Medicalization is a wonderful newish word. It means the process of taking a natural condition and convincing people that it’s a disease to be treated and cured by the medical profession. Once a condition is medicalized, the pharmaceutical industry can sell drugs, doctors and hospitals can charge fees. The cash registers just keep on ringing up the profits. Once this happens, there’s a kind of bandwagon effect. The condition suddenly becomes a lot more serious. It’s now a disorder or disease. For health insurance companies, it’s a pre-existing condition.
Now there’s a funny thing about health insurance companies. They are never shy about coming forward with new reasons for not paying out on their policies. One of their classic excuses is the “disclosure” rule. The law sounds quite reasonable. If you are sitting in your office and never get to meet the person applying for a health plan, you have to rely on the honesty of what the person says when you decide whether to write the policy. It’s a sad fact that some people are less than honest when they apply for policies. They forget the heart problem and declare themselves fit and healthy. Insurance companies therefore need the right to rescind the policy – to cancel it if the applicant failed to disclose information needed to assess the risk.
So now we come to the case of Otto Raddatz who, courtesy of his sister, became a famous victim after his death. She testified to a Senate committee about what happened and the story, in suitably dramatic form, was later picked up by President Obama in support of his campaign for healthcare reform. The facts are easy to state. Here was a man lining up to get surgery for cancer. The hospital appointment was booked when, surprise, the insurance company decided to rescind the policy. Why? Because Otto had failed to disclose the fact he had acne as a teen! This was a serious pre-existing condition and likely an indicator he would get cancer later in his life. His failure to disclose it justified rescission. Well, fortunately, his sister was an attorney and she got the state attorney general on the job. Six weeks later, the insurer reinstated the policy and Otto got his operation. This gave him six more years of life.
It’s sometimes odd to see how the world works. The medical profession goes to great trouble to convince everyone that acne is a disease. The pharmaceutical industry sells us accutane which is an almost always effective treatment, clearing the skin and restoring beauty during the first period of treatment. And then insurance companies accept this medicalization and require people applying for policies to disclose acne as a pre-existing condition. This is a logical and predictable progression. If doctors say acne is a disease, it must be a pre-existing condition and everyone should disclose it when they apply for health insurance! Do not be deceived! The Illinois attorney general does not fight for everyone. Otto was lucky that his sister was an attorney with the right political connections. So never lie about having acne! The risk of rescission is real. And while you have acne, rely on accutane, the sure-fire way of solving the problem.