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The Problem of Audience...

Kevin Drum finds a very good piece by Cathy Seipp in the Los Angeles Times, as she writes about her two-front war against her lung cancer and against her insurance company, WellPoint-Blue Cross:

The Washington Monthly: BATTLING THE INSURANCE INDUSTRY.... Cathy Seipp, who contracted cancer several years ago, tells us that if we're in the market for a health insurance policy, we should pay close attention to the policy's out-of-pocket cap. Hers jumped recently from $5,000 to $7,500 in a single year.... Battling cancer is bad enough. Why should cancer patients have to battle private insurance companies as well?

It is well worth reading. Here's what Cathy Seipp writes for the Los Angeles Times:

Battling Cancer -- and Blue Cross - Los Angeles Times: Unlike THE TYPICAL Blue Cross "valued member," as the annual letter on rate and benefit changes always calls us, I wasn't upset to learn that my monthly premium would increase by $50, to $395 a month, for me and my daughter. That's because I'm not really a Blue Cross valued member. I'm a Blue Cross problem member -- the kind who actually uses the valued benefits. So I don't really care about premiums; I was just relieved that my yearly out-of-pocket cap, which jumped from $5,000 to $7,500 in 2004, didn't go up yet another 50%.

Without me, Blue Cross' parent company, WellPoint, which reported a $2.5-billion profit last year, could have seen a profit of $2.5 billion plus about $50,000. I was diagnosed with advanced, inoperable lung cancer in 2002 and so now typically reach my $2,500 individual deductible by January and my out-of-pocket cap by February.... Lucky you, if you don't know what your out-of-pocket cap is. And if you're like every single healthy person I've queried, you probably don't. But you should know, because the out-of-pocket cap is the most important part of your policy, meant to stave off financial disaster in case of catastrophic medical expenses....

Policy wonks keep arguing about market competition and consumer choice. But healthcare for the sick isn't a market because choice disappears. You can't shop around for generic drugs when you have cancer. Whatever chemical treatment the doctor suggests, it almost certainly will be a brand name costing several thousand dollars a month. My out-of-pocket cap is $7,500, which means that after I reach $7,500 in co-payments, Blue Cross pays 100% of my medical expenses for the rest of that year -- except for the $30-per-brand-name prescription I have to pay the pharmacy after I reach my $500 annual deductible for drug coverage. According to the policy, it's supposed to be a $30 co-payment for a month's supply, but a new anti-nausea drug I was taking for weekly chemo costs $285 for just three pills, so Blue Cross made me go to the drugstore and fork over $30 every seven days.

Another thing working in insurance companies' favor is that cancer patients rarely have the energy to argue about such nickel-and-diming. I recently managed to spend a morning forcing my way through multiple disconnects and transfers on the Blue Cross 800 number, but I was eventually told that the company would probably reimburse me for the extra $90 a month I was paying for that weekly anti-nausea drug if I filled out the right forms. My far bigger worry is that out-of-pocket cap, which is essentially what insurance is for. To drastically raise it seems the definition of bad faith.

Or so I thought — until I began getting letters from Blue Cross in February announcing that it was retroactively disallowing the anti-cancer drug Avastin treatments it had been paying for since October, at $5,000 a pop every other week. It seems Blue Cross decided this new and expensive targeted therapy is experimental. (It looks as if Blue Cross is not asking to be repaid for my relatively unexperimental chemo, which had been costing about $2,500 every single week, but who knows?)...

Cathy Seipp's major weekly outlet is her "From the Left Coast" Column for National Review. I think her National Review readers really need to hear her views on how market-based health insurance is working--need to hear her much more than the average Los Angeles Times reader needs to hear her on this topic. Yet so far this year, here's what she's written on for National Review: Patterico's critiques of the LA Times, Richard Feynman, right-wing columnists on the take, high school math, ex-Moynihan aide Lawrence O'Donnell, laundry, how Westside kids are regarded as freaks if they don't have their own cars at 16, HBO's polygamy series, bilingual education, how UCSD has a healthy College Republican chapter, "Pepper Dennis" vs. "Gidget," gay marriage, earthquakes, and Patterico vs. Hiltzik.

If she would write for National Review what she writes for the Los Angeles Times, maybe some of National Review's readers would start thinking that blanket Republican opposition--opposition sight unseen--to proposals for health care reform is kind of stupid.

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