Friday, August 15, 2008

New book on financial crisis uses example of health insurance fight of someone with MS

From The Washington Post review of HIGH WIRE, The Precarious Financial Lives of American Families by Peter Gosselin:

You might not expect a book on economic policy to be a page-turner, but Peter Gosselin's High Wire is just that. Gosselin, a national economics reporter for the Los Angeles Times, has written a systematic investigation of the many ways financial risk has been transferred from employers, the federal government and insurance companies to individuals and families. Gosselin shows, in frightening detail, how our lives as Americans have become riskier over the last few decades. Instead of believing that we are mutually responsible for each other, we now rely on markets that have repeatedly demonstrated that they are distorted by greed, corruption and irrationality.

Gosselin makes his case using statistics and stories of real people, such as Debra Potter. Potter was a stay-at-home mother until the late 1980s, when she became an insurance agent to supplement the modest income of her husband, a Presbyterian pastor. In 2001, she earned more than $250,000. But by the end of May 2002, she had become so disabled by symptoms of what was later diagnosed as multiple sclerosis that she had to give up her job. Her insurer, whose policies she had previously sold, tried to reclassify her disability to reduce her benefits substantially.

Despite continued appeals, the insurance company stood by its decision, and Potter's condition worsened. As a result, the Potters spent almost all of their savings on Debra's treatment and living expenses and were forced to pull their son out of college. In August 2003, her diagnosis was definitive, and Social Security began disability payments. Nearly two years after the definite diagnosis, Potter's insurer finally began paying benefits. A check for the benefits previously denied arrived three years later, but the damage was done.

Gosselin marshals evidence that Potter's case was more than an unfortunate or isolated mistake, explaining how insurance companies routinely reduced payments of claims. In cases involving employer-provided insurance, the courts have let them off the hook by interpreting the Employee Retirement Income Security Act (ERISA), which covers employee benefits, in a way that favors the insurance companies.