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DEL.ICIO.USInsurance companies choose wealth over health
The Atlanta Journal-Constitution
Have you been following the battle between Blue Cross Blue Shield of Georgia and Piedmont Healthcare? It’s the latest saga in the story of insurance companies attempting to manipulate the market.
First, a brief history on the origins of insurance.
The practice of insurance was perfected by Marcus Licinius Crassus, a wealthy businessman and general who financed the reign of Julius Caesar. Crassus owned a bunch of slaves, all skilled builders.
He would go to the wealthy and middle class people of Rome and offer them his slaves to put out fires - for a fee, of course. If they didn’t pay and a fire broke out, Crassus would stand outside the burning building with his slaves, lamenting the homeowner’s decision not to hire him.
Then, he would offer to buy the burning/destroyed properties and neighboring buildings. He’d rebuild them and either keep them to rent or sell them for a huge profit. Some say that he and his crew even managed to start a few of those fires at “opportune” moments. If the property owners did pay - well, you get the point.
Fast forward to today.
Blue Cross took out a full page ad in the paper not too long ago telling people, in effect, that they must all switch doctors immediately if Blue Cross and Piedmont couldn’t reach a deal on a new contract.
There was no mention in the ad that Blue cross is obligated to allow patients to continue to see their doctors in certain situations (for example, pregnancy and terminal illness). They only said that people had to do something now.
Blue Cross further neglected to tell senior citizens that Medicare folks didn’t have to make the switch. “Patients are being held hostage by Blue Cross and their misleading communications,” Nina Montanaro, a spokeswoman Piedmont Hospital, told the Atlanta Journal-Consitution.
I’m singling out Blue Cross because they are the latest insurance company to publicly display the tactics perfected by Crassus some two thousand years ago. Almost every health insurance company has been or is now guilty of this kind of behavior.
We all know people who have had one horror story or another. Here are a few examples from around the country that the media has reported:
There was the man who had heart attack and had to be rushed to a hospital, but had to pay an exorbitant amount of money because the ambulance took him to a hospital not covered under his insurance plan.
Because the man didn’t ask to go there - the fact that he was unconscious and near death appears to have been irrelevant - the insurance company said they were free from obligation. They ended up settling in the patient’s favor, but only after a time-consuming battle. This is typical of insurance companies officials who hope the appeal process is too much for their clients to endure.
Then there’s the woman who has a brain tumor but can’t get the operation prescribed by the doctor because the insurance company says there haven’t been enough of them performed to be “accepted standard procedure.”
Everyone has a story.
My brother had a stroke several years back and his battles with the health insurance company included: Calls from creditors, reading documents that would challenge a lawyer, hours of anguish talking with insurance company employees who weren’t helpful and knew nothing about his condition.
The goal of a business is to maximize profits. I understand that. I also understand that there are people who take advantage of the system. But too often it seems that the goal of health insurance companies is to maximize profits, not the best treatment for clients.
Research the McCarran-Ferguson Act that explains an insurance company’s exemption from federal antitrust laws (yes, they play by different rules than most businesses). Learn about actuarial tables, and how they will help determine what kind of treatment your health insurance provider will recommend for you.
The bottom line is, as wealthy as this nation is and for all of our advancements in medical technology, we are not getting anywhere close to the kind of care for which we have worked. And somewhere, Crassus is laughing.
Do you have any suggestions as to how to improve our health care system?
Permalink | Comments (9) | Post your comment | Categories: Bill Allen
Comments
By Right Thinking Conservative
June 23, 2006 09:13 AM | Link to this
Yes Bill I do have suggestions as to how to improve our health care system:
1) Get Government out of the healthcare business
2) Get healthcare provision off the backs of business
3) Return healthcare to hands of the people through MSA’s and HSA’s
4) Create a national healthcare lottery to supplement funding. Proceeds to be directly deposited into an established MSA or HSA for every U.S. citizen, so every citizen will have at least some money to buy insurance or pay for medical services directly as needed. Which will do three empowering things if follwed through, for every individual:
a) Keep our money out of government hands so the politicians can’t raid our funds like they have with Social Security b) Will give every citizen the freedom from having to depend upon the government, business and private sector insurance companies in order to have secure portable healthcare. c) Universal Access Assurance: Create at the State level a quasi-insurance corporation (that will operate similar to self-insuring companies) which can’t refuse to insure any state resident U.S. citizen healthcare insurance, to compete with private sector healthcare insurers.Give this quasi-insurance corporation in law the authority to bulk purchase and re- import drugs prescribe by physician to provided drugs at the lowest possible costs to the quasi-corp insured. Require all hospital, doctors and others providing medical services in this state to participate in order to be licensed in the State of Georgia.
5) Appropriate portions from all sin taxes charged on alcohol and tobacco into the MSA’s of the sinfully addicted to supplement their having to pay for the higher rates they will incur and to relieve any undue burdens placed upon the saintly among us. And to provided services and drugs necessary to possibly redeem the sinfully consuming from their miserable addictions.
6) Give businesses that contribute to their employees MSA’s a dollar for dollar tax deduction.
7) Increase tax deductions anywhere possible for MSA’s and HSA’s and expand present law on MSA’s and HSA’s for parents to include covering families.
This needs a lot more fleshing out in details from these basic seed thoughts but to me it beats socialized medicine, the present Mafioso preclusive healthcare system we have and the Massachusetts Plan I’ve recently but briefly reviewed.
By LB
June 23, 2006 11:28 AM | Link to this
I have always seen insurance companies as middle men between doctors and patients. Why can’t people just go to the doctor, pay the doctor a fair (low price) and not have insurance companies at all.
If doctors charges per the hour, say like $100.00 an hour and they saw 10 patients during that hour average, then the cost per visit should be only $10.00 per person. They are still getting a lot of money. The more they see in an hour the more they make. This would prevent them from always making people wait forever even when they have appointments. Time will become money for them.
Surgeries of any kind should be reasonable and people should be able to pay monthly installments for surgeries. Hospitals should also be fined for charging $20.00 for a plain asprin etc. Things are out of control.
Pricing should be cost plus no more than 10%. There would no longer be any need for insurance companies at all. People who can’t afford $10.00 should also be given an option of paying installments of a dollar a month. I am under the impression illegals are using a lot of free services that are depleting the resources. They should at least pay for services/drugs and no more freebees.
By Bill Allen
June 23, 2006 01:26 PM | Link to this
To RTC: That is a very thoughtful and reasoned answer, though I confess I don’t know what HSA and MSA represent (I’m sure it’s common jargon, but I don’t mind asking if I don’t know).
By Right Thinking Conservative
June 23, 2006 04:18 PM | Link to this
They represent Health Savings Account and Medical Savings Account.
Put HSA or MSA into any search engine, you’ll get plenty of info returned.
By Glynis from Duluth
June 23, 2006 09:30 PM | Link to this
“This is typical of insurance companies officials who hope the appeal process is too much for their clients to endure”
We went through a very long appeal process in an effort to get my son’s speech therapy covered by our health insurance. Eventually we had to complain to the GA Insurance Commissioner - the insurance company basically caved when they got the complaint, but we were right all along - the therapy should have been covered! It took about a year to get our money back but it was definately worth the fight.
By Doris
June 24, 2006 10:54 PM | Link to this
HSA’s are only going to work if patients can shop for healthcare and if costs of procedures are disclosed up front.
By Right Thinking Conservative
June 25, 2006 11:13 AM | Link to this
Healthcare presently is limited and preclusive. Forming a pool of citizens in a state, into a quasi insurance corporation (with state government oversight) as a self-insuring entity (named it whatever) with all hospitals, doctors and others providing medical services in the state available to choose from should allow some price shopping. MSA’s, HSA’s basically are dedicated personal savings accounts which offer tax-free advantages devoted to pay for medical services and healthcare insurance. Amending laws governing MSA’s HAS’s to assure that every U.S. citizen can qualify and give consumers greater flexibility might be necessary. One other benefit from this would be to pressure private sector insurers to match the state quasi insurance corporation entity’s pricing, flexibility and ending the present “cherry picking” practice of private sector insurers. The idea here, is to give the individual more choices and freedom: Buy non-preclusive healthcare from the quasi state insurance entity or buy healthcare from any of the private sector healthcare insurers that refuses to insure some people, use some doctors and hospitals.
Healthcare over the years has been pushed out of the reach of most people. Now people for the majority depend on company plans, government plans or they plan on not getting sick and have no plan at all. That has to change. Healthcare must be returned to the hands of the people. To do that it has to become affordable once again. The only foreseen draw backs to this schema will likely mean that everyone will have to buy healthcare insurance (mandatory personal responsibility), no more running to big welfare government for any healthcare assistance. Transferring from one plan to another (plan hopping) may be severely limited or restricted altogether.
By Karen
June 25, 2006 08:36 PM | Link to this
My brother is going through a terrible situation right now. His insurance company cancelled his disability after a larger company bought it out. He had been on disability for eight years for congestive heart failure. The new company (No. 1 in the nation right now for bad faith, by the way) decided he isn’t disabled and cancelled his payments in August. He appealed, and the appeal was denied, of course, because I’m sure the company thinks he either won’t sue or will die before settlement. These people are vicious and without conscience. All they are concerned with is how many people they cancel each month in order to meet their quota of money saved. Government control is definitely not the answer, but families should not have to go through this kind of pain and suffering.
By Fed Up
June 29, 2006 07:55 AM | Link to this
You should also mention that Blue Cross sent out a letter to all of its policy holders that go to a Piedmont physician. In that letter, they told us to call Piedmont to complain, and included Piedmonts CFOs direct phone number. Piedmont was flooded by calls from concerned patients. They fielded every call. You dont see Blue Cross publishing their CFOs phone number.
Add to that the fact that they only gave us three weeks notice that we would have to change doctors by July 1. Ever try and get an appointment with a specialist? Sometimes you wait three months.
How would you like to be an 80 year old person that has been going to Piedmont for 50 years and now you have three weeks to find a new doctor?
Ive worked in healthcare for 19 years. This whole mess started when Hillary Clinton, an un-elected politician at the time, decided she would fix healthcare. Government needs to get out of healthcare.