Blue Mass Group

Reality-based commentary on politics.

Health Care Reform or Bust

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A Harvard study found that medical expenses were the leading cause of personal bankruptcy filings. The study also found that most bankruptcy filers had health insurance! But that is only half the story. As health care costs skyrocket, companies are pushing more of the cost of health insurance onto employees, either by increasing employee contributions or increasing co-pays and deductibles.  If some sort of reform is NOT passed, you will pay more and more of your income for health care.

Companies, large and small, are being forced to reduce or eliminate health benefits or absorb costs which make them less competitive. Most industrial nations do not have for profit health care insurance. Their governments control the cost of care and that provides foreign companies an advantage over ours. If health care reform is NOT accomplished, we will be less competitive in world markets.

If the nation does not come up with a reform plan that reins in the explosive growth of health care costs, Medicare taxes will have to increase or benefits will have to be cut.

Please notice what I said just now. If reform is NOT done, Medicare will be cut, US companies will be less competitive in world markets, and you will pay more of your income for health care. The reality of our unsustainable health care system is that it must be reformed, not only for our physical health needs, but also for the economic health of the country.  Other countries provide high quality, universal health care to their citizens (scroll down to middle of the page for Canadian example) at fraction of the cost of our system. This country must find the necessary reforms to do likewise. It is either health care reform or bust

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  1. The California Nurses Association just released a report that clearly indicates the current evil of our private health insurers.

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    p>http://www.calnurses.org

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    California’s Real Death Panels: Insurers Deny 21% of Claims

    More than one of every five requests for medical claims for insured patients, even when recommended by a patient’s physician, are rejected by California’s largest private insurers, amounting to very real death panels in practice daily in the nation’s biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

    CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care — 22 percent of all claims.
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    “With all the dishonest claims made by some politicians about alleged ‘death panels’ in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation’s biggest and wealthiest insurance companies simply because they don’t want to pay for it,” said Deborah Burger, RN, CNA/NNOC co-president.

    For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

    Claims denial rates by leading California insurers, first six months of 2009:

    * PacifiCare — 39.6 percent (FYI, Pacificare is United Health Group)
    * Cigna — 32.7 percent
    * HealthNet — 30 percent
    * Kaiser Permanente — 28.3 percent
    * Blue Cross — 27.9 percent
    * Aetna — 6.4 percent

    “Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger.

    PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

    Cigna gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life.

    In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval. At the time of denial, which she calls “insurance hell,” Kutcher had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.

    Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.

    “The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said. “Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.”

    “The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” she said.

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    p>The CNA’s research has been seen credible enough to trigger a California Attorney General investigation of health insurer practices.

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    p>http://ag.ca.gov/newsalerts/re…

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    p>And, the routine denial of claims by health insurers rings true to most physicians that I know (and, also from my own personal experience).

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    p>What special type of evil does it take to steal from sick people, like United Health and their ilk? And why are so conservatives so intent on defending them? Is it just because a President they didn’t vote for is proposing to place a little control on these health insurers who’ve proven themselves to be so untrustworthy? They should ask themselves, what if George W. Bush was proposing the same controls, would they still oppose them? Back in 2003, did they oppose Bush’s Medicare Part D Prescription Drug Plan — after all, Bush’s drug plan was more costly and more socialistic than any health bill being proposed today?

  2. The health insurance system is broken when claims are routinely denied. We need some consumer protections.

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    p>Many conservatives assert that “market-based” solutions should be applied.  This prescription is faulty.  For market-based solutions to work, there needs to exist an environment where:
    1. Consumers are informed.
    2. Consumers are price elastic.
    3. There are plenty of suppliers.
    4. There are low barriers to entry and exit.

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    p>I suggest none of these conditions exist in the health care insurance industry.

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    p>1. Health insurance policies vary greatly and are extremely complicated (e.g., preexisting conditions, deductibles, annual and lifetime limits, who’s in-network and who’s out, which procedures are covered and what’s not, etc.). In any other industry, we’d insist upon national standards.

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    p>2. Sick patients are notoriously price inelastic.

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    p>3. Most Americans have, in actuality, very few health insurance choices. Either their locality is only covered by one or two options, or their employer limits their choices. So,the reality for most Americans is that health insurance is an oligopoly.

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    p>4. Barrier to entry in the health insurance market couldn’t be higher. To offer health insurance, a firm must first negotiate with local hospital groups, local medical groups, many individual doctors, drug companies, etc.

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    p>So, the current health insurance economic environment is heavily biased in favor of insurers. In other industries where consumers are at the industry’s mercy, it has been seen as a proper role for government to offer some consumer protections. That is, in essence, what the Obama administration is proposing to do.

  3. The pressures on the privately insured will just become the same pressure on the publicly insured once private insurance is gone.

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    The cost of health care is growing at a much faster rate than wages, most corporate profits, and tax receipts.

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    p>This is because the value of the dollar was cut in half in the early 2000s. Healthcare is simply a sector which takes less easily to cost-cutting than many other parts of the economy.

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    p>Everything is going to have to cost 200% of what it did in 2000 to make the same money for its producer. It is unfortunate that many of us have fixed salaries or hourly wages, because those take longer to be negotiated up compared to our costs in food and energy.

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    p>The government “prints” too much money essentially to cover its over-promising. The government isn’t going to deliver all it promises… either it pays less for medicare, so those patients go untreated, or it inflates the dollar so it pays out less than it promised. The difference comes out of the provider’s hide. What you are asking for is another over-promise which will be diluted by more financial shenanigans.

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    p>Nothing comes from nothing. If you want better health care, allow the economy to be more productive.  

  4. Are there really cost controls, or is Obama going to enrich the insurance CEO’s the way he did with the banking industry and the defense contractors?

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    p>I think we have a serious credibility gap with the mass of lightly partisan voters who above all are sick of our corrupt and ineffective government.

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    p>I say that as a single payer supporter. We are a long way from that, and maybe worse than nothing at this point.

  5. take in the international news about swine flu and the S2028 legislation and call me after October.  My health decisions are mine and not the states.

    • What private company is going to front the cost for a flu vaccine as governments have done? If it were lucrative, where are the private investors? Your prescription is a public health nightmare. Can you say, pandemic?

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