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Wendell Potter

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Health Insurers Have Had Their Chance

Posted: 05/31/11 08:43 AM ET

Of the many supporters of a single-payer health care system in the United States, some of the most ardent are small business owners who have struggled to continue offering coverage to their workers.

Among them are David Steil, a small business owner and former Republican -- yes, Republican -- state legislator in Pennsylvania who earlier this year became president of the advocacy group Health Care 4 All PA.

Another supporter is Vermont Gov. Peter Shumlin, who last Thursday signed a bill that sets the stage for the country's first single-payer plan. If all goes as Shumlin and the bill's many backers hope, all 620,000 Vermonters will eventually be enrolled in a state-run plan to replace Blue Cross, CIGNA and other private insurers whose business practices have contributed to the number of Vermonters without coverage -- approximately 60,000 and growing.

Both men told me last week that their feelings were shaped by their backgrounds. Their experiences as businessmen convinced them that a health care system controlled by private insurers cannot be sustained, regardless of attempts to force those insurers to provide affordable access to care for all Americans. They are both skeptical that the Obama administration's Affordable Care Act will provide the fix the country needs, even with the new regulations and consumer protections.

Steil, president and owner of a small manufacturing company in Bucks County, Pa., told me he grew increasingly frustrated about having no leverage in dealing with private insurers, which demanded double-digit premiums increases every year.

Shumlin, who along with his brother took over the management several years ago of a travel business their parents founded, echoed the same frustration. Shumlin, who also served as a legislator, shared another frustration with Steil: not being able to help political constituents, many of them farmers and small business owners, who called begging for help in finding coverage.

"During my 16 years in the legislature, my staff and I were frustrated time and again trying to help people who had lost their coverage and couldn't find a single insurer willing to offer them a policy, usually because of a preexisting condition of some kind," Steil said. "We could deal with almost everything else, but this was one thing we could not solve. There simply was no solution."

I know exactly what he means. I have spoken to hundreds of groups about the health insurance industry over the past two years, and invariably at least one person -- and sometimes several -- will grab me afterwards to ask for my advice on obtaining coverage. They assume that someone who spent two decades as an insurance company executive ought to be able to help them out.

Unfortunately, I have no better answers than Steil or Shumlin had for those constituents. If you've been sick in the past, or have a spouse or child who has been treated for one of hundreds of conditions insurers consider "preexisting," about the only way you can get coverage is to convince an employer that still offers health care benefits to hire you. Good luck pulling that off in this economy.

And if you would much rather work for a small employer or become your own boss, be prepared to remain in the ranks of the uninsured.

The number of employers of any size still offering coverage dropped from 69 percent to 60 percent between 2000 and 2009, according to the Kaiser Family Foundation. The decline has been much steeper among small businesses with 10 or fewer workers. In 2009, far fewer than half of them were still offering coverage.

The Affordable Care Act, which provides tax breaks to small employers if they offer coverage and subsidize premiums for their workers, might at least slow that trend. Some of the big insurance companies have reported a recent uptick in the number of small businesses offering coverage -- many for the first time -- as a result of those tax breaks.

But even with financial help from the government, most small companies are still finding it difficult to pay what insurance firms are demanding. Another Kaiser Family Foundation study found that health insurance premiums employers paid for their workers in 2010 stood at $13,770 for family coverage -- more than double what they paid just 10 years earlier.

In a Crain's magazine survey of 300 small businesses in Michigan earlier this month, 24 percent said they had considered cancelling their group policies in 2011, primarily because of rising premiums. Several employers in Michigan did drop coverage.

Of those that decided to offer benefits for at least another year, a growing percentage are making employees pay a heftier share of the premium, and they're shifting them into plans with higher deductibles. A survey this month by PriceWaterhouseCoopers (PwC) found that 17 percent of employers offered high-deductible plans, up from 13 percent last year. PwC says that if the trend continues -- and why wouldn't it? -- high deductible plans will be the most common type of coverage by 2014.

Low income individuals and families will become eligible that year for subsidies from the federal government to help them pay their premiums. But even so, Steil and Shumlin don't believe the current system, dominated by private insurers, is sustainable in the long haul. You can't keep shifting more of the cost of both coverage and care to people--and also make them pay increasing amounts of tax dollars in subsidies that will go straight to private insurers--and not expect people to eventually stage a rebellion.

Private insurers, say Steil and Shumlin, have had their chance to control costs and expand access and have failed miserably. It is time, they believe, to replace them with a single payer -- the government.

 
 
 

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gopgotnosoul
Helping turn AZ blue one vote at a time
01:11 PM on 06/02/2011
Insurance Companies managing your health care is the equivalent of a teenager with a pocket full of cash having to make a choice between paying for your treatment or buying that sports car they have their eye on.
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moAb
"when bad men combine, the good must associate”
10:50 PM on 06/01/2011
Think of insurance companies as mutant versions of the investment banks. They take your money after the promise of something in return. Instead of a return on investment of capital they tell you they will 'guarantee' some aspect of medical care that will yield a return on capital in terms of better health rather than dollars. Except they are unable to do so. They don't actually provide care. They just pass through the money. So in fact you give them money that they really don't want to pay out and instead they want to invest it for their own good, healthcare be damned. Sorry but that new kidney will have to wait, unless your friends hold about 800 bake sales. Good luck with that!
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moAb
"when bad men combine, the good must associate”
10:49 PM on 06/01/2011
For health insurance to work effectively the number of individuals in the 'risk pool' should be as large as possible. That allows risk to be 'spread' and those who need more care and incur more cost are balanced out by those who are healthy and use little or no health care and thus present little cost to the insurance plan.

While some of the insurance companies have fairly large membership, they have been able to avoid much of the increased costs for those who are quite sick by a variety of maneuvers. One was recission, now illegal, where they were able to drop a member for some technicality upon realizing that the person had been diagnosed with cancer or some other expensive illness. They were also able to exclude base on pre-existing conditions.

Now that such practices have been taken away from the companies they are more reliant on the size of the risk pool to ameliorate annual costs of delivering actual health care. Big problem...the risk pools are not large enough. So we will all hear language about 'quality of care' and 'cost of care' as if they mean something good for you. In fact they are attempts to deny or further limit care (thus payouts of premiums) rather than truly deliver value to the member/customer.
03:39 PM on 06/01/2011
No thank you. All those that want socialist health care should move to Cuba.
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moAb
"when bad men combine, the good must associate”
10:31 PM on 06/01/2011
Single payor does not necessarily equal 'socialist health care'. Unless you are independently wealthy alhorvath, and I mean filthy rich, you are either subsidizing bonuses of executives at insurance companies or you don't have insurance (assuming you don't have some form of Medicare, Medicaid, or insurance from another country). You need to get with the program. You and millions of us who pay a premium or any part of a premium are getting fleeced.
05:23 PM on 06/05/2011
So you are against Medicareand the VA?
01:26 PM on 06/01/2011
Insurance, an d especially employee provided insurance, is a terrible business model to use for this problem. It may have made sense back in the 30's-40's when it all began, and became popular, but it's an inefficient and wasteful solution given the realities of today. Direct evidence of this is the current state of the system in terms of cost and coverage.

It makes about as much sense as employer provided "food insurance". You go to the supermarket, buy as much of whatever you want, throw into the basket anything/everything the grocer recommends, then pay a $10 copay at the register on the way out, knowing tha you're "insured" for the costs above that. Would you be buying hot dogs and a loaf of day old bread? But that's exactly how we are dealing with healthcare. And then we wonder why we get too many procedures that cost a lot.

Single payer using private providers has proven itself to be the most efficient, modern healthcare system in the world. If we can't figure out how to craft such a system for ourselves, we should just copy the system of Canada or Taiwan. Our HC costs would be cut in half overnight.
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Aikaterina
A Greek-American living in California
01:03 PM on 06/01/2011
The public now sees the disadvantages of a privatized, for-profit health care system. Every industrialized nation (except the US) has universal, non-profit, or single-payer health care systems guaranteeing citizens affordable (if not free) access to health care, including most of our trading partners.

The GOP raised fears about a government take-over, bureaucrats coming between doctors
12:26 PM on 06/01/2011
Insurance Companies are a CANCER on the face of healthcare and should be removed as such.
These companies look at profit above care. So, it is counter-intuitive to have such companies.
DrSnuggles
You label me and I'll label you
10:22 AM on 06/01/2011
The first couple of paragraphs say something that I've been saying over and over again regarding health-care. The current healthcare system is biased against small employers and the people who would be helped the most by a single-payer system are the small businesses, the entrepeneurs and the innovators. While there's nothing tacitly wrong with supporting big business, regarding our healthcare system they are being helped to the detriment of EVERYONE else.
11:54 PM on 05/31/2011
Potter is like 60 Minutes' "whistleblower", Jeffery Weigand, ("The Informer") who "exposed" that Big Cig used ammonia in cigs to speed up nicotine effectiveness, to enhance addiction, to sell more cigarettes. (He didn't mention “sin tax” revenues that please complicit govt officials.)
Was ammonia theb banned? Was anyone warned that ammonia and chlorine in typical (very non organic) cigarettes is a deadly mix? Were cig firms busted? Were specific warnings required? Did “concerned” anti smoking activists say anything? Were victims compensated? Were govt officials who allowed it removed from office?
No, to all.
Weigand’s whistling was below what even a dog can hear. Is Potter doing something similar...just elaborating on what we already know via “Sicko” and etc.?
That Weigand "forgot" about the residues of any of 450 or so tobacco pesticides (from pharms, big oil, petrochemicals, big chlorine), and the cancer-causing rads from certain fertilizers, and dioxins from the chlorine cig adulterants and bleached paper, and the deadly relationships between ammonia and chlorine, and about 1400 of other non-tobacco additives (none tested for safety), and other incriminating things, hasn't been widely noticed. Too bad...especially since top for-profit insurers (set to take reins of what should be public health system) invest hugely in the lot of them.
Are we to trust THEM to be near our, or our kids', health care administration? If yes,
is that because not so bad, "lesser evil", Democrats, instead of evil Repugs, push it?
11:30 PM on 05/31/2011
When Mr. Potter speaks of "the government", without qualification to underline the major parts of government owned and paid for by private corporate interests, it's confusing. "Government" is supposed to be We, the People...but hasn't been that since the good ol' J.P Morgan days when the "regulatory" system was created to protect Big Biz FROM we, the people. Without these pretend "regulators", the public would have tarred and feathered the criminal CEOs, and their allies in "government", long ago. Ah...but now we sit back and think we are protected...as if all we need do is write a letter to "our" representative legislator or regulator. I'll bet they don't even properly recycle that mail.
We have pretend government...nothing to do with fully informed democracy.
One iota of PRIVATE influence in Public Government pollutes it. "Pollute" being a dual-meaning appropriate term.
When Mr. Potter openly condemns his former (?) employer, CIGNA, for its huge investment holdings in most of the top health-damaging industries on Wall Street (cigarette manufacturing, tobacco pesticides, pesticide in general, chlorine-dioxin industries, military contractors, coal, oil, fracking, etc.) THEN we have reason to trust his "whistleblowing" missives. He's no Wikileaker or Julian Assange, or Ellsberg. He's no threat to his "former" health insurer employers. He serves them by ignoring and distracting from their biggest crimes.
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Democrat in the South
Empathy, the most important word
08:38 PM on 05/31/2011
I am assuming that if we had a single payer system in America it would operate like Medicare. And if I understand the cost to seniors ( which isn't discussed much ) is very small and manageable, then why would anyone prefer to spend MORE when they can spend LESS? Especially voters who SAY they hate everything the Democrats are for, who can't afford a pot to p.e.e in.

What a better world we could have if we didn't have to pay off insurance companies to drain us of all our hard earned spending money. Just think of how we could stimulate the economy?

Instead we give all our money to big oil
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Democrat in the South
Empathy, the most important word
08:07 PM on 05/31/2011
The amount of money I pay for homeowners, health and auto insurance is obscene. I am at the point that I may have to take my chances because I can't afford one more penny of insurance. My large employer provided health insurance increased by almost two thousand dollars a year (this year) and my homeowners insurance increases over one thousand dollars every year. Something's gotta give or I am in big trouble. My family won't make it til 2014 at this rate. Insurance companies are out of their minds.
DrSnuggles
You label me and I'll label you
10:43 AM on 06/01/2011
The scariest thing about this is the comparison between the types of insurance; automotive insurance companies increase profits the safer roads and vehicles are, homeowner's insurance increases profits by minimizing damage and crime - but health insurance increases profits by not providing healthcare.
06:58 PM on 05/31/2011
What is wrong with the current system is that if Big Insurance cant get the money from Uncle Sam they will get it from the general public. Either way, tax payers lose. Single payer is the way to future profits for most American companies as well as individual Americans. I see no reason why family savings shouldnt increase. I see no reason why individual purchases would not increase. That there would still be a market for private insurance seems to go without saying. There would still be available cushion or cadillac plans for a price. Maybe even a reasonable price. After all the money dose not belong to the insurance companies. They just manage it, right?
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nkurland
I'm going to leave this planet alive
05:44 PM on 05/31/2011
Any health care system that devotes 30% of all expenses to administrative costs for the purpose of protecting profits and disputing claims to protect a "medical loss ratio" shouldn't exist.

The single payer trains chugs on! Next stop: California and Pennsylvania.
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thejazz
I'll burn that bridge when I come to it.
04:21 PM on 05/31/2011
"Steil and Shumlin don't believe the current system, dominated by private insurers, is sustainable in the long haul. You can't keep shifting more of the cost of both coverage and care to people--and also make them pay increasing amounts of tax dollars in subsidies that will go straight to private insurers--and not expect people to eventually stage a rebellion"

yep. What you are currently seeing in health care is a bubble. When it bursts, and it will, you may have some very sick people going without care (bad for people) or some people managing their conditions on their own (very very bad for health insurance, and health care). But this bubble will burst, unfortunately the affordible care act kinda saves the insurance industry. A bad think amongst all the good.