Jim de Bree | Legal Reasoning Undermines Our Institutions

Jim de Bree
Jim de Bree

As many readers know, my daughter was born with cystic fibrosis, an inherited disease that is extremely expensive to treat. 

Back in the late 1980s/early 1990s, our family’s costs were outrageous. In those years, if we kept our annual out-of-pocket medical costs under $50,000, we thought we were having a good year. Unfortunately, we had several bad years.

Like most Americans, I obtained health insurance through my employer. At that time, my employer, a Big 4 accounting firm, purchased a group health insurance policy from an insurance company. 

Employees were provided a multiple-page summary of the policy discussing coverage and costs, but were not provided with the actual policy, which was hundreds of pages in length.

Cystic fibrosis is a disease that attacks many organs, so it is costly to treat. It also requires unusual treatments, which were often excluded from insurance coverage. We also had situations where the medical provider withdrew from the insurance company’s network on or about the day the medical procedures were provided. Even though we checked with the insurance company prior to the provision of medical services confirming that the provider was in network, when the insurance claim was processed, it was treated as an out-of-network claim, meaning that we had to pay substantially all of the costs. 

Frequently, the insurance company denied claims based on terms contained in the actual policy that were not discussed in the employee summary. 

So, we were repeatedly blindsided by fine print of which we were unaware. 

Every time the insurance company rejected a claim, there was a legal basis for the denial, but the weasel words sure did not feel fair. As the insurance companies’ cost containment measures progressed, more employees were affected. 

The unfairness of the arrangement became increasingly apparent to my employer, and in a broader context, threatened our health care system.

After the turn of the century, my employer realized that 90% of its employees were under the age of 40 and it chose to self-insure, which eliminated most problems. Subsequently, the Affordable Care Act constrained the ability of insurance companies to conduct the shenanigans to which our family was subjected. This is one of many reasons why I fear the challenge to the Affordable Care Act that the Supreme Court will consider in the near future.

But, in a more vital sense, my family’s medical situation can be analogized to the Supreme Court nominee dilemma that has divided America recently. Just as the insurance companies relied on abstract logical reasoning by focusing on the applicable legal text rather than on the social, economic, or political context of the issue, Republicans applied a rationale for preventing Merrick Garland’s nomination from being considered. 

Now that we were faced with a somewhat similar situation following Justice Ruth Bader Ginsburg’s death, the Merrick Garland rationale was further refined to suit the Republicans’ self-interests. 

Similar to the denial of medical claims that were based on technicalities, the Republicans constructed an argument that was largely factually correct based on historical precedent. 

But just as employees were appalled at the insurance company’s ability to deny medical insurance claims, many Americans are disgusted by the Republicans’ disregard of the socioeconomic and ethical context of their actions. Winning at all costs tears at the fabric of our democratic institutions. 

Republicans attempted to justify their behavior by claiming that Democrats would do the same thing if the roles were reversed. There is a fundamental problem with this argument.

Justifying bad behavior by asserting that others also engage in similar behavior is no moral justification. If doing something is wrong, it is wrong irrespective of who participates in the action. Such justification merely encourages others to engage in further bad behavior. 

The inevitable result is the abandonment of social norms that have held our society and form of government together.

Coming from a family of Republicans, this column is difficult to write. 

When my parents became U.S. citizens in 1952, they joined the Republican Party. My mother worked in numerous Republican campaigns. As a 9-year-old in 1962, I was thrilled to meet Richard Nixon, who was running for governor. 

In 1989, I had the honor of working on the accounting matters related to President Ronald Reagan’s presidential transition from office. I met Mr. Reagan several times, and although he was declining somewhat, he was clearly a man of character and intellect. 

Today, I am no longer a Republican. I am an independent voter who tries to look through political obfuscation, objectively examine the issues and pursue optimal solutions. I inherently distrust both parties, but recently I have come to have the least trust in the Republican Party because their recent actions do the most to undermine our democracy. 

It reminds me of how I was treated by the health insurance companies a quarter-century ago. 

Jim de Bree is a Valencia resident.

Related To This Story

Latest NEWS