Showing posts with label for-profit insurance companies. Show all posts
Showing posts with label for-profit insurance companies. Show all posts

Friday, September 28, 2012

Reflections on a Medical Career

The Impending Collapse of American Medicine
by Robert S. Dotson, M.D.


Just as is every issue in the US, Obamacare and the wider question of the state of American health care are obscured by propaganda and disinformation. In the article below, Dr. Robert S. Dobson looks back on a lifetime of medical practice and provides facts and insights that might help us to understand our situation.

The US medical system is the most expensive on earth without being the best and without providing full coverage. One-sixth of the American population has no medical coverage.

There are two main reasons that US medicine is so expensive. One is that profits are piled upon profits. In addition to wages and salaries for doctors, nurses, and medical personnel, the American health care system has to provide profits for private hospitals, diagnostic centers, insurance companies, and for the accountants, attorneys and management consultants made necessary by the enormous litigation and regulatory compliance cost. American medicine is the most regulated in the world and the most criminalized.

What “Obamacare” does is to divert Medicare and Medicaid monies to the profits of private insurance companies. Instead of providing medical care to those in need, the taxpayers’ money will provide bonuses for insurance executives and profits for their shareholders. It is the height of folly for Obama worshipers to defend a law written by the private insurance companies that uses public revenues to provide insurers with 50 million more customers and to add yet another layer of profits to the cost of American medicine. ~ Paul Craig Roberts
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Reflections on a Medical Career
Robert S. Dotson, M.D.

All lovely things will have an ending, All lovely things will fade and die; And youth, that’s now so bravely spending, Will beg a penny by and by.
~Conrad Aiken (“Disenchantment IV”- 1916)

Thirty years have passed since a much younger physician opened his ophthalmology practice in East Tennessee. A lifetime of hopes and expectations, intermingled with the usual collection of fears and uncertainties, has sped past at blinding speed. Children came, grew up, and moved on to their own lives. Parents and grandparents, aunts and uncles, many friends and colleagues have returned to dust in advance of their fading photos.

Patients and their parents and children and grandchildren have moved in and out of this world, too, inextricably woven into the fabric of my life. Sadly, a few may have been hurt by lapses in judgment or the arrogance of youthful physician pride and overconfidence. But, at the end of the day, most were helped. I was fortunate to be recognized as a “doctor’s doctor” early on and, though there was no attendant reward other than the respect of peers, that was a sufficiently gratifying laurel to carry.

As in any human story, joy and pain, love and sorrow, have marked these same years. The Millstone of Time has also worn away foolish aspirations and vainglorious pretensions. There is no one left to impress, no accolades to seek, no rank to which to aspire. Consequently, I feel freed to offer some end-of-life reflections on my profession and career.

Any thinking American knows that there is something terribly wrong with the health care system in this country. Throughout my career, the political ruling elite has been enacting piecemeal a version of “universal” healthcare coverage to satisfy the demands of an increasingly vocal, but also increasingly disenfranchised citizenry. Our overlords, of course, have been more motivated by enhancing corporate bottom lines and enriching themselves, than in genuinely helping the peasantry.

Every U.S. President since Kennedy in 1962 has dealt with the issue in one way or another – by policy statement or passage of legislation. LBJ oversaw the creation of Medicare and Medicaid in 1965. Nixon oversaw the passage of the HMO Act (Health Maintenance Organization) in 1973 and ERISA (Employee Retirement Income Security Act) in 1974. Amazingly, he also introduced CHIA (Comprehensive Health Insurance Act) in 1974. Even more incredible was the spectacle of Ted Kennedy working to ensure its defeat. Doubtless, Kennedy regretted that in future years. Following the untimely departure of the 37th President, Gerald Ford signed ERISA into law in 1974 on his behalf, thereby introducing some minimal regulations to ensure that separated employees could maintain benefits, such as health insurance, for a limited time.

Carter campaigned in favor of National Health Insurance, but failed to pass anything similar during his time in office. He cited Kennedy’s opposition to CHIA and to his own proposals as the main reason for failure. Reagan’s era witnessed the passage of EMTALA (Emergency Medical Treatment and Active Labor Act) and COBRA (Consolidated Omnibus Budget Reconciliation Act) in 1986 that, among other things, provided for emergency medical treatment coverage for anyone who could drag themselves into an emergency room (of course, such a visit might bankrupt them unless they were lucky enough to be an illegal alien). Medical labs and imaging centers (and, the providers staffing them) were given “special attention” under CLIA (1988).

The first President Bush had little time for national health care issues, as he was primarily focused on launching the NWO. Poppy’s “Thousand Points of Light” degenerated into in-coming tracers from the illuminated Angel of Death – simply more “peace, freedom and liberty” being delivered to millions of innocents across Battlefield Earth. It seems so trivial now, but Bush was unseated after reneging on his pledge of “no new taxes,” not for offshoring the US economy or taking the first step toward turning US foreign policy into the pursuit of world hegemony.

The Clinton administration tried to force through “Hillarycare” in 1993, but met with stiff opposition from their Republican opponents (of course, the opposition was due to perceived threats to corporate profit margins). Nonetheless, Team Clinton was able to push through HIPAA (1996) (Health Insurance Portability and Accountability Act) and SCHIP (1997) (State Children’s Health Insurance Program) which, contrary to the titles of the acts, neither improved health insurance portability or accountability nor improved the health of children.

The Clinton White House had more important fish to fry: war in the Balkans; the liberal distribution of depleted uranium and cruise missiles across the globe; test wars on Americans at places like Ruby Ridge, Waco, and Oklahoma City (OKC); the appearance of numerous “Arkan-cide” victims whose mortal remains seemed to be discovered at the most inconvenient times; and, a semen-stained blue dress. The first versions of the Patriot Act were trotted out in response to the false flag event of OKC, but Congress and even the Imperial Senate balked at moving so precipitously toward the New Amerikan Security State.

The ascension of son Bush and his neoconservative cabal turned the government to the drive toward world hegemony. The serendipitous events of 9/11 opened the door for passage of the neocon’s PATRIOT Act and for the still on-going implementation of their Project for the New American Century (PNAC). New alphabet agencies like DHS and TSA were created to augment existing departments and agencies (FDA, DHHS, IRS, FTC, FCC, EPA, FEMA, DEA, BATF, FBI, NSA, CIA, and DOD) charged with dominating the nation and the planet beyond. Orwell’s dystopia, 1984, became reality: “War is Peace. Freedom is Slavery, Ignorance is Strength.” President Bush modeled Big Brother’s third slogan for an admiring populace more concerned with Harry Potter and Janet Jackson’s nipple than with the deadly machinations of the psychopath in charge.

It seems likely that steps toward the Third World War were taken during Bush II’s reign with “war, war, WAR” being unconstitutionally declared against the nebulous (some might say, non-existent) terrorists lurking under every bed and in every closet, cave, and country on the planet. In spite of a premature proclamation of “Mission Accomplished” from a flag-festooned carrier in 2003 by the Decider-In-Chief, the killings have continued with little pause up to this day. The Great Decider used the opportunity of “victory” abroad, however, to turn his attention to the healthcare needs of his subjects.

What could be a better bone to throw to the peasants than the expansion of pharmaceutical coverage for those under Medicare? And, what could be a better pay-off for corporate buddies than massive new government wealth transfers of taxpayers’ dollars to Big Pharma via such a plan? It was a perfect “win-win” for the oligarchs at the top of the pyramid and a “lose-lose” for the peons at the bottom. To the great joy of Big Pharma, the Medicare Prescription Drug, Improvement and Modernization Act (Medicare, Part D) was launched in 2003 to insure unimaginable profits for its corporate members and more expense for the common people it was alleged to help. As in any casino, our healthcare croupiers are well trained to leave no dollar on the table.

President Obama, a corporate stooge par excellence, was able to ram through “universal healthcare” with the help of a Howdy Doody smile, his corporate sponsors, and the slavish devotion of an ever-delusional, pseudo-Left. It mattered not that the legislation was written by the insurance companies who had been profiting from the misery of patients for decades.

It is no accident – and would be comical, if it were not so serious – that there will be no true, equitable national health care system under the Patient Protection and Affordable Care Act of 2010 (aka, “Romneycare II” or “Obamacare” or, lately, “Robertscare” in homage to a Supreme Court judge) and its accompanying legislation, the Health Care and Education Reconciliation Act. No Single Payer. No mutual insurance system that provides a basic level of healthcare for the proles of this collapsing Security State. Instead, we are witnessing the imposition of a system that will further enslave and impoverish the peasants here in Gulag Amerika. How poetic that a self-identifying “black man” is the front for resurrecting a 21st century version of chattel slavery in the twilight years of Empire.

Obama was positively beaming in his many photo-ops with the sponsoring corporatist representatives of Corporate Medicine, Big Insurance, Big Pharma, and Big Government who enabled the Prince of Change to achieve this milestone deception of America. The very fact that this “wonderful” new system – lauded by supporters as “revolutionary” – is to be enforced by a projected army of 16,500 new IRS agents should give us pause.

Notwithstanding passage of the legislation, decades of bad healthcare policy and corporatist plunder are finally taking their toll. The collapse of the ill-conceived US health care system might be near.

Ever more intrusive regulations are driving up the cost of medical care, and the practice of medicine is being criminalized. Even with all of their flaws, Medicare and Medicaid have provided a safety net for the elderly and disadvantaged since their inception. Those systems’ days are numbered, however, as they are being gutted to turn health care into profits not for doctors and hospitals but for insurance companies and Big Pharma. For starters, large sums have been ear-marked to be taken from Medicare and Medicaid to help fund PPACA (Patient Protection and Affordable Care Act). Is looting Social Security and Medicare “change one can believe in”?

If this system is bad for patients, what does it mean for doctors? It means falling reimbursement rates and rising overhead costs for providers, onerous government mandates and regulations, and institutionalized, legalized larceny by Big Pharma, Big Insurance and Corporate Medicine. As an example of how time and circumstance have affected my own profession of ophthalmology, one need only look at Medicare approved reimbursement rates for cataract surgery.

In reflecting back over my many years in the field of ophthalmology (as of this writing, I am 63 years old and feeling pretty shop-worn), I am staggered by the changes that have occurred. When I opened my practice in 1982, Medicare approved surgical fees for cataract and implant surgery were near $1200. By 2012, that approved charge had dropped to about $570 in Tennessee. (There is some variance within states based on rural versus metro areas and between states where some are declared to have higher costs of doing business.)

Additionally, the US dollar has declined in value an average of almost 2.5% per year over the past 30 year period. Needless to say, overhead operating costs – salary, rent, insurance, personnel costs, taxes, and normal business expenses – have exploded during this same 30 year period. My office rent was raised 20% in the Fall of 2011, for instance.

To further illustrate the absurdity of the situation, it is worth recounting an anecdote. Several years ago, a patient excitedly told me of the vision restoring cataract surgery that her poodle had received at the local veterinary college. It “only cost $2600 for both eyes!” At the time, Medicare was paying about $1400 for two eyes in a human – including work up, surgical fee, post-op care for 90 days, and the very real liability associated with being a physician in a litigious society.

I do not begrudge my animal doctor friends their success, but surely the worth of human care should at least approximate that for a poodle. Although I know veterinarians who are struggling in their own practices due to the economic recession, at least they do not have to deal with government fee-setting and the liability and costs associated with treating humans. They are able to price their services sufficiently to keep their practices open and to provide for their own health care and retirement.

In my own practice, the amount of “write off” on charges for legitimate services rendered began to climb as we entered the 21st Century. For years, the “disallowed” charges by Medicare and private insurers resulted in “discounts” of 20-25%. As the economic upheaval of 2008 rolled around, those fee adjustments (actually theft of labor from providers) began to climb – 30%, 32%, 35%, and in my last year of practice over 60%! For years, I had been able to subsidize my Medicare (cataract) side of the practice by offering elective refractive surgery procedures (LASIK, PRK, etc.) to my patients. As these were private pay cases, they offset the draconian cuts in Medicare and insurance fee “adjustments.” The economic collapse of 2008, however, reduced that income stream for many ophthalmologists and, subsequently, led to the closing of many practices throughout the country.

Most general ophthalmologists are, by definition, primarily cataract surgeons. Many people – including Medicare recipients – do not realize that the fees paid to their physician are fixed by the U.S. Government after consultation with its many corporate sponsors within Big Insurance, Big Pharma, and Corporate Medicine. Patients also do not realize that those reimbursement levels are set by central planners at below-cost levels.

Medicare issues cut across all specialties, and ophthalmology has not been alone in experiencing cutbacks. Primary care physicians have increasingly become “piece good workers” – managed by corporate pencil pushers to see a patient every 6-8 minutes while being forced to carry all the liability and manage all the data and coding previously done by insurers.  

Who can diagnose, much less treat a patient in 6-8 minutes?

My own solo cardiologist was forced to close his practice last Fall and seek employment with an area hospital, due to declining reimbursement levels. More than 51% of cardiologists in the U.S. are now hospital employees. One of my medical school classmates, a successful internal medicine specialist, has recently given up the fight and has plans to enter some other line of work. Several friends in Radiology have seen their incomes decline as more and more work is “outsourced” to tele-docs in Asia. Still other long-time friends who are general surgeons are struggling to survive (a surgical fee for incisional cholecystectomy, for instance, is now under $400). Several have retired prematurely and others are looking for other work to do. As a final example, another of my friends is one of five physicians in a busy urology practice (2 offices and 26 employees) and they are now borrowing from the bank to make payroll. A recent article from CNN, “Doctors Going Broke,” confirms the growing problem. http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

As income reductions are being imposed on private practice, costs are being driven up by exploding regulations. In addition, the plethora of new mandates and laws have increasingly criminalized every aspect of the practice of medicine and created vast new armies of armed bureaucrats whose sole aim is to impose civil and criminal penalties on any provider unlucky enough to be singled out for attention. The old Soviet dictum attributed to Lavrenti Beria (Stalin’s NKVD chief), “Show me the man and I’ll find you the crime,” is in full force in Amerika.

The present puppet in the White House has completed the work begun by his predecessors in moving the nation into a police state. The NDAA passed in the Fall of 2011 was the final nail in the coffin of personal freedoms guaranteed by the US Constitution. By suspending habeas corpus and even trial by judge or jury, the Act has made certain that no person is safe from being violated by a power-mad Security State. At the mere movement of the Unitary Executive’s pen, it is now permissible to “disappear” or even execute anyone on the planet – all on the whim of the unaccountable psychopath in charge. Judge Andrew P. Napolitano has reported that our present Unitary Exec spends every Tuesday morning reviewing and signing off on a kill list supplied by his loyal minions. Nobel Peace Prize worthy stuff, indeed!

One is presumed guilty now in Amerika until proven otherwise and nowhere has this been more demonstrated than in the policing of medicine. Heaven help the poor provider who is targeted by the Medicare Police – or now, one supposes, by the new IRS Medical Special Branch. If targeted, his or her practice will be shut down without due process. His or her assets will be seized without due process (assuring the inability to even defend oneself). Finally, the unlucky guilty-until-proved-innocent physician will be permanently discredited (libeled) in his or her community with the ready help of the Government’s countless propaganda organs – press, radio, and TV – all before any day in court is seen.

New restrictions, rules, and regulations on healthcare – on providers and patients alike – have imposed legal constraints with which full compliance is impossible. Medicare rules and regs alone fill tens of thousands of pages, and ignorance of any of them is no defense for the unlucky. The original HIPAA legislation has been amplified with many additions since its inception in 1996: FERPA, HITECH, ARRA (2009). Each additional act or regulation has further criminalized the practice of medicine.

Finally, the entire health care system is being forced to switch to electronic health records (EHRs) and, soon, to a completely new coding system (from ICD-9 to ICD-10). Failure to comply with these mandates will result in further reductions in provider payments with every year that they remain unimplemented. For a solo physician practice, it is estimated that each mandate will cost as much as $80,000 to implement initially and, then, $10-15,000 annually to maintain. For multi-physician practices, costs run as high as three times (or more) that of a single provider practice. Of course, the purpose behind all of this is to make each person’s most private and personal information available to government bureaucrats and regulators while also ensuring its accessibility to the Security State’s many law enforcement tentacles and to all the corporate members of the Medical-Industrial complex.

Unfettered access to this information will ensure that the Corporate State can maximize its profits, largely avoid all risk and liability, and eliminate any potential competition (such as, often cheaper and more effective alternative medicine providers and therapies, non-GMO whole foods, and nutritional supplements). It will also ensure that medicine is practiced/delivered within strict cookbook guidelines that are carefully written by non-physician bureaucrats to maintain corporate profits and government power. All of this is well along in implementation.

A recent article, “Efforts to implement Obamacare law raise concerns of massive government expansion” from Fox News, 5 July 2012, (http://www.foxnews.com/politics/2012/07/03/efforts-to-implement-obamacare-law-raise-concerns-massive-government-expansion/#ixzz1ziuZDCSV) informs us that lawyers have already “drafted more than 13,000 pages of Obamacare regulations and that this number will increase further over coming months. In addition, we are told that DHHS (Department of Health and Human Services) has been given more than one billion dollars to date in order to begin oversight of this mess and that more than 180 “commissions, boards, and bureaus” within the Agency are already hard at work implementing the final destruction of American medicine.

Widespread vaccination of the population with untested “stabs” will be mandated and enforced. As long predicted by Tin Hatters around the planet, this will permit biometric “nano-chipping” of the citizenry without the unpleasant need to ask their permission.

Vast sums will be committed to “preventive” medicine which will prevent nothing and will only expand the reach of the Medical-Industrial complex into every nook and cranny of a person’s life – and, into every wallet. Certain corporate profit-driven diets and treatment regimens will be mandated and enforced; access to nutritional supplements and alternative medicine practices will be limited or banned altogether; behavior patterns of all types will be monitored and carefully scripted and controlled (what we see, hear, read, do, eat, drink, and breathe – where and how we work, play, and live) under the guise of State Security concerns and its new companion, Public Health or Public Good; and, finally, the Corporate State will deploy “death panels” to decide when a person has outlived his or her economic usefulness to the State. In spite of Obama’s denials that such bodies exist and Palin’s diversionary, hysterical rantings at Tea Party rallies, there is clear provision in the Act for bureaucratic decision-making bodies which will make end-of-life decisions for us all. These entities are already being formed and deployed across the land. Our Anglo cousins in the UK are showing us the way by withholding food and fluids from as many as 29% of their hospital patients now who are judged to be living beyond their government-dictated “use-by” dates (pragmatically justified “to free up beds” – oh, those Brits and their refined sense of humor).

What can be done about the failing American health care system and the wider collapse of the economy and civil liberty? Frankly, very little. The system is rigged against the people as it has always been, only now one can be “black-bagged” and disappeared at any time. Protest too loudly and one is liable to literally see a grim Reaper overhead with one’s personal biometrics programmed into its fire control system. Like every other institution within the United States, the medical system is totally and completely broken. It can no longer be fixed by “voting” for the lesser of evils, by printing bales of fiat currency, or even by deploying fleets of obsolete aircraft carriers across the planet.

If as it seems we are arriving at the end of an age, if we can survive the end, something better might arise from the ashes. The prospect of collapse turns one’s thoughts to escape and survival. Can you do either? Volumes have been written about preparedness in a time of chaos, so I will spare readers a rehash. But, a few comments about healthcare, in particular, might be in order.

In a perfect world, it is my opinion that we should have some form of single payer healthcare system and divorce ourselves from corporate medicine. In my opinion, this will not happen without the complete collapse of the present system. Since that is unlikely to occur before more seasons of national election fraud are imposed on us, a few “in-the-meantime” suggestions follow:

Avoid contact with the existing health care system as far as possible. Yes, emergencies arise that require the help of physicians, but by and large one can learn to care for one’s own minor issues. Though it is flawed, the internet has been an information leveler for the masses and permits each person to be his or her own physician to a large degree. Take advantage of it! Educate yourself about your own body and learn to fuel and maintain it as you would an expensive auto or a pet poodle. One does not need a medical degree to:

  1. avoid excessive use of tobacco or alcohol or, for that matter, caffeine;
  2. avoid poisons like fluoride, aspartame, high fructose corn syrup, and addictive drugs (legal or illicit);
  3. avoid unnecessary and potentially lethal imaging studies (TSA’s radiation pornbooths, excessive mammography, repetitive CT scans – exposure to all significantly increases cancer risk);
  4. avoid excessive cell phone use and exposure to other forms of EMR pollution where possible (the NSA is recording everything you say and text anyway);
  5. avoid daily fast food use and abuse (remember: pink slime and silicone) ;
  6. avoid untested GMO foods (do you really want to become “Roundup Ready?”);
  7. avoid most vaccinations and pharmaceutical agents promoted by the establishment;
  8. avoid risky behaviors (and, we do not need a bunch of Nanny State bureaucrats to define and police these);
  9. exercise moderately;
  10. get plenty of sleep;
  11. drink plenty of good quality water (buy a decent water filter to remove fluoride, chloride, and heavy metals);
  12. wear protective gear at work and play where appropriate (helmets, eye-shields, knee and elbow pads, etc.);
  13. seek out locally-grown, whole, organic foods and support your local food producers;
  14. take appropriate nutritional supplements (multi-vitamins, Vitamin C, Vitamin D3);
  15. switch off the TV and the mainstream media it represents;
  16. educate yourself while you can;

And, lastly…

17. QUESTION AUTHORITY!

Doing these simple, common-sense things will add healthy years to a person’s life and help one avoid most medical encounters during his or her allotted time on earth.

Finally, we have a responsibility to our neighbors and our families. We need to reach out to those around us – talk to them, listen to them – sympathize and empathize. Take time especially to listen to those who are in pain and are suffering and to help them by being humane. If you do this, you will discover that we have more in common with each other than the ruling elite wants us to believe. Governments obtain power and control by taking advantage of divisions along religious, ethnic, class, economic, ideological, and nationalistic lines. We must awaken to this fact if the 99% are to prevail against the 1%.

As for me, I was finally forced to close my practice earlier this year. Nearly two years of consulting with multiple attorneys, accountants, practice management consultants, and bankers, and expending most of my resources in a vain effort to keep operating, were simply not enough. It seemed only poetic that April Fool’s Day 2012 should be chosen for turning out the lights and ringing down the curtain. Patients and employees and suppliers were notified of the end. Many had been with me for my entire career and leaving them was and remains painful. More than nine thousand active charts were transferred to the care of a younger ophthalmologist still trying to stay afloat.

I share the heartache of many physicians forced out of medicine by the high cost of practicing it. As the health system is stripped of medical care in behalf of corporate profits, its exploitative character will become clear to all. In the meantime, don’t give in or give up. Plan for something better on the other side of chaos.

I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle and end.
~ Gilda Radner

Glossary of Terms:

ARRA American Recovery and Reinvestment Act of 2009
CHIA Comprehensive Health Insurance Act
CIA Central Intelligence Agency
CLIA Clinical Laboratory Improvement Amendments of 1988 – administered by CMS
CMS Centers for Medicare and Medicaid Services
COBRA Consolidated Omnibus Budget Reconciliation Act of 1985
DHHS Department of Health and Human Services
DHS Department of Homeland Security
DOD Department of Defense
EMR Electromagnetic radiation
EMTALA Emergency Medical Treatment and Active Labor Act – part of COBRA1986
EPA Environmental Protection Agency
ERISA Employee Retirement Income Security Act
FEMA Federal Emergency Management Agency
FBI Federal Bureau of Investigation
FDA Food and Drug Administration
FERPA Family Educational Rights and Privacy Act (1974 original legislation)
GMO Genetically Modified Organisms
HCERA Health Care and Education Reconciliation Act of 2010 – supplement to PPACA
HIPAA Health Insurance Portability and Accountability Act
HITECH Health Information Technology for Economic and Clinical Health Act (2009)
HMO Health Maintenance Organization
ICD-10 International Statistical Classification of Diseases and Related Health Problems 10th Revision
IRS Internal Revenue Service
NDAA National Defense Authorization Act
NSA National Security Agency
NWO New World Order
PPACA Patient Protection and Affordable Care Act
SCHIP State Children’s Health Insurance Program
TSA Transportation Security Administration
USAPA Unifying and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism – aka, The Patriot Act

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Whether you agree or disagree with his points, you have to agree that it was a compelling read.--jef

Saturday, December 17, 2011

Do We Need Health Insurance?



Do Americans need health insurance? The short answer is no — at least not in the form it currently exists in America.

It is true that in many wealthy countries private insurance companies are used in the financing of universal health care systems. But they are nothing like American companies. They are regulated public utilities and are told by their governments who to insure, what to cover and how much and when to pay. Most are prohibited from making a profit and are required to pay any willing provider. Not exactly the American model.

The purpose of health care financing systems should be — and is in all other wealthy countries — to facilitate the delivery of health care services, to protect individuals and families against huge medical care expenses and to avoid breaking the national bank while they do so. But in America, our private insurance system actually interferes with the delivery of health care and is rapidly becoming too expensive.

Last month I argued for adopting a universal health care system on moral, ethical and economic grounds. It is not only more humane but cheaper to cover everybody. We have moved in fits and starts toward that goal since the enactment of Medicare in 1965.

The recent federal health reform law took a few steps forward. But we are now taking a couple steps back, especially in Maine. Last week Gov. Paul LePage proposed disqualifying 65,000 beneficiaries of MaineCare. Earlier this year, the Legislature enacted PL90 that rolls back regulations intended to spread the financial risks of illness and improve access to health care for those most in need of it.

A little history may be informative. Private employment-based health insurance in America was not a planned system, but grew out of World War II wage and price controls. It was one of the few ways employers could attract and retain employees in a tight labor market. The spread of these benefits received a boost when the federal government exempted them from federal taxes.

Private health insurance was dominated by nonprofit Blue Cross and Blue Shield plans until about 1990. That changed when Blue Cross plans across the country began to convert to for-profit status, arguing that it would improve their efficiency. Maine Blue Cross made that transition in 2000 when it changed from a company whose mission was facilitating health care to one whose mission was maximizing shareholder wealth.

The business model of for-profit insurance companies is pretty simple. The creation of wealth for shareholders, including many of their executives, depends upon profitability. To maximize profitability they must charge premiums as high as the market will bear, offer skimpy policies that limit coverage, impose high deductibles and minimize what they must pay out for the services they do cover.

Maximizing premiums, imposing high deductibles and limiting the scope of coverage are pretty straightforward. Minimizing payouts for services they do cover is a little more complicated. Four techniques are used.

First companies try to avoid insuring people likely to require health care, such as those with a history of illness or who are elderly or in dangerous occupations.

Second, they dispute the need for health care that is recommended or has already been provided to their customers by micromanaging the decisions of doctors and patients and denying as many claims as they can. This is a very expensive and contentious process that often damages the quality of care.

Third, they bargain down the prices health care providers charge as much as possible, shifting costs to other payers. This has created the curious and uniquely American situation where uninsured people pay the highest prices for health care products and services.

Fourth, many companies try to find a reason to retroactively dump sick customers who have filed claims by asserting that they have failed to accurately state their health care history, therefore defrauding the insurance company.

These people end up on public insurance or on the roles of the uninsured. This practice, called “rescission,” is particularly unfair but nevertheless appears to have become widespread. It has been banned by the new federal health care reform act.

What is the problem with this picture? It is not that for-profit insurance companies are failing in their mission. In fact, they are doing a very good job of exactly what their mission demands, maximizing the wealth of shareholders. The problem is that their mission fundamentally conflicts with the mission of a decent health care system.

What can we do to fix this problem? The obvious first step — but not the last — is to replace for-profit insurance companies. They are like a camel entered into the Kentucky Derby. No matter how much it is trained, how hard it tries, how hard it is whipped or who the jockey is, it never wins. It just wasn’t designed for the job.

Although insurance companies could play a role in a redesigned system by becoming public utilities, that is not the most efficient way to finance a system that includes everybody. For example, private insurance companies are currently fighting the new federal health care law’s requirement that they keep their overhead below 20 percent. Medicare, financed through publicly mandated premiums and taxes, spends less than 5 percent on overhead and interferes with health care decisions much less than private carriers.

Maybe it’s time to replace that camel with a racehorse. While we’re at it, why not go for a thoroughbred? An improved Medicare-like system for all could provide better coverage while spending less. What’s not to like about that?

Monday, August 29, 2011

Perry Sought Profits from "Dead Peasants" Insurance on Elderly Texas Teachers

Rick Perry Sought State Profits From Teacher Life Insurance Scheme
First Posted: 8/25/11 - HuffPo

WASHINGTON -- Two weeks before Thanksgiving in 2003, top officials from Texas Governor Rick Perry's office pitched an unusual offer to the state's retired teachers: Let's get into the death business.

Perry's budget director, Mike Morrissey, laid out a pitch that was both ambitious and risky, according to notes summarizing the meeting provided to The Huffington Post.

According to the notes, which were authenticated by a meeting participant, the Perry administration wanted to help Wall Street investors gamble on how long retired Texas teachers would live. Perry was promising the state big money in exchange for helping Swiss banking giant UBS set up a business of teacher death speculation.

All they had to do was convince retirees to let UBS buy life insurance policies on them. When the retirees died, those policies would pay out benefits to Wall Street speculators, and the state, supposedly, would get paid for arranging the bets. The families of the deceased former teachers would get nothing.

The meeting notes offer the most direct evidence that the Perry administration was not only intimately involved with the insurance scheme, but a leading driver of the plan.

It was a back-room deal at odds with Perry's public persona as a career politician who had successfully sold Texans on his vision of minimal government intrusion. And it still is. Nearly eight years after the meeting, when Perry formally announced his run for the presidency in Charleston, S.C., he honed that vision into the perfect applause line: "I'll promise you this," he had said in his West Texas drawl. "I'll work every day to try to make Washington, D.C. as inconsequential in your life as I can."

Death in Texas, on the other hand, is another matter. That first meeting with teacher groups and retirement plan officials in November 2003, recalled one attendee, was an effort by Perry's office to solicit support for the life insurance idea from teacher associations. There was little question who was promoting the plan.

"His office was pushing it," the source said. "It was like, 'We've got to do whatever we can. ... Here's an innovative idea. We really want you on board.'"

The governor's office was even prepared to put down a little cash up front. If retirees balked at the notion of the state profiting from their deaths, Perry's budget men suggested they could be persuaded for the cost of a pair of shoes, according to the meeting notes. If a retiree signed a contract allowing the state's teacher pension fund to buy life insurance on them, the governor was prepared to give them between $50 and $100.

"Precious little for what they were giving up," said the meeting attendee.

The notes make clear that the governor's proposal deliberately targeted the elderly. The state was only seeking to take out life insurance on people between the ages of 75 and 90. At a separate meeting five days later, the plan's proponents discussed the "mental capacity" of these retirees to grant consent as one of three major technical obstacles to the plan, according to notes from that meeting.

At the first meeting, Morrissey said it could take 10 to 12 years for Texas to "earn" money from the scheme, but insisted the deal could be worth up to $700 million for the state if the retirement fund could sign up 40,000 retired teachers.

The meeting notes show Insurance Commissioner Jose Montemayor, a Perry appointee, joined Morrissey in the sales pitch, claiming that "this arrangement" was already being utilized by "some very rich people" who had set up similar plans to benefit the University of Texas and Texas A&M.

"It was a pretty hard sell: 'This is something you need to get on board with,'" the source said, paraphrasing officials' comments at the meeting.

The source says the claim involving a similar program benefiting the Texas universities turned out to be untrue -- the "rich people" had taken out the policies themselves with the intent of sharing any life insurance payments with the universities. Montemayor, as insurance commissioner, would have had to waive "insurable interest" regulations to allow the schools to buy life insurance on their professors. There is no public record that he did so. The University of Texas and Texas A&M did not return requests for comment.

The aggressive push from the Perry administration differs remarkably from its later public characterization of its involvement in the deal. When the proposal leaked to the press that winter, the governor's spokespeople attempted to tamp down any notion that Perry was the engine behind the plan -- and said if there ever was a plan, it was nowhere near final.

That December, spokesman Gene Acuna told the Dallas Morning News that the plan was merely "a concept." "Questions are being answered, questions are being raised," he said. "Depending on the answers to those questions, plus input from all affected parties ... that will determine the next step."

In a January story in the Fort Worth Star-Telegram, another Perry spokesman attempted to create more distance between the governor and the plan. "We never endorsed any concept," said Robert Black. "The governor's opinion is that it's prudent to look at ideas and concepts ... particularly when it won't result in a loss of benefits or raising taxes to shore up the retirement system."

Messages left for Perry spokespeople requesting comment for this story were not returned. But the behind-the scenes meeting notes reveal Perry's office had not only endorsed the concept, but had already formulated a plan to implement it. That first meeting on Nov. 12 was run by Perry's staff. The man who would become the fall guy for the controversy -- former senator-turned-financier Phil Gramm -- was not even present.

THE GRAMM BARGAIN
Gramm had made six-figure campaign contributions to Perry's campaign and had been -- and may still be -- one of Perry's most trusted political allies and personal mentors. "Perry worships at [Gramm's] feet, intellectually," said one semi-retired political consultant in Austin. "He considers Gramm an economic genius."

After lending political aid to Perry, Gramm was poised to make a fortune from the life insurance deal. His role in the scheme had the appearance of banal corruption and cronyism.

Although Gramm wasn't in on the first meeting with teacher groups, he played an active role in subsequent efforts to push the scheme.

It was Gramm who could make the plan a financial reality. He left the U.S. Senate in November 2002 for a lucrative vice president post at UBS. After Morrissey, Montemayor and Perry budget aide Brian Guthrie first articulated the plan on Nov. 12, Gramm came to Austin to help push the deal. That move eventually prompted Texas Democrats to file an ethics complaint against Gramm for making a the pitch without registering as a lobbyist.

Gramm was hoping to put together a new package of complex assets for speculators to gamble on. Corporations had been using mass purchases of life insurance policies on their employees for years as part of an elaborate tax avoidance scheme (the government doesn't tax insurance premiums or death benefits). The employees themselves -- affectionately referred to as "dead peasants" among insurance experts -- received no benefit. Only the companies who bought the policies would receive payouts when these "peasants" died. Gramm wanted to convince investors to bet on peoples' lives by purchasing pools of life insurance and annuities taken out on individuals.

Gramm and UBS had concocted a gruesome combination of what are now regarded as two of the most infamous Wall Street scams on record. The resulting package closely resembled the growing market for mortgage-backed securities, but instead of allowing Wall Street to bet on peoples' homes, it would enable bets on peoples' lives.

Friday, May 20, 2011

America’s Healthcare Crisis is Getting Worse


by Roger Bybee


Gas at $4 per gallon (or higher) has left working families very cautious about using their cars during a time of falling wages, food-price increases and widespread economic insecurity.
Similarly, millions of Americans with health insurance are now afraid to actually use their insurance to seek treatment.

"I don’t think the American people want shared sacrifice. I think that they want shared prosperity."—John Watson of Chevron, testifying this month against a proposed $2 billion cut in oil-companies' annual tax breaks in a year when they are on track to make $100 billion in profits The reason: Employers have successfully shifted a huge portion of costs to their workers, so working families face such a daunting barrier of high deductibles and co-pays that they have become reluctant to go to the doctor or the hospital or request a particular course of treatment.

The New York Times’ Reed Abelson concisely captured the cruel reality that working families now confront while insurers rake in record profits and CEOs collect record salaries and bonuses:
The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.
The plight of typical patients was outlined in a Times interview with a California grocery worker:
For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.”
In just nine years, the cost of family coverage has doubled, from $9,235  in 2002 to $19,393 in 2011, Maxwell Strachan reported in the Huffington Post:
Take away costs paid by employers, and the employee's share of costs has still doubled. In 2010, the average employee paid $8,008 for his family's healthcare, up from $3,634 in 2002…. Of that $1,319 increase [in the last year], employers … paid for 48.6 percent of the increase, while the additional 51.6 percent was the responsibility of employees.
That $8,008 may easily consume 20 percent of many working families' incomes, meaning that rising health costs are fattening the profits of insurers while forcing families to cut back severely on spending, even for necessities.

A 'DEFECTIVE AND UNRELIABLE' PRODUCT
For-profit health insurance is a product that is “both defective and unreliable,” as Dr. Steffie Woolhandler of Harvard Medical School aptly depicted it.

Particularly disturbing is the growing trend toward high-deductible insurance, which provides no insurance until a very high level of expenses has been paid by the hapless family stuck with such a policy. These policies are spreading rapidly:
In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.
But while it is the worst of times for some, it is the best of time for those in the healthcare insurance industry.

Thanks to what CIGNA called “lower usage” that allow insurers to retain more premium income; profits are once again on a trajectory to set ever-higher profits.

Thus, insurers are directly profiting from Americans avoiding needed tests on troubling or suspicious health conditions, leading inevitably to patients being in a far more acute state when they can no longer put off seeking treatment.

Further, for-profit insurers continue to aggressively “purge” small-business accounts from coverage whenever someone in the group comes down with an illness that is expensive to treat, observes Wendell Potter, former CIGNA public-relation director and author of Deadly Spin. As Potter explains:
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 been declining for several years and why the number of Americans without coverage reached a record high of nearly 51 million last year.
According to the National Small Business Association, the number of small businesses that provide health insurance to their employees fell from 61 percent in 1993 to 38%.... Along with “rescinding” (cancelling) the policies of individuals who become seriously ill, purging small businesses that employ workers who get sick is a tried-and-true way of meeting Wall Street's expectations.
But even when seemingly sitting on top of the world with an ever-growing streak of record profits and the prospect of 30 million new customers required to buy insurance under the Affordable Care Act (ACA) passed into law last year, the for-profit insurers are pushing for more. As the Times' Abelson noted,
Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends…Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates.
In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals.
NEITHER 'SHARED SACRIFICE' NOR 'SHARED PROSPERITY'
The writing on the wall could not be clearer: the health insurance industry is not interested in either “shared sacrifice” via lower profits (i.e. lower premiums) or “shared prosperity” through covering the uninsured.

In sharp contrast to the incredibly slow implementation of the Affordable Care Act passed by the Democrats last year (it won't be fully implemented until 2014), Medicare managed to be up and running 11 months after passage in 1965, a feat all the more astonishing given the lack of computers were not universally available.

America's healthcare crisis—acutely felt by both the insured and uninsured—is getting worse. It will continue to do so, and even with the ACA in full effect, isn't likely to reverse course.

Saturday, May 14, 2011

Your Federal Government: Massive Insurance Company with an Army

By Kenneth J. Bernstein, AlterNet
Posted on May 14, 2011

... here’s the quick-and-dirty summary of what the federal government does: It’s a giant insurance company, mainly serving older people, that also has an army.

So writes Paul Krugman in his column--Seniors, Guns and Money-- today. Like most Krugman pieces, it is well worth reading.

I don\'t often write on Krugman, because I know others will.

But I am one of the leading (or bleeding) edge of the baby boomers - as I have noted, I turn 65 on the 23rd (although I will not retired from teaching for at least one more year). Thus Krugman was writing about me when he opined

And in case you hadn’t noticed, there will soon be a lot more seniors around because the baby boomers have started reaching retirement age.

Yes, we have.

I urge you to read the Krugman. I will touch on part of it. I will explore somewhat differently than does he.

First, Krugman does goes go after the 42 freshman Republicans who now want to "wipe the slate clean" so that they are not beaten up on for wanting to end Medicare. They are complaining about "Mediscare" tactics while conveniently forgetten their own use of scare tactics to get elected. Of course there is a difference - their support of the Ryan proposals would effectively end Medicare, while their rhetoric about "death panels" was flat out untrue. How nice to see them hoist by their own petard.

What is key is this:

Given the realities of the federal budget, a party insisting that tax increases of any kind are off the table — as John Boehner, the speaker of the House, says they are — is, necessarily, a party demanding savage cuts in programs that serve older Americans.

It is true that technically Social Security and Medicare are funded by separate streams, but while the former is effectively financially secure for the next few decades, the latter is badly underfunded, and its revenue stream will have to be addressed.

But then there is Medicaid. And this is critical. As Krugman notes,
... while Medicaid is often thought of as a poverty program, these days it’s largely about providing nursing care, with about two-thirds of its spending now going to the elderly and/or disabled.
He also calculates that in 2007 Seniors counted for roughly half of Federal spending.

Demographics present a problem. In that year, the ratio of seniors 65 plus to those of working age (20-64_ was 20.9 to 100. By 2020 that will rise to 27.5, and in another five years to 31.7.

Krugman also uses a rhetorical question from a Stanford professor who noted that the commitment of GDP to programs for seniors in 2007 was about 19-20%, as he argued for a freeze on spending on such programs.

Except there will be more of us. And medical costs continue to rise - here I note how much worse it would be without the changes we will see with Health Care reform, and how much better it would be with even more meaningful health care reform. We should remember that not only do Republicans want to slash support for programs for Seniors, they also want to gut health care reform.

Ultimately we will have to raise taxes to cover the additional costs for the bulge we baby boomers will impose upon the system. We already recognized that in Social Security, when what we and our employers have been paying in FICA was raised to provide a cushion for the impact as we reach retirement age.

But there is another issue, one upon which Krugman touches but does not explore thoroughly in the limited space of his column. That is the guns part of his title. There is a real question of whether our current pace of military commitment overseas, which goes far beyond Iraq, Afghanistan and Libya, is affordable at all. It is certainly not affordable unless we are willing to pay for what we are doing. Those costs are not merely those of military operations, but also the future costs of care for our wounded warriors. It is immoral to commit men and women to harm\'s way without also committing the resources to care for them when they are injured in national service, and to pay for the operations in which they are engaged.

If the United States wishes to remain as significant a military presence overseas as Republicans insist, then Republicans should be willing to pay for that presence, and not by cutting other programs. Too many people are profiting from war and conflict without coming close to paying their share.

In one sense, we are increasingly a nation in which selfishness is rationalized. You could hear that in the testimony of oil executives and the arguments on their behalf by Republicans who want to cripple the government by restricting its revenues and by Democrats such as Landrieu and Begich who as Senators from the oil patch seem to have a greater commitment to the energy companies than to the American people.

That is a failing of our society. It is one that should be addressed both by our religious and other moral institutions as well as by our public schools - of course some of the former distort and misread religious texts in order to justify selfishness and our public schools are in the process of being destroyed either so some can profit additionally or because some would rather impose training that excludes critical thinking, ignores the educational needs of minorities, and reduces America to profit motives and a Hobbesian world view where there is no Commons, no shared sacrifice (except of those in the military to protect their personal economic benefits).

My sense is that there is an opportunity right now to change the dialog. Americans reacted viscerally against the Republican proposals to slash Medicare. Too many still think that Medicaid is for other people, those "undeserving" poor people. But there are enough around who have already had to use it for their parents, there are increasing numbers who are realizing that given the disappearance of defined benefit pensions access to federal support for medical care becomes even more important.

I can only hope that those of us facing these issues that affect us directly do not so narrow our perspective that we fail to realize that to address our needs should require of us that we understand how many other needs there are in our society that the Republican approach would deliberately ignore.

Republicans do not want to pay taxes. Perhaps they do not want to receive benefits? Oh wait, THEIR benefits are fine, they just don\'t want to pay for those of anyone else. That includes not being willing to pay with their own bodies and those of their children in military misadventures that too often exist because we won\'t address other issues, such as our dependence upon petroleum increasingly derived from overseas. And no, more drilling at home and increasing fracking for natural gas does not solve the problem, it merely postpones the reckoning that is inevitable if we do not change our approach to energy and creates "collateral damage" that by itself should serve as an absolute bar to such an approach.

It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.

Four days after I turn 65 we should celebrate the 100th birthday of the man who offered those words, Hubert Humphrey. While I still work I am now entering the twilight of my life. I am able to keep working if I so chose, so I do not face the economic pressures so many of my generation will. One cannot realistically continue many kinds of work even to the age I now am, much less into one\'s 70s.

We have financial issues we need to address. How much of what we pay in taxes should be for guns, how much for Seniors, how much for all the rest of what government should do?

We also have moral issues to address. Who should pay, and how? What is our responsibility to those other than ourselves? What is our moral responsibility not to use our politics to try to turn one part of our society against another?

Krugman concludes by noting that the Democrats are telling the truth, not engaging in scare tactics:

Policy details aside, the G.O.P.’s rigid anti-tax position also makes it, necessarily, the enemy of the senior-oriented programs that account for much of federal spending. And that’s something voters ought to know.

I agree. They should know that.

They also should know that we need to rethink how all of our policies and politics interact. We should be aware of the consequences to those other than ourselves and our kith and kin.

There have been times when as a society we chose to act on a moral basis. Such actions gave women the vote, workers the right to unionize, minorities the right to equality in society. We recognized the need for oversight of our food and drug protections, regulation of railroads, providing for seniors with Social Security and Medicare, providing for the poor in many ways, including Medicaid. Remember, it was not so long ago that the largest portion of our poor were seniors.

Our politics should be moral. They should be about more than merely winning for its own sake.

And if our politics should be moral, so should our economics.

I am about to officially be a senior. Today I read Krugman. I had some additional thoughts.

Thanks for taking the time to read them.

Peace.

Corporate Demands, Federal ‘Reform,’ Keep Shifting Healthcare Costs to Workers


by Roger Bybee 
 
Despite its $14.2 billion in profits last year untouched by federal income taxes, General Electric is now demanding that its unionized workers accept a new high-deductible “Health Choice” health savings account plan.

GE’s demands are particularly obscene because it is sitting on $25 billion in savings and is threatening to close more U.S. plants, i.e. move more jobs to Mexico, China and elsewhere. And they're particularly dangerous because GE is modeling bad behavior for other corporations to emulate.

As UE-GE Conference Secretary Steve Tormey has said, “Nobody is more symbolic of the assault on workers than General Electric." The United Electrical workers union, one of a handful of unions now negotiating with GE, warned its members:
...numerous studies of these high-deductible plans...reveal that employees forced into plans like Health Choice are “significantly more likely to avoid, skip, or delay healthcare because of costs” than those with more comprehensive insurance. ...
What GE is really saying with Health Choice is that medical expenses are no longer primarily their responsibility, but that of GE employees.
But GE is only the latest entrant among employers trying to establish a new healthcare normal by thrusting heavy additional costs onto the backs of working families. And the much-trumpeted federal healthcare "reform" legislation may actually exacerbate this race to the bottom.

(Of course, public employers—like the state of Wisconsin, led by labor's arch enemy Gov. Scott Walker—have also been pushing to make public workers take up even more of the burden of healthcare costs. This despite the fact that, as David Cay Johnston has pointed out without managing to dent mainstream media coverage, public employees have always been paying 100 percent of their benefit costs. When they gained improvements in health and retirement benefits, they had to sacrifice on wage increases.)

How federal healthcare 'reform' helps drives the race to the bottom

The race to the bottom is, unfortunately, likely to be intensified as we get closer to fully implementing the Affordable Care Act in 2014. In fact, the ACA may well tend to establish a bare-bones, high-deductible policy as the new norm. The taxation of perversely mis-labeled “Cadillac” benefits has the very real potential of putting the squeeze on union-won healthcare benefits, especially in high-cost states.

Despite the efforts of AFL-CIO Richard Trumka and others to limit the damage created when the Obama administration suddenly adopted John McCain’s regressive idea of taxing better benefit plans to fund expanded healthcare coverage for the uninsured, it may not take long before fast-rising medical inflation pushes the dollar value of union-won health benefits up to the Cadillac level, as IUE-CWA Local 201 President Jeff Crosby has noted.

As Dr. David Himmelstein and Steffie Woolhandler wrote recently,
The insurance required under the federal ACA is no better than Massachusetts’ bare-bones plans. And as employers emulate this inadequate coverage, the race to the bottom leaves an increasing number of Americans UNDER-insured. Public workers are just the latest group to see their coverage downsized.
What used to be called “health insurance” is now labeled “Cadillac coverage” – and reserved for those who drive Mercedes.
Himmelstein and Woolhandler remind us that the Democrats’ ACA plan was based on the Massachusetts model passed in 2006 with Gov. Mitt Romeny's signature, and whose “achievements” are much less than splendid. Bankruptcies caused by catastrophic medical costs, which account for over half of all bankruptcies, are still rising in Massachusetts, they state:
While only 4 percent of the state’s residents remain uninsured, much of the new coverage is so skimpy that serious illness leaves families with crushing medical bills.
For instance, the cheapest (and most commonly purchased) coverage available to a 56-year-old Bostonian through the state’s health insurance exchange costs $5,616. Yet, if you’re sick, the policy doesn’t start paying bills until you’ve paid a $2,000 deductible. And even after that you’re responsible for 20 percent of the next $15,000 in medical expenses.
Insurers try blackmail

By basing itself on the Massachusetts plan which keeps for-profit insurers as the parasitic middlemen at the core of the healthcare system, the ACA sacrificed the potential for comprehensive, high-quality benefits covered from the first dollar.

This potential has been underscored in the fight over retaining ACA’s requirement that 80 percent of premium revenue be used by insurers to provide healthcare and improve quality, freeing up 20 percent for profit, bureaucratic overhead, and sales and promotion.

No less than nine states are seeking waivers from the 80 percent requirement, falling prey to insurers’ blackmail demands. Insurers are threatening to stop selling individual coverage in a number of states unless they can spend, in several cases, just 65 percent on paying for healthcare and quality improvements.

Both the states and the Obama administration are petrified by this coercive technique. The Obama administration’s timid mentality was revealed in this statement by Robert Laszewski, a consultant to the health care industry and a former insurance executive. "The last thing the Obama administration wants is the Des Moines Register writing about 500 people who lost their health insurance in Iowa because of the Obama health plan," he chortled.

Single-payer destiny?

The emerging situation is not pretty. Major corporations and right-wing state governments are fighting furiously to shift more costs onto workers and their families. Instead of setting a new, higher standard, ACA effectively serves to reinforce a new lower standard of “acceptable” coverage. Given this, the limitations of the ACA may become very obvious very quickly both to the public and Congress.

There may even be a possibility that that the essential need for maximum-strength single-payer or “Medicare for all” healthcare system—unburdened by for-profit insurers—will become evident much faster than most have imagined. (Sens. Bernie Sanders (I-Vt.) and Rep. Jim McDermott (D-Wash.) introduced  single-payer bills in Congress this week; Vermont has now passed its own single-payer system into law.)

Himmelstein and Woolhandler make the case concisely:
While the ACA can’t live up to its “affordable care” moniker, a single-payer reform could save $400 billion annually on administrative costs, enough to offer every American first-dollar, comprehensive coverage. While U.S. insurers fight tooth and nail against the 20 percent limit on overhead, Canada’s single-payer program runs for 1 percent.

Wednesday, September 22, 2010

Private Health Care Insurers Skirt New Health Care Law

(Is there anyone else left in the country who doesn't understand that the insurance industry--particularly the health insurance industry--is run by scumbag assholes who are interested in nothing but profits--NOT your health or especially the health of your children, particularly those with health problems? If not, raise your hand and read this article or the others I've posted about the subject. Insurance executives are the scum of the earth. They are corporate Hitlers and deserve the bad that will happen to them if they keep denying sick children unabated access to health care.--jef)

***


Democrats were extra proud when they put a requirement that insurance companies cover children with pre-existing conditions in their new health care law. Now, I bet the CEOs at the country’s largest for-profit insurance companies are even more proud of themselves for easily finding a way around this regulation: simply stop offering child-only policies. From the Denver Post:
At least six major companies — including Anthem, Aetna, Cigna and Humana — have said they will stop writing new policies for individual children not covered by their parents’ or other plans, insurance officials said.
They blamed health reform mandates taking effect Thursday requiring companies that write such policies as of that date to also cover sick children up to age 19.
Of course, President Obama and the rest of the Democrats have already begun pretending to shake their fists in anger at the insurance companies for being evil and putting profits over people. From the Washington Post:
But officials of the Obama administration said the move contradicted a letter from the leader of one of the insurance industry’s most important trade groups after the law’s adoption in March. Karen Ignagni, president of America’s Health Insurance Plans, expressed support for the law’s provisions concerning children with preexisting conditions and promised to “fully comply” with them.
“We expect [insurance companies] to honor that commitment. Insurers shouldn’t break their promise and turn their backs on some of our most vulnerable Americans,” said Jessica Santillo, a spokeswoman for the Department of Health and Human Services.
Frankly, the complaining from Obama is just sad. Either it is hollow grandstanding, or Obama actually thought that the private, for-profit health insurance companies were honest brokers he could trust to not try to find loopholes in the new regulations. If it is the latter, President Obama’s much-touted intellect needs a reevaluation.

At this point, for Democrats to blame the for-profit insurance companies is pathetic. Private insurers are the scorpion in the story of turtle and the scorpion. They have proven for decades they will do anything to avoid regulation, and will always put profits over the health care needs of regular Americans. Heck, by law, as for-profit corporations, they are required to put profits over everything else. Democrats let insurance companies hop on their back, and now they are smack-dab in the middle of the river with them. Don’t scream when they sting you–it is just their nature.

Of course, watching this recent action should fill all Americans with dread. Democrats actually chose to expand coverage to millions by forcing them to buy insurance exclusively from these same misbehaving private companies. If Democrats really believe the job of the government is to insure every American, then they should have had the government do it directly–and more cost effectively–through expanding Medicare for all or a public option, instead of outsourcing it to untrustworthy private insurers that put profits before people.

Signs don’t point to sunny skies ahead

This most recent revelation, cutting out new child policies, combined with the latest massive and apparently unstoppable rate hikes is just more proof of what I spent months warning about: the new law leaves the health insurance companies completely unchecked and the regulations are almost meaningless due to a lack proper enforcement. Frankly, given the billions at stake, and the drive of the for-profit insurance companies to maximize profits, I don’t even know that a really well-designed regulator system could prevent insurers continuing to exploit loopholes.

This might be one of the first examples how, due to poor design, weak regulation, and weaker enforcement, the new law fails to live up to expectations, but I promise you (as someone who read the entire law thoroughly, which apparently even Sen. Max Baucus didn’t) it won’t be the last.

***

(I too read just about every page of the law and there are a ton of potential--and purposefully included--loopholes the scumbags of the for-profit health insurance industry will exploit. There's the other loophole for denying adults with pre-existing conditions: purposefully underfunding the account that will pay for their medical requirements so that when the full law goes into place in 2014, those with pre-existing conditions who expected to be covered won't be. There are many more that will come to light soon enough. I've listed several here on my blog and in discourse with others on Google Buzz.


When you allow corporate/industry lobbyists to write ALL of your laws, you should expect them to include as many loopholes as they think they can get away with. And they will keep doing it as long as THEY ARE WRITING THE LAWS!!!


This law will go down in history as one of the biggest fleecings the corporations have ever put over on the government. And it will be Obama's legacy.--jef)

Saturday, March 6, 2010

"Justify High Rates"

Justify High Rates, Health Secretary Tells Health Insurance Execs

by Diana Carlton

WASHINGTON - Health and Human Services Secretary Kathleen Sebelius told insurance executives Thursday that their companies should be more transparent when they seek higher premiums amid what she called "jaw-dropping rate increases" from California to the East Coast.

"The top five largest for-profit insurance companies filed earnings of $12.2 billion last year while dropping coverage for 2.7 million Americans," Sebelius said. "It just doesn't make a lot of sense to people across America frightened that they're being priced out of the market."

The CEOs of UnitedHealth Group Inc., WellPoint Inc., Aetna Inc., Health Care Service Corp. and Cigna Corp. attended the meeting with Sebelius at the White House, along with officials from the National Association of Insurance Commissioners.

Sebelius later said the meeting "focused on what is happening with the kind of jaw-dropping rate increases that people are seeing."

President Obama dropped into the meeting briefly to hand the insurance executives a letter from Natoma Canfield, a cancer survivor of Medina, Ohio, whose health premium increased over 40 percent this year, according to Sebelius.

With comprehensive health care legislation struggling on Capitol Hill, the White House is trying to focus public attention on the record-setting insurance premium increases being announced from Connecticut to California.

Sebelius said she asked the companies to file their rate requests online, along with actuarial data that supports those requests, to give transparency and justification for raising the rates.

"Put it on a Web site, tell us what your loss trends are," she said. "Tell us what you're paying out. Tell us what you're spending in overhead and CEO salaries and advertising."

WellPoint executives have blamed their rate increases in California, which average about 39 percent for individuals, on rising medical costs and a pool of customers that is gradually becoming older and sicker as younger, healthier people drop their coverage.