These are just a couple thoughts I have. I'd like to hear yours.
My main concern about national health care is how it will be paid for. I want all people to have the benefit of good medical care but, I'm already seeing in Medicare that certain procedures are passed on by Drs. because Medicare won't pay for them. My Dr. wanted to do a blood test on me for a problem she thought I might be having but was told Medicare wouldn't cover it.
Also, how are procedures determined for all? I have a friend in my 70 age bracket who will be having extensive major surgery for a aortic aneurysm, and possible valve replacement--under a national program, would they consider her age and determine it wasn't practical for someone of her years to have an expensive operation?
Just a couple things that I'm concerned about. How about if someone gets in there to make the rules and determination is made against non workers--that people on welfare shouldn't be given expensive medical procedures, since they aren't contributing to the system. It's possible that could become a reality too. Who will determine the standards of who gets what kind of care? Think about it.
Let me know what you think!
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Comments: 86 ( 8 removed by M. Bradley McCauley McCauley )
I'm sorry about your mother Heather--it is so sad to be in an emergency room and not be cared for--as I age I am becoming more thoughtful about my own health care--
Trust me, I'm going to do everything I can to stay healthy for as long as I can. I post articles on the web about doing things to be healthier and I have seen a major difference in my personal health since I've started taking better care of me.
Already the hospitals and doctors know if you are of a certain age, no lawyer will take your case if their decisions cause the death of someone. Many people do not realize that age does have an impact on your care:
For example, My late mother was taken to the hospital in 2000. They took blood work, decided her organs were shutting down. They tilted the table she was on and packed her in ice. They said she had a bad infection. My dad was crying as they told him she was dying. He called me and they were there an hour or two before I got there. I told him, "It ain't over until the fat lady sings" I just felt strongly it wasn't her time...but see she had altzhemiers and was an invalid from rheumatoid arthritis.
A few minutes later a nurse came in, fixed the table took away the ice and started an iv for antibiotics. My mother was being moved to the ICCU, from the blood work they could tell she had a heart attack and began treatment.
Then they wanted my Dads permission to try and put a central line in after they failed 3 times. I told my Dad, if they kept doing it she might likely have another heart attack...they should wait til she needed it. She didn't need it and she lived another 3 years.
But she died because they took about 5 hours to "get to her" she had gone to the doctors who sent my parents to the emergency room with paperwork saying she needed a blood transfusion. Although she had her 3rd pacemake put in the month before....by the time she was in a room minutes before the person arrived to blood type her, she passed away.
I doubt a child would have had to wait so long. All my mother said over and over was "Would someone please help me"...it was all very sad.
I have heard other stories and the whole reason they can do this is, no lawyer will take a case on an older person as courtwise, they are not worth anything. See if you are young and have a lucrative career, the award can be mighty big.
Age isn't the only factor, being poor nearly killed me. I waited for HOURS with an appendix that was so infected that it was covered in gangrene. They told me that if they hadn't taken it out when they did, it would have ruptured and sent gangrene through my entire system. It likely would have killed me, and definately would have killed my now 2 year old son.
My largest concern is probably who is going to pay for it. The other worry that I have is fraud. We hear so often about medicare and other insurance related fraud. Who is going to be the watchdog or will it just run rampant?
Age/treatment thing is a LIE
Medicare, a government run, very controlled plan, covered double hip replacements for him when he was 80, of course he had no heart disease, vision, or mental issues, just the arthritic joints. He lived to 95, stayed active.
We better learn to be the watch dog. How many people look at their medical bills beyond what they have to pay.
Single payer health care that covers everything that is necessary is the only way we will get any health care worth having.
Right now they are singling out certain groups to pay the bill for the entire country which is not going to work.
Most of will pay our own. The tax is to cover people who can't pay and who we pay for by default via taxes, higher fees, higher insurance costs.
So do you object to the tax increase, now it is to be only for those making over $500,000, I am ok with that, when it was only $250.000, I objected, that is just solid middle class pay, for a family of 4 or 5.
with America becoming more and more a welfare state what do you think will be your income? Health care reform is only good for one regime and the next one will just take away the reform and go back to playing crony with big business and the CBO has said single payer is the cheapest way to go.
The doctors don't like the paperwork for medicare, nor the long delay before they get paid.
The government is always a pile of red tape hoping you will give up and go away.
They do like that color, don't they.
I don't know where you got your information.
One tactic insurers for privately insured is to keep denying payment, for months, the Doctors have to keep resubmitting the paperwork.
All b.s.
Both DO take Medicare.
I've made no secret my stance on nationalizing health care, so I hope I don't upset you when I say I didn't want it before, don't want it now, and will refuse to use it in the future.
My take, is it is one step closer to socialism and complete control, and I fear it will be the beginning of the end of teh freedomes as we know them
I'd rather die a painful death than put my life in the hands of a quack, because that's what I'm told to do.
Mooch
The insurance companies have been doing all these things, for years.
I'm refusing to use health insurance now, and will do so until, if and /or when it is made a law to have it.
When it becomes law to have it, then it may as well be a public option insurance, as I will not be able to afford qny other.
Will you also turn down Medicare when you are 65?
We absolutely must have a public option. Private insurance cost is going up, up, up, and each year they deny more care for more reasons. They even with the no turn-down for pre-existing conditions are going to be allowed to charge as much as 5 times for coverage for workers over 40. . .
Go private insurers. . .They will still be around after the plan passes and they, the private insurers will love people like you. They will tell you you won't get care, sell you some supplemental plan, but will never pay on it.
That is their game. Legal theft.
Sometimes, new kinds of stupid have to be invented. When I see a comment like that, I know that there's a new one.
My big concern is with the quality of care received. Because certain procedures won't be covered and/or the amount for services will be so regulated, those wanting to be doctors and specialists will decline. In addition, the quality of doctors will also decline. So while I am concerned on where the money to fund the program will come from (*cough* higher taxes *cough*), I think the care people receive will be substandard as well.
They are getting better care than most workers.
Medicare + Medicaid is not so good, very underfunded now, (for low income retirees)
Anyone with private insurance, even when company provided face turn downs for care, the turndowns are increasing.
The co-pays are increasing.
We need comprehensive healthcare reform, not just health insurance reform. That means more doctors, nurses, clinics, and the ability to train these people at lower costs. We don't have the healthcare infrastructure to suddenly take on 47 million more people and maintain the level of care that those of us fortunate enough to have health care are accustomed to.
Actually, I don't pay any attention to the news on healthcare anymore.....I'm just disgusted with the whole thing so leave the news off......I have NO idea what's going on........my husband has excellent (almost free) healthcare through his union; however, our 22 yr. old son doesn't, so if he needs to see a doctor, we pay for it.....we use a "quick care" clinic, in one of our grocery stores, that has a nurce practitioner. Otherwise, we very, very, very rarely use/need doctors/treatments, etc......
ur concern is genuine
As long as doctors are paid for the number of patients they see, the number of tests they do and the number of procedures they do we will have problems in Health Care in the US.
Preventative Medicine needs to be the first and primary thing to do with the patients, and that will reduce the patients a physician sees thus the tests and the procedures that a physician does, thus also their revenue if they are paid on a fee for service basis. Therefore there is little to no incentive to do preventative medicine.
And that needs to change.
I agree with the idea behind what you say regarding preventitive health care. But the primary focus of any physician has to be the immediate problem that a patient has seen them for or which the doctor finds. Preventitive care must come second. The problem is not that it is a second priority. The problem is that being the second priority, doctors often ignore preventitive health care. They should not.
It's similar to fixing the plumbing in your house, you have to tend to a major leak first. But don't ignore what caused the leak or you will probably be facing more of the same in short order.
There are basically two types of physicians RF the primary care physician and all the others. The primary physician has what are called S.O.A.P. notes on all their patients.
Those refer to the following:
Symbolic or what the patient says is the problem.
Objective or what the physician says in the problem
Action or what to do about the current problem now.
Plan what to do about the future health of the patient.
The notes are standard now and should be done everywhere and by all primary care physicians. There is no excuse to not suggest and give advice to the patient about their future health and the patient's current risk factors, and what should be done to alleviate them or to reduce the patient's risk factors.
My in-laws and brother and sister-in-laws all live in Canada ... they have never complained about the care they receive. My father-in-law is 89 (turning 90 this year) and he had surgery for a broken hip and has always had adequate care/tests when needed.
Their care is not entirely free in Alberta they now pay co-pays and small fees for Rx like we with private health insurance in the United States. I haven't heard much about what the president is proposing ... but if they model it off Canada I wouldn't complain!
I agree.
It's my understanding that in Canada, each province has a lot of control over how the health care system works in their province. There are some provinces that don't administer the program as well as others and I believe these few provinces is where people touting our private non-insurance system look for propaganda with which to denigrate the Canadian system.
I don't like the idea of taking away people's own personal options for health care. If I am forced to contribute to the national health care system, then I won't be able to use my money the way I want to, on whatever system I decide is best for me. Yes, everybody should have health care. And, yes, everybody has a right to health care. But should I have to pay for someone else's health care? Not so sure.
I think the only way UHC will work is if almost everyone is paying into it. It's true that UHC would limit your choice of who you would pay your premiums to. But it would reduce the amount the average person pays and insure everyone. UHC would save a lot of money in the long run.
One has to ask themselves if they really care about having a choice to pay say CIGNA or AETNA or Blue Cross/Blue Shield as opposed to everyone paying into one system that keeps everyone more healthy. To me, that's not a difficult choice to make at all.
So yes you might never need care you pay for until you have a child or what most often happens to young people an accident.
We must raise the revenue to pay for Health care, and almost all the folks in the US know that and are ok with that.
And understand it is important to do so.
All of us must sit upon the floor, cross our legs and assume the lotus position, and keep repeating the mantra:
"Spread the wealth.....Spread the wealth.....Spread the wealth....."
But, Berf, I have no left hip joint; therefore, I can't get into the lotus position! :-) Any suggestions?
Larry
It will save the world!
To be on Forbs 400 list now requires min $1.2 Billion
No one worth less than $500 million is "wealthy"
and please do your math $500 mil is a lot less than $1 Bil.
You aren't even rich if you are worth less than $5 Mil.
So neither of you will be spreading any wealth, now or ever.
Many major concerns. I for one lost my coverage when my husband got lung disease at work. I have major health problems and get no help at all. I just don't have anything done and don't get all the meds. I need because of the costs. My income goes for small medical things I can have done.
And hubby's medical is a mess also because we are still fighting it over 6 years of litigation although the company was at fault.
The burdens are tremendous on this country. Although, I can't get any help, I am still working and paying for others. Go figure!
I can't get any help, I am still working and paying for others. Go figure!
You're correct. You are paying for others. So why not support a system that covers everyone from the get-go. We're all going to pay anyway. We might as well have a system that acknowledges that, cuts overall costs and gives us the health care we deserve. UHC can do that.
I think there are going to be people excluded no matter what. Until we come up with something practical and sustainable, I doubt that we are going to see any real change. I think we need to be the ones to take charge of our health and start doing preventative measures, like eating healthier, quitting smoking, etc. that needlessly the bad habits we indulge in add to the costs of health care.
The smokers are the group they are targeting to pay for everyone's health care.
I know Jack, and well they should. My father passed away from lung cancer, and I long to have him back. He was a smoker and smoked for 45 years. Smoking brings no health benefits to anyone, not to mention the emotional costs to people who lose a loved one to lung cancer.
But I admit my bias freely in this regard as it is as personal as my loss is.
No matter what the excuse its wrong to target any single group of people to pay a nations bills. Do people that have bad eating habits pay more for their food? What about the health cost for consuming alcohol?Their are many ways to harm you health but you are not singled out for them.
Maybe people should just sit with their hands folded and do nothing so the insurance company can collect money for nothing.
Well Jack... that IS, in fact, the next group lined up in the taxing sights. Sin taxes are always popular with the self-righteous. The good news for me is that they did actually tip me to the "nuffa this nonsense - I'm quittin'" side of the smoking issue after 50 years of smoking.
Doesn't matter if you smoke or not its unfair to make any group pay the national bill for everyone.
Right, you are, Chuck!
"""Maybe people should just sit with their hands folded and do nothing so the insurance company can collect money for nothing""".
That says it all, Jack.
Just like with any other healthcare plan, this one has holes.
It is already a terrible system where we as patients aren't getting the care we deserve.
And, most insurances are already denying claims and the hospitals are already turning those away who can't pay.
So, what's the difference if it comes from the Government instead?
That's my take on things.
Me too!
The first thing we must do, is stop comparing our health care system with that of other countries. Just as all marraiges are different, so are health care systems. You enter a marraige, come up with a plan of managing the budget, your time, chores, food and recipes, having (or not) children, etc. Many people enter into marraige lightly, without discussion of anything, while others have long talks and feel confident in making a happy life together.
With that in mind, we need to make sure that all systems are in place before we commit to the plan. That will be a huge undertaking. We need to look at the system we now have, what works, what doesn't work. We also have to be realistic, knowing there are many, many unscrupulous people out there just waiting to take advantage of all the "free" money. We know they will, they are doing it now. Insurance companies, Big Pharms, proprietary (for profit) hospitals, they are all taking the big amount off the top. But it doesn't have to be that way.
Accountablility is the name of the game. Didn't we just see what happens when banks, insurers, stock bokers, auto companies, etc. don't have someone keeping them honest? They take advantage of every opportunity to grease their own pockets regardless of who they harm. We have to ensure this doesn't happen in the health care system. Those who are afraid of having the government oversee the system and who see it as "socialism" will never be convinced that a one payor health system will work in this country. Yet, they need to recognize that we are in the current financial environment BECAUSE there was no over sight of the unscrupulous businesses.
The insurance companies are currently ruling health care, increasing the need for more and more paperwork, employees to regulate their continual denials, and creating the need for outrageous pricing to make them a profit. That has nothing to do with the government. Hospitals will need to conform. If there are shortages of beds, new hospitals will need to be built. There needs to be a larger number of fairly-paid personnel working in health care, otherwise, why would anyone look for that kind of employment. Doctors need to feel they have control over patient care and not have their hands tied by the insurance companies, drug companies and hospitals. The money they currently spend on extra personnel to do the insurance paperwork and deal with potential law suits would make their salaries higher, not lower.
Lastly, we need to stop spreading rumors about all the things we hear and fear. We need to let our representatives in Washington and in the health fields do their jobs. We also need to keep them accountable by staying informed and not voting for people who are trying to keep the "status quo". We all know that the vested interests are spending millions of dollars right now to stop Obama and a fair health care system. We've seen the scary TV commercials and if we believe them, then we are just as much to blame if we fail.
It's going to take a long time, a lot of work and a lot of working together before we have a good health care system. It is possible, even probable that it will happen, hopefully sooner rather than later. I am tired of seeing unhonest people taking advantage of the sick citizens in this country regardless or whether or not they are poor or wealthy. We are all suffering financially right now. It would be great if the money we currently spend actually went for health care and not insurance profits.
"""The first thing we must do, is stop comparing our health care system with that of other countries. Just as all marraiges are different, so are health care systems. You enter a marraige, come up with a plan of managing the budget, your time, chores, food and recipes, having (or not) children, etc. Many people enter into marraige lightly, without discussion of anything, while others have long talks and feel confident in making a happy life together""".
Let's see. Stop comparing our healthcare system, and any future healthcare system we might have with that of other countries,...but by all means, we'll all get the problem solved if we compare healthcare systems with marriages.
Hmmm.
I thought the object of health care reform was to offer affordable medical insurance to everyone, not socialized medicine. There are and will be many debates in the congress and senate and I hope the greed of the existing system will not just "carry over" to the new.
As it is now, the insurance companies, some unscrupulous doctors and the drug companies make sure that there are medical bankruptcies filed every few minutes in this country.
Just a quick comment about the smoking issue. There are many other ways in which people abuse their bodies that lead to their death ie. "all you can eat buffet or supersized fast food". Actually, I believe obesity is one of the leading causes of heart problems and is on the rise in our youth. Also the "doctor runner" hypochondriac group who have a medicine cabinet filled with enough prescriptions to combine into a lethal chemical cocktail aren't helping their health either. There are legitimate reasons to visit a doctor, but I know many people that just use the doctor as a method to obtain a bucket of drugs. All these groups contribute to the cost in health care, not just the smokers.
It's a very complicated issue. We need to find a way to eliminate the corruption and offer the truly sick the ability to obtain safe and sane medical care through affordable medical insurance.
You hit on the biggest problem Bonnie, greed rules everything in America.
Nobody is offering "Socialized Medicine." We're trying to get those self-centered, bloviating blowhards in Washington to give us a single-payer INSURANCE program that will allow the folks who have NO insurance now to get coverage.
I support a Single Payer, but it is a socialist program. We do not have a society or a civilization when we have a system in which privileged wealthy elite with more than any elite that ever existed feel and act like they have no responsibility to the rest of the people.
Anyone who is against something because of the word socialism is someone I have no respect for. Socialism is not a dirty word, it is what countries that do things better than we do - do a lot of, and it is what we do as well.
Using the word socialism as a straw man because of associations that were formed during WWII shows that the US also has an elite that can be as totalitarian as anything that is happening in Iran, and uses sophisticated propaganda and marketing techniques, that we are the best at in the world, to manipulate reality for our people.
We should be using our media technology to teach people to be smarter more effective citizens, not peons that are programmed against their own basic interests and well-being.
Single payer is what we need and exactly what we will not get. Obama is still allowing the drug and insurance cons to write legislation behind his shield to transparency.
I'm for single payer healthcare, but since that's not allowed I feel little interest in discussing the details as to how best to allow the big business of Insurance and drugs to to screw us now, and in the future.
Sorta like "socialized" police, "socialized" military, "socialized" public schools, "socialized" etc., eh?
Gouge out your eyes if you ever read a book from a library! That's a socilized resource!
You know by now what my recommendations are: http://nopom.info/articles/medicine.html
I just hope and pray we scrap the old, unsustainable system and adopt the new one before it's too late.
I'd take this new system, of everything over single payer, anyday, Lydia, but we won't get this one either.
I lived in a country that had its own version of national health care for 22 years. I could choose my own doctor. I did not suffer long waits for medical procedures. Maybe it could be said that I led a charmed life -- well, considering the other things I endured during those years, that would be extremely inaccurate to say. However, with the health system, I never had a problem.
The current system in the United States is not a system at all, is extremely costly and feeds into greedy hands more than it does into the public it should be serving. That change is needed is hard to question. The real problem is <b>what</b> change needs to be done. That's what has people nervous.
Even where I lived, people paid a health tax -- much like we pay premiums -- for health care, and everyone paid it; salaried people paid through their salaries, self-employed people paid directly, unemployed people had it deducted from their unemployment benefits and welfare recipients had it deducted from their welfare payments. So the health care was not free in any sense. For those people wondering who paid for the service, that is the explanation.
Could or would the United States implement a similar system? That remains to be seen. My own suspicion is that it is more likely to be implemented on a state level than on a national level, but we shall see what comes out of all the current negotiations what, if anything, emerges.
Thanks for the imput--it will be interesting to see what emerges. It could even end up being state and federal! I just hope this administration doesn't rush into it because of campaign promises like the stimulus bills that passed without reading.
The bills have always been passed with little to no reading. That's the system we have had well before we had an Obama in the Whitehouse.
I live in a country which almost invented a National Health Service.
Whilst it is not perfect, it does mean that service is free at the point of need - and whilst there are great imperfections in the system - I am grateful for the NHS. I have had multiple health concerns, all dealt with in a timely and satisfactory way - and without bankrupting me or my family.
I had a British email pal at one time and she wrote one day she needed to pop down to the doctor and get a medication for her headache. I asked if she had private care and she replied that she used the NHS and rarely had to wait more than a few hours to see her primary care doctor. She just called in the morning and got an afternoon appointment.
I couldn't even get that kind of service when I had decent insurance.
EmJay - I think your friend's tale is probably true of most GP surgeries in the UK - I can see a doctor the same day - it may not be my personal choice GP, but they are all pretty good and so I don't care!
We have private health insurance, too. My husband and family use it - I have never used it - I have always received reasonable treatment via the NHS. My husband had a serious illness which was treated by private insurance - he saw the same doctors/specialists/surgeons as he would have seen under NHS - the room was fancier and the food better, and that appeared to be the only difference in care... same medications, same operating theatre, same personnel.
Thanks Ishbel, it's nice to hear from someone who has had first hand experience.
I'm beginning to fear we're not gonna have to worry about what kind of national health care or insurance we're gonna get, because we're gonna watch the democratic Senators manufacture defeat from the open basket of victory we handed them.
I am sorry to say, you are probably correct, Chuck.
Any idea why they are doing so poorly? They had a mandate handed to them.
I don't have health problems yet, neither does my hubby, but his mother does. I hate going to the doctors with her, I have to fight with everyone, she is unable to stand or sit for 30 minutes or more. Getting a chest xray is next to impossible! She has Scoliosis, and is almost bent in half. One heart doctor here charges $285.00 for a 15 minute visit? I don't get it! I have no illusions about who will pay for this new Health Care System, that is you and me. Will it be fair, I doubt it!
The real problem is that there are two schools of thought. On one side, there are a group of people who believe that everybody is entitled to the same health care, regardless of their social/economic standing. Opposing them, of course, are those who feel that one gets what they pay for. That national health care should be afforded to the uninsured and lower income, but not necessarily the same quality. In other words, wards and clinics as opposed to semi-private rooms and private physicians.
The latter seems unfair on the surface, but do we provide the same housing for everybody regardless of income? What about home heating and cooling? Transportation? Food?
Most would think that the above items are as essential as health care, but that it's unrealistic to provide the same for everybody.
So a person with a lower income isn't as "valuable" as a person of wealth?
Health care is different than housing because without health, a person has very little chance of improving his/her employment situation. As for food, people on food stamps buy what they can afford and often it isn't the best quality. The choice to eat well versus eat all month is a difficult one.
Our food industry needs to be reviewed and honestly, we need to get back to locally produced food and nothing with HFCS in it. There is a connection between health and what we eat. This also ties into teaching preventive care at every level - start with the kids right on through to doctors. A pill is not the answer for every ill and Big Pharm needs to go back to research and stop all the pimping and payouts to doctors.
Sorry to ramble, but it all ties together.
Using your argument, does a person with lower income deserve to buy the same quality food? The same quality transportation? The same quality clothing? The same quality house?
All of these are essentials of living and, unfortunately, there will always be people who have "more" and people of have "less".
thanks!
I've had health insurance and rarely used it. I've gone without health care for most of my adult life because I didn't have health insurance.
But I was raised in a small town and we didn't run to the doctor over every little bump or fever. We took care of ourselves. You will find that many of us who have little or no access to health care and lack insurance are careful about our lifestyle choices.
I need a public option because I am not immune to aging. Though I take care of myself, who knows when an accident will happen or an illness occur?
Since Wil had his heart attack in February, I've accompanied him to many of his doctor appointments. The doctor never makes a decision about treatment without first consulting the insurance company. They know what company will cover which treatments and which medications. If he did not have very good insurance, we would lose our house. The statements so far total over $91,000 for a stay that was less than 72 hours in the hospital. His insurance has covered the bulk of it, but if they had been willing to offer him preventive care, a package option his employer chose NOT to offer, then the whole drama and cost could probably have been avoided.
The insurance companies are willing to gamble that you will die. A public option for health insurance would force them to step up their service to their customers.
"My main concern about national health care is how it will be paid for." ROFL.
Quelle surprise! Instead of raising taxes to pay for health care, the new trend is "revenue sharing" or "revenue sourcing". Le Prince Obama has discerned a serious lack of funding sources in the current economy, but has found the revenue to finance his grandiose plans.
Introducing: Your wallet! The most reliable source of funding in the USA now presents the concept of sharing. NO, your taxes will NOT be raised. You will simply deposit a larger amount of your money into the national, feel good sharing fund to finance whatever is chosen by Le Prince. Don't even think about asking for that money or its benefits to be shared back to you in the form of health care! Are you unpatriotic? Tsk! Americans are so selfish.
Testimony of
Wendell Potter
Philadelphia, PA
Before the U.S. Senate Committee on Commerce, Science and Transportation
June 24, 2009
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Mr. Chairman, thank you for the opportunity to be here this afternoon.
My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick – all so they can satisfy their Wall Street investors.
I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand—or even to obtain—information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.
When I left my job as head of corporate communications for one of the country’s largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry’s charm offensive—which is the most visible part of duplicitous and well-financed PR and lobbying campaigns—may well shape reform in a way that benefits Wall Street far more than average Americans.
A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA’s health care division was one of three industry executives who came here to assure members of Congress that they
3
would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton’s proposals, they said they enthusiastically supported several specific goals.
Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn’t be here today.
Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.
The average family doesn’t understand how Wall Street’s dictates determine whether they will be offered coverage, whether they can keep it, and how much they’ll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies’ quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ―benefit‖ ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.
To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going
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to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they’ve failed to trim medical costs. I have seen an insurer’s stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company’s first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later.
To help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation’s largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.1 The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.
They also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether –
1 Samuel Zuvekas and Joel Cohen, “Prescription Drugs And The Changing Concentration Of Health Care Expenditures,” Health Affairs, 26 (1) (January/February 2007): 249-257.
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leaving workers uninsured. The practice is known in the industry as ―purging.‖ The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.
http://voices.washingtonpost.com/ezra-klein/Potter Commerce Committee written testimony - 20090624- FINAL.pdf
8k that way.