Big Brother

Not long ago, my son asked me for my opinion about a topic that was discussed in one of his classes.  He wanted to know how I felt about the NSA and the government spying on us.  I told him that I personally feel that if it’s for the greater good, such as keeping us safe and secure, that I don’t have a problem with it.  My life is not of interest to the government, so if I get looked over, it’s in passing because I don’t have much going on in my life that is of a threat to anyone, so no, I don’t worry about the government looking me over. We are constantly being monitored these days anyway because of social media and various internet search engines that our lives are not private, and it’s foolish of us to believe that it’s only the government doing the spying. How many times have you looked at an object of interest, say, a pressure cooker, and noticed that the same item keeps popping up every time you go to Amazon or any other online store?

It is quoted that  insurance companies spend $18,000 on the average natural childbirth in America.  The cost for a complicated pregnancy is much more. I recently had a cash-pay patient  who didn’t want to apply for Medi-cal because both she and her husband didn’t want Big Brother intruding into their finances.  Her pregnancy was as normal as can be for a 44 year old having her 5th baby.  At 28 weeks, her belly looked as if she was carrying triplets. Evaluation by a perinatologist showed that the sudden change was due to massive fluid build up that was caused by a blockage in the baby’s intestine.  The change in event was over the week prior to her office visit, and this unforeseen diagnosis could potentially bankrupt the family.  The sudden change in circumstances forced them to apply for Medi-cal and luckily they found out that her policy was effective even prior to the pregnancy.  There was no fear of Big Brother picking up the tab for the numerous testings and consultation visits with the specialist, the surgery that the baby had within days of the delivery and for the 3+ weeks of post operative hospitalization in the neonatal intensive care unit.  The cost for this one baby is over a million dollars.

Insurance companies are Big Brothers.  What my patient may not realize is that her original fear of California’ Medi-cal’s Big Brother is not without merit.  It will grudgingly pay that $1 million for the care of the newborn, but both she and her husband will be forever monitored by the state so that it can recoup the money that was paid. Their every expense, their every good fortune will be monitored. The lifelong scrutiny  may also affect the baby’s life.

There  are various health care apps out there to help women keep track of their menstrual cycles,  fertility days and pregnancy.  The various apps such as Ovuline, Due Date Plus, Ovia Fertility seem innocuous enough and some don’t share your information.  What you don’t realize when you sign up for some health apps is whether or not your insurance company has vested financial interest in the app and can use the data obtained from you to know what is going on with you that may end up costing them money. If  a woman is interested in knowing when she ovulates, her insurance company may want to know that. If she fills out a form and risk factors are identified (high blood pressure, obesity, and family history of metabolic diseases like diabetes for example), it can intervene by offering prenatal counseling whose ultimate goal is to get you to lose weight, see a doctor, and get you healthier prior to conception. Yes, they do care about how many steps you take and what your weight goal is. They do care about the low back pain and cramping you are experiencing at 24 weeks into your pregnancy.  Ultimately it  is for your benefit, but their ulterior motive is cost. Getting you to lose weight by offering nutritional support and discounted gym memberships, and notifying you & your obstetrician about risks of preterm labor for example, are clever ways to intervene before financial disaster can strike. Not all Big Brother intervention is evil.

Insurers therefore want to do whatever they can to help identify  risk factors and the apps are now being looked at as an easy way to identify and seek out those individuals with higher risk for a catastrophic medical event like a stroke .  Prior to Obamacare, preexisting conditions were used as criteria to exclude many high risk individuals. Now  this loophole has been removed.  Are you surprised then at the sudden interest in the various health care apps?  Obesity is rampant in America and is the number one health risk affecting one-third of adults.  According to the CDC, the annual medical cost for care related to complications from obesity exceeds $147 billion dollars.  Preventative medicine wasn’t always supported or embraced by the health insurance industry.  Health care apps are leading the way to the greater good I believe.

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