Healthcare Industry Stifles Healthcare

[Don1]

In the http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/23/BU7NV7CSI.DTL&type=health">news today is a story about a woman who lost her healthcare right in the middle of breast cancer treatment. Health Net corporation claimed that she lied about her weight and a heart condition on her application. As a result, she had $129,000 in debt and doctors stopped treating her because of her inability to pay them. A judge found that the insurance company screwed her over and the judge awarded her $9 million. Who knows if she will get a chance to use that money because there have been health complications since then.

Some may wonder if $9 million (total from punitive damage, paying for the healthcare and emotional distress) is the "right" number to award the woman. There is a clue in the article to figure this out:

Hundreds of cases in California have been settled quietly in confidential agreements.

Hundreds have gotten themselves a lawyer and won out-of-court. So, how many never got lawyers in the first place? How many did lawyers turn down? Thousands? And this is just in California....Across the whole US? Tens of thousands?

During the case http://www.cbsnews.com/stories/2007/11/09/eveningnews/main3482856.shtml?source=mostpop_story">it was revealed that Health Net had a policy to give bonuses to reviewers who dropped more people (just like Michael Moore said in SiCKO):

Documents Health Net was forced to hand over reveal senior analyst, Barbara Fowler, single-handedly dropped hundreds of policy holders like Bates from the rolls every year.

The shocker: the company awarded her bonuses based on how many policy holders she dropped.

Who knows the number, but insurance companies like Health Net are not going to rescind policies as a general rule when people get sick unless it is financially worth it to them. If judges typically award punitive damages one or two orders of magnitude higher than the cost that the insurer would have had to originally pay ($9 million versus $129K), then you can expect that to be 'worth it', that insurance companies are rescinding policies and not getting caught an order of magnitude more frequently than they have to pay up. So, $9 million makes them screw people over less. It's the right number.

Of course a better system would be to get the corporations who are out for themselves out of the system in the first place: universal healthcare.

[PA Democrat]

1. I had a problem with my former insurer refusing to pay a claim

based upon a purely fictional "preexisting condition". It was the threat of a lawsuit and a complaint to my state's insurance department that finally made the crooks pay up.

However, this same company (Assurant Health, formerly known as Fortis) has been successfully sued, and has had HUNDREDS of complaints filed with various states insurance departments for this same problem. During one lawsuit a former employee told of bonuses based upon the percentage of claims denied. The company continues this corrupt and sometimes deadly practice because the worst they get is a slap on the wrist, and occasionally, someone successfully sues them.

It's still more profitable for them to be corrupt and keep denying claims based upon manufactured reasons. IMHO, these bastards need to be personally prosecuted for theft, manslaughter, or whatever charges may apply, and the company should be put out of business for repeat offenses.

[Don1]

3. You Hit the Nail on the Head

"It's still more profitable for them to be corrupt and keep denying claims based upon manufactured reasons."

For every person like you who has won a case, there are N people who did not win their cases or never had the opportunity to even begin a case against them. The per-person-value-of-dropping-insurance x N > cost of lawsuit of 1 person. It's their cost-benefit analysis.

IMHO, the core problem is not the values in the formula for profitability but the formula itself. If there is no formula (because there would be a not-for-profit universal healthcare system), then there would be no issue of insurers trying to optimize the values for their self-interest above that of the insured.

[Warpy]

7. They budget for lawsuits like yours

because they're generally cheaper than providing care to everyone who needs it. They know most people will just roll over and die quietly.

For profit insurance makes money three ways: denial of coverage to anyone who presents a risk of getting sick or who already is sick; denial of partial of even whole coverage of approved treatments because some computer model has been violated; and denial of timely and appropriate treatment, often leading to the death of the patient through a lengthy appeals process.

Face it, these ghouls are killing us even if we pay them every month.

They should be the first up against the wall come the revolution.

[Don1]

10. Zackly. n/t

[jtrockville]

2. The health insurance system prevents health care.

It should be abolished.

[Don1]

4. I agree.

Problem is that the news media paints a different reality for people so that it is hard to see. And Congress is on the take.

[PA Democrat]

5. The MSM also benefits from the status quo. Think of all of the ad revenue they would lose without

ads for health insurance companies and prescription drugs.

[Don1]

8. True.

Gloria Steinem did a good piece on that years ago.

[warren pease]

6. That's because there's no relationship between health care and medical insurance...

...except in the fevered brains of the hundreds of delusional Milton Friedman clones running around polluting the public discourse declaring that "free market" solutions are always superior to government-run programs and that health care is too important to be left to the people who run the post office, blah, blah, blah.

This leaves us in arguably insane situations like the one described in the OP, and that case a couple of months back when Cigna killed that kid Nataline Sarkisyan by denying her a liver transplant.

But here's the thing. The relationship of health care to health insurance is manufactured out of thin air by the US obsession with applying market-based, privatized solutions to nationalized, systemic problems.

Health care is what happens when patients and health care professionals interact to successfully diagnose and treat a medical condition or injury.

Health insurance is the protection money you have to pay the middleman to enable this transaction and keep you out of bankruptcy court.

Why would anyone want to give a single penny to some parasite intermediary that skims billions while doing absolutely nothing to provide health care?

But the US, unique in the world in its child-like belief in corporate good citizenship, expects these rapacious profit machines to completely abandon the legal requirement that they churn out ever more money for their shareholders and, instead, act in the best interests of their customers.

I don't know what it's going to take to get people in the US to wake the fuck up and discover for themselves that, gee whiz, I really AM getting screwed here. Given media narcotization and status quo propaganda, maybe it's impossible.

I have boundless faith in the American people to ignore self-interest and choose the course most likely to result in shooting themselves in the foot. Some day, it's going to be an entire country of wheelchair-bound morons with feet perforated like swiss cheese. But by christ, they'll still have their free-market medical extortion system intact.


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[Don1]

9. Funny

This visual is incredibly funny:
"I have boundless faith in the American people to ignore self-interest and choose the course most likely to result in shooting themselves in the foot. Some day, it's going to be an entire country of wheelchair-bound morons with feet perforated like swiss cheese. But by christ, they'll still have their free-market medical extortion system intact."

When it comes to this, though, people will get up and we will have a real democratic revolution on our hands. Sometimes, it has to get worse before it gets better.

[warren pease]

11. How much worse can it get...

... and how much more shit will people swallow? From here, it looks like the answers are a) plenty, and b) as much as is shoveled down their throats.

I really thought critical mass for a 20th century health care system would have been reached a decade or two ago, and that it would have eventually become a litmus test to weed out candidates who didn't support single-payer, universal-access health care.

And yet, Kucinich makes that a key part of his campaign and he's branded a left wing radical loon and literally removed from the public consciousness by our media gatekeepers, their corporate masters and his own goddamn party. Now we have two left standing: Ms. Clinton, who has accepted around $10 million from the for-profit medical biz -- pharma, medical facilities, the AMA, HMOs, other insurers, hospital chains and so forth.

Mr. Obama, with the second tallest pile of money from the for-profit medical establishment, is also a darling of Wall St., which is where the for-profit medical biz dumps all its extra cash, taking yours and my money spent on obscene premiums, skimming about 35 percent off the top that might otherwise go to pay medical claims, and investing it in hedge funds in hopes of making even more money for themselves while constantly taking even more money from us.

Amazingly, this is called the American health care system, and I've never seen a politician or industry shill break down and laugh uncontrollably when attempting to justify it. Talk about incredible self-control...

There's enough well-annotated information, enough advocacy groups, enough web sites, enough studies, enough white papers, enough case studies and enough testimonials out there for people to find out for themselves how utterly screwed they're getting by for-profit medicine. If they choose to take the three monkey approach and prevent their senses from absorbing it, then fuck 'em and their decrepit little minds. Unfortunately, in the process of fucking themselves over, they're fucking us over, too. And that's what REALLY pisses me off about this whole situation.


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