A Desk Murderer

(Door Hugo Kijne te Hoboken USA)

I have ‘chronic idiopathic demyelinating peripheral neuropathy.’  It means that my feet are gradually becoming numb, and if I don’t get treatment I’ll soon be walking with a cane, then with a walker, and eventually I’ll be in a wheelchair.  The only known treatment, IVIG, is a biweekly infusion with a substance that is made of the blood plasma of at least 100 people, so it is very expensive.  When I was diagnosed with the condition five years ago I still had private health insurance through my employer.  To make sure that I would get the treatment my neurologist wanted to run some tests, but the insurance company didn’t give him permission to do that.  Since he was confident that his diagnosis was correct he wrote the prescription for the treatment anyway, and submitted it to the insurance company for approval, which was denied because the tests had not been done.  With his support, I appealed that decision.  My first appeal was rejected, but after an appeal of that decision I was informed that I would have to appear in front of a panel of experts.

That committee, consisting of doctors and nurses, would make the final decision about my treatment.  I acknowledged that I would appear before the panel, but also informed the insurance company that I would file a lawsuit if I didn’t get the treatment.  The night before I was scheduled to appear before the committee I got a phone call that the meeting had been cancelled and that the treatment was approved.  Obviously the insurance company had been trying to save some money, and in most cases they would have succeeded.  As my neurologist said: “How many people would go as far as you did in fighting them?”  This year I turned 65 and now I have Medicare.  With Medicare there was no problem continuing the treatment, because the program’s only criterion is whether the treatment is appropriate in light of the diagnosis and what is considered good medical practice. Which brings me to Paul Ryan, Speaker of the House, who has been intent on ending Medicare ever since he read Ayn Rand as a boy and decided that government couldn’t do any good.

If Ryan has his way, Medicare will be transformed into a voucher program via which seniors get a certain amount of money to buy private health insurance.  Those who can afford it can supplement the voucher money with their own to buy a plan that covers all their conditions, those who cannot afford it have to accept the coverage the plans they can afford with the voucher money offer, and leave conditions that are not covered untreated.

The term ‘desk murderer’ was coined by Hannah Arendt in her reporting about Adolf Eichmann’s trial in Jerusalem.  It refers to a bureaucrat who condemns people to death with the stroke of his pen, as the consequence of a policy he implements.  Paul Ryan is no Eichmann, but people who could be cured will die if his Medicare plan is implemented.

With the election of Donald Trump Paul Ryan may very well have become the most powerful man in DC.  During the campaign Trump has said that he won’t allow changes in Medicare to be made, and we’ll soon find out if he has the cojones to stand up to Ryan.

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