

My question today is whether there should be any limits on the health insurance company? I’d like to cap the number of lies they can tell at a reasonable number, and require them to go through a medical review before telling more lies.

This morning’s example: Cigna denied a claim from March 3, 2015, because of a lack of precertification (prior authorization, prior auth, PA, precert, it’s important to keep shifting the terminology). But we had a precertification approved by Cigna last year, valid until April 14, 2015. When asked this morning, Cigna said that the precertification did not exist. Then Cigna said that the precertification had never existed. It took some forceful arguing before they were willing to admit that the precertification actually was on file exactly where it was supposed to be in their system, and that Cigna needed to approve the claim. But nowhere in there did the Cigna rep think there was any problem with her script or training requiring her to lie repeatedly, nor did she think that there was any good reason for me to be aggrieved about being lied to.

I think there’s a way to fix that. Require that all health insurance companies keep records of all communications with customers, including recordings of phone calls, along with all notes made by CSRs. Customers should have full access online, the same way that I can access claims information. (Right now, I theoretically have the right to get copies of those notes, but it requires notarized mailed paperwork, months of waiting, and an incomplete reply on disorganized printouts.) Then establish a Consumer Health Insurance Protection Bureau modeled on the Consumer Financial Protection Bureau, whose complaint system works quite smoothly for simple problems. Along with straightening out simple problems, the CHIPB could have a swear jar with a set penalty for each time the health insurance company lies to a customer in a recording or in their own notes. Maybe $20, with half going to the CHIPB budget and half being given to the customer? And a higher penalty for the health insurance company “losing” recordings or notes.

At the moment, Cigna doesn’t care whether they lie to a customer about a precertification, or about whether a procedure or medication is covered, or about whether a provider is in network, or even about what they themselves have said within the same conversation. Cigna loses nothing for lying, so over time they lie more and more. That needs to change.

If we ever shift to single-payer, we’re going to have a reintegration problem for health insurance company employees. We’ll have to train them not to lie, not to erase records and evade responsibility, not to see the customer and the provider as enemies. Because having thousands of Cigna reps working in Target without a lot of retraining is going to be hell on everyone. What, you want to buy socks? There’s going to be a waiting period for that, you can only buy 1 sock per week, we’ve never sold socks, the socks that your wallet covers are only available in a single store in New Hampshire, you have to prove that you tried stockings and those didn’t work, and the price for the socks will be randomly assigned 3 to 12 weeks after you’ve worn them.

Monday, March 16, 2015

Release your wrath

A friend came over yesterday to talk about one of the most problematic passages in the traditional Passover haggadah where we ask God to pour out His wrath:

Pour out Your wrath against the nations that know You not, and upon the kingdoms that call not upon Your name; for they have consumed Jacob and laid waste his habitation. Pour out Your rage upon them and let Your fury overtake them. Pursue them in anger and destroy them from under the heavens of the Eternal.

After much of the seder, after the festival meal, after much reading and singing and talking, after the third cup of wine, we fill the fourth cup, open the door for Elijah, and let loose with that righteous anger. It’s quite the contrast to when we start telling the Passover story early in the evening and say “All who are hungry, let them come and eat. All who are needy, let them come and celebrate the Passover with us.” But we don’t open the door for that part.

Who is the righteous late-evening anger directed against? Surely we are not asking for vengeance against the non-Jews who are at our seders and in our families, nor our actual non-Jewish neighbors with whom we just shared roof rakes and calcium chloride in the midst of a record-setting winter. But ritual language does not just express what was in the hearts of those who wrote it. It shapes how we see ourselves, every one of us who recites and hears those words. It shapes how others see us. And it shapes how our children come to understand who we wish for them to become.

An unbroken continuation of this anger is not what I wish for my son.

My friend’s haggadah had replaced this passage with a Holocaust remembrance passage before the door is opened for Elijah:

On this Seder night, we recall with anguish and with love our martyred brothers and sisters, the six million Jews of Europe who were destroyed at the hands of a tyrant more fiendish than Pharaoh. Their memory will never be forgotten. Their murderers will never be forgiven.

Trapped in ghettos, caged in death camps, abandoned by an unseeing or uncaring world, Jews gave their lives in acts that sanctified God’s name and the name of His people Israel. Some rebelled against their tormentors, fighting with makeshift weapons, gathering the last remnants of their failing strength in peerless gestures of courage and defiance. Others went to their death with their faith in God miraculously unimpaired.

Unchecked, unchallenged, evil ran rampant and devoured the holy innocents. But the light of the Six Million will never be extinguished. Their glow illumines our path. And we will teach our children and our children’s children to remember them with reverence and with pride.

We invite the souls of all who are missing, the souls of all who were snatched from our midst, to sit with us together at the Seder. This invitation was uttered by Seder celebrants in the Vilna Ghetto in 1942...and we repeat it tonight. For on this night all Jews are united in history and in hope. We were all in Mitzrayim. We were all at Sinai. We were all in the hell that was the Holocaust. And we will all be present at the final redemption.

While I like it as a personal reading, it feels too long for the haggadah. So too does my haggadah’s version of the fifth child, the child of the Holocaust who did not survive to ask a question.

Faith should be stronger than hate, and the impulse for peace should be stronger than the desire for vengeance. That may not be true in the moment, but the haggadah is a durable statement of remembrance and hope. So here’s my new plan for after the third cup of wine, shortening and refocusing the Holocaust reading, and replacing the traditional wrath and fury paragraph:

After the third cup, pour the fourth cup.

On this Seder night, we recall the six million Jews of Europe who were murdered in the Holocaust. Their memory will never be forgotten. We draw inspiration from the strength of Jews who held onto their faith and celebrated Passover in the Vilna and Warsaw ghettos and all over Europe even as their communities were being destroyed.

In their names, we invite the souls of all who are missing to sit with us together at our Seder. For on this night all Jews are united in history and in hope. We were all in Egypt. We were all at Sinai. We were all in the Holocaust. And we will all be present at the final redemption.

Open the door for the prophet Elijah. All rise.

We do not know when the final redemption will come, but we open the door for the prophet Elijah at every Seder with hope. We work to cast aside wrath and fury, longing for Isaiah’s description of the time to come when violence shall no longer be heard in our lands. Never again let us be slaves, and neither let us be the taskmasters to others. Let us strive for peace and justice so that we may hear Elijah announce the coming of the Messiah.

All sing Eliyahu hanavi.

That’s what I want to teach my son. Remembrance and faith, connections through the generations, and hope made real by the work we must continue to do.