LIFETIME MAXIMUM – A CAREGIVERS PERSPECTIVE
by Stan Seagraves, M.D.

Anyone paying attention to recent healthcare legislation may have heard the term “lifetime maximum” batted around. You'll learn elsewhere on this site the ins and outs of this, so I will limit my comments to one docs perspective, and try not to get too political. I cannot tell you how hard this will be. I will likely fail.

Have I seen lifetime benefit limits hit? You bet. Can't tell you how many times, but patients have reported this to me, with a level of anger, desperation and helplessness that you can readily imagine. Some did not know they even had a maximum. Do you know what yours is? Did you know you had one? I cannot tell you mine, right off the cuff.

How hard is it to hit the max? That obviously depends on the number, but $1,000,000 was a common figure in the past, and in 2008, 36% of employer sponsored plans had maximums of $1million or less. One million does not buy what it used to. In fact, you'd need $1.6 million today to get what you could with a cool million in 1999. Cancer, major trauma, organ transplants, multiple sclerosis, hemophilia and a lot of other serious chronic diseases - and not necessarily rare ones – can run the register to a million, easily. Not all benefit maximums have kept up with our horrific rate of health care inflation.

What happens to people who hit the maximum? Bad stuff. Death. Divorce. Besides the marital discord these financial crises bring, some divorce becomes quite strategic – a divorce from the spouse's health insurance, and a means of access to Medicaid. Selling off of assets to qualify for state assistance. Kids yanked out of college, move in to help run the family business. Litigation. Why the latter? With our current lottery legal system, some patients try to hit the jackpot to get out of debt. There is some good stuff, too, I suppose – but its generally too late. Folks do start thinking about the costs of their care.

Do I really need that particular drug or surgery? How can I shave some costs?

I have seen insufficient lifetime insurance benefits tear families apart. I don't pretend to know the solution. But the subject brings into better focus some of the core issues that swirl about in the health care reform debate: How do we deal with out-of-control costs? How can we better enroll patients in such cost control? Is the idea of some kind of national re-insurance healthy? How much profit is reasonable for a health insurance company? How much will premiums really need to rise to cover the new prohibition against lifetime maximums. How much is posturing, how much is fiscal reality?

I'd suggest we all pay close attention. Not only to the language in our own policies, but to the rhetoric and proposals that are now front page news.