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Quick thought: our elected officials are catching heck for not holding more town hall meetings to answer to their constituents for their health care policies. But why don't we hear similar cries for the folks in charge of our health coverage now, our insurance agents and their managers and CEOs, to hold town halls and explain their inefficiency, their exclusion of maternity and pre-existing conditions, their unfair legal tactics and anti-competitive practices?
Surely we have at least as much cause to be enraged over the actual harm done by insurance companies and the 22,000 Americans dying for lack of health insurance each year as we do over the potential problems in an evolving House bill that hasn't even had floor debate yet.
But do I get to march into Tim Campbell's office and shake in his face a poster showing him with a Hitler mustache? I think Monica would come from behind the desk and throw me out on my ear (and I'd have it coming).
Do I get to call for the firing of the folks running DakotaCare for their unwillingness to take hard questions about fascism and euthanasia at a public meeting called by local political agitators?
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Trying to move the shells around in your healthcare blame shell game won't work. Elected officials are elected officials. Elected by the public to represent the public who votes for them and supports them in campaigns. They have an obligation to present themselves to the same public who elected them and we, as good citizens, have the right to offer opinions and ask hard questions about the most sweeping healthcare changes in 70 years. Most people would agree that we need to make changes to our healthcare system, but you stated it correctly, the evolving healthcare bill is a moving target, unclear, unfinished and not understood. It is directly related to the person who wants healthcare the most (along with Nancy Pelosi). The same person who has still not presented his healthcare proposal to Congress, as a presidential leader should. No wonder people are upset. Nobody knows what the final bill will be and how it will affect each of us. Keep the target where it belongs. Our elected leaders.
ReplyDeleteAnd that's exactly why I'd rather have a single-payer system: my government is obligated to be publicly accountable. Insurance companies apparently are not. (Curious, Rod: will you and Randy be holding any joint public meetings on rising premiums and other issues in the insurance industry?)
ReplyDeleteOf course Rod is going to defer any debate to politicians. He is part of an industry which contributed $46,819,206 to campaigns in the 2008 election cycle. The politicians have his back, he's got nothing to worry about.
ReplyDeleteMark O'Loughlen
I'm sure if we felt holding a joint public meeting with all health insurance agents would be productive, it would happen. Unfortunately, agents don't make the rules or set the rates. We simply offer the products to our clients and try to console them when healthcare rates increase at four times the rate of inflation each year.
ReplyDeleteA task force needs to be created to identify the problems and come up with solutions that will assist a larger number of people to obtain and keep healthcare. It cannot be driven by the federal government, other than creating the task force of public, private and healthcare professionals.
Nobody is arguing that we don't need reforms, but reforms and overhauls are two vastly different things. As I said before, the healthcare target is still moving, so until you have a firm package to present to Congress and the public, there will be unrest and questions. Frustration and fear are powerful emotions and you're seeing that in public forums.
Cory, you say our gov't is obligated to be pubicaly acountable. That's what we are trying to get our elected reps and sens to be, and you see how that is working out here in SD?! Just why should we trust a fed bureaucracy offering the only health care option available or allowed, operated and funded by the fed gov't itself, to be anything other than a monopoly answerable only to itself?
ReplyDeleteOops, forgot my name again. I'm proud to sign these posts!
ReplyDeleteLinda M
Linda:
ReplyDeleteI would direct your attention to:
http://www.pbs.org/moyers/journal/07312009/profile.html
The private insurance agencies are not actors for the public good. There is no accountability. Their only motive is profit, as our economic systems dictates.
As this former insurance company board member states, they don't look out for your best interest, that isn't their charge. If you get sick, it is their obligation to try to avoid paying you because it maximizes their profits. That is what the private sector does.
However, the government can be altruistic in nature. Its charge isn't to be profitable. WE the people can define its objective. If we decide that its job is to make sure that everyone sick gets taken care of to the best of our collective ability, then it can happen.
Let me reiterate: PRIVATE INSURANCE CANNOT DO THIS. It would be irresponsible of them to try to do so. Such companies exist to make profits, not to make sick people better.
Tony, in an ideal gov't situation, you statement has merit. However, I do not trust this gov't. I do not trust that it has my best interest at heart. I do not trust it to make the best use of any tax dollars. I do not trust it to tell me the truth. And I do not trust the massive power it is amassing. I do not want it to get its sticky fingers anywhere near my health care. That doesn't mean that the insurance companies are perfect either, but I just might trust them more than the present administration. And if you listen to the town hall meetings, many, many people feel as I do.
ReplyDeleteLinda M
Tony, I really take offense to your comment, "If you get sick, it is their obligation to try to avoid paying you because it maximizes their profits" while discussing private sector health insurance companies.
ReplyDeleteYes, companies in a capitalistic society do strive for profit versus loss, but you are blanketing every health insurance company as fraudulent and uncaring, and that simply is not true.
Case in point, my wife is in her eighth month of fighting breast cancer. Tally so far, just over $80,000 with surgery, chemotherapy, radiation and doctor visits. Wellmark Blue Cross Blue Shield is our provider and all we've paid is our monthly premiums, deductible and some co-pays. They have only turned down one test, the BRCA1 BRCA2 genetic test to determine whether she would pass the breast cancer gene on to our daughter. We understand that the test was not necessary to treat her cancer.
There are companies who have been in the news for declining just about every claim, but just like everything else in life, those few bad apples don't reflect the majority of ethical health plans who do what their contracts require.
It is a health plan's obligation to cover that which it is contractually obligated to cover, so read the contract before you buy (I know, nobody ever does that). I'm sure there are gray areas that crop up, but for the most part, those who have healthcare with a quality reputable company get what they pay for. We all just wish we could pay a little less, although I'm not complaining this year.
Goldman:
ReplyDeleteI'm not attacking anyone personally here and I'm glad to hear that your wife is receiving the care that was agreed upon. I hope that everyone can receive such good treatment from their insurance providers.
However, my argument is that if we are to ask ourselves, which entity is best suited to providing such care, I still believe it resides in the public realm. Our capitalist system is setup in such a way that maximizing profits is the only objective. That is all. Good service, due to competition to maximize profits, can be one outcome. Do not forget though, that denial of care and being dropped from insurance plans are tools that allow a company to maximize its profits also. In the PRIVATE sector either option is perfectly legitimate. Please listen to the board member of a major insurance company say just that! (as I posted above) Not my word, the words of someone who helped run a major insurance company with MILLIONS of clients!
This is the inherent and impossible to correct problem with our private system. It cannot be repaired. Perhaps massive amounts of regulation, but that's just turning them into public trusts and removing them from the private sector. Which is what I view must happen.
Rod, it appears you didn't take the time to read the link Tony provided. Allow me to quote from it at length:
ReplyDelete"Among the other testimony heard by the Committee on Commerce, Science and Transportation was that of Robin Beaton. It reflected some of the insurance company tactics condemned by Potter.
It was a nightmare scenario. The day before she was scheduled to undergo a double mastectomy for invasive breast cancer, Robin Beaton's health insurance company informed her that she was "red flagged" and they wouldn't pay for her surgery. The hospital wanted a $30,000 deposit before they would move forward. Beaton had no choice but to forgo the life-saving surgery.
Beaton had dutifully signed up for individual insurance when she retired from nursing to start a small business. She had never missed a payment, but that didn't matter. Blue Cross cited two earlier, unrelated conditions that she hadn't reported to them when signing up — acne and a fast beating heart — and rescinded her policy.
Beaton pleaded with the company and had her doctors write letters on her behalf to no avail. It was not until Rep. Joe Barton (R-TX) personally called Blue Cross that her policy was reinstated and she could undergo surgery. In that year, Beaton's tumor doubled in size, leading to further complications necessitating the removal of her lymph glands as well.
The practice is called "rescission" and Beaton's is not an isolated case. The House Energy and Commerce Committee found that the major private health insurers had rescinded the policies of approximately 20,000 people in a five year period, to avoid paying out approximately $300 million in benefit claims.
Appearing before the same committee, CEOs of the major health insurance companies stated that they would continue to use rescission, arguing that it is a necessary protection against fraud and abuse."
The link again is: http://www.pbs.org/moyers/journal/07312009/profile.html
Let me say, too, our best wishes go to your wife, Rod. At the same time, I can see no cause for offense at Tony's words. He expresses a truth of the market (just like my truth that private insurance companies are less accountable to citizens than our elected officials and the public bureaucracy). And Erin points out a vital and scary point: even if you think you are following the contract to the letter, the insurance companies can and will look for ways to break that contract and save themselves money, regardless of the medical reality or the morality behind your claim.
ReplyDeleteAs an insurance agent, you may have a leg up on keeping your insurer honest and protecting your own coverage. But even if every citizen could spend all day working with insurance, we would still see profound health insecurity and the market-skewing impact of unaffordable, untransferrable insurance, pre-existing condition exclusions, and rescission.
Your wife's condition is one more reason I'll keep arguing for national health insurance for everyone, guaranteed, cradle to grave.
" ... the insurance companies can and will look for ways to break that contract and save themselves money, regardless of the medical reality or the morality behind your claim."
ReplyDeleteAbsolutely true! This brings up my number one concern about any sort of public plan.
If sign up for a public plan (which I might do, if it becomes available), or if we go to a completely socialized medical delivery and payment system (which in theory I favor), why should I believe that the government will treat me any better than the insurance companies do?
Stan, I can make no promises. But I look at it this way: I have a lot more authority to walk into the courthouse or some other public office building and raise my voice over poor service than I do to walk into a private office building and do the same. Even though some other bloggers made fun of this post by saying I show a childish lack of understanding of the difference between government and private business, that difference in accountability is exactly the point of this post. The government by defintion and Constitution has an obligation to respond to us, regardless of how much we pay in taxes or whether we even voted for the officials in charge.
ReplyDeleteSome of the issues we're all concerned about, recission (Erin, Robin Beaton appears to have lied on her healthcare application which is grounds for recission) , seamless transferring from one company to another, unfair riders for pre-existing conditions and other concerns can be repaired through legislation without revamping the entire system. It is no different than the recent credit card rules clampdown.
ReplyDeleteControling the cost of healthcare is another challenge. Medicare and Medicaid have agreed pricing which is pennies on the dollar for procedures doctors perform. Insurance companies negotiate pricing at half price or less of the full cost of procedures, but if you walk in with no insurance, you pay 100% of full cost unless you negotiate on your own, usually after you get the bill.
How do you maintain continued research and development without stifling advancements in medicine through cost controls?
I still maintain that a diverse task force can identify the issues and create a plan to solve them, rather than Congress, President Obama or the Senate, who have limited vision.
Task force? What a dodge. We've piddled around for 15 years since the last time fear-mongering and lying conservatives killed a serious effort to reform health care. Any other delay tactics you care to propose?
ReplyDeleteAnd on Ms. Beaton: "lied"? Come on: she failed to report acne. Yes, technically, the insurance company can cut her for that. And if she had reported it at the beginning, I imagine the company could justify turning her down because of this dread condition that had nothing to do with the breast cancer she later got. So what's she to do: just go without insurance because she had acne?
But hey, liars don't deserve health care. Neither do pimply teenagers. Neither does my mom, who had a heart attach a few years ago and who fell on the rocks by the lake and broke her finger this summer. She's clearly too much of a risk to a good company's profits.
Thank you, Rod, for making clear the thinking that explains why we need a more moral health insurance system than the private sector can provide.
And do you remember the Zaniya Task Force here in South Dakota? They met all summer in 2007, and I don't recall any of their suggestions fueling major legislative debate. "Task force" is code for "let's put off taking action."
ReplyDeleteYou mentioned acne, but not Ms. Beaton's rapid heart beat, which she failed to disclose. In my opinion, the company should have simply surcharged her for the premium they would have charged had she been honest in the first place about her medical history, and they should have covered her cancer treatment immediately. Maybe they would have denied Ms. Beaton's application initially, who knows?
ReplyDeleteI'm not trying to skirt or delay the issue, but it makes no sense to have Senators and Congressmen who know nothing of healthcare, other than they get it free on the taxpayer's backs, decide what reforms are needed or to create a government option or single payer plan.
Bring in Tom Daschle if you feel he is the person to drive the wagon, bring in select respected physicians, insurance companies, pharmaceutical reps, hospitals, nursing home providers and researchers and within one year, you'll have a comprehensive plan that people will accept.
No diversion here, no delay, but an educated, methodical way to identify the issues and address each one in a new comprehensive way of providing healthcare to more people and controling future costs. Patience will help patients.
Goldman:
ReplyDelete"I'm not trying to skirt or delay the issue, but it makes no sense to have Senators and Congressmen who know nothing of healthcare, other than they get it free on the taxpayer's backs, decide what reforms are needed or to create a government option or single payer plan.
Bring in Tom Daschle if you feel he is the person to drive the wagon, bring in select respected physicians, insurance companies, pharmaceutical reps, hospitals, nursing home providers and researchers and within one year, you'll have a comprehensive plan that people will accept."
As soon as you bring in insurance companies the game is over. THEY DO NOT CARE ABOUT THE HEALTH OF THEIR PATIENTS. Paying for care reduces their profits. And if any regulations are put in place they will find a way to get around them to make more profits. THAT IS THEIR JOB!!! MAKE MONEY. Not make people better.
"You mentioned acne, but not Ms. Beaton's rapid heart beat, which she failed to disclose. In my opinion, the company should have simply surcharged her for the premium they would have charged had she been honest in the first place about her medical history, and they should have covered her cancer treatment immediately. Maybe they would have denied Ms. Beaton's application initially, who knows?"
Don't you see the inherent problem here. This woman bought insurance, did everything right, and got screwed because of the profit motive. Even in the best case with our private system, you can still and will probably lose. So either we can regulate the insurance industry until it's a public trust like the power/water companies out there or just nationalize the whole thing. Either way, the solution is a public system.
Lastly, what exactly does an insurance company do that benefits us as a whole vs. a public system? They have a much higher overhead rate, will try to drop you if you get sick, and if you get sick while not having coverage will not cover you or help with your treatment. The only possible argument would be to reduce the cost by negotiating with health care providers but a large public system would have so much more bargaining power that even this possible advantage is moot.
Competition you say? We've had "competition" for decades now and guess what it leads to: people being dropped when they get sick because it costs the companies money.
Freedom of choice you say? Choice is good but only when you have a selection of options, some of them good and some of them bad. Right now, all of the possible choices are bad. Also, a public option increases choice, does not decrease it. (competition is making our possible choices worse, not better)
Tony: Your comment, "This woman bought insurance, did everything right, and got screwed because of the profit motive" makes no sense at all. She didn't do everything right. She "lied" on her healthcare application by not declaring her full medical history and when the company discovered it as she started to use her healthcare plan, they initially declined her coverage, but later, under pressure, covered her treatment.
ReplyDeleteI agree that this situation should have been handled much more quickly and delicately, but don't tell me that the government will handle it any faster or with less hassle. Wait until you qualify for Medicare and the prescription drug plan. Nothing worse than our elderly trying to figure out the paperwork and jump through government hoops.
Dave Billion is still waiting on $1.4 Million in Cash For Clunker Rebates (300) from Obama's crew, and talk about HOOPS to jump through! That was for only 475,000 vehicles nationwide. Imagine the nightmare of handling 50 Million younger people or more for their healthcare issues.
This issue certainly isn't going away, and we probably won't solve it here in Madison, SD.
Goldman:
ReplyDeleteFirst, neither acne nor a fast heart rate lead to cancer. The insurance company was grasping at straws to drop her from the plan to save money. The insurance company was completely in the wrong here.
Second, you provide no argument for why private health insurance is better than a public option. Instead, you attack existing systems and say that this obviously means a public system would be bad, but of course do not provide evidence for your position or define a metric for success.
Let's define a metric for success. I'm going to define it as customer satisfaction with health care. Please refer to:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
All of these nations have "socialized" care and rank substantially higher in customer satisfaction, pay way less for care, and live longer than Americans!
Also, CAH has pointed out that both of our socialized health care programs (medicare/VA system) have substantially higher satisfaction rates than the private system.
Please, point me to a metric that shows private insurance is better. Don't just scream out the guberment is going to screw it up because it's the guberment. THE GOVERNMENT programs have higher rate of satisfaction and cost less than private programs per person.