Short Story: “Health Care Reform”

“Health Care Reform”
by P. Orin Zack

The health insurance reform debacle of 2009 had been the last straw. Desperate to protect its unconscionable business model, the industry had used their lackeys in the media to set neighbor against neighbor, and burnt through their war chest to strip the last shreds of self-respect from the senators and representatives in their pocket, the shills who fronted the worst piece of legislation ever conceived. And it all might have worked, too, if it hadn’t been for an innocuous little clause buried in the body of that beast by an overzealous staffer.

But I’m getting ahead of myself.

+ – – – + – – – +

Barry Oernstead had led a pretty uneventful life until that day. Sure, he’d had the usual assortment of childhood illnesses and injuries, but there was nothing in his medical file to suggest that he’d become such a problem for his new employer’s health insurance company. He’d zipped through the forms checking off all the little boxes marked ‘No’, until he came to one that had just been added the previous summer, when the insurance company decided to update all of their customer-facing documents. Barry paused for a few seconds, and reread the question.

‘Have you had a DNA screening?’

Now, in point of fact, Barry had not, up until that point, even considered the possibility of having one. But it had been an annoying day on the job, and he didn’t think it would make much difference, so he smiled sheepishly and reported that one had, indeed been performed.

He didn’t think about it again until his cell phone rang one evening during dinner about a month later. “Barry,” he said, not even glancing down at the caller ID.

“Mr. Oernstead,” the unfamiliar female voice said, “this is Rhonda Kim, at your employer’s benefits company. We’re having a bit of trouble processing your enrollment form this year. I was wondering if you could clear something up for me.”

“Sure. What’s the problem?”

“You’ve reported having had a DNA screening, but we haven’t been able to locate a report of it in the national medical records database. Do you have the paperwork somewhere?”

“Database?” he parroted.

“Sure. It’s taken a while for us to hook up to it, but now that we are, we can correlate all of your doctor visits, tests, treatments and medications, regardless of where you might be when you need any sort of health care. So anyway… about that DNA test, Mr. Oernstead… can you get me a reference number for it?”

“Actually, um, no I can’t.”

“Well,” she said, “if you’ve lost or misplaced the forms, we can try looking it up a few other ways.”

He stifled a chuckle. “No, no, it’s nothing like that. It’s just that I didn’t really have a screening. You can straighten that out, can’t you?”

“You lied?” All of the color seemed to have left her voice.

“Call it a mistake. What’s the big deal?”

She didn’t speak for an uncomfortably long time. Barry held his breath so he could hear whatever background noise was on the other end more clearly, and was pretty sure that his caller had begun to hyperventilate.

“Ms. Kim?” he said at last. “Are you all right? ‘Cause if you’re having some kind of health problem, I can call 911 for you. Well, I could if I knew where you were.”

“I’m okay,” she said, her voice barely over a whisper. “But I’m not sure you’ll be.”

“Me? Why?”

“It’s a felony,” she said, somewhat louder.

“What is?”

“Lying on your insurance form. If you fabricated having had a treatment or a test in order to affect the demand-pricing scheme and reduce your personalized premium, I have no choice but to report you to Homeland Security. You’ll lose your health insurance, and probably your job. You’ll be arrested and tried. Convicted. Sentenced.”


“And so would I if I refused to report you.”

“Wait. What?”

“I’d be charged with a felony if I didn’t report you for filling in that checkbox.”

“How would anyone know?”

She took a deep breath. “You don’t understand. I’m responsible for the correctness of any form I’m assigned to verify. My ID is logged against your form.”

“Let me get this straight,” Barry said, pacing. “You’re saying that I committed a felony by filling in a checkbox in error.”

“That’s right.”

“And that you would have committed a felony if you didn’t report my felony?”


“Well, Ms. Kim,” he said, “I think our only recourse is for you to report that I lost the paperwork. That way neither of us gets in trouble.”

“But you didn’t. I mean, you just told me it was an error, that you never had the screening.”

“Sure, but nobody has to know. Besides, what would you do if I’d told you I’d lost the papers? How would it get resolved?”

“I’m not sure. After all, the database supposedly has everything in it. If you insisted that you had the test, and it wasn’t there, then the alternative would have to be that whoever ran the test never reported it, or maybe it got lost some other way.”

“So, is it a felony if someone else lost it? Wouldn’t they just go after someone else in the alleged chain of custody?”

“I hadn’t really thought about it, but you’re probably right. In any case, unless there’s some record of where the screening was done, there wouldn’t be anyone to go after.”

Barry stopped pacing. “Are you suggesting that we insert a note about where the screening was performed?”

“Well,” she said tentatively, “it would get us both off the hook.”

+ – – – + – – – +

Having fabricated an explanation for Barry’s missing medical file, the two put the matter out of their minds, unaware that their spur-of-the-moment conspiracy would have far-ranging effects. Initially, the issue simply moved to another venue, where a second-shift medical center admin, afraid to commit a felony by leaving the request for paperwork for a DNA screening that could not have taken place, since the equipment had been down for repairs on the date in the claim, verified the existence of the procedure, but noted that the record was somewhere among the backups that had been lost in a fire.

This, of course, laid the blame for the lost file on the disaster recovery firm that was responsible for maintaining the backups. And that’s where the conspiracy ran off the rails, because the medical center had outsourced that project to an overseas company, which of course made it a matter for the State Department to resolve.

The first sign of trouble occurred at the start of business for the overseas contractor, when they discovered that every one of their US-based financial services accounts had been frozen. Several frantic phone calls later, their VP for US Contracts had managed to track down the intergovernmental liaison office at State, and had begun grilling the unsuspecting low-level clerk who had answered the phone.

“Are you trying to tell me,” he said angrily, “that our accounts have been locked because someone claims there’s a missing file on one of our backups?”

“Well, yeah,” she said, with an exasperated tone that telegraphed her unspoken ‘duh’. “I’m sure you’re familiar with the terms under which your company is permitted to conduct business from overseas. State can’t go after any assets that are in institutions based offshore. These accounts, however, are held with domestic companies. So I suggest you get your IT people on it rather than wasting my time. Does that clear it up for you, sir?”

Of course, there was no way his IT staff could find the missing file, because it didn’t exist. But that didn’t stop them from making it yet someone else’s problem. In the meantime, however, the company was unable to pay its US-based front-line staff, a situation that was not taken lightly. To make matters worse, over fourteen hundred medical centers across the US suddenly discovered that their document servers had gone offline, and that the offshore radiologists who assessed the ongoing deluge of CT scans were unable to report their findings.

Things did not go well. ER patients waiting for turn-around on their CT scans were stranded in medical limbo. Once the empty beds were full, triage staff was called in to determine whether incoming patients or those already in beds ought to get priority. Angry patients and their families on both sides of the divide converged on hospital administrators demanding action. Frustrated and confused, the crowds started calling for help, clogging the local cell towers and playing havoc with medical equipment.

The panic set off by the initial press reports on the fiasco was in full swing when an enterprising legal intern in a Boise hospital raised a question with the local newspaper. She’d been digging through the convoluted text of the health care reform act of 2009, looking for a loophole that could be used to opt out of the mandated coverage scheme that was crippling the organization, when she found the missing comma.

“I’m not sure what this means,” she told the medical reporter, “but without that comma, the whole sense of the limitations on who can opt out of the system seems to be turned on its head. The way I read it, anyone with a pre-existing condition can terminate their coverage if the insurance company used it to determine the cost of their premiums or the amount of reimbursement on tests and procedures.”

“But…” the reporter said, and then paused for a long moment, “but that’s everyone.”

“Yeah. I know. So what do we do?”



Copyright 2009 by P. Orin Zack


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