"A collision with a semi-trailer truck seven years ago left 52-year-old Deborah Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, and three sons found a small source of solace: a $700,000 accident settlement from the trucking company involved. After legal fees and other expenses, the remaining $417,000 was put in a special trust. It was to be used for Mrs. Shank's care.
Instead, all of it is now slated to go to Mrs. Shank's former employer, Wal-Mart Stores Inc.
Two years ago, the retail giant's health plan sued the Shanks for the $470,000 it had spent on her medical care. A federal judge ruled last year in Wal-Mart's favor, backed by an appeals-court decision in August. Now, her family has to rely on Medicaid and Mrs. Shank's social-security payments to keep up her round-the-clock care.
"I don't understand why they need to do this," says Mr. Shank on a recent visit to the nursing home, between shifts as a maintenance worker and running a tanning salon. "This girl needs the money more than they do." Mrs. Shank, who needs help with eating and other basic tasks, spends more time alone since Mr. Shank had to let her private caregiver go. At some point, he says, she may have to be moved from a private to a semi-private room in the nursing home where she lives.
The reason is a clause in Wal-Mart's health plan that Mrs. Shank didn't notice when she started stocking shelves at a nearby store eight years ago. Like most company health plans, Wal-Mart's reserves the right to recoup the medical expenses it paid for someone's treatment if the person also collects damages in an injury suit."
As far as I can tell from the article, the damages Mrs. Shank (or rather, a trust set up for her care) collected were not supposed to cover the medical care Wal-Mart had already paid for. They were for her loss, which is ongoing, and which will continue to cost her family both economically and in other ways. And this isn't uncommon in catastrophic cases:
"In cases like the Shanks', where injuries and medical costs are catastrophic, accident victims sometimes can be left with little or none of the money they fought for in court. Health plans are increasingly adopting language such as Wal-Mart's, which dictates that it is to be paid first out of any settlement, regardless of what remains for the injured person. Moreover, the victim is responsible for all legal costs in pursuing the suit.
"It's especially in the catastrophic cases that people are almost never fully compensated," says Roger Baron, a professor of law at the University of South Dakota and a specialist in health-plan law. "And then their health plan, that's been collecting premiums from them all this time, wants to take it away?""
I support any reasonably well-designed plan that will provide affordable health insurance to all Americans, but given a choice, I prefer a single-insurer plan (basically, there is one insurer who insures everyone, and it's the government. Sort of like universal Medicare.) There are a number of reasons for this, including the advantages of integration and administrative savings. But one of them is that in a world in which there was no question who was going to pay for Mrs. Shank's care, no one would try to weasel out of it in this way. As things are, many patients and their families have to go through this horrific nightmare of figuring out who is responsible for what, and whether what they need will be approved, at the very time when they least need that kind of stress.
I recall someone who used to clean my house. She and her husband were hardworking, good people. She had not signed up for her own health insurance because his employer provided good coverage, and it was cheaper for them to enroll in his plan as a couple. But then one day he was in an accident on a motorcycle, and his leg was shattered. His health insurance paid for the first of a series of operations, but guess what? He couldn't do his job after the accident, so he was let go. That, of course, meant that he and his wife lost their health insurance, which in turn meant that they had to pay, out of pocket, for the rest of the operations (I think there were nine in all, but I could have the number wrong) that he needed to put his leg back together. They applied for various forms of assistance, and were rejected by several because they were insufficiently poor. They burned through their savings before they were done, but they also had to spend a lot of time and emotional energy that they didn't have trying to slog through one bureaucracy after another, trying to find someone who could help.
Eventually -- I am not making this up -- she went to work at Wal-Mart, because she could work the night shift and care for her husband during the day. They never did get their savings back: savings they had worked for over a lifetime.
This happens because our system of insurance is so fractured that it's unclear who will end up paying for what. There are a lot of wonky reasons to prefer a single-insurer model, but there are also reasons like this one: our present system is just inhumane. f you aren't convinced yet, consider the punchline to the WSJ story:
Here's the punch line:
"In August last year, U.S. district judge Lewis Blanton sided with Wal-Mart, ruling that when Mrs. Shank signed on to Wal-Mart's health plan she was obligated to abide by its terms.
The ruling came six days before the Shanks' 18-year-old son, Jeremy, was killed in September last year in Iraq shortly after he arrived in the U.S. Army's 25th Infantry Division.
"I wanted to give up at that point, tell Wal-Mart they won," Mr. Shank says, but his lawyer, Mr. Graham, said he'd continue with appeals.
Mrs. Shank went to Jeremy's funeral. But because of memory problems due to her injuries, she gets confused about what happened. On a recent morning, she cried several times and asked what had happened to her middle son. Mr. Shank says that he obtained a divorce from Mrs. Shank this year, partly because of advice from a health-care administrator that she might be more eligible for public aid as a single woman. Mrs. Shank, who has been declared incompetent by a court, hasn't been informed of the divorce by her family."
Obviously, I don't hold our health care system responsible for the fact that the ruling came right before the Shanks' son was killed. But I think that no one should ever have to divorce his wife in order to get care for her. Ever. Not in my country.