I have been thinking quite a bit lately about who drives practical policy decisions in this country. I am not talking about health care reform or climate change legislation or any other hare-brained scheme that may or may not actually emerge from Washington, D.C., at any point in my lifetime. Rather, I am referring to actions and reactions, how those become ingrained in our lives, and the unwitting consequences that flow therefrom. Two illustrations will help.
(1) The first is a story that ran in the Denver Post and later garnered national headlines about a health insurance provider who refused to cover an infant because of its weight. The child measured in the 99th percentile for weight, and the parents' insurer rejected coverage based on a preexisting condition of obesity. Eventually - no doubt after its ridiculous policy made national headlines - the insurer reversed course and extended coverage to the baby. But permit me to muse for a few moments about some of the messages that could be drawn from this story.
First of all, while obesity is definitely a health concern among adults and children, I find it absolutely absurd that an insurer would even have a policy with weight-based preexisting conditions for infants. Having a small child of my own, and having more than handful of friends with children in close proximity, infancy is probably the only time in life in which a hefty waistline is not considered a medical problem. Spare me the 265-pound infant tabloid headlines. I am attempting to be serious here. What mother is going to complain about her infant maintaining a healthy weight? None that I know. In infants, weight gain and maintenance is indicative of so many aspects of good health. Why on earth would an insurer punish a child for being healthy?
Secondly, the baby in question was exclusively breastfed at the time he was denied health coverage. This, no doubt, contributed to the weight "problem." The great irony here is that, despite any drawbacks from his weight (if there were any), this baby is probably ten times as healthy as children of the same age who are exclusively formula-fed, even if those other infants fit more nicely into the insurer's percentile charts. Infants who are exclusively formula-fed miss out on a host of health benefits from mother's milk early in life, not the least of which is antibody and immune boosters from the mother. That's right, there's a good chance the obese baby will have fewer sick-child visits at the pediatrician's office. That's right, insurance company, the baby you initially rejected will probably cost you less money over time than the 50th percentile babies you take without a glance.
As I said, the insurer in this case eventually reneged and covered the infant, but the cynic in me wonders if that would have happened without the negative publicity. In that vein, think about the messages that an average person could draw from the insurer's policy. Do I need to deny my child food to keep their weight within acceptable limits? Do I need to change what I feed them, even if that means taking away the most nutritive option, to keep them within an insurer's policy?
Even if the insurer's policy was based on sound criteria - a big if - do we want insurance company policy determining what infants are fed? I said - but did not promise - that I would avoid opening the can of health care reform worms, but the relevant question today is "Who is driving policy?" In the medical field, it seems clear that insurers have at least as heavy a hand as care providers, if not more so. Without the insurance, there may be no access to the care provider. To pare down the message: money drives policy. And that is unfortunate. Opponents of government-sponsored health plans cry that a bureaucratic health care system would remove the human element from medical decisions. Frankly, I do not see how the two would be all that different.
(2) Enough ranting about health care, and on to the second illustration. An editorial ran in the New Year's Eve edition of the Denver Post relating airline baggage fees to terrorism. Simple comparison, right? If not terrorism, baggage fees must at least be some kind of crime. In all seriousness, though, the editorial opined that the increase in checked-bag fees has, obviously, led to more travelers carrying more luggage onto flights. In turn, this means more items for TSA officers to inspect at security checkpoints. (If any of my loyal readers post a comment stating that they are just willing to wait longer in security lines, I will know that those readers do not fly that often.) The point of the editorial was that both of these consequences of the checked-bag fees - more luggage in the cabin of the plane plus less time for security officers to spend on each piece of luggage or individual - expose flights to a greater risk of criminal or terrorist activity. When two and two are put together in one sentence, that seems like a commonsense proposition.
The Post editors urged airlines to reconsider their policies in light of the Christmas Day terrorist attempt. But somehow I have a feeling that the $740 million in bag fees collected in the third quarter of 2009 alone will speak just as loudly. (That stat is from the L.A. Times, via the Post editorial.) Look, I know that airlines and the air travel industry have suffered mightily since 9/11. And I know that they have to put measures in place to ensure they can still provide some services. But at what cost to the rest of us? When a bottom line drives policy, those with no stake in that line often shoulder the consequences. In this case, it appears travelers are left with the options of longer security waits and more invasive screening procedures or further heightened fear.
I do realize what I am advocating by arguing against policies like those illustrated in the two instances above. Do I absolutely and universally favor a heavy government hand in all aspects of life? No. But if the alternatives are limited, I may have no choice at all. The Post editorial summarized the incongruity succinctly and poignantly: "It would be a shame for the industry to be regulated into doing what is best for all concerned, but it very well may come to that."
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