A Response to “Tragic Tale”

What is society's responsibility to any one person? When does the welfare of the group override what is spent for any one person? Money is a finite resource and there is not an unlimited reservoir to use for health care costs for any one person. In past societies, those that could not keep up were left behind to die, because to do otherwise put everyone at risk. When 1% uses 52%, and if this is not sustainable, when do we start to ration? If someone feels "society" has an unlimited responsibility—remembering that we ourselves are society—what can that someone afford?

Does everyone understand insurance companies do not "pay" claims? They redistribute premium dollars to benefit dollars according to a contract. If benefit payments go up, premium dollars increase. CIGNA has a responsibility to their policy holders to honor the contract, and it appears they did. I can only come to this conclusion because you do not mention of any lawsuits from Bill's employer, the Legal Aid Society, against CIGNA. If CIGNA erred, I have to believe that the Legal Aid Society would have questioned CIGNA.

When was it decided it is society's responsibility to provide custodial care other than as a last resort? Why is Bill in a nursing home and not staying with one of his children? My mother-in-law who was confined to bed and lived in my house until her death at age 83. We made adjustments and made it work. And her mother lived in her house until her death at age 93. My grandmother was cared for by her three daughters, one of which was my mother, until her death at age 92.

So, where do we go from here?

We have people living longer than ever before and we have treatment options like never before. None of this could have been anticipated. My experience in 36 years is that insurance companies use an objective standard and pay the claims as the contract specifies. No one is at fault. We are wasting time trying to assign blame and need to direct our efforts to dealing with the real issues, longer life and the related expenses of living longer.

People need to understand the funding of our current system. Social Security was and is designed to supplement retirement income, not to be the primary source. This is stated in most Social Security Administration publications. Medicare is to pay for sickness and injury not wear and tear. As part of my civic responsibility, I have done educational seminars for seniors, on Social Security and Medicare. The audience is predominantly middle class. I have them bring their Social Security benefits statement that shows cumulative contributions by the individual and their employers into the system. I offer that if anyone feels they will get less from the system than they have paid, they can call me and I will help them investigate their situation. I have made this offer to more than 500 people. I have received not one call.

People need to understand their income and expense needs as life expectancy increases. Few people have planned for future retirement income that will last for 25 year after they stop working and even fewer have saved toward the estimated $150,000 of unreimbursed health care expenses over this time.

Longer life and better technology affect all areas of our society. I am a volunteer for our local Developmental Disabilities County Agency that supervises 95 residents with multiple disabilities who have no other available option other than this group home. Most of them have exhausted insurance benefits and have Medicare and Medicaid. We raise funds and help the parents. A major issue we have is that with our improved health care system many of the clients who did not previously outlive their parents will now outlive their caregiver. This is a whole new set of variables.

Combine this with funding cuts and we work very hard to efficiently deliver care to a growing population of people who were born with a condition that through no fault of their own requires they have support to live. As a point of information, no person in my family has ever been a recipient of developmental disabilities services. I chose this project because I wanted to help people that through no fault of their own needs help.

We need for people to plan and be as productive and self-sufficient as possible. There will need to be more emphasis on individual funding of their expenses. We need to design a transition for the elderly who are living longer and who have limited ability to create new wealth; we need to provide for their care for the remainder of their lives. This does not mean everyone gets everything that they want for free. The sooner we start on these issues the better the results.