If a thief promised a judge that he would never steal another car stereo again, and demanded his release under "the honor system," the judge would rightfully laugh at the thief's audaciousness. Then the judge would sentence the thief according to the law. Unfortunately, in America, that system of law only works for criminals like the petty thief.
Healthcare CEOs pocket an average of $14.2 million a year and the industry reports annual profits (PDF) of roughly $10 billion. Naturally, the American people (including 48 million uninsured and 25 million underinsured) threw a fit when these record profits were made public. When the Obama administration hinted that it might actually flex its tiniest regulatory muscles, the private health insurance companies freaked out and promised to play nice from now on.
"Playing nice" included halting their most criminal practices, like denying coverage to applicants with pre-existing medical conditions. This practice is very common, according to Wendell Potter, a former Cigna executive. "The reason they do that is so they can get rid of people who are more likely to use their insurance benefits," says Potter.
Insurance companies have been known to dump clients under the guise of a "preexisting condition" for frivolous reasons. A particularly nauseating example is Robin Beaton's ordeal with an insurance company. In June 2008, Robin was diagnosed with invasive HER-2 genetic breast cancer, a very aggressive form of this cancer. She needed a double mastectomy immediately, but when it came time for her surgery, her insurance company red-flagged her chart because of a "preexisting condition." The condition? Acne. Beaton testified before a congressional subcommittee:
The congressional committee found out that over the past five years certain insurance companies -- Assurant, Golden Rule and WellPoint -- had cancelled 20 thousand individual policies. But such behavior isn't "criminal" according to America's two-tier justice system. This kind of behavior is tolerable -- even commendable -- under Capitalism's pyramid scheme where millions of Americans suffer and pay into a system that may or may not be there for them when they get sick, and a few healthcare CEOs reap millions in rewards.
The only reason the insurance giants are promising to "play nice" now is because they were afraid a torch-wielding citizenry would finally come after them, resulting in the health industry's worst nightmare: universal healthcare. Terrified of the single-payer option, the health industry swore to stop their most monstrous practices.
Leading the way in this friendly approach to exploiting the needs of sick people is Karen M. Ignagni, the industry's chief lobbyist. Ignagni, who earned $1.6 million in 2007, just doesn't get why the mean ol' American citizenry is victimizing the poor, defenseless healthcare industry. She has been meeting privately with Senators, including Edward Kennedy, to "hammer out" the details of any future reform. Surely, any reform advocacy on Ignagni's part will ultimately be advantageous only for the healthcare industry (see: sinking the public option), and not the American people (see: a universal coverage plan).
Potter calls Ignagni's maneuvers "charm offensive." Only in the world of white-collar crime can charm get a criminal industry off the hook. Just imagine if a crack dealer tried to bat his eyelashes at a judge and smile sweetly in order to beat his charges.
This isn't the first time the health insurance giants have promised to behave themselves. Back in May, the industry promised to cut $2 trillion in costs over 10 years. Back then, Ignagni was at the forefront of the promise to trim the fat. She reportedly "contended that the voluntary cost-containment effort would help lawmakers who are aiming to craft health overhaul legislation by August." But at the time, many economists and lawmakers questioned how much the cuts would really help in coming up with a solution for the millions of uninsured. Turns out, the cuts didn't help much, nor were they mandatory. They were voluntary cuts the industry could make over the next decade (or not) depending on if anyone is still paying attention.
Now it's August, and Ignagni and Co. are privately meeting with Senators again, and they're probably making all kinds of sweet promises about really changing this time, and really looking out for the American people's interests. Such empty promises wouldn't hold up in a court of law if we were dealing with petty crooks and thieves, but this is Big Health we're talking about. And Big Health has Big Influence in Washington. Their empty promises carry a lot of weight, and the industry's influence may succeed in sinking the public option for good.
Cross-posted from Allison Kilkenny's blog. Also available on Facebook and Twitter.
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Potter was vice president of corporate communications for Cigna, the fourth biggest health insurance company in America, when he decided to resign and become a public advocate for reform.
For health ins. coverage, just take out the ins. and we get coverage. Its too simple.
Americans have already lost their jobs, they don't have much sympathy for the crooks that defrauded them...selling a product to them that didn't exist. You paid premiums for months and years, and ooops you already had acne so your cancer surgery is denied...insurance that didn't exist though paid for.
"- under Capitalism's pyramid scheme"
Isn't this exactly what it is? What a racket.
We have to get the lobbyists out of Washington, we have to change out the congressional regime, we have to get in there and fix this mess.
Here's the kind of coverage I used to have back about 18 years ago as a young married woman.
I paid less than $200/mo for me and hubby
I had $7 copay to see the doctor/dentist
All dental work was covered. I had 4 wisdom teeth filled, paid $7 and didn't bother to get the pain pills.
Had a baby, hospital stay 3 days, my portion = $500
My kid fell off the bed at 6 mos old, her pediatrician was still on shift and saw us immediately $7
My kid was jumping in the tub at 2 and split her chin open. Trip to the emergency room $0
Fillings for my kid at 4 - $7
Depoprovera shots every quarter after my kid was born $0
Tubal ligation after 5 years $0
Annual checkups for me, kid, hubby. $7 each visit.
Medicines $10 no matter what
The doctors/nurses all worked for the actual insurance company in their medical complex, if you wanted to see a private practice doctor, same payments.
This was in Guam. Go figure. I'm sure the benefits aren't so great now, but back then, neither I nor my husband nor anyone I knew on this company's plan ever worried about going bankrupt or broke from being sick, or having a terminal illness.
Something to think about.
Insurance companies - like any for-profit business - have a vested interest in working within the law. They don't want bad publicity or money-draining lawsuits any more than the next person. The problem with insurance companies is not what they are doing, but what they are _allowed_ to do under the law.
And the laws that govern their behavior were made by the people who are supposed to represent the American taxpayers. That is something we need to hear until we can't stand to hear it anymore, because it's the one overridingly important point in the healthcare debate. Our representatives are not working for us. They are working for big business, including the insurance companies.
Given that fact, is it reasonable to expect that they would start looking out for our interests, that all the talks on capitol hill, the petitions and phone calls would make the slightest bit of difference? No it is not. It's all just spitting into the wind.
The enemy is not big business. The enemy is not the health insurance providers. Our true enemies are the people who allow big business and insurance providers to ruin our lives in large and small ways every day. The bad guys are the people we elected to represent us.
http://www.getclaimhelp.com/public-adjuster/10-worst-insurance-companies-deny-claims-raise-premiums.html
They know that over the last 30 years enforcement of regulations has largely disappeared, so nothing will happen from the regulators. They also know that they have more money than their subscribers, so either the subscribers can't afford to sue them, they will spend years in court or the sick will just die without the treatment. The health insurers know that ERISA laws do not allow the claimant to sue for any more than the cost of the procedure that they refuse to pay for.