When Health Insurance Isn’t Health Insurance

But…We don’t want the government deciding these things.

A friend of mine was jogging and stepped off the curb and sprained her ankle. She went to the ER ‘cuz she thought it was broken and thought nothing of it, filing it with her insurance.
About a month later, she got a form that she was denied, so she called and they said that they didn’t cover domestic violence injuries, and since she had said to the ER doc that her boyfriend pushed her off the porch they wouldn’t pay.
Of course it was all b.s.; she tried to track down the ER people to figure out what the heck was going on. After spending something like 20 hours getting the run around from the ER and especially the insurance company, she finally just paid the $170 bucks or whatever she owed.

Again, it’s just the free market grinding to its inevitable ‘efficient’ conclusion.
.
Why are we surprised?

.
We’ve got the best Senate money can buy.
.
Envy of the free world, peeps!
~

Of course, if it was “faceless bureaucrats” deciding your health care choices, the outcomes would be worse in non-specific ways that include lots of repetition of the words “choice” “rationing” and “competition”.

Obviously, these cases are problematic, and contracts need to be enforced. But isn’t the reality that most people are satisfied with their health coverage? What do the docs say? “First do no harm.”
.
Let’s look at something the government does control–the criminal justice system. How many people have been killed, raped or brutalized by criminals who committed serious violent crimes, got a light sentence or early parole and went to predate again? I don’t see any hand-wringing about that–but on anecdotal evidence we’re going to hand over a fifth of our economy to a White House that fires Inspectors General because they do their jobs.

spob,
-
Here’s a guess. The vast majority of those who experienced rescission were “satisfied with their health coverage” before they got screwed by their insurance company.
-
The private care system we have now is awful, and has been awful for a long time now. People not realizing that and thinking they’re satisfied with a product they’ve never used isn’t an excuse to ignore the problem.

The people that are satisfied are like Robin Beaton, who had insurance when they were healthy, and once they weren’t, the death for profit industry would do absolutely anything and everything to destroy their lives over an executive bonus here, or a payment to a mistress there.

Here’s something else the federal government controls and that everyone across the political spectrum agrees should be managed by the government: national security. And I would argue that ensuring our nation has an effective health care system falls under that broad heading. I am not suggesting that the Pentagon take over our health care. I am suggesting that we need to see affordable, accessible health care for all of our citizens as a national security issue. Because what we have right now is horrible and contributes to ballooning debt, loss of productivity in terms of work hours missed, and generally poor health care. Unless you have lots of money, in which case it doesn’t matter, at least to you. Not immediately.
.
Protecting its citizens from poor health, and ensuring that its citizens get preventative health care to avoid future health care issues with all their attendant costs, seems to be something our government should work to provide.
.
You know what else the docs say? They seem to want a universal health care system, despite what the AMA might think.

executive bonus here, or a payment to a mistress there
.
There’s no need to demonize business people here. As I’ve tried to point out several times, what they’re doing is absolutely rational and therefore reasonable. The problem is that the ‘market forces’ that everyone seems to think have magical powers to do everything best without government involvement are absolutely incapable of assigning a ‘proper value’ to human life and health.
.
The fact that certain segments of our society still insist that they can, points to incredible callousness and willful ignorance.
.
OK, I giuess there’s some old fashioned greed involved as well after all.
Cancel what I said about not demonizing the Insurance execs…..

When’s the last time a member of congress had their coverage rescinded while in the midst of an illness? Answer is simple folks, mandate that all health insurance offer coverage as good as available to members of congress, at no greater price as a percentage of salary.

The Republicans have spent thirty years trying to assure that government doesn’t work – imposing ludicrous ideological restraints, shorting agency budgets, appointing incompetent leadership and sowing cynical public mistrust 24/7. That doesn’t mean government can’t work, anymore than we should assume the military – a government operation – can’t fight.

KT, your post answers the question you posted earlier: “Does health reform require [a public plan]?” Only if we want it to work.

[...] the rest here: When Health Insurance Isn’t Health Insurance (Time Magazine) var addthis_pub="khoapham"; // Tags: commerce, companies-engage, Health, look-today, [...]

[...] and against public vs private options. Anyone actively engaged in this discussion should read this: When Health Insurance Isn’t Health Insurance – Swampland – TIME.com. Even if you strongly believe that the private way is the best way to go — I don’t [...]

It’s really odd that the Congress people who criticize public health care for the reason that government management would be so terrible work in the very system they’re so paranoid about. If they hate it so much, maybe they should get the hell out. The bottom line is, out health care system is broken and needs to be fixed. It doesn’t matter that Obama’s proposal isn’t perfect; it’s a start. The naysayers should stop their grousing and chip in to find a solution. That’s the real American way.

There is no need to bloat the federal government on this. What is needed is serious, thoughtful, well-researched reform with new regulations and vigorous oversight of insurance companies and caps on premiums and other rates. Perhaps a government Bureau of Health Service Oversight, whereby people could report claims of rescission and other unethical actions that violate clearly established Legislative guidelines on the matter. I think it is imprudent to hand complete control over to government when definitive regulations and enforcement would work in its stead. Whenever possible, smaller government!
.
One major problem with this proposal, however, is that when dealing with life and death issues the average claimant cannot afford to wait for government bureaucracy to address their claims; therefor the agency tasked with enforcement and oversight would need a broad and authoritative mandate enabling it to move swiftly and directly against any offending insurance company.
.
I think a proposal along these lines makes more sense than a government run health option, at least according to my libertarian leanings on matters of government scope…

neoration,
-
Your comment is just all kinds of awesome. It only took you one sentence ONE SENTENCE to go from “There is no need to bloat the federal government on this” to “Perhaps a government Bureau of Health Service Oversight…”
-
That’s just too awesome man. Are you in physical pain from that much cognitive dissonance?

So I take it you’d rather nit-pick than comment on the substance of my comment? Post #15 suggests that the “naysayers” chip in to find a solution. I did so, in a manner that I feel would reduce the role of government from the single-payer system, no matter how close those two sentences were to one another, and this is response? Ridicule? You people wonder why no one wants to cooperate or work with you on anything…

The only ridiculous thing here is the idea that private, free-market companies who have every economic incentive to deny health coverage is capable of working in the interests of their customer base. A customer base, I might add, that can generally drop the insurance company on a dime either intentionally or accidentally (getting fired, etc).

There is no need to bloat the federal government on this. What is needed is serious, thoughtful, well-researched reform with new regulations and vigorous oversight of insurance companies and caps on premiums and other rates. Perhaps a government Bureau of Health Service Oversight, whereby people could report claims of rescission and other unethical actions that violate clearly established Legislative guidelines on the matter. I think it is imprudent to hand complete control over to government when definitive regulations and enforcement would work in its stead. Whenever possible, smaller government!
-
The closest system you’re sort of describing here is what is done in Switzerland. They are technically private companies but very heavily regulated and controlled. I have to agree about the cognitive dissonance though, you argue for less government interference then turn around and propose a new government regulatory agency with a broad mandate. This is really not a case where you can have your cake and eat it too. Government-run single payer systems are employed with varying rates of success all over the world (I’m partial to the Australian system myself, the public/private split there seems to be very effective), if we’re going to create another layer of bureaucracy we might as well go all in and guarantee health care for everyone.

I can’t find myself caring for these people, and it’s not because I don’t have a heart. It’s because so many of these people who have insurance never start to care about the deplorable conditions that so many Americans have to live with who can’t afford any health insurance. They don’t care right up til they too find themselves in that category.

They might be nice people, but nice just don’t cut it. Most people who have insurance live in blissful denial about the rest of those who don’t. Only now that they’re faced with that darkened reality do they shed a few crocodile tears and say they never knew how bad it was. We should be saying too late, you never cared before, why should we suddenly start caring for you now.

Am I cynical? Am I suffer from apathy? AT the moment I’m writing this I guess I do. And maybe tomorrow when I read my words with the fresh perspective of a good nights rest I’ll feel less inclined to be write this way. But I won’t stand by anymore and weep, or lie and say I do, for people who never cared before that the system was rotten until it came crashing down around them.

And I’m not referring to the people in this TIME’s article. I’m referring to a lot of the people I know, both educated and non, higher social class and lower. Those people who have the luxury of having good coverage through their jobs or family members. And I’ll tell you, a lot of them just don’t give a thought to the people not so fortunateas them. It’s a “glad I’m not them attitude and pass the heart clogging-greasy-fat McDicks hamburger down cause I got health insurance and a free ticket to ride.”

If anything, the focus should be on fixing the system overall, not on fixing the cracks that appear in the walls. We need to rebuild the foundation on which it dwells. If we can’t do that, then stories like this will be replaced each week by another tale not unlike the last, til it too is soon forgotten as well.

You’re article on Robin Beaton struck close to home. I listened briefly to Ms. Beaton on TV. I knew she had faced a really tough time.
And that she was not the only one who’d been made to suffer by the insurance industry.
My former business partner has cancer. Rather a tumor. It weights well over a 100 pounds now. She has been rated as “terminal” for some time now.
A few years ago, she received notice from her life insurance company that they were dropping her. The reason was that she was late with her payments. Seems that the insurance company sent her a payment book. The date on the payment stubs was later then that listed on the policy. She used the payment stubs.
But she had one thing on her side: me. I had been in the insurance business dealing in the senior market, life and health. I knew that the law in Texas stated that you had some many days to pay your premium before you were dropped.
I knew the insurance company was in violation of the law. It was the only life insurance she had. No one, and I mean no one was going to offer her any coverage because of her health condition. The only way to get coverage was to have the insurance company reinstate her.
I told her to file a complaint with the Texas Insurance Commission. She did. It took almost a year for her to have her coverage reinstated.
But she got reinstated.
Later I found out that her insurance company was facing financial hard times when they dropped her.
My only thought was just how many others were in the same situation as her. Sadly I knew that these victims of the insurance company didn’t know they had any recourse.

And sadly, you never ever hear about the FRIVOLOUS LAWSUITS filed every day by the insurance industry. It seems that so called “Tort Reform” is only to protect those who have billions. Not the victims.

Test…

Am I the only one who saw rumor of this? Perhaps conspiracy theorizing, but spooky nevertheless:
~
http://www.truthdig.com/report/item/20090614_the_american_empire_is_bankrupt

Just a reminder, something I maybe wasn\’t clear enough about in the post: This practice is ALREADY ILLEGAL. And yet the insurance companies continue to do it, and–as the LA Time story showed–continue to REWARD their employees for doing it. If those three companies in the congressional study saved $300 million doing this, they are doing way more than rooting out fraud.

You have to watch the current spate of insurance ads for car coverage to know how the industry as a whole has little acquaintance with the truth. If you believe the ads, you take out the insurance at the cheapest price and all your worries are over. Didn\’t we see this way back when health insurance was sold to us?

Just remember: the people who sell the policies are different from those who deal with claims. Each has a different mandate. One rakes in the bucks, on commission; the other stops the buck from leaving the account.

These people are still at it.

For those who fear a govt bureaucracy what do they think of the insurance bureaucracy?

Yes, I want the government deciding these things!
.
I really wonder about what working for these soul-searing insurance companies does to their employees’ psyches – and, for that matter, their health. This is as good a description of evil as I’ve seen in some time.
.
Those on the right who are still defending the insurance companies should reread “Screwtape proposes a toast” by C.S. Lewis. Certainly those who work for the insurance companies would find it uncomfortably familiar.
.
This was OT yesterday, but relevant today: Bernie Sanders has a petition to Congress up on his site for single payer, and an invitation to tell him your encounters with insurance companies:
.
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Insurance companies must be controlled. They are only driven by profits and nothing else. Similar situation told by a mother of a patient at http://iamsoannoyed.com/?p=1802

I say this every time KT post’s about health care. Our current system can not be substained. People without jobs can’t afford it, people with jobs can’t afford it, people without health care can’t afford it, people with health care can’t afford it, employers no matter how small or how large can’t afford it, even state and local governments can not afford our current system. A town in PA has already went bankrupt and will not be able to offer any services to its residents let alone health care. CA is on the brink of collaspe. We are making our economy worse attempting to save a system that is destroying it. This does not make any sense.

Off-topic:
My apologies for accidentally hijacking MS’s “global warming” thread into an overpopulation discussion yesterday and then never checking back — I kinda got hijacked myself for the evening.
But thanks for the interesting conversation! And special thanks to PD, pirate, sacredh, & rose for representing my viewpoint more articulately than I could.
Which for the record is primarily that we need to gradually reduce our planet’s population primarily by limiting births (NOT eliminating any existing people, neo –sheesh!). I’d hope we can find voluntary non-draconian means to do so — personally I’ve never managed to reconcile the concept of a “breeding license” with a free and just society, although some of my fellow travelers occasionally provide motivation to try.
OK, now on to today’s stuff.
And apologies to you KT, for veering off from your very relevant posting.

[...] Karen Tumulty at Time presents several other heart-breaking, and outrageous, examples. [...]

OT: Iran continues to be very interesting.
.
The long-standing Middle East correspondent for The Independent, Robert Fisk, is defying the government crackdown on foreign media reporting in Iran.
.
I’ve just been witnessing a confrontation, in dusk and into the night, between about 15,000 supporters of Ahmadinejad – supposedly the president of Iran – who are desperate to down the supporters of Mr Mousavi, who thinks he should be the president of Iran.
.
There were about 10,000 Mousavi men and women on the streets, with approximately 500 Iranian special forces, trying to keep them apart.
.
It was interesting that the special forces – who normally take the side of Ahmadinejad’s Basij militia – were there with clubs and sticks in their camouflage trousers and their purity white shirts and on this occasion the Iranian military kept them away from Mousavi’s men and women.
.
In fact at one point, Mousavi’s supporters were shouting ‘thank you, thank you’ to the soldiers.
.
One woman went up to the special forces men, who normally are very brutal with Mr Mousavi’s supporters, and said ‘can you protect us from the Basij?’ He said ‘with God’s help’.
.
It was quite extraordinary because it looked as if the military authorities in Tehran have either taken a decision not to go on supporting the very brutal militia – which is always associated with the presidency here – or individual soldiers have made up their own mind that they’re tired of being associated with the kind of brutality that left seven dead yesterday – buried, by the way secretly by the police – and indeed the seven or eight students who were killed on the university campus 24 hours earlier.
.
Quite a lot of policeman are beginning to smile towards the demonstrators of Mr Mousavi, who are insisting there must be a new election because Mr Ahmadinejad wasn’t really elected. Quite an extraordinary scene.
.
There were a lot of stones thrown and quite a lot of bitter fighting, hand-to-hand but at the end of the day the special forces did keep them apart.
.
There were a lot of stones thrown and quite a lot of bitter fighting, hand-to-hand but at the end of the day the special forces did keep them apart.
.
I haven’t ever seen the Iranian security authorities behaving fairly before and it’s quite impressive.
.
http://www.abc.net.au/news/stories/2009/06/17/2600571.htm
.
Here is a report on how the different tactics being used by each side. The pro government side has government resources, but Mousavi’s people are being pretty resourceful themselves.
.
http://www.globalpost.com/dispatch/middle-east/090616/counter-insurgency-sorts-iran

Why not make the law that Health Insurance cos cannot access their potential client’s medical background? -limit it to age and gender.
.
If you want to be in the business of insuring citizens, then this is the pool you get to work with. Compete among your peers for lower costs with the care providers and encourage preventive medicine rather than try to profit “as a result of rescissions”.

-limit it to age and gender.
.
There’s a surprising amount of sense to that suggestion though the desire to cheat AND to grossly invade privacy in order to do so would probably be insurmountable.
.
Insurance operates on the premise that by pooling risk we can allow the people who are lucky enough to not to need to file claims to subsidize their less unfortunate co-customers. The more information that the company applies to the process of evaluating risk, the less it’s functioning to pool risk and the more it’s functioning to simply rip healthy people off by selling them a service they don’t need.
.
Our debates would be a lot clearer if we cut through all the layers of jargon that we apply to simple arithmetical calcualtions and started looking at each transaction in its raw form.

There is nothing that suggests that a gov’t run single payer plan would be better. In reality, it is just going to be a gov’t bureaucrat denying your claim rather than a insurance adjustor. In fact, Obama actually signalled that he thinks that Americans shouldn’t be getting MRIs, that doctors do too many tests, and that OBs perform too many C-sections. So if you’ve hurt your shoulder and want to get it fixed, you have cancer and want a second opinion on treatments, or you’re an expectant mother who might need a C-Section, you’re out of luck under the Obama plan.

I think that the best thing would be to have a modified version of the Swiss system with caps on basic health insurance and oversight of the insurance companies. If insurance companies actually have to compete for their customers, then the service will get better. It is certainly that way in Switzerland where insurance companies have to compete to attract customers. And the gov’t would have oversight of the industry like they do with all other sorts of industries to protect consumers through some sort of Patients’ Bill of Rights.

Joe –
.
Ye be most welcome, me hearty! After gettin’ a good night’s sleep meself, I’ve come t’ th’ conclusion tha’ neo & ili be newborn troll-ies, an’ I not ought t’ be feedin’ ‘em no more. Thar be nothin’ anyone ‘ere can be sayin’ tha’ they not be pickin’ apart in their delusion an’ (ri’ successful, fer much o’ yesterday, but it won’t be happenin’ ag’in!) desire t’ hijack an’ spam th’ threads. Even spongy were appearin a wee bit relevant in comparison .
.
Starve th’ trolls, me buckos, starve th’ bloody trolls!

An’ everyone get yerselves over t’ Sanders petition (th’ link be in kathy’s post above decks) an’ sign th’ bloody thing an’ pass it along!
.
That be an order, me mateys !
.
Arrgh!!!

Uh-oh – happened to read i-lyindiva – make that starve th’ bloody LYIN’ trolls!
.
YARR!

Karen, Halprin has this posted on the page
.
http://www.google.com/hostednews/ap/article/ALeqM5hL8Vyx9jlIHpOKVVVGk0V62TgrRwD98S9ADO0
Daschle, George Mitchell, Bob Dole, Howard Baker to release a $1.2 trillion proposal Wednesday fully paid for by spending cuts, tax increases.
.
Could you let us know what reactions you hear about this from congress and the Presidents office?

I really wonder about what working for these soul-searing insurance companies does to their employees’ psyches – and, for that matter, their health.
.
Wonder no longer: You either train yourself not to think about it, or you get out. I tried to do the first, but ended up doing the second. “Soul-searing” and “evil” are spot-on as descriptives.

illinidiva says: In fact, Obama actually signalled that he thinks that Americans shouldn’t be getting MRIs, that doctors do too many tests, and that OBs perform too many C-sections. So if you’ve hurt your shoulder and want to get it fixed, you have cancer and want a second opinion on treatments, or you’re an expectant mother who might need a C-Section, you’re out of luck under the Obama plan.
.
Reasoning like this buries your later comments about better government oversight of existing health insurance companies. The “Obama plan”–and there is no “Obama plan” really, it’s more of a goal and he wants Congress to work out the details, but I digress–is not about limiting medical services. He’s talking about wasteful spending, which includes unnecessary tests. There’s a lot of fraud out there, and that, along with tests people don’t need, jack up health insurance costs.
.
Your point about looking at the Swiss model (which I haven’t done yet) is valid. But to simply dismiss Obama’s plan as “oh, he just wants to get us crappy service” is to parrot a talking point from other people, like John McCain, who have demonstrated that they don’t know what they’re talking about on health care. (For that I refer you to this post by Matt Yglesias: http://yglesias.thinkprogress.org/archives/2009/06/john-mccain-once-again-demonstrates-total-ignorance-of-vital-public-policy-debates.php.)

Should be “jacks up health insurance costs”…

God bless the free market!

This has been a very interesting discussion. I’m from Canada, and I’d like to share some of my perspectives. Generally, our single payer system works well. The best part: something happens, I need treatment, I go to a doctor or hospital emergency, and it gets treated. This has been the case for me and my family, through several terminal illnesses. Your comments about incompetent government agencies apply here (and everywhere) as well, but generally the system works. I think that you demonize the public sector too much.

The problems as I see them: huge costs, presenting enormous challenges for government budgets, and growing constantly. But Americans have the same problems, and worse. Your governments spend as much per capita as mine, your health care costs overall are twice those in Canada per capita, and the bottom tier of your citizens receives far worse treatment than ours.

Another problem here is that because government is trying to limit costs, there are waiting lists for many things, ranging from short for life-threatening issues to overly long for non-life-threatening, but painful, conditions.

Possibly, some treatments that would be paid for by private coverage in the U.S. aren’t covered by our public plan, but these are very much on the fringe, and I suspect U.S. insurers prevent an equal number of treatments that would be covered by our plan.

Summing up: based on my experiences, and my discussions with Americans on my frequent trips to the U.S., would I trade my system for yours? Personally, it wouldn’t affect me, as my profession pretty much guarantees that I’d have good health insurance as a benefit from my employer. In terms of the public good? I think our system is light-years ahead of yours.

Fr’m th’ looks o’ i-lyindiva an’ neorationalizationalist, their insurance no be coverin’ mental disorders…cognitive dissonance, complusive lyin’, superiority complex, persecution complex…per’aps their free-market cov’rage be not quite as great as they be maintainin’
.
YARR!

If insurance companies actually have to compete for their customers, then the service will get better.
.
Duncan Black points out the obvious fallacy in this argument far more succinctly than I ever could:

No matter how you package it, the free market fairies aren’t a solution to the health care problem. People shouldn’t need to shop for better insurance, their insurance companies should pay for the care they need. The moment you find out your insurance company sucks is the moment you kind of need it to not suck.

The problem with “competing for customers” is that individuals will still be deadly f*cked whilst insurers decide for themselves at their own pace whether or not the public relations fallout from care denials warrants any change that put withholding care or payment at a more comparable rate to other insurers.
.
When I buy an LCD TV from Best Buy, it doesn’t turn on a month later, and I find out that their returns policy screws me out of a refund, the damage done from the lag between my personal, individual customer dissatisfaction and whatever arises from their incentive to compete for my business amounts to the cost of an appliance.
.
When I find out that the insurance policy that I’ve been paying for every paycheck for a decade doesn’t apply in practice toward getting the health care that I (or my family) desperately need, the damage done between the start of my family’s new tragedy and the insurer deciding that it may be in their interest to deny claims a bit less often amounts to the cost of somebody’s life.
.
Maybe the Swiss are in possession of the perfect system, but it sure wouldn’t be because of free market fundamentalism run wild. Maybe, with the combination of a penitentiary-esque regulatory framework, strong cultural traditions, and a history of practical reactions to organizational problems, it’s because these private firms are essentially public in practice. Maybe it’s because the Swiss are unlike us, in as much as that they simply can’t bring themselves to f*ck other Swiss people as badly as insurers here do.
.
If the argument is going to be “But it could be worse!“, then let it be, but let’s dispense with the silly ideologically-based claims about “competition” being the magic fairy dust that solves our health care access problems.

Stuart – thank ye. Ye be right on th’ point regardin’ th’ myth o’ market competition bein’ th’ solution in th’ area o’ health care cov’rage.
.
Arrgh!

[...] Tumulty has the goods over at Swampland. Allow me to serve you this Amuse Bouche: What Robin went through after that was [...]

The private sector has a built-in morality filter: “We’re very sorry you’re going to die a painful death, but we have a responsibility to our shareholders.” And evidently private insurors think they’re already in competition, ’cause I see plenty of their ads. So what will competition fix that it hasn’t been able to fix yet?

The magic of the health insurance market at work:

Lawmakers ask three executives if they’ll stop dropping customers except where they can show “intentional fraud.” All say no.
.
By Lisa Girion June 17, 2009 Los Angeles Times
.
Executives of three of the nation’s largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.
.
An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.
.
It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.
.
But they would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle.
.
Experts said it could undermine the industry’s efforts to influence healthcare-overhaul plans working their way toward the White House.
.
“Talk about tone deaf,” said Robert Laszewski, a former health insurance executive who now counsels companies as a consultant.
.
Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show “intentional fraud.”
.
The answer from all three executives:
.
“No.”

Somehow the magic of free-market competition just isn’t compelling each of these insurance executives to stop the horrifying practice of “rescission”, i.e. “f*cking their customers when they are sick and can’t fight back”. Each of these savvy entrepreneurs (bureaucrats are only in government, see?) had the opportunity to “compete for customers” by differentiated themselves from their competitors, and each of them somehow came to the bizarre conclusion that they would remain more competitive by f*cking sick customers than by helping those people.
.
I wonder why the magic of the marketplace didn’t work this time?

KT, thanks so much for this diary. Reading about this woman’s plight made me so angry I had to wait before posting anything.

“Free-market” health insurance companies have felled us. That system is not working for a lot of insured people, not to mention all of those who cant get any/have no coverage at all.

ssgchester:

You raise an interesting problem with the private health insurance market being left to “solve” the current state of health care – what happened if your carrier goes under? If I’d had something like “AIGCare” I’d now have coverage only thanks to billions of public dollars pumped in to keep my carrier afloat.

[...] 9:53 am by LeisureGuy Health insurance works only when the insurance company decides to allow it. Karen Tumulty of TIME magazine: In May, 2008, Robin Beaton, a retired registered nurse from Waxahachie, Texas, went to her [...]

And evidently private insurors think they’re already in competition, ’cause I see plenty of their ads. So what will competition fix that it hasn’t been able to fix yet?
.
This doesn’t get said enough. If a Laissez-Faire approach worked for providing health care we wouldn’t be having this debate because we would all be happy with the current system.
.
In point of fact, the government DOES provide some services cheaper, better, and more comprehensively than the private sector does. This makes the private-sector ideologues’ head explode.

The Borgen Project has some good info on the cost of addressing global poverty.

$30 billion: Annual shortfall to end world hunger.
$550 billion: U.S. Defense budget

atsegga:
.
Spamming threads is wrong.

Pirate-
To be accurate I am without health insurance at the moment, so my delusions of grandeur continue untreated.
.
You’ve done well to turn me into the raving, misguided lunatic who takes everyone out of context and picks arguments apart. Yet, for 3 days now, nearly every one of your posts is filled with theatrical insults and personal attacks against me. Very interesting indeed. If you wish to stop feeding me, you should cease your hostility and maybe focus on rational discourse rather than flaming the fires of yesterday’s discussion. I think you taught JC extremely well, though, he seems to use your playbook daily with me.
.
Anyway, back on topic. I still fail to see the contradiction between wanting to see as little government control as possible, generally speaking, and advocating an oversight agency over the insurance industries. Would regulation and oversight not be less intrusive than government run health care? I’ll be honest, the health care debate is pretty much a non-issue for me. I’m young, have never needed any serious medical care, and I haven’t had health care since I was on my parents’ plan, several years ago. With that said though, I still have not seen any substantive argument against the system I proposed.
.
Its simple, you have more rigorous regulations addressing rescission, premium rates, background checks, etc. Then you have one agency with oversight and enforcement capabilities. In theory, the agency would ensure a fair and legal environment where competition would not be dampened. Claims of illegal practices would be addressed by the government agency, who in turn would be be given the authority to act quickly and directly against any offending insurance company to ensure expediency in remedying the individual’s claim. If health care, by way of legislation, were more affordable, expeditious, more inclusive, and less profit-driven I see that as a reasonable alternative to government controlled health-care. As someone points out, Yutsano I believe, this system reflects a similar set-up in Switzerland which appears to be rather effective. I simply do not understand why this issue needs to be resolved through the extremes only. Why must we either continue using our clearly broken system or hand it over to the government completely? Is there no middle ground solution?

It’s clear to me that health insurance companies aren’t actually in the health insurance business.
.
They’re in the business of collecting premiums. The end. Paying claims is a pesky business expense they’d like to do away with.

“I haven’t had health care since I was on my parents’ plan, several years ago.”
.
By choice? Do you have a job?

Not one that offers a health-care plan.

So you have income for if/when you need to see a physician.
Going years without coverage is pretty gutsy.

I know it is. At this point, thankfully, I haven’t needed it and because I am young it hasn’t been quite the priority that it should be. But, in the grand scheme of financial responsibilities it simply is a luxury currently, one which I cannot afford.
.
I clearly see the need for reform. I understand the need to drive down costs on premiums. I understand the need to do away with shady, unethical conduct in denying those with pre-existing conditions and finding loopholes to deny those who have been covered for some time. But, the need for reform doesn’t necessarily equate to a government run health plan. Thats my sole point here.

Would a government-run health plan that competed with private insurance companies be more effective in addressing current health care needs than expanding and strengthening government oversight of private insurance companies? Both seem like massive proposals, but while the first seems like it will cost a whole lot of money, the second seems like a bigger expansion of federal power.

Shakespeare-
Indeed, that is an accurate assessment.
.
Regulation would be through legislative enactments, not unlike many other industries subject to government oversight. Enforcement would require the creation of an agency/bureau with authority to intervene in matters deviating from the legislative scheme.
.
However, the alternative, a single-payer system, would incur astronomical costs and require the establishment of a government run organization to collect health-care fees and pay health-care costs. This plan calls for a ‘global budget’ which would allocate annual lump-sums to hospitals to cover their operating expenses. This would require:
-Replacement of employer contributions to premiums with a payroll tax increase of 4.5%
-Eliminate individual premiums, co-pays, ect replacing these with an additional payroll tax increase of 3.3%
-Relieve state/local govt’s from their payments of government health-plans with another tax increase of 4.5%
.
This is an increase of 12.3% on the working tax-payer in the US. So, for those who currently do not have insurance because they cannot afford it, how is such an extensive tax increase going to help them? Yes, they will now have access to health-care, but at what cost? Those already struggling to get by day-to-day would be in more dire financial circumstances. Its seems that we should focus on oversight/regulation aimed at driving down costs, by capping premium rates and such, allowing the struggling blue-collar worker to choose to if they can handle the now cheaper policy, rather than provide this health-care for anyone who can’t pay, but with the additional tax burden that will further the detrimental impact on the lowest class in America.

“neorationalizationalisticism”
~
?

JC-
That would be a shout out to Ms. Pirate….

“Reasoning like this buries your later comments about better government oversight of existing health insurance companies. The “Obama plan”–and there is no “Obama plan” really, it’s more of a goal and he wants Congress to work out the details, but I digress–is not about limiting medical services. He’s talking about wasteful spending, which includes unnecessary tests. There’s a lot of fraud out there, and that, along with tests people don’t need, jack up health insurance costs.”

He basically argued as much in his speech to the AMA. One thing that really got me as a young woman was his desire to curtail C-sections. As someone who would perhaps want to have a baby, I’d prefer that doctors’ were overly cautious about pregnant women.

Pirate Wench: Can I meet you in person? Please?

KT, if you’re still reading, can you unlock my last comment? Prudish moderator…

Hi from Spain. I cannot really understand why many US citizens fear of public, universal health care. Many -if not all- European countries have it, including my own country, Spain. And here I decide if I want to change my family doctor, I will alwasy the best treatment available, I will not be left in the street if I don’t have any money to pay for the health care, no matter the reason, because EVERYBODY has the right to receive medical care. What’s more, our health system, even if we consider it to be quite good, is not the best among European health care systems, for example UK and France public and universal health care systems are even better, and you country has much more economical power than mine or any other European country, you could have one of the best systems if you REALLY want it. I cannot understand why “you, the people” have not DEMANDED already that system to your representatives.

What are your tax rates louisbcypher?

@neorationalizationalisticism:

It’s progressive, depends on wages and income ranging from 15 to 40%, IIRC. According to this graphic ( http://es.wikipedia.org/wiki/Archivo:Tipo_impositivo.gif ) it looks quite similar to yours.

Ah, Louis, you have to understand that the world beyond US borders (unless they’re places to make war or gain resources) is wholly irrelevant to US political discourse, and ABSOLUTELY to our beloved media apparatus. Americans are exceptional, didn’t you know? Don’t dare speak to us of how in Europe you do things better–this is simply intolerable to our national pride, and furthermore, irrelevant to the narrow parameters of our own debate.
~
Global models that work: Not allowed
Ideas left of “Center”: Not allowed
~
A place at the table for the corporations parasitically destroying the body politic: Warmly welcomed

[...] did a bit more digging, her insurance company was Blue Cross. This Time article is a lot less insurance-friendly. [...]

And see here for how ludicrous our tax debate is in America. Obama is ridiculed as a socialist for seeking to restore rates to Clintonian levels, yet the Sainted Reagan, by the GOP’s current standards, was a Stalinesque:
~
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132×7510120
~
For a microcosm (and perhaps coming attraction) see California’s mess. Contemplating eliminating their entire social welfare system, shuttering their amazing parks’ system, and god knows what will come to education, all b/c they’re incapable of even discussing tax hikes.

@jcapan

Your national pride should allow you all to take the people, the citizens of your great country as the ABSOLUTE PRIORITY, and public, universal health care should be the first action to be taken into consideration if your representatives and your government is really thinking of the people, no matter where the system or the ideas for a good health care system come from.

I think what needs to be said here is what typically constitutes a recission. An individual applies for insurance and fills out a form that lists their medical history. This history is used to help determine rates (young, healthy people pay less because they use less insurance). If this individual lies on their application– let’s say they forget to mention they’ve had three heart attacks in the last 5 years–then the insurance company can say that they were essentially defrauded by the individual. So there are several solutions to the problem. 1) Make no changes. Use existing regulatory oversight and the risk of litigation to help ensure insurance companies have valid recission practices. 2) Require insurance companies to do a medical history analysis on every application before covering someone, which means the rates for EVERYONE will increase dramatically due to the costs associated. 3) Make all recissions illegal and believe irrantionally that all people will be honest on their applications (because if they lie it is the honest, premium paying insurance holders who pay those medical bills). or 4), the obvious answer is Universal Health Care. Guess what, when everyone is covered by insurance, there’s no such thing as a recission.

Louis,
~
I was being satirical–your English looked fluent, so I thought you’d catch that. I’m mocking my “great country.”

@jcapan: “Ideas left of “Center”: Not allowed”

BTW, for those who didn’t know that little detail, our current public, universal health care system was initially established in 1967 by our own ultra right winged dictator, Franco, during his 40-years-long dictatorship, not by any left winged communist or socialist.

@jcapan: “I was being satirical–your English looked fluent, so I thought you’d catch that. I’m mocking my “great country.” ”

I know, and I catched it And I really think your country is great, I mean, the people who makes the country, but I don’t think the same about your government, I neither understand nor share many of its decisions. Irak war, or lack of public and universal health care system, for one.

Oh, and thanks for saying my English looks fluent

“BTW, for those who didn’t know that little detail, our current public, universal health care system was initially established in 1967 by our own ultra right winged dictator, Franco, during his 40-years-long dictatorship, not by any left winged communist or socialist.”
~
Now, that’s interesting! Not the Franco I learned about in Hemingway! The great irony of autocracies (from gender equality in China to health care in Cuba) is that without opposition or a corporate media, things get done, sometimes, gasp, for the benefit of the people. The only conclusion one can reasonably come to in recent decades in America is that democracy, shiny, happy new president notw/standing, seems rather impotent in the face of an array of crises it faces.

Neorationalist makes an unintentional argument for universal coverage above. He’s young, healthy, and uninsured. While lots of people like to sell the story about the uninsured as being the poor working class (and there are no doubt lots of people who fall in this category), the majority of the uninsured are just like Neorationalist. People who can completely afford insurance but choose to risk it because they’re typically healthy. If they HAD to buy insurance, guess what? The rates for everyone goes down because we’ve just introduced a lot less risky population into the risk pool.

“And I really think your country is great, I mean, the people who makes the country, but I don’t think the same about your government”
~
Americans are great, but no greater or worse than any other nation’s people. Our government is, without doubt, worse (relative to the power it wields). As with the feudal lord making decisions about how best to preserve his status, benefits and lifestyle, this is what a rich & powerful country does in a global village.

jcapan wrote:
For a microcosm (and perhaps coming attraction) see California’s mess. Contemplating eliminating their entire social welfare system, shuttering their amazing parks’ system, and god knows what will come to education, all b/c they’re incapable of even discussing tax hikes.
.
Yes. After Reagan, and then Prop 13, and now an intransigent extremist GOP minority with veto power over the state’s budget, we in California are finally winning the race…to the bottom. If you throw sand in the gears of government long enough, you can make the ‘government is bad’ ideology seem almost reasonable. What’s kind of creepy is that the right-wingers I know are responding to the destruction of the state with approval.
.
Getting back to the subject at hand — Remember, the goal is to achieve good and affordable health care. The goal is not to keep government out of health care (unless you’re a goper). The private insurance companies have had their chance and they’ve not only failed, but they are fighting to continue some of their most egregious practices.
.
The majority of America’s doctors and nurses support a public health care system because they have personally experienced how badly the present system has failed.

Kevpvp-
I cannot afford health-care right now, by no means is that even a possibility for me. However, I agree that there is a significant proportion of the populace who can afford it, but choose not to. With that said, though, the single-payer option would require a ‘global budget’ through which the federal government would pay annual sums to hospitals to cover their operating costs. This budget would require a 12.3% income tax hike. The result is that if you can’t afford to pay, you still get health-care. However, how do those struggling to make ends meet deal with such a significant tax hike?

Yeah, Bob, I try to follow CA’s situation. I lived in SD for about 5 yrs. and did my grad work there. I simply love the state, espec. the parks & never would have left except for the COL. Absolutely tragic what’s happening. You see any hope for change? It should be a cautionary tale for America writ large, but I don’t see any consciousness in DC either.

neorationalizationalisticism wrote: With that said, though, the single-payer option would require a ‘global budget’ through which the federal government would pay annual sums to hospitals to cover their operating costs. This budget would require a 12.3% income tax hike.
.
Who proposed the system you are describing? Your numbers are remarkably precise given the early state of the proposals I have seen. Are they the result of an actual proposal, proposed by single-payer advocates, that I can read (and possibly support)? Or are they just scare numbers produced by opponents of a public option, with no actual proposal behind them?

Bob:
Its not necessarily government involvement that scares people. This mentality that anyone opposed to universal health-care, single-payer system, whatever, is opposed because they think the government will not do it right is a farce. The real problem lies with taxation. Providing care for everyone, regardless of whether they can pay or not, is admirable and desirable. But, with the tax-hikes necessary to cover the federal ‘global budget’ ordinary, tax-paying Americans get hit hard. The plan is to:
-Replacem employer contributions to premiums with a payroll tax increase of 4.5%
-Eliminate individual premiums, co-pays, ect replacing these with an additional payroll tax increase of 3.3%
-Relieve state/local governments’ from their payments of government health-plans with another tax increase of 4.5%
.
How can those who are behind on their mortgages, barely keeping their electric on, and having a tough time feeding their families as it is, deal with a 12.3% income tax increase? Its not that they don’t want health-care; its not that they fear the government; its simply that they do not want the extra costs for something that is mandated. That is why reform should center around legislative regulations/oversight which prevent unethical practices while capping premiums, co-pay, ect driving down costs and enabling those on the lowest financial levels to make a choice about what they can and cannot afford.

Bob:
No, they are numbers provided by NPR and Physicians for a National Health Program based on a legislative outline in 2001 concerning the idea of a single-payer health-care plan in the US.

jcapan,
No, I don’t see things getting better anytime soon. The gopers (including our latest actor-governor) are using the disaster as an opportunity to push as much of their ideology as they can. Sort of like they did when they used 9/11 to get us into the war they wanted.
.
The only good news is that people are starting to get fed up with giving a tiny minority veto power. It’s a crazy way to run a state. I’m hopeful that we will eventually pass legislation restoring democracy (majority rule) here.

@jcapan on “autocracies”

Well, fact is that the vast majority of those ultra-right-winged militar dictators DO think of the people they subjugate as their children, their sons and daughters, and they themselves as the parents, the fathers of the people, so they have to take care of.

neorationalizationalisticism,
Any links?

You can find the single-payer plan outlined on healthcare-now.org, they have a detailed outline of what the plan would consist of. It largely looks reasonable, however, the taxation issue is what I find to be particularly troublesome, especially in regard to the lowest class in the US.

http://www.healthcare-now.org/hr-676/whats-single-payer/

You must understand that most people do in fact want health-care reform. But many of us want it in a manner that does not overburden the populace with taxes. The single-payer plan, for all its benefits, still fails to recognize how detrimental its taxation needs would be to the lower class. This is why I am positive the only real solution is a legislative regulation of the insurance industry. Regulate premiums, co-payments, and deductibles to drive down costs. Regulate recissions and corporate loopholes to ensure compliance with ethical standards. Enforce these measures through a national Bureau of Health Care Oversight. This is the way forward. This is what is best for the country. This is what is best for the taxpayer.

Here are a couple of thoughts I have about this in no particular order:

1. any insurance executive who works for a company who engaged in this practice–even once–should be arrested and put on trial. it is illegal, and at some point or another the law should be enforced.

2. health care is a national security concern. we guarantee a free public education to every American, but we can’t guarantee free access to health care? yes, i did say “free”.

3. imagine if fire prevention and control services were provided by fire insurance companies instead of the “inept government that can’t run anything”. personally, i’ll take the socialized fire department over a big insurance company any day.

4. our congressional representatives have a public health insurance option included with their benefits. i’d invite you to ask your local congressperson why they would deny you the same rights they have.

thefoff: I started beating a drum on health care being a national security issue a day or two ago. Glad to see someone else agrees.

And neo, thanks for the link. Something to chew on.
.
I’ll say this for now. Setting aside the tax issue for a moment (and that’s a big set aside, but just go with me)…if the problems we see with health care seem to stem from the fundamental state of the threadbare patchwork system we have and the insurance industry’s focus on making money (which makes sense–that’s what businesses do), aren’t legislative regulations of this flawed system just so many fingers in a dike?
.
And wouldn’t creating a Bureau of Health Care Oversight likely require tax increases as well? (I think anything we do will probably require tax increases to Clinton-era levels of taxation.)
.
Surely we could create tax increases/progressive tax for health care that kept lower-income-bracket taxpayers from being taxed into the poorhouse?
.
I need to read about some single-payer plans that exist in the real world and learn how they work and don’t work.

You should give some serious attention to Sweden. The single-payer system they have had has been entirely too burdensome on the tax-payers, waiting lists are lengthy, and as a result they have actually looked towards market-oriented reform of their health-care system. Just noting…

Anyway, thanks for hearing me out people. I’m off for a few days now, a little R&R with the family…Ciao a tutti!

neorationalizationalisticism,
Thanks for the link. It’s a fascinating plan. The link you provided is a high level overview of the HR 676 plan, and I think you are misreading the tax aspects of the plan that’s being promoted. Other sites describing the same plan explicitly state that the plan would be progressive and that the tax burden on the poor would either be reduced or eliminated entirely.
.
Much more detailed documentation can be found at: Physicians for a National Health Program (link). Here’s a section of their documentation, describing their concept of the payroll tax:
The regressive nature of a payroll tax makes it a less-than-healthy revenue source; the employer share is often shifted to employees as lower wages or to consumers as higher prices.30 It should be made more progressive by reducing the employee share for lower-wage employees, by raising the employee share for high-income employees (eg, eliminating the current Social Security cap), and by reducing the employer share for small business. Employers and employees currently pay almost 2% of total payroll for Medicare-related Social Security taxes and approximately 10% for private health insurance – a combined health-related payroll tax of 13%.29, 31, 32 Using Department of Commerce figures, we project that under the NHP, an average tax rate of 9% for medium and large employers, with an average 2% rate for employees, and half these rates for businesses with fewer than 20 employees, would raise $228 billion in revenues.33 These precise tax rates are only initial suggestions and must be negotiated with the affected parties. (link)

For those who cite anecdotes of individual countries that may be having problems with single payer plans — let’s learn from their problems. Let’s emulate what works well in their plans and avoid what doesn’t. I would also note that there are NO countries (no matter how bad they perceive their problems to be) that want to emulate the health care system we have here in the US.
.
Also, some have noted that universal coverage could lead to increased waiting times for care. That’s probably likely (at least initially). We will suddenly have over 40 million more people who have access to care. Personally, I don’t think the solution to waiting times should to deny large numbers of people the care they need.

An interesting point in this discussion is that of young and healthy people who believe they don’t need health insurance. Under a single-payer government system, their taxes towards supporting the system, which they will need when they are older, are extracted at source. They don’t notice, they don’t miss it, and if they experience a catastrophic health care problem, the system doesn’t have to figure out how to treat them as an “exception”, which will always be expensive and inefficient.

Similar in principle to Social Security and to the principal of all taxpayers paying taxes towards education, even though only families with school-age children get the benefits.

Why are you all so opposed? Believe me, your political system is enough like us that large inefficiencies will be found and pointed out by the political opposition, and eliminated.

I can’t say this clearly enough: YOU ARE ALREADY PAYING TWICE AS MUCH PER CAPITA FOR HEALTH CARE AS PEOPLE IN “SOCIALIZED” COUNTRIES!

[...] Healthcare, Media at 9:10 am by LeisureGuy Karen Tumulty in TIME magazine: Paul Begala took note of our post the other day about some terribly tragic health insurance stories that had been told before the [...]

[...] When Health Insurance Isn’t Health Insurance (Time Magazine) The House Energy and Commerce Committee’s oversight and investigations subcommittee took a look today at an immoral — and illegal — practice in which some health insurance companies engage [...]

[...] When Health Insurance Isn’t Health Insurance (Time Magazine) The House Energy and Commerce Committee’s oversight and investigations subcommittee took a look today at an immoral — and illegal — practice in which some health insurance companies engage [...]

[...] subcommittee also heard testimony from patients and families of patients who had lost insurance coverage after developing serious health problems. Robin Breaton, a nurse [...]

[...] has been the focus of congressional hearings and would be banned by the reform proposals on the table, especially because pre-existing [...]

[...] companies, pre-existing condition, recissions There's a depressing sameness to them, but these kinds of stories can't be told often enough. Today, the Washington Post has a front-page look at yet another: "They [...]

skin dermatologist site and how to prevent skin cancer here. http://www.skindermatologist.net

[...] Revoke Policies To Avoid Paying High Costs, National Public Radio, June 22, 2009 Karen Tumulty, When Health Insurance Isn’t Health Insurance, Time, June 16, 2009 Lisa Girion, Health insurers refuse to limit rescission of coverage, Los [...]