Middle-aged Males, Avoid All Swine

28 09 2009

Sorry for the silly title… Couldn’t help it.  Heh…

So, I got the following notice from Blue Cross / Blue Shield relative to coverage for the H1N1 flu vaccine (edited to just give the good bits…):

A Message from BCBSIL Concerning Coverage for the H1N1 Vaccination

As you may be aware, the vaccine for the H1N1 (swine) flu virus has been approved and will be available in the coming months from the U.S. government at no cost to health care providers. However, health care providers may charge fees for administering it.

Blue Cross and Blue Shield of Illinois (BCBSIL) has announced it will cover the administration of the vaccine for the H1N1 flu virus for all members – who are in the targeted priority groups (defined below) (emphasis added)– ….

* * *

It is important to understand that these benefits are subject to the vaccine’s availability. The Centers for Disease Control and Prevention (CDC) is working with local health departments to ensure the following targeted priority populations receive the vaccine first:
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Healthcare and emergency medical services personnel
4. Persons between the ages of 6 months through 24 years
5. People ages 25 through 64 years who have chronic health disorders or compromised immune  systems.

This communication relates to the H1N1 flu vaccine only. Coverage for other vaccines will remain in accordance with the member’s plan…

The rest of the notice is legal stuff, not relevant to my point:  My point being to question why if one is not pregnant, with young children, work in health care, under 24 years old or have chronic health conditions, BC/BS has decided that the money taken out of pay every paycheck does not entitle one to the same coverage for vaccination against a possibly (however unlikely) deadly illness?  Shouldn’t coverage for one be coverage for all?

I’m sure that BC/BS would say that it is going further than it has to in providing full coverage for  those in the “targeted priority populations”.  They could sit back and collect co-payments or deny coverage for all H1N1 Swine Flu vaccinations – but I’m sure they know they’ll look bad in doing so.  Heck, it may even be patting itself on its figurative corporate back for being so “generous” with its policyholders.

However, I would change the question to be why should this matter?  Do we not all subscribe to the same insurance contract?  True, the priority list is something the government came up with – but its expected that there eventually will be enough vaccine even for the rest of us.  So, why isn’t BC/BS covering us?  Indeed, isn’t BC/BS making a decision to protect its corporate profits by only extending coverage to those in the select categories based on some actuarial calculation that “they better do it” as the people in the select categories getting swine flu are more likely going to need thousands of dollars of healthcare in order to deal with the sickness?  If you don’t think this is how it happens, well then you’re not a manager at BC/BS corporate parent Wellpoint, I guess (check out the financials for ticker symbol WLP – over $61 Billion – that’s “Billion” with a B – in gross profits last year!)

BC/BS Profits = 61 of this

BC/BS Profits = 61 of this

For those that don’t get sarcasm – yes, I’m suggesting that BC/CS is only doing this based on a calculation that they will save money in the long run by prompting the select populations to get the vaccination.  For the rest of us, we’re sort of like that calculation Ford made with the Pinto long ago:  Sure, we’ll see some explosions with the gas tank in that spot, but in the end the payouts will be less than what we’ll pay on the redesign of the car.

But, if we look at this from the position of the policyholders, it seems to me that those excluded from this extension of coverage (middle-aged people in generally good health) are the ones most likely subject to losing significant pay and expense should they come down with Swine Flu.  Likewise, these people are the ones that, in many cases, are the family members primarily responsible for supporting those in the select classes.  But that’s OK to BC/BS, cause in the end they’ve likely calculated that the expense for the remedial care they’ll get hit with will be less than the cost of extending coverage to everyone.  After all, they’re not the one’s riding in that figurative Pinto…

Anyway, grist for the mill.  Even though BC/BS has decided I don’t qualify for their grant of coverage, I’ll probably get the shot and go ahead and pay the co-payment.  I’m lucky enough to be in a position that this is not a financial decision I have to worry much about.  But what about the husband and father my age scraping by on what’s left of his pay after taxes and deductions for BC/BS’s health ‘coverage’ who is stretched thin?  What happens to those guys who don’t get the shot (yes, there will definitely be people that will avoid the shot because of its cost) and then get sick, lose work or worse?  What about their family members when this happens?

Anyway, this notice seemed unfair to me and sort of an arbitrary classification of who gets the encouragement of getting the preventative care of the immunization.  Would a “Public Option” insurance carrier make this kind of selection of who gets coverage like this?  I think not.




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