Monday, September 7, 2009

Your Health Insurer Will Screw You

The Huffington Post
September 7, 2009
Peter J. Ognibene

Got health insurance? Think you're sitting pretty? Think again.

Health insurance companies fatten their bottom line not by helping people but by screwing them.

For-profit companies make money three ways:
First, they use medical underwriting, which is industry shorthand for finding ways to reject those applicants most likely to need care. Not only people with serious illness are denied insurance; so are individuals who may be 20 pounds overweight as well as those with acne or an old athletic injury.

Second, health insurers routinely weasel out of, or delay for months -- even years -- making payments for valid medical and hospital claims.

Third, they look for plausible reasons to reverse payments they have already made on your behalf. These reversals can occur one or more years after you thought your bill had been paid. And when a physician or hospital has to refund a payment, guess who gets the bill. You.
And it doesn't stop there. Investigative units routinely look at individuals who have been seriously ill to see if there's anything in their medical or prescription history they can use as a pretext to terminate their insurance. The industry term is "rescission."

Many large organizations -- municipal agencies, major corporations and labor unions -- have the negotiating power to eliminate exclusions of so-called pre-existing conditions from their employees' health insurance policies.

Small companies often do not. Worse still, individuals who lack the negotiating leverage that organizations exercise on behalf of their members wind up paying the highest rates for coverage and then are left to hope they won't get trapped by one of their policy's many exclusions or loopholes. When such individuals have the audacity to incur a major illness, you can bet the companies will look for ways to screw them -- with delays, payment reversals or outright rescission of their insurance.

Many who work for health insurers quickly learn that the surest way to get ahead is to screw as many policyholders as they can.

Recent documents obtained by the House Committee on Energy and Commerce indicated, for example, that Blue Cross of California awarded a perfect evaluation score to an employee whose efforts to rescind the insurance of thousands of policyholders saved the company nearly $10 million that would otherwise have paid their doctor and hospital bills.

This is no isolated case. If you get cancer or need expensive surgery, your insurance company is likely to investigate every medical claim ever filed on your behalf, the prescriptions you have taken at various points in your life and any lifestyle elements that might give them a pretext to reverse a payment or rescind your insurance.

In recent testimony before the same House committee, Karen Pollitz, Research Professor at Georgetown University Health Policy Institute, pointed out:

Representatives of the insurance industry have testified that rescission is rare and occurs in less than one percent of policies. Even if this estimate is accurate, it is not necessarily comforting. One percent of the population accounts for one-quarter of all medical bills. The sickest individuals may be small in number, but they are the most vulnerable and most in need of coverage.

Most individuals who have a job get health insurance through their employer. Yet, employer-based health insurance makes no sense in the modern world. It is an artifact of World War II when companies were desperate to attract and hire workers but were bound by federal wage and price controls from writing higher paychecks. So, companies competed for workers in other ways, including health insurance.

Two years ago, the Congressional Research Service issued a report, "U.S. Health Care Spending: Comparison with Other OECD Countries," which found:

The United States spends more money on health care than any other country in the Organization for Economic Cooperation and Development (OECD). The OECD consists of 30 democracies, most of which are considered the most economically advanced countries in the world. According to OECD data, the United States spent $6,102 per capita on health care in 2004 -- more than double the OECD average and 19.9% more than Luxembourg, the second-highest spending country. In 2004, 15.3% of the U.S. economy was devoted to health care, compared with 8.9% in the average OECD country and 11.6% in second-placed Switzerland. In assessing what drives the difference between U.S. health care spending and the rest of the world, some leading health economists responded this way: "It's the prices, stupid." Put more formally, a report from the OECD declared that "there is no doubt that U.S. prices for medical care commodities and services are significantly higher than in other countries and serve as a key determinant of higher overall spending."

Though Americans are paying ever higher premiums, they are not getting better health care for their dollar. Current projections suggest that the average annual cost for employer-sponsored health insurance for a family of four will rise from $13,000 to nearly $25,000 by 2018.

Appearing recently on Morning Joe, Rep. Anthony Weiner (D, NY), a leading advocate in the House for publicly financed health care, made these observations:

I have heard people say, repeatedly, 'well, if the public option is too muscular, the insurance companies won't be able to compete.' Well, if they can't compete, then they're not gonna get customers. They're not gonna get patients coming to them. Isn't that what we want? To give people that choice?

The problem that we have here is we're trying to jerry-rig this system so that insurance companies still continue to make healthy profits. Why? [They] don't do a single checkup; they don't do a single exam; they don't perform an operation.

Medicare has a four-percent overhead rate. The insurance companies take about $230 billion out of the system every year in profits and overhead. The real question is: why we have a private plan?

These costs drive up the insurance premiums of everyone with private health insurance. With universal health care, these costs will disappear. Even the insurance industry knows that.
In recent testimony before the House Committee on Energy and Commerce about the rescission of individual health insurance policies, Don Hamm, the president of Assurant Health, admitted: "If a system can be created where coverage is available to everyone and all Americans are required to participate - the process we are addressing today -- rescission -- becomes unnecessary because risk is shared among all."

Sunday, September 6, 2009

What Obama will say in his address

What Obama will say in his address
By: Mike Allen and Carrie Budoff Brown
September 5, 2009 12:36 PM EST

President Barack Obama plans to reach out to Republicans and reassure — rather than confront — his liberal supporters when he addresses an extraordinary joint session of Congress at 8 p.m. ET Wednesday.

But he will warn lawmakers against seeking a perfect plan and then winding up doing nothing, as happened to the last Democratic president back in 1994.

The high-stake speech makes sense because Obama is such a gifted orator. But it is also risky because if poll numbers on health-care reform don’t improve after he speaks, it will be clear that the problem isn’t in the packaging, but in the proposal itself.

The contents of the speech were still being debated over the weekend. But here is what POLTIICO gleaned from conversations with top aides:

1) Obama will lay out a specific “President’s Plan,” even if he doesn’t call it that. He will make clear what’s on the table, and what he thinks warrants further debate, such as how to pay for the overhaul.

2) He will not confront or scold the left. “This is a case for bold action, not a stick in the eye to our supporters,” said an official involved in speech preparation. “That’s not how President Obama thinks. The politics of triangulation don’t live in this White House.”

3) He will make an overture to Republicans. “He will lay out his vision for health reform – taking the best ideas from both parties, make the case for why as a nation we must act now, and dispel the myths and confusion that are affecting public opinion,” the aide said.

4) He will make it clear that it’s better to get something done than nothing done. White House aides are reminding fellow Democrats that the party lost Congress in 1994 by failing to do any health reforms at all after Congress balked at the original plan by President Bill Clinton. “The lesson of 1994 is not that tackling health reform is politically perilous. It’s that failing to act could be devastating,” said Dan Pfeiffer, the White House deputy communications director.

5) Obama will try to reassure the left about his commitment to a public option, or government insurance plan. Aides said they are rethinking what he will say about this. He wants to thread the needle of voicing support for a public option, without promising to kill health reform to get it. But liberal congressional leaders were unyielding in their support for it on a conference call he held from Camp David yesterday, and he's going to meet with them at the White House early next week.

The White House line has been: “We have been saying all along that the most important part of this debate is not the public option, but rather ensuring choice and competition. There are lots of different ways to get there.” But now he’s going to step on the gas a little harder. One top official gave this formulation: “He has consistently said that he thinks the public option is an important way to make sure that there is both cost and competition control. He’s also said consistently that if someone can show him a better way or another way to get there, he’d be happy to look at it. But he’s never committed to going with another way. He’s always said he’d be happy to look at any proposal that gets to these goals, but that he thinks this is probably the best better way to do it.”

The speech was very much in flux over the weekend, because key decisions are being hashed out. Even the length is not yet set.

“He has not made any final decisions about the ultimate form of his package,” said a top official guiding speech preparation. “Anyone that tells you that he has is misinformed or extrapolating from conversations. He’s going to talk to a lot of people between now and next Wednesday. The president is in the process of deciding what his ultimate proposal will look like."

Also undecided: whether to follow up with nitty-gritty legislative language. “He has not made decisions about how he’s going to move this thing forward,” said a top West Wing aide.

Obama’s speechwriters were on the West Coast over the weekend for the wedding of Ben Rhodes, the deputy director of speechwriting. So the West Wing is coordinating the speech over a three-hour time difference.

On Tuesday or Wednesday, the leaders of the four liberal House caucuses will meet Obama at the White House. The meeting pledge came a day after progressives urged him in a letter to stand firmly behind the public insurance option.

Obama spoke by phone Friday with the leaders of the Congressional Progressive Caucus, the Congressional Black Caucus, the Congressional Asian Pacific American Caucus, and Congressional Hispanic Caucus.

“Caucus leaders expressed absolute commitment to the idea of a robust public option, and said they expect it to be part of any health care reform legislation,” the groups said in a statement. “The president listened, asked many questions, and suggested that the dialogue should continue.”

© 2009 Capitol News Company, LLC

What Obama will say in his address - Print View

What Obama will say in his address - Print View

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Move On.Org video of people who cannot wait for health care reform

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Here is a link to write to the White House. Please write in support of the Public Option and Let the President know he should avoid the 'trigger' option.

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Friday, September 4, 2009

What do You Want Obama to Say Wednesday Night?

What do You Want Obama to Say Wednesday Night?

President Obama will address a joint session of Congress next Wednesday night (September 9th) and make his case for health reform. What do you want him to say?

All the media are saying this is high wire, high risk speech-making for the president. And perhaps it is. But it is what we expected from him all along. We hoped that his sense of timing would mean that he would start really putting himself on the line sometime in September, after Congress had had the chance to draft its legislation. And so it has come to pass (Biblical allusion intentional).

This weekend, Obama and his speech writers and advisors will be drafting his address. As many organizations have noted, now is the time to make your views known.

There are a few options I can think of:

1. Make an emotional and moral appeal for health reform. Talk about people dying and suffering without health insurance or going broke with it. Explain why it is a disgrace that the U.S. does not cover all its citizens while every other industrialized country has done so for a long time. Maybe mention his mother and grandmother again.

2. Make a more factual and analytic appeal. Talk about costs (again). Show connection with the deficit. Explain how health reform can be funded. Get specific.

3. Use the time to knock back the myths and lies about health reform. Shame the Republicans in the Chamber for their death panel, granny-killing, abortion-covering, Medicare destroying lies.

4. Come out swinging. Remind those who voted for him why they did. Stand firmly behind the public option. Be tough.

5. Be bipartisan. Reach out to Republicans in the Chamber. Do not embarrass them. Ask them to join him in passing health reform. Make some compromises and offer yet another olive branch. Suggest the public option as a trigger if private plans don't behave.

6. Some combination of the above. But with what emphasis? How much detail? What do you think Jane Q. Public will or can hear?

This weekend is the time to make your opinions known. But be constructive. There has been plenty of mindless opposition this summer. If you don't like one of the above options, explain why and give your own suggestion. Maybe someone in the White House will listen!


This is a petition to the President to support the Public Option. Please read and sign.

PETITION TO PRESIDENT OBAMA: "We worked so hard for real change. President Obama, please demand a strong public health insurance option in your speech to Congress. Letting the insurance companies win would not be change we can believe in."

"We have been told we cannot do this by a chorus of cynics. It will only grow louder. We’ve been asked to pause for a reality check. We’ve been warned against offering the people of this nation false hope. But in the unlikely story of America, there’s never been anything false about hope." -- Barack Obama