Insurance Companies on The Huffington Post

Wendell Potter: The Insurance Industry's Lethal Bottom Line -- and Sen. Al Franken's Solution

2009-12-06T19:33:58Z

There was a time, in the early 1990s, when health insurance companies devoted more than 95
cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.

Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.
Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.

The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.

Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American
patients and their doctors, according to the industry's trade group.

And they do this by finding every excuse in the book not to pay a claim, even if it means
canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging." In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main
consideration.

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.

The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.

Senate Takes Aim At Insurance Company Executive Pay

2009-12-05T09:44:58Z

WASHINGTON — Senate Republicans forced Democrats to vote in favor of cutting billions from providers of home care for older people as partisan debate flared Saturday during a rare weekend session on President Barack Obama's health care overhaul.

Obama planned to travel to Capitol Hill on Sunday to help Democrats resolve internal disputes that stand in the way of Majority Leader Harry Reid bringing the 10-year, nearly $1 trillion legislation to a vote.

Dr. Garrison Bliss: Health Care Reform Irony: Thousands Could Be Denied Low-Cost Coverage

2009-12-02T16:12:17Z

If offered the choice, how many of you would sign up for access to a primary care physician 24/7 for a flat monthly fee of $49-$79 per month? Imagine -- no more lengthy waits for a doctor to see you and no more dealing with insurance companies for routine, preventive care. That sounds pretty good, doesn't it?

Ironically, the health care legislation being debated by the U.S. Senate does not allow this option. Direct primary care medical homes, which form the foundation for a high functioning, lower cost, higher service health care economy, will no longer be an option for the 50,000 Americans (a number that is growing by double digits annually) who prefer this health care delivery model.

As one of the first doctors in the country to set up a direct primary care practice, I wouldn't practice medicine any other way. I simply prefer to work directly for my patients, not insurance companies, and use my time to treat my patients, not fill out paperwork.

At my practice in Seattle, individuals and employers pay a flat monthly fee for unlimited access to services that include everything from urgent care to preventive treatment, from chronic disease management for things like diabetes or hypertension to wellness education and hospital care coordination. There are no co-pays, no disagreements over covered treatments and no insurance forms to be filled out because there is no insurance billing necessary with these practices. Most importantly, there are no barriers for those with pre-existing conditions.

In my community, many local businesses and unions have turned to practices like mine as a way to offer their employees health care at substantial savings over traditional insurance-only health care. For example, one Washington state non-profit employing 75 people expects to save more than $1 million over the next five years by moving employees from traditional insurance plans to a local direct primary care medical home and supplementing that care with a lower-premium insurance for emergency and catastrophic care. Washington state's largest employee union just announced that it will be participating in a pilot program that will provide their members access to this proven health care delivery model.

Like so many other innovative business models, direct primary care medical homes are growing in numbers across the country and are currently thriving in at least 20 other states. If utilized nationally, direct medical homes could save tens of billions of dollars - money that is currently wasted on administering health care insurance - and could reduce needless hospitalizations and procedures while providing world class primary care to all 46 million uninsured Americans for roughly $35 billion a year.

As a physician I am supportive of efforts to reform our broken health care system -- especially to provide care to those who for whatever reason lack health insurance. However, that doesn't mean that we should deny access to innovative health delivery models such as direct primary care medical homes.

Thankfully Senator Maria Cantwell (D-WA), with strong support from Senator Patty Murray (D-WA), has pledged to introduce an amendment that will preserve states' rights and ensure direct primary care medical home plans - in conjunction with a lower-premium insurance policy - will be able to compete in the proposed health insurance exchange where Americans will shop for health care beginning in 2012.

Direct primary care medical homes have proven that we don't need health insurance for our most basic health care needs. As a nation we are at the tipping point where the skyrocketing cost of health care will bankrupt families, businesses and eventually as the U.S. Treasury. As the Senate begins debate on its version of health care reform, let's hope they consider the cost-savings to the country of direct primary care medical homes and the security tens of thousands of Americans have already found in this innovative concept.

Alec Baldwin: The Republican Way: Keeping Everything The Way It Is

2009-11-24T12:10:50Z

Didn't you know, all along, that the goal of U.S. policy in Iraq was about accessing oil?

Not oil as in those production levels at the onset of the Bush era incursion in March, 2003. But newer, stronger, American-style production levels. American oil companies had been forbidden from exploring and developing new oil fields since the nationalization of Iraq's reserves in 1972 and those American oil companies have long contended that Iraqi estimates of their potential reserves are grossly underestimated, by perhaps as much as a couple of hundred billion barrels.

Likewise, didn't you know all along that Republican opposition to current health care reform is about maintaining the unconscionable monopoly that insurance companies have in the American economy. Why? For the same reason Bush went to war in Iraq, spent money we didn't have, pushed the country into financial ruin and did more to threaten our long term national security than any modern president. The GOP needs contributions. I would never contend that the GOP is alone in this practice. When an administration awards contracts to some supporter, they anticipate more support. But no group, in the history of this country, has ever done this to such an extent. Remember, I am always careful to separate the leadership of any party from its rank and file. So when I level such a charge against "Republicans", I am referring to their leadership on Capitol Hill. But, I think it's safe to say now that the war in Iraq was started to provide U.S. oil companies with the opportunity to develop new oil fields there in return for the massive campaign contributions those oil companies will make to the Republicans in 2010 and, especially, 2012 in their effort to unseat President Obama.

The same is true for the health care industry, and insurance companies in particular. They don't want reform. The current system works quite well for them. If an excess of Americans die due to insufficient health care, so what. Republican leaders argue that health care reform will lead to a big, fat, incompetent bureaucracy that will gobble up billions of U.S. taxpayer dollars and provide little accountability. But wait. Isn't the Pentagon a big, fat, incompetent bureaucracy that gobbles up...? Well, you get it.

The Pentagon wastes more money on more crap that you and I don't need and gets it wrong, on a policy level, more often than not since 1960 (I'll give them a pass on Korea, due to all the Cold War anxiety at the time). Republicans never flinch. Spending on the military, and subsequent sales of those weapons systems around the world, help the U.S. economy, in their mind. Those companies, in turn, contribute to the campaigns of men like George W. Bush. This is especially so now that the Pentagon, in the ultimate sign of their stupidity, abdication of their responsibilities and tacit compliance with GOP fundraising goals, have privatized the U.S. military to the tune of one million dollars per soldier in Afghanistan.

Think about that. Recruitment is down. This Pentagon has a shortage of willing and competent soldiers who can run our military machinery. So what do they do? Do they improve recruitment, training and pay for soldiers? No. They privatize as much of these duties as they can (with no bid contracts for staggering sums of money) and create new businesses that, in turn, will contribute to those that helped them

The health care industry wastes untold billions, then passes those costs on to insurance companies who then exploit your fear and pass them on to you. Fear of Al Qaeda. Fear of getting sick without insurance and, therefore, access to effective medical care. Keep everything the way it is, out of fear. Fear that it could get worse. That's the Republican way. These guys have this country coming and going.

Health care reform means less money for insurance companies. Thus less money for the GOP. We should pass this bill for that reason alone.

Fortune 's Stanley Bing: What Are You Thankful for?

2009-11-23T13:38:23Z

Thanksgiving is upon us. And it's the rare individual among us who doesn't have a lot to be thankful for. As we prepare for Thursday's festivities, I thought it would be nice to ask you what you would put on that list. Personally, here are some of the things that give me a warm and fuzzy:

I am thankful that Bernard Madoff is now a big kingpin in prison, both because it means he is in prison and because I also get a laugh at the mental image of two old farts indulging in a pushing match from which the despicable swindler emerges triumphant. I like to think that a background in high finance prepares you for anything.

I am thankful that most of my friends still have at least modest expense accounts. It means I can still sponge off them now and then.

I am thankful that my house is still worth basically what it was assessed at when I got my mortgage.

I am thankful that Wall Street is still a festering sump pump of illogic, hubris and greed, and will continue to provide me with plenty to write about for the foreseeable future.

I am thankful GM still exists and is making a new Camaro.

I am thankful for Tim Geithner's temper. It makes him do funny, interesting and sometimes very satisfying stuff.

I am thankful that fewer people than ever can talk about the benefits of a deregulated, free-market system without laughing. Of course, I'm not thankful that they'll keep trying until, in the end, they win again.

I am thankful that I haven't needed to speak to a single attorney on a matter of personal importance this past year.

I am thankful that my medical insurance company paid a small percentage of my costs back to me, even if it was under protest and after repeated bludgeoning. Actually, I'm not that thankful. I think they stink. But I'm grateful that I have this opportunity to say so.

I am thankful for newspapers and magazines. I know that every smug aggregator out there must be too, since they provide 95% of all content you get on the web.

And in that regard, last of all, I'm thankful that a new system of communication exists by which I can write whatever the hell I'm thinking on any given day, with no benefit of research, no fact-checking and very little personal responsibility attached. In short, I'm very thankful for the Internet.

How about you? What do you find yourself appreciating at this potentially festive season?

Aaron E. Carroll: I Am a Scorpion. It Is My Nature.

2009-11-17T09:35:06Z

The fable, as it is told, involves a scorpion and a
frog. The scorpion needs to cross a
river, so he asks the frog to carry him on his back. The frog is skeptical; after all, scorpions
kill. The scorpion calms the frog,
explaining that if he stung him on the swim across, they would both die. Therefore, the frog can be assured the
scorpion will do no such thing. “Trust me,” says the scorpion. “We’re in this
together.”

Halfway across the river, the scorpion stings the frog. As
the frog seizes up and they both begin to sink, the frog croaks, “Why?”

“I am a scorpion. It
is my nature.”

This is not a morality tale.
It is a parable about the nature of things. The scorpion isn’t evil any
more than the frog is good. But the frog
ignores what the scorpion is at its peril.

We, as a country, are in trouble. If we don’t find our way out of this mess,
the stability of the United States is in danger.
This year, we will likely spend more than $2.4 trillion on
health care. That’s 16%
of our GDP. It’s unsustainable, and
if we don’t get a handle on it, it will sink us.

We know why health care costs so much in the United
States. It’s because everything costs too much. It’s compelling to try and find the bad guy
in this, the one entity to blame. Some
people blame the private insurance companies, others the pharmaceutical
industry, and others the government. The
truth is that this isn’t a battle of good versus evil - we are all to
blame. And instead of reforming the
system in such a way as to take care of these many moving parts, reform as
currently prescribed does as much as possible to keep the current system in
place. That is why it will ultimately
fail.

“Trust us,” say the insurance companies. “We’re in this together.” We are meant to believe that if we put regulations
in place, they will stop cherry picking patients. We are told that now they will start equitably enrolling
patients regardless of pre-existing conditions.
They won’t.

In the 1990s, private HMOs began to offer their services to
Medicare recipients. If you were over
65, you could choose a (private) Medicare HMO or regular (public) Medicare on a
month-to-month basis. In 1997, researchers
examined how people moved in and out of Medicare HMO plans and traditional
Medicare. Regulations were in place to
make sure there would be no cherry picking.
So what happened?

People who wound up joining the (private) HMOs used 66% less
care before joining than those who stayed in the (public) Medicare group. Somehow the private insurance HMOs figured
out a way to get the healthy people to jump ship out of the public plan into
the private one. Not only that, but
people who left the (private) HMOs and went back to the (public) Medicare used
180% more care after leaving than the people who stayed. Somehow the private insurance HMOs figured
out a way to convince the sicker people to jump back to the public plans.

So we had a system where a private system and a public
system were in an exchange like environment.
Regulations prevented cherry-picking.
And yet – somehow – the private plans figured out a way to do it. That is their nature.

“Trust us,” say the pharmaceutical companies. “We’re in this together.” We are meant to believe that the astronomical
prices we pay in the Unites States for pharmaceuticals will be remedied. Apparently, President Obama has gotten a
pledge from them that they will reduce drug prices charged to Medicare on the
order of about $8 billion dollars a year.

Forget that the pharmaceutical industry claims they need
astronomical payments to pay for research and development, when those costs
comprise less of a percentage of sales than profits, and much less of a percentage of sales than marketing
and administration. Forget that we
already pay far more for drugs than
any other country in the world – for the same drugs. We should trust
the pharmaceutical companies that they will do their part to reduce costs. After all, if our health care system sinks,
so will they.

And
yet:

In the last year, the industry has raised the wholesale
prices of brand-name prescription drugs by about 9 percent, according to
industry analysts. That will add more than $10 billion to the nation’s drug
bill, which is on track to exceed $300 billion this year. By at least one
analysis, it is the highest annual rate of inflation for drug prices since
1992.

The drug trend is distinctly at odds with the direction of
the Consumer Price Index, which has fallen by 1.3 percent in the last year.

Drug makers say they have valid business reasons for the
price increases. Critics say the industry is trying to establish a higher price
base before Congress passes legislation that tries to curb drug spending in
coming years.

“Trust us,” says the American Medical Association. “We’re in this together.” And yet, as independent reports show that outpatient
and inpatient care account for most of the unnecessary health care costs in
the United States, the AMA fights first and foremost for increased
reimbursement – effectively increasing the cost of care.

“Trust us,” say the
politicians. “We’re in this together.” And yet, it becomes impossible to distinguish
the policy from the politics; the politicians
from the lobbyists; the truth from the lies.

I am in no way suggesting that any of the groups I have mentioned here are bad people or have evil intentions. But we must acknowledge that their interests and ours do not always align. This is not a morality tale.
It is a parable about the nature of things. We recognize the danger, but
we seem committed to reform that depends on the good will of these
stakeholders. They ask us to recognize
that we’re in this together. They ask us
to trust them.

But we ignore their nature at our peril.

Read more about health care policy and get your
questions answered at Rational Arguments.

Lesley Stern: How to Live on $0 a Day: Assuaging Rage, One Prick at a Time

2009-11-12T10:53:50Z

If you've lived your life believing that hard work, ethics, observing the golden rule and fiscal responsibility will be rewarded, you're probably a little ticked off right now. Okay, you're probably roiling with rage (especially if you stopped taking your anti-depressants because your insurance company canceled you for being depressed).

A lot of that anger comes from a sense of betrayal and helplessness at seeing people who broke every law of decency living high on the hog while the rest of us are hard pressed to afford a swine flu shot (if we could find one).

The logical recourse is to seek justice. You've appealed to their non-existent sense of decency. You've written your elected officials, attorney general, chamber of commerce and better business bureau. Clearly, you can't afford a lawyer. Crank calls and Internet heckling bring no relief. And while sending offenders cat poop in the mail is satisfying, the postage is costly--there are no bulk media rates for mass poop mailings (which REALLY pisses you off). And try as you might, you can't seem to get your friends interested in storming Wall Street or the Capitol because pitchforks are too expensive.

If you're quivering with rage just thinking about it, it's time to take action. I've discovered a way to calm my ire and achieve a semblance of inner peace without costly aids like therapists, tranquilizers, a masseuse or weapons.

Whether your anger is directed at a TARP recipient harassing you for an overdue $69, a vile CEO, pundit or politician, someone who screwed you over, the neighbor's dog, or the waiter who lied when he told you the chef's special chicken was all white meat, my methods ensure that all bad behavior is met with swift and decisive punishment (finally!). I can't tell you how much better you'll feel. Here's how it works:

Marcia Angell, M.D.: Is the House Health Care Bill Better than Nothing?

2009-11-08T20:02:08Z

Well, the House health reform bill -- known to Republicans as the Government Takeover -- finally passed after one of Congress's longer, less enlightening debates. Two stalwarts of the single-payer movement split their votes; John Conyers voted for it; Dennis Kucinich against. Kucinich was right.

Conservative rhetoric notwithstanding, the House bill is not a "government takeover." I wish it were. Instead, it enshrines and subsidizes the "takeover" by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn't regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers -- those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65's will be more likely to go without insurance, even if they have to pay fines. That's OK with the industry, since these would be among their sickest customers. (Shouldn't age be considered a pre-existing condition?)

Insurers also won't have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an "option" at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it's been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers -- government and employers -- will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It's a shell game in which money is moved from one part of our fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it's a better program, because it ensures that everyone has access to a uniform package of benefits.

Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors' practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.

Is the House bill better than nothing? I don't think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

Robert Weissman: The Medicare-for-All Moment

2009-11-04T12:46:26Z

There is only one solution to the twin problems of escalating health care costs and the epidemic of the uninsured: a Medicare-for-All, single payer system.

Unfortunately, the healthcare debate on Capitol Hill has evolved without serious consideration of the Medicare-for-All single payer health proposal. There are many reasons for this, but one is that many who actually support Medicare-for-All have claimed that the proposal is "not feasible."

With the House leadership having settled on a single proposal, now is the time to set aside worries about feasibility. The House process is resolved. Members of Congress should have the opportunity to vote on the merits, up-or-down, on a Medicare-for-All single payer health proposal.

Whether they will have this chance is in the hands of Speaker Nancy Pelosi, and is likely to be decided soon. Contact her right away to urge that the House be permitted to vote on a Medicare-for-All single payer health proposal. Call (202) 225-0100 or (as a second best alternative, submit comments on the Speaker's web page).

Representative Anthony Weiner, D-New York, has proposed to introduce such a Medicare-for-All measure on the House floor in the form of an amendment to the leadership's healthcare package. If a vote is permitted, it will mark the first time either house of Congress has voted on Medicare-for-All, and will be a landmark in the inevitable march to a national Medicare-for-All system.

Meanwhile, Representative Dennis Kucinich, D-Ohio, is seeking to enable states to implement their own Medicare-for-All single payer health initiatives. Representative Kucinich introduced an amendment in the House Education and Labor Committee to facilitate such action, by providing for waivers of ERISA (employee benefit) requirements for states adopting single payer plans. This amendment passed the committee with bipartisan support. If Speaker Pelosi decides to incorporate it into the leadership bill, it stands a good chance of becoming law.

Although there are reasons to be skeptical, one can hope that the health reform package that ultimately becomes law will significantly expand coverage and curb insurance industry abuses.

But it is certain that the health reform package will not solve the overwhelming problems of coverage, cost and quality of care facing the country. Solving those problems requires going to the source: the health insurance corporations.

With its private health insurance industry-dominated system, the United States spends far more than other wealthy nations on health care (at least 50 percent more than every country except Luxembourg) but sports middling health indicators.

The private health insurance industry-dominated system in the United States permits 45 million people to live without health insurance, denying them access to preventative and routine care, resulting in the death of at least 35,000 people a year.

The private health insurance industry-dominated system tolerates private health insurance companies making life-and-death rationing decisions for millions of people with only minimal accountability.

The private health insurance industry-dominated system lets private health insurers refuse to take sick people as customers and engage in endless manipulations to discard its customers if they do become sick.

The private health insurance industry-dominated system features a system in which medical bills and illness contribute to almost two of every three personal bankruptcies -- even though three-quarters of these bankrupt people had insurance when they became sick.

Not least, the private health insurance industry-dominated health care system translates into a private health insurance industry-dominated political system. As a result, too many politicians refuse to consider real solutions.

There is a cure all for these ills. It is a Medicare-for-All, single-payer system, in which the government pays medical bills (thus operating as the "single payer").

In a Medicare-for-All system, health care is available as a matter of right. No one is denied treatment because they can't pay. No one is mandated to buy coverage. No one is denied coverage because of pre-existing conditions. No one goes bankrupt paying medical bills.

A Medicare-for-All system would save $350 billion - $400 billion a year in costs (up to $4 trillion over the 10-year period routinely analyzed by the Congressional Budget Office) -- enough to cover all of the uninsured. No scandalous CEO pay packages. No money siphoned out of the system by rent-seeking middlemen. No needless paperwork and bureaucracy.

A Medicare-for-All system succeeds by doing away with the private health insurance industry.

The powerful insurers, understandably, don't like this idea. Yet despite waves of deceptive and misleading propaganda about the purported horrors of government-run insurance, the people do like the idea of Medicare-for-All -- polls show it is supported by a majority of the public.

But insurance industry dollars have spoken louder than the people's voices. And so Medicare-for-All hasn't been given a serious hearing in Congress. Speaker Pelosi should at least enable a clean up-or-down vote. Call (202) 225-0100 and urge her to do so.

Sahil Kapur: So What if a Public Option Leads to Single-Payer?

2009-10-30T13:00:00Z

A common indictment by conservatives against a public health insurance option is that it's a Trojan horse for a single-payer system. Providing people with a public option today, they say, will drive out private insurance companies tomorrow and lead to a purely government-run insurance program -- a la Medicare, but for all.

The problem with this argument is not that it's entirely implausible; the problem is that it implicitly prioritizes the well-being of providers over consumers. To its defenders, it seemingly doesn't matter how vexing the system is for patients as long as Blue Cross Blue Shield is profitable.

If the public option leads to a single-payer system, it'll be because private health insurance couldn't offer as good a product to consumers -- that government-run insurance turned out more affordable, of higher quality, and better overall. It'll be because consumers preferred government-run health insurance to private insurance. Isn't that their choice? Isn't the main purpose of business enterprises to effectively serve consumers?

The public option puts consumers in the driver's seat, letting them decide whether to trust corporations or government with their health insurance. People should have that choice -- just as they do between public and private universities or between FedEx and the Post Office. It's very likely that private insurers will continue to coexist alongside a public option -- many two-tier systems prove this works. But if private insurers don't survive, it's because they were ripping off customers or operating inefficiently. Quite simply, if they fail, they deserve to fail.

In other words, wherever the public option leads -- single-payer or not -- it's up to the consumer. One way or another, the competition would force insurance companies to behave more decently and humanely, creating a better deal for all patients.

The conservative indictment against a public option is deeply ironic, and when closely examined, consists of two entirely contradictory cases about the nature of government.

The core conservative conviction for the last thirty years has been that government is inherently inefficient and incompetent at performing serious tasks. Therefore, it should refrain from meddling in the private sector -- be it with regulation or public enterprise -- because that will just spoil things. Free markets can better address consumer problems, including health care, they say.

Cut to today's health care debate, and the conservative view of government suddenly morphs into exactly what it once dismissed. Government is now too good, too effective and too capable at providing consumers with good products -- so much so that it'll put well-oiled, multi-billion-dollar corporations out of business if allowed into the market. That's ostensibly why we can't have a public option -- because poor little Aetna could never compete.

The fact that both these arguments are being simultaneously used by the same people reflects a perverse irony, if not hypocrisy. So, what's really going on?

It's that somewhere along the way, the end-game for lawmakers gradually shifted from satisfying consumers to satisfying providers. Private enterprises used to be the means to an end -- they would spur growth, innovation and provide choice and competition for consumers. Now, with contributions from corporate lobbyists increasingly necessary for political survival, the goal itself has become to serve the interests of narrow, wealthy industry groups.

That's why it's less relevant to Republicans and some conservative Democrats that people are dying and going bankrupt because of the failed health care system -- insurance companies are making money, and that's what important. So, anything that could get in the way of that -- such as the creation of an entity that would make life better for consumers by increasing competition -- should be dismissed off-hand.

The notion that the public option might lead to a single-payer system isn't a cause for concern. The real Republican fear, as their Freudian slips show, is that a public option will be popular and serve consumers better than private insurers. After all, these are the people who have long said government can't do anything right. It would devastate their political philosophy if rapacious private enterprises are unable to compete with a self-sustaining government enterprise that plays by the same rules.

Ultimately, if conservatives really believe in their core conviction -- that government is ineffectual -- they would be willing to put it to the test, and let the people decide whether they're right or wrong. But that's not the case. Instead, their actions and rhetoric continually raise questions as to what their true motivations are, and their loyalty to special interests increasingly seems to trump their loyalty toward their real constituents.

Kathleen Reardon: H1N1 Vaccine Delays Remind Us Why We Need a Sound Public Option

2009-10-29T17:10:09Z

I must have had a premonition the other day when I wrote a blog about delays in H1N1 because my daughter is now in bed with a fever, aches, and the symptoms of flu. She had the seasonal flu shot weeks ago, so this may very well be H1N1. Her doctor says that as an otherwise healthy 17-year-old she is not in the group that should immediately begin an antiviral medication. She should drink liquids, stay warm, stay in bed, and take ibuprofen. And we should keep alert. But I'm worried, as any parent would be. Knowing we're in a "national emergency" and having seen how severely some children are affected, you can't exactly rest easy when your child has flu symptoms. So I bring her liquids and stay near as so many other parents are doing.

As a professor of both business and preventive medicine for years, I'm appalled at how long it is taking for the H1N1 vaccine to reach at least those at high risk. Does this mean I believe less in a public option for health care coverage? No. One is the result of misjudgment and likely some degree of negligence in working with manufacturers of the vaccine. The other is about making sure that people without health care coverage have an option so that they are not left out in the cold, suffering like my daughter, but with nowhere to turn.

If anything, the lateness of the H1N1 vaccine, actually the very existence of H1N1, tells us that we need a public option. As Jane Hamsher's blog indicates, the more we allow pharmaceuticals and insurance companies to dictate when, how and to whom needed medication will be dispersed at reasonable costs, the more people without sufficient monetary means will suffer. By contrast, the more pharmaceuticals have to worry about whether our government might make a deal with someone else and that they aren't running the whole show, the better off we'll be.

My daughter's illness reinforces my frustration about vaccine delays. But illness like hers also reinforces the need for options, the need for competition (which Republicans used to like) and a way for all of us to have access to medical care no matter where we are in the inevitable up and down cycles of life. In fact, it reinforces the need for more options, not less, so that vaccines will be safe.

Let me add, that I'm not opposed to pharmaceutical companies or insurance companies. They do what they do well at times and often save lives. Some of their research has helped people fight dreaded illnesses, in my case cancer and Parkinson's, and live longer than expected. But it is up to us to insist that that they do so in ways that assure, to the best of our ability, medical care of countless people whose lives could be at risk were we to leave such companies to their own devices. The banks have proven that point again and again.

Those in whose hands we place our health, as individuals and as a nation, need to know that people like Jane Hamsher are watching them. They need to know that there will be a public option and not just one that means victory on paper for a few on the Hill - not a sell-out - but one that assures, to the extent possible and without regard to wealth, survival of future H1N1 type illnesses and those we cannot as yet foresee.

Dr. Reardon also blogs at bardscove.

Charles Kolb: Our Health Future: The Business Case for Wyden-Bennett

2009-10-28T10:08:06Z

Recent action on health-care legislation is headed for a strategic disaster -- rising health-costs and a fiscal explosion. Business leaders need to recognize this, and work to change course before it is too late.

Health care and insurance are complex systems with interacting parts. The consensus wants coverage to be available to everyone (except illegal immigrants), with no penalties for pre-existing conditions. The insurance companies want everyone to buy insurance, so that the cost of covering the sick will be offset by premiums from today's healthy. Legislators want to limit the premium cost to low-income households, and to allow those with incomes too high for Medicaid coverage but too low to purchase their own insurance to have a relatively painless exemption from buying coverage. Business leadership organizations want to maintain control of the health plans of their employees. And everyone wants the total cost of the initiative to be limited, and to be fully paid for by savings elsewhere and by taxes.

These demands cannot all be met at once. The price of insurance cannot be set by law; it is determined by the cost of health care for the population to be covered. Legislators are unable or unwilling to enact effective measures to mitigate health expenditure growth. To cover the health care risk for everyone, everyone must buy coverage. If modest-income families are to buy insurance, they must be subsidized. Those subsidies have costs, and those costs drove the total cost of the health care bills in Congress higher than the target. To save money, the subsidies were cut. For political appeal, more low-income families were excused from purchasing insurance, and penalties for refusing insurance were reduced. With fewer healthy people in the risk pool to share the cost of covering the sick, the price of insurance inevitably will rise.

This process will feed on itself. As insurance becomes more costly, those who see themselves as healthy will refuse insurance in increasing numbers, even if they must pay the now-reduced penalties. After all, if they do become sick later, they will be able to buy insurance virtually on the way to the emergency room - because discrimination against pre-existing conditions will be banned. As more healthy people drop insurance, the price per person will rise - inducing still more healthy people to decline coverage, in an ever-worsening spiral.

This legislative process appears preordained to fail. Democratic leaders in the Senate and the House are working to combine their five bills without violating the President's cost constraint. The House and the Senate reject each other's cost offsets. Every additional feature will have to be paid for. Legislators will not want to burden poor people with higher costs, and likely will reduce, rather than increase, the penalties for not having insurance.

The final bill certainly will raise funds by imposing various taxes on firms and especially insurers. These taxes will be passed on to customers through higher insurance premiums. (It is ironic that the taxes in the Finance Committee bill will be on insurers, whether for-profit or nonprofit, but not on self-insuring employers. This will tilt the playing field in favor of self insurance, which is almost always costly fee-for-service, and against efficient prepaid plans like the Group Health Cooperatives and Kaiser Permanente, which compete for members in employment groups.)

The standards for an acceptable policy under the mandate will probably increase premiums too. So people will increasingly go without insurance until they need it, and thanks to guaranteed issue, they will then enroll when they anticipate medical needs. When they foresee no more medical needs, they will drop insurance because $4000+ per year in premiums is a lot more than $200-750 of penalties for going without insurance.

This vicious cycle will become a "death spiral" as more and more healthy people drop out of the insurance pool. So finally, insurance companies - quite possibly including the nonprofit integrated delivery systems like Group Health Cooperative and Kaiser Permanente, which have been commended for driving competition and innovation - will have to withdraw from the individual market.

As the insurance companies withdraw, the advocates of the "public option" will say, "We told you so." So access to the public option will be expanded and it will grow rapidly. Its premiums will have to be high by today's standards - unless it is able to draw on open-ended public subsidies the way Medicare does. So, to provide "competition" and "challenge the private insurers," it will be subsidized - either explicitly with cash, or implicitly with the right to compel doctors and hospitals to participate at artificially low reimbursement rates. Private insurance companies cannot survive against a subsidized public insurance company backed by the full faith and credit of the federal government, with the power of law to extract below-market services from providers. There will be a government "single payer" for people not in self-insured employment groups. But a government insurance company will be no more able to bring health expenditure growth to sustainable rates than Medicare has been. Just look at the politics of the Sustainable Growth Rate formula for physician fees in Medicare for an example of what will happen.

Rising costs will overwhelm the subsidies to cover low-income people. Those subsidies will have to rise to keep pace with costs. The Federal budget deficit, already far too high, will continue to grow unsustainably as health expenditures continue to outpace revenues (and the GDP out of which those revenues are collected).

The end of the story is a sequel to the economic thriller of the last two years. The foreign investors who have been our nation's lenders of last resort - and even American investors - will be increasingly reluctant to buy the torrent of US Treasury securities needed to finance our health-cost-driven deficits. The Treasury will have to pay higher and higher interest rates, sending deficits still higher, stoking inflation, and stifling investment and economic growth.

Only market forces - insurers, providers and consumers, all with aligned incentives to seek and deliver the highest-quality care at the lowest possible price - can stop our health-care industry from piling onto the already outsized budget deficit. The Wyden-Bennett bill introduced in Senate Finance, based on the principle of cost conscious individual choice of health plan, is the only proposal that gets health care costs under control and avoids a government single-payer system in the long run. The legislation now under consideration heads in the opposite direction, and its momentum is strong. Business leaders, with their interests grounded in the long-term health of the economy, need to stop this march into madness and work to get the Wyden-Bennett bill enacted.

"FAIR Health" Database Will Allow People To Compare Health Care Costs

2009-10-27T15:12:47Z

SYRACUSE, N.Y. — Consumers across the country soon will be able to find impartial information about out-of-network health care costs on a new Web site, New York Attorney General Andrew Cuomo said Tuesday.

The information will be collected by a new not-for-profit company, FAIR Health, in partnership with a research consortium based at Syracuse University, Cuomo said.

Aislin Bates: Colorado Toddler Denied Health Insurance For Being Underweight

2009-10-20T12:21:59Z

The parents of a two-year-old girl in Colorado are unable to obtain health insurance for their daughter because the insurer, United Healthcare Golden Rule, claims she is too small. In a letter sent to the family of the child, Aislin Bates, United Healthcare Golden Rule writes, "we are unable to provide coverage for Aislin because her height and weight do not meet our company standards." According to a Colorado news station, Aislin weighed six pounds, six ounces at birth, and now weighs 22 pounds.

When Robert Bates, the girl's father, left his former job to start his own business, he was forced to seek out his own health insurance, and enrolled his family in an insurance plan with United Healthcare Golden Rule. "It took me by surprise," Bates told ABC 7 in Denver. "I didn't think that her size was that abnormal and that it was something that you'd consider to be unhealthy." As ABC 7 reports:

A spokeswoman for United Healthcare Golden Rule said 89 percent of the people who apply for insurance get it. Ellen Laden, the company's public relations director, told the station that most insurers have their own propriety height and weight guidelines.

"Ours are based on several medical sources, including the Centers for Disease Control, and are well within industry standards," she said.

Laden said she couldn't talk about specific cases like the Bates'.

Robert Bates, however, isn't satisfied. "What we want to see is that insurance companies have legitimate reasons for denying coverage," he said.

Recently, another child in Colorado, Alex Lange, was also denied coverage, but for "preexisting obesity" instead of being underweight. In that instance, the insurer, Rocky Mountain Health Plans, reversed their policy after the parents of the 17-pound infant gained media exposure. After the reversal, Rocky Mountain Health Plans attributed the boy's rejection for health coverage to a "flaw in our underwriting system."

The Bates family is hoping for a similar change in policy. In the meantime, Aislin Bates remains uninsured.

Ian Pearl: I Am Not a Dog

2009-10-19T14:14:54Z

I am not a "dog." That's what health insurance executives called me because I have a disease. I'm also not a "trainwreck," another term they used for members like me.

Soon after I was born in 1972, I was diagnosed with muscular dystrophy. By the time I was six years old, I was confined to a wheelchair. Doctors doubted I would survive, but I inherited my parents' determination, and I proved them wrong.

I was the first wheelchair-bound student "mainstreamed" in the schools of Broward County, Florida. I became a poster child for the Muscular Dystrophy Association and president of my high school class. I entered college in 1990 with plans to work in politics and patient advocacy, but at 19, I had a severe setback and I was confronted with a stark choice. My survival would require a machine to breathe and round-the-clock nursing care.

A breathing machine usually means life in a nursing facility. But my father's small business had health insurance from Guardian Life Insurance Co., which promised "Solutions for Life." The health policy had no lifetime benefit cap and covered home nursing care. Relying on that contract with a 149-year-old company, I decided to go on a mechanical ventilator for the rest of my life.

Since then, I've endured life-threatening medical complications and long hospitalizations. I've lost my privacy and ability to travel. But I never regretted my decision to live, to continue to learn and write, and to share in the lives of family and friends.

After decades of medical emergencies, we still weren't prepared for the latest crisis -- this one created by the same insurance company that once saved my life. Guardian abruptly withdrew our health plan from all policyholders in New York where my father's business is based. Guardian offered a 'replacement' plan with low benefits and no home nursing benefits. They knew that I would never survive with such a plan, but they didn't care.

Suspecting that this action was related to the high cost of my care, we filed a lawsuit and have asked the U.S. Department of Health and Human Services to enforce existing federal laws and require Guardian to continue my health plan. Without federal intervention, I will lose this insurance, and that would be a death sentence.

Our lawsuit uncovered insurance company documents that confirmed my suspicion that I'm a target of discrimination. The documents revealed Guardian had compiled a "hit list" of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as "dogs" and "trainwrecks," and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.

Although my medical costs constituted a minuscule fraction of Guardian's profits, the company had been trying for 15 years to sidestep its obligations to me. The insurer hired private investigators who searched in vain for evidence to justify canceling the policy. Guardian had similarly targeted the other "dogs" without success. Finally, Guardian launched the unprecedented strategy of withdrawing an established plan throughout an entire state in order to discontinue a few costly members.

When we checked the private insurance market to see my options, we discovered that benefits covering the care I need to survive are no longer available to small businesses. We learned that the insurance industry has replaced risk management with risk elimination, offering only benefits that guarantee permanent profitability. The human toll is not a factor in their calculations.

While all this was going on, Guardian reported $7.5 billion revenue, net income of $437 million, and available capital of $4.3 billion in 2008. Unlike small businesses, Guardian's financial strength remained unscathed by the economic downturn.

The health insurance industry remains unchecked, unaccountable and uninterested in the health needs of Americans. Nothing is more important than profit.

Don't think what happened to me was unusual. Insurance companies regard everyone as potential dogs and trainwrecks. They won't hesitate to use similar tactics to avoid your claims if someone in your family suffers a catastrophic illness. Insurers don't like it when sick people live too long and cost too much.

I know firsthand that America's health care system has the capacity to provide incomparable, life-saving care. But I am living proof that insurance-company "death squads" meeting behind closed doors routinely make life-sustaining benefits vanish.

Without stricter enforcement of existing laws and the creation of a public health insurance option to keep private insurers honest, it's only a matter of time before you or someone you love will become the next victim.

CBO Health Care Estimates: Washington Post Profiles Agency That Estimates Health Care Bills' Costs

2009-10-18T23:23:45Z

Phil Ellis may be the most powerful guy you've never heard of in the health-care debate. A senior analyst with the Congressional Budget Office, Ellis is the man who has to decide what it would cost to rebuild the health insurance system. He has essentially condemned two legislative proposals by slapping them with trillion-dollar price tags. A third plan rocketed to prominence after he said it would cost much less.

Julie Farby: Obama's Rx For Health Care: Pull Plug On Insurance Companies, Not Grandma

2009-10-18T20:51:07Z

Crazed, shrieking mobs of birthers, secessionists, and teabaggers are one thing. As annoying and demented as they may be, Barry knows these confederate flag-waving patriots simply can't help it if their brains don't function like the rest of us. Such feeble minds deserve our pity, not our scorn!

Not so for those motherf**kers over at the insurance companies whose years of lying, scheming, and fleecing the public finally caused Mr. Barry Chill to lose his signature cool and unleash the full-force of his long-simmering fury.

This time, Badass Barry used his weekly radio/internet address to fire back at the insurance industry, accusing the no-good bastards of using "deceptive and dishonest ads" to derail health care reform because apparently Michael Steele's sacrificial cow on tracks didn't exactly get the job done.

Calling insurance companies "obstacles to change only interested in their own profits and bonuses...willing to bend the truth or break it," Obama blasted the greedy, selfish crooks for being more concerned with fattening our hearts (and thus their wallets) than fixing the system.

But only if by fix you mean repair, 'cause otherwise that's totally not true! They're more than happy to make some under-the-table "arrangements" if you catch my drift.

"It’s smoke and mirrors," Obama said. "It's bogus. And it’s all too familiar. Every time we get close to passing reform, the insurance companies produce these phony studies as a prescription and say, 'Take one of these, and call us in a decade.' Well, not this time."

Rather than trying to curb costs and help patients, he said, the industry is busy "figuring out how to avoid covering people ... And they’re earning these profits and bonuses while enjoying a privileged exemption from our antitrust laws -- a matter that Congress is rightfully reviewing."

"The insurance industry is rolling out the big guns and breaking open their massive war chest to marshal their forces for one last fight to save the status quo."

But look on the bright side, at least they're trying to save something, even if it is their own ~~assets~~ asses.

Unlike us miserable wretches, I guess some things are worth fighting for.

Axelrod Refuses To Say If Obama Will End Antitrust Exemption For Insurance Companies (VIDEO)

2009-10-18T15:50:32Z

During an interview with George Stephanopoulos on ABC's This Week, senior Obama adviser David Axelrod refused to say directly whether or not President Obama would sign health care reform legislation that would end the antitrust exemption for insurance companies, something Obama teased in his radio address yesterday.

Pressed repeatedly by Stephanopoulos, Axelrod continued to dance around the issue, finally saying "we'll see what Congress does."

WATCH:

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House Vote On Insurance Industry Antitrust Exemption Coming

2009-10-17T13:27:27Z

The battle against the health insurance industry is steadily intensifying. House Democrats have formally scheduled a vote to revoke the industry's cherished antitrust protection, according to a statement from Judiciary Committee Chairman John Conyers Jr. (D-Mich.). The move comes after House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nevada) have put up a unified front, calling for an end to the anti-competitive practice.

On Thursday, Pelosi noted to reporters that the Judiciary Committee had held a hearing on repealing the 1945 McCarran-Ferguson Act, which exempts the insurance industry from antitrust laws.

Conyers announced Friday he'd take it to the next level and hold a vote on October 21. "These abuses are plainly illegal in other industries, and it does not make sense, when Congress is working so hard to bring meaningful reform to the market in health insurance, that health insurers should continue to be exempted from federal antitrust oversight," said Conyers. "This bill is an important complement to the public insurance option in ensuring that American families get the full benefits of choice, affordability, reliability, and quality service that competition brings."

That Conyers' announcement followed Pelosi's and Reid's push indicates an orchestrated offensive against the industry. A statement released Friday night by Rep. Chris Van Hollen (D-Md.), a close Pelosi ally and the chairman of the Democratic Congressional Campaign Committee, further indicates a concerted effort.

"For far too long, health insurance companies have been exempted from playing by the rules that most other businesses must live by. They have abused that benefit. Now is the time to require them to abide by the same rules as everyone else. I believe it is long past time to repeal this exemption," he said.

Obama Weekly Radio Address: Insurers Are "Filling The Airwaves With Deceptive And Dishonest Ads"

2009-10-17T09:39:29Z

Norman Goldman: Health Insurers Have It All But Want Still More

2009-10-16T16:40:41Z

The health insurance industry has us all by the throat -- and yet they want more! They have a "10 Point Stranglehold Program" on America -- but they want 13. Here's what I mean:

Insurance companies have 10 things already:

1) No rate regulation;
2) No rate caps;
3) No competition;
4) No federal regulation;
5)Anti-trust exemption;
6) ERISA protection (podcast my Oct. 8, 2009 show for lots on ERISA);
7) Domination of state regulators;
8) Pre-existing conditions to cherry-pick only the customers they want;
9) Rescission to dump patients who cost them money;
10) Life time caps to limit their liability and exposure to paying claims.

But wait, there's more! They now demand three more things:

11) A federal mandate to buy coverage;
12) Whopping penalties to enforce the mandate and make our government their enforcement and collection agent;
13) Whopping subsidies of tax dollars (some call it money laundering) to pay for their overpriced, crappy product.

According to the rules of capitalism, a product that is bad and overpriced fails in the marketplace. So does the company selling the junk. But, in corporate, crony capitalism-land (America, 1980-present) the rules of the game don't apply. Yet, they call us Communists and Socialists. They are Fascists - plain and simple - the merger of big business and big government.

Only single payer will break their grip from around our throat.

Cross-posted from Justice for You.

Baby's Insurance Company Denies Coverage, Family Left In Health Crisis With Over $100,000 In Medical Bills

2009-10-16T14:10:05Z

Sixteen months ago, I gave birth to a wonderful baby boy, Trypp. After a week, Trypp began sleeping longer than usual and refused to eat. I took my son to the hospital, as he was quickly losing weight and shriveling up into a ghost of a baby.

Our doctor and specialists did everything in their power to try to get him to eat, but nothing worked. As a last resort at Grand Forks hospital, our doctor put Trypp on a feeding tube. Three days later, his stomach was distended; our doctors were at a loss, as the treatment wasn't working. It was decided they would life-flight him to Minneapolis-St. Paul for hopefully life-saving treatment.

Michael J. Wilson: Insurance Companies Want Caviar on the Gravy Train

2009-10-16T12:38:34Z

Insurance companies have been playing nice on health care reform. If you sell a product, and the government requires every American to buy it -- even subsidizes the cost for people who can't afford it -- what's not to love?

On October 13, the Senate Finance Committee, chaired by Max Baucus (D-MT) finally unveiled its health care reform bill. As with all proposed reform bills, insurers could no longer refuse to cover people on the basis of pre-existing conditions. But Baucus would provide no public program to compete with private insurance companies and deter them from raising premiums. The insurance companies would get 22 million new paying customers, 18 million of whose premiums would be subsidized, but not sufficiently enough to make out-of-pocket costs really affordable.

So why did the Health Insurance Association of America (HIAA) suddenly return to its Harry & Louise mode and oppose the Baucus bill? Care for their bottom line, of course. HIAA claims companies would raise premiums more than the Committee and Congressional Budget Office (CBO) estimate, and well they might with nothing in the bill to stop them. The Baucus bill is estimated to leave 25 million Americans without insurance, who would be required to pay a $750 penalty -- a pittance compared to an estimated $14,700 to pay for a low-cost insurance plan.

The insurance companies figure that it's young, healthy people -- the kind they love to cover -- who would opt not to buy insurance. (Of course, a small percentage of those who choose not to buy insurance will get seriously ill, and to their sorrow will regret their choice.) So the industry isn't satisfied with being handed 22 million new paying customers who might get sick. In fact, the insurance industry is just fulfilling its duty to its stockholders. They want a reform program in which absolutely everyone must buy their costly product, with hefty subsidies for everyone who can't afford the premiums (excluding those in Medicaid and Medicare). If 25 million young and healthy Americans can opt out, while the companies must insure those sick people they have heretofore spurned, the Baucus bill fails to provide the gravy train they've been bargaining for.

In truth, I don't like the Baucus bill either. HIAA and I both want everyone insured, but on different terms. Without a public option nothing will stop premiums from rising, requiring taxpayers to foot the bill for subsidies that ought to make premiums affordable (but don't under the Baucus bill). For example, according to the CBO, using current premium estimates (that HIAA thinks are unrealistically low), the Baucus bill would require a middle-income family of four with an annual income of $78,000 to pay $15,100 out of pocket (premiums, deductibles, and co-payments), or 19% of its income. (Sometimes it seems legislators have difficulty putting themselves in the shoes of a family trying to house, feed, clothe, and educate its members on $78,000, minus $15,000 for health care.)

The Finance Committee has opted to save money by leaving 25 million Americans out, and by providing subsidies far too meager to pay for expensive health insurance. HIAA insists that those 25 million healthy Americans must buy their product. Both Baucus and HIAA fall far short of my goal of affordable comprehensive health care for all Americans.

Lesley Stern: How to Live On $0 a Day: Bailouts for the Rest of Us

2009-10-15T16:46:05Z

Maybe you have to pay your past due Citicard balance down so you can charge some food on it. Or you need an emergency appendectomy but your insurance company canceled your policy because you need an emergency appendectomy. Or you desperately need a new corporate jet. It doesn't really matter why you need the money, all you know is that life as you know it will cease to exist if you don't get your hands on a big chunk of cash. Yesterday.

Now, if you're the corporate jet guy, you can always go to the Fed and get some help. But what about those of us who aren't too big to fail? Where are our windfall opportunities?

First, the obvious
Make sure that your dog or child doesn't have any unused credit lines from when the credit card companies were giving credit to anything with a name. An acquaintance found thousands of dollars of unused credit on the family dog's (Barkie Von Barkenburg's) forgotten Chase Mastercard. Apparently, Labradoodles are a great credit risk. The funds were a lifesaver, allowing him to buy a month's worth of Celexa, some blood pressure medicine, groceries, a tank of gas and a nice box of Milk Bone for Barkie.

Look for forgotten stock certificates, Oxycontin, Michael Jackson paraphernalia (a potato with his face on it is now going for more than one with Jesus') and sell them on the open market.

Search your mouth for gold crowns (worth almost as much per ounce as Oxycontin). If you're plum out, check your family and friends' mouths while they're sleeping. Wear a scary mask so if they wake up during the extraction process, they'll just think it's a bad dream. A couple of gold crowns could solve a lot of your problems.

Hire a pretend lawyer (or become one)
Lawsuits are a great way to make a buck without actually working (especially for lawyers). Try using this time-honored American tradition with a twist. Forgo the expense of engaging a lawyer or purchasing a neck brace for your court appearance. Just threaten to sue and go for a quick settlement.

You'll have to learn a few fancy legal terms and start thinking like a lawyer, but it's preferable to the consequences. Don't forget to add "Esq." to your name on all correspondence.

Be on the lookout for things that can lodge in your throat and cause damage. Bottle caps, dry cleaning tags and bits of packaging (ie: candy wrappers, the cotton on top of the aspirin bottle) are always good bets. We've already seen what a shrewd businessperson can do with a hot cup of coffee. Keep your eyes open for wet floors, loose tiles and rugs to slip or trip on.

Before you go to the trouble of choking, slipping and otherwise hurting yourself, make sure your target has quick access to money. In other words, your best bets are banks, pharmaceutical and insurance companies.

Sadly, gone are the days when banks gave out free toaster ovens that you could easily electrocute yourself on. But be alert for potentially harmful pens, candies and monthly statements. Not long ago, my bank was giving away free nickels. I still regret not taking the opportunity to choke on mine.

If you don't want to go the corporate route, just hurl yourself in front of an expensive car driven by someone who is text messaging while driving. If you survive, you'll be in for a hefty settlement. If you don't, at least your financial problems will be over.

Cashing in on guilt
Have your parents contributed to your present dysfunction? Have they ruined your life in any way? Of course they have!!! If they have money and they're selfishly spending it on themselves, it's time to start dredging up the past.

Have a coffee with your mom (she'll pay). Share a warm memory of that sunburn you got when you were 2 years old that undoubtedly led to premature wrinkling and a constant fear of skin cancer. Muse how these days, parents lose their children for less. If that's not enough to get her to fork over some cash, you might want to mention that the photo of poor adorable you at 2, all red and blistered, could be worth a lot in a court of law. Or on Oprah.

If you don't have physical evidence, focus on emotional damage. It can be anything from how they spanked you (which made you unable to form lasting relationships), they didn't spank you (you never learned discipline and limits, making you unemployable), they forced you to go to private school (setting you up for unrealistic success and continual heartache), they forced you to go to public school (setting you up for failure and continual heartache) or they forgot to go to your ballet recital when you were four which destroyed your burgeoning career as a dancer. The possibilities are endless.

If the situation is reversed and you're a needy parent with solvent children, use the same approach. Let them know that you gave up a burgeoning career as a dancer/Nobel prize winning scientist/Pulitzer prize winning journalist/pick your favorite profession, to raise them. Make sure they know that their years of poor grades and shoplifting precipitated your drinking problem. If you're divorced, let it slip that it's all their fault. Unless they're callous, amoral ingrates they'll be cutting you a check in no time (do not try this if your child is an insurance company executive). At the very least, they'll renovate the room over their garage for you to live when you're evicted from your retirement community.

The same concept can be applied to non-family members. Introduce a now happily married ex-lover to an adorable child obviously conceived during the time of your affair. If you don't have an adorable child of your own, borrow one from a friend or relative (never try to rent a child or borrow from a stranger unless you need free room and board in jail). If you've ever slept with a politician or celebrity, that's always a great place to start (mention your good friend who works at TMZ). The success rate for this method is much higher if you're a woman.

Extortion is such an ugly word
I prefer to call it "threatening to educate the public." If you have any information on a celebrity, now's a good time to let them, and possibly the world, know about their sick, deviant behavior. Even if the celebrity calls the cops and gets you busted, the celebrity's transgressions will be the focus, rather than your crime. You'll probably get a book deal or a spot on dancing with the stars. Win/win.

Psssst: Conan, call me.

Ari Melber: Rattlesnakes, Progressive Bluffing and The Public Option

2009-10-14T14:51:17Z

Baby rattlesnakes kill faster than their adult counterparts.

The little guys release all their venom in a single bite, while adult snakes use a small dose initially, having learned it's best to save lethal attacks for the end of a fight.

In Washington, the oldest snakes in the health care debate finally emerged this week. After months of dithering and slithering, the insurance industry is going in for the kill.

In the industry's new "frontal assault" on reform, as The Washington Post dubbed the effort, politicians must now counter more negative ads and voters have to slog through another round of specious fear-mongering.

While the days of "death panels" and "illegals" have passed, the crude code words are giving way to a decidedly highbrow misinformation campaign.

The new industry-backed health care report -- which marks a final, official rejection of President Barack Obama's conciliatory industry stance -- runs 19 pages with 17 charts and 22 footnotes.

It warns that insurers could jack up premiums by 111 percent -- a prospect that should actually drive people toward stronger reform proposals, as Rep. Anthony Weiner (D-N.Y.) noted Monday.

It overshoots the nonpartisan Congressional Budget Office cost estimates by $7,000 per person -- with a quirky methodology that was swiftly panned by The New Republic and The Washington Post.

The report was written to confuse, not convince. And it reveals an important shift as the health care fight enters this lethal homestretch.

"The insurance industry is getting scared," concluded health policy expert Ezra Klein, in response to the report's release. The insurance industry spent months presenting an aura of "quiet constructiveness," he noted, only to launch a sudden "broadside" that rocked the Senate Finance Committee and "shocked" the administration. Couple that with how Obama aides were "shocked" by progressives' demand for a public option, and you might wonder what's wrong with the political thermometer at the White House.

Those two surprises are strategically similar, by the way. Both camps say they will thwart legislation that fails to meet their conditions.

The difference, of course, is that Washington knows the insurance industry is serious about obstruction. (Many observers were counting on it before the industry went negative.)

The Congressional Progressive Caucus, by contrast, loudly pledged to oppose any bill without a public option, but its resolve remains an open question.

"The weakness of progressives among House Democrats," observed David Waldman, a former congressional aide and liberal writer, "has always been that their threats are not viewed as credible."

Waldman cheered progressive members for shifting that perception "by insisting that no bill without a serious public option can get their vote." If the House does force a public option bill into conference negotiations, he argues, then the political pressure shifts to (more conservative) senators. They would have to choose between compromise and killing the entire proposal.

Darcy Burner, who has been huddling with members of Congress as head of the newly minted ProgressiveCongress.org, stresses that the liberal wing is "not bluffing" this time. "We don't have to bluff. Health care reform can't pass the House without progressive votes, and we are fighting for a [public option] policy that is supported by an overwhelming majority of the American public," Darcy said in an interview.

That promise was reinforced by Rep. Raul Grijalva (D-Ariz.), Progressive Caucus co-chairman, who says the caucus will not "blink" or "roll over" in this standoff. Last week, Grijalva joined five members of Congress in a private Hill summit convened by Burner's team for more than 30 organizations, including an alliance of faith and minority groups that have often felt sidelined in Washington's health care policymaking.

Once you aggregate all these countervailing threats, it's hard to understand Washington's conventional wisdom that "moderate" members of Congress are the only ones holding the cards to scuttle reform. The insurance lobby fills that bill now, too -- whether you already knew it or had to be shocked and awed into the realization this week. So does the Progressive Caucus, which insists it will never opt in to a public option that is merely opt-in.

The dispositive question is whether progressives' bark is worse than their bite. In Washington, of course, the bite is always most important. Just ask the snakes.

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This column is from Politico. Ari Melber Twitters news and politics at Twitter.com/AriMelber