Health and Sanity category archive

1. Read Steven D’s story.

2. Read the note below.

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Enough with insurance company death panels.

The alternative seems to be no payer.

The report linked below focuses on a man whose artificial leg was approved in advance, but whose insurance company is stalling payment of about a third of the bill. The whole thing is about three webpages long and is worth the five minutes it takes to read; it’s a wonderful tale of buck passing, blame shifting, and delay.

If UNC has not invented the Carolina Four-Corner, the health insurance companies would have.

A nugget (emphasis added):

In Delaware, 111 complaints were filed from the beginning of last year through the end of last month for delays in payments by insurance companies. Like nearly every other state, Delaware has prompt payment regulations that require insurers to pay within 30 calendar days. But three insurers who do business in Delaware were found to have a pattern of payment delays that resulted in significant fines.

(snip)

Dan Emmer of Horizon Blue Cross Blue Shield of New Jersey said the outstanding fee in Fine’s case was due to internal processing errors — although the company’s customer service representatives told Fine that the delay was due to the charge being a “high dollar amount.”

“We apologize to Mr. Fine for this delay and, as our records indicate, that he had to contact us 10 times about this matter and it has still not been resolved,” the company said in a statement. “It will be resolved as soon as possible.”

Clif Garboden, writing in the Boston Globe, discusses his insurance carrier’s denying him treatment for a chronic condition which sometimes follows cancer treatment. Fortunately, this flare-up was more inconvenient than serious, but the condition is potentially life-threatening A nugget:

Harvard-Pilgrim recently took time out from stonewalling state regulators over proposed double-digit premium increases to deny me coverage for therapy to treat my chronic lymphedema, an expected after-effect of stage-four neck-cancer treatment during which 39 lymph nodes were removed from my neck and shoulder. Harvard-Pilgrim turned me down simply because I’d been treated for previous attacks. That was several years ago, but no matter, the clause in the policy says “per condition,’’ and that’s that.

Doesn’t Harvard-Pilgrim understand what “chronic condition’’ means? Yes, I believe it understands perfectly. “Chronic’’ means it happens over and over again, so if an insurer wants to cut costs, what better place to begin than by eliminating payments for recurring problems?

I have the right to appeal this rejection (the process takes 180 days), but frankly, I have better things to do with my remaining time on earth than play against a stacked deck with a bunch of bandits.

TPM does the math and figures how many chickens it takes for health care in the U. S.

• Total U.S. health care costs in 2008: $2.3 trillion
• US population: About 300 million
• Average cost of health care per person: $7,681
• Average weight of a chicken: 5.9 lbs
• Market price per pound: 85 cents
• Average spot price per chicken: $5.02
• Average number of chickens per resident needed to cover health care costs: 1,530 chickens
• Total number of chickens needed to cover United States health care costs: 459 billion chickens
• Estimated worldwide chicken population: 16 billion chickens
• Current worldwide chicken shortage to cover U.S. health care: 443 billion cluckers

Maybe if we throw in a can of gravy.

Root canal:

Ramos, 43, was a young mom when she took her 4-year-old to a dentist for swollen gums more than 15 years ago. Uninsured, she made a partial payment and expected to be billed for the rest. But she never received a subsequent bill and soon forgot about the episode.

Meanwhile, a lingering charge for $67.72 went to collections and was brought before a judge. Ramos says she was not notified. The judge awarded the collections agency hundreds of dollars and ordered the sheriff’s department to sell her house to make up for the debt.

The home sold at auction in 1996 for $1,550, though Ramos had paid $51,000 for it.

It wasn’t until two years later that Ramos learned on a fluke that she had lost the title to the buyer, Jarmaccc Properties LLC.

They want a mulligan. In my experience, persons who deal in good faith don’t need mulligans.

Bloomberg (emphasis added):

A U.S. mandate forcing insurers led by UnitedHealth Group Inc. and WellPoint Inc. to spend 85 percent of revenue from premiums on medical care is the newest front in the battle between the Obama administration and companies over industry profits.

In 2009, UnitedHealth spent 82.3 percent of revenue from premiums to pay customers’ medical expenses and WellPoint spent 82.6 percent, according to company filings. While individual insurers now decide what categories to include in this ratio, the health law signed in March demands that all companies define medical costs the same way beginning in 2011.

Many insurers include only customer claims in their current ratios. They want to keep the number low to impress investors, said Sandy Praeger, of the National Association of Insurance Commissioners. Under the new law, lobbyists would include technology expenses, wellness programs and pay-for-performance incentives. That would make it easier to reach the 85 percent threshold, and free up revenue to boost profit.

Shaun Mullen:

The moment that the (health care) crisis went from being worrisome to dire was when hospital administrators stopped considering nurses to be care givers and they became “cost centers.”

. . . which moment coincided with the move of hospitals and health insurance companies from a non-profit cooperative model to a for-profit one.

You young ‘uns may not remember that, once upon a time, BCBS was non-profit, as were many, if not most, hospitals. And it wasn’t called “health insurance,” it was called “hospitalization.”

Sure, they made money, but making money was not their goal. Care was their goal. Now that country club memberships for executives is their goal, care is sacrificed to it.

Choosing to wring profits from misery makes misery.

. . . because it’s more of the same.

So is this: Health insurance companies that don’t want to insure (anything but country club memberships for executives, that is):

Last week, the Associated Press and Congressional Quarterly reported the first weasel words from insurance industry officials that the language in the law allows them to duck away from full coverage of sick children. Insurers say they read the law to mean that, sure, if we offer insurance to a family, we cannot discriminate for children’s pre-existing conditions. But, ah, they say, there is nothing in the law that says we have to offer insurance to the family in the first place until 2014, when insurance companies have to accept all Americans for coverage, regardless of medical conditions. The dispute concerns families who lack employment-based insurance and seek coverage in the non-group market.

The industry take on this sounds like the Peter Sellers “Pink Panther’’ routine where he sees a dog at the hotel door and asks the clerk if his dog bites. The clerk says no; the dog bites; Sellers re-questions the clerk and the clerk says, “but that is not my dog.’’

Tom Levenson comments on Cosmo’s piece in the Boston Globe. A nugget:

But the piece itself is almost a type specimen of the GOPs one trick (a sadly effective one): it is nothing more than the usual list of plaints, trumpeted as high crimes and misdemeanors. Everyone of them has been painstakingly debunked, but the trick is to keep on repeating it — the caged-monkey faeces-flinging tactic– until the debunkers weary, and the falsehoods get to parade around the public square unmolested. All it takes is a willingness to check your brain in a jar by the door, and it becomes easy to do this.

Follow the link for point-by-point take down.

Click for a larger image

Via Atrios.

Charles Krauthammer makes stuff up:

As the night follows the day, the VAT cometh.

This is not to say that a VAT is impossible in the United States, though it is highly unlikely. A few persons outside of government have proposed one and been thoroughly ignored. But anything is possible yadda yadda yadda.

But this “as night follows day” stuff is typical Krauthammer fear-mongering.

Wingnuts monger fear because fear is what they know.

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But anything would be better than what we’ve got.

By opposing health care reform, Republicans voted for more of this.

The only permissible conclusion is that they just do not care.

The Health Care Reform bill includes a provision to create a body to study the comparative effectiveness of treatments for ailments.

The health industry doesn’t like that. Buried in a story at Bloomberg (emphasis added):

Comparative effectiveness will probably be “a headwind for the health-care industry,” the Boston-based analyst said in a March 23 phone interview. “If research shows that less complex and maybe less expensive products and therapies work just as well, that is not good news” for the companies.

Heaven forbid that doctors should know which brand of snake oil works best.

Read the whole thing:

Blue Cross Blue Shield of Delaware, through a third party, has rejected coverage in the last two months for diagnostic heart procedures for at least 11 patients whose doctors felt stress tests were medically necessary, The News Journal has learned.

Froomkin:

That’s because while the health care debate has been raging in Washington, the recession continues to rage everywhere else. And state governments across the country are dealing with massive budget shortfalls by reducing spending on the people who need it most, with health costs a chief target.

The Booman summarizes my reaction so I don’t have to:

Is the bill a piece of (excrement–ed.)? In one sense, yes, yes it is. It’s far short of what we’d do if we had no opposition. We probably could have done modestly better with some more smarts and a little luck. But ‘progressive’ means ‘incremental.’ You make progress, you don’t get everything you want in one fell swoop.

The post I linked to is the first of several thoughtful analyses of this weekend’s events in Congress. You can start with it, then work your way upblog.

Those folks who thought that President Obama couldn’t or wouldn’t play political hardball might should reconsider.

We have rationing. It’s not rationing based on need or any rational measure; it’s rationing based on demand for country-club memberships.

On Feb. 10 — after Blue Cross Blue Shield of Delaware denied coverage three times for a stress test that would have revealed severe arterial blockage — doctors opened Fields’ chest and performed heart-bypass surgery that his cardiologist said almost certainly prevented a massive heart attack and saved his life.

(snip)

Health care reform legislation pending before Congress would not restructure that system, although it could provide more transparency.

The whole article is worth a read.

A related story points out that health insurance premiums have doubled in the last ten years.

The quality of health care sure hasn’t doubled in the last ten years.

Afterthought:

Profiting from misery–>miserable profits.

The system is broken.

A health insurance mandate is hardly single payer, but anything would be better than what we’ve got. And compelling insurance companies actually to insure–that’s a good thing.

Over at the Central Virginia Progressive, Scott Wichman guest-posts some thoughts on the health insurance bill and health insurance mandates. As context, remember that the Regency has tried to outlaw mandates.

Two nuggets from the post:

Yet here is where the insurance industry is freaking out– they will actually have to deliver on their promises, instead of being able to slip out of their responsibilities so callously. If folks on the right are freaking out over the gov’t mandate to buy health insurance, why don’t they protest Car insurance mandates as ‘Tyranny’?

———————

It makes no sense to me that when we send food, supplies, and medical care to a country halfway around the world, we are seen in this country as noble and heroic. If the government offers to do the same thing stateside, is is Tyrranical/Socialist/Fascist and people protest it.

Read the whole thing.

I emailed back, not that I shall get noticed, that he did the right thing. Sometimes, you take what you can get and keep working for what you want.

But you take what you can get when you can get it.

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