Health Insurers Have Cheated Consumers Out of Billions of Dollars

On Tuesday the Senate Commerce Committee released a report showing that health insurers have cheated consumer's out of billions of dollars. Though that amount seems astounding, most of us have experienced the methods used by these giant corporate criminals to extort that money from us. If you have ever had a claim denied on the basis of a clause in your policy that you didn't even know about then you have been a victim of these cold hearted bastards. Have you ever read the fine print in your health insurance policy? Most people who aren't lawyers haven't. According to testimony in the hearing the policies are written to confuse consumers on purpose.

According to the Washington Post article:

"At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."

"...Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged..."

In New York State Attorney General Andrew Cuomo has discovered that health insurers bilked consumer's out of millions of dollars by underpaying for out-of-network physicians and hospitals. The accomplished this by using rates determined by a database OWNED by United Health Care called Ingenix. The AG asserted in court that this database was routinely "scrubbed" of justifiably higher rates and "low-balled usual and customary rates and shifted costs from insurers to their customers.."

"Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said. A dozen insurers have reached settlements agreeing to change their practices; UnitedHealth agreed to the largest payment, $50 million, to help a nonprofit organization set up a new database to replace Ingenix."

We desperately need to have a reasoned debate about the reform of health care and I know that everyone involved in delivering health care has contributed to the burden it places financially on everyday Americans. Cuomo's findings just proved what most of us have known for a long time. This hearing was a shot fired across the bow of the ship of the insurer's who have been playing hard ball to undermine real reform of the system they profit by. Many more salvos are to come and the debate seems to swing back and forth. It isn't easy to figure out what will work better than the crazy quilt of a system we now have. Don't be mislead by easy answers because they are the ones that will leave us stuck with a dysfunctional result.

Ralph Hall brings the Republican Lie Machine to a "Town Meeting"

On May 27th I witnessed one of the slickest displays of marketing I have ever seen. Marketing is that skill the Bush white house used so skillfully to first confuse voters and then later to fill their heads with propaganda. And for most of the past eight years it worked to further a Reaganistic vision of big bid'ness first and the hell with the rest of society. War was the answer to all international conflicts whether they were real or not. Wall Street was allowed to run hog wild and every other regulatory agency was turned into a frat house for Bush's incompetent buddies. Anyway, back to the meeting. It was titled "Americanize US Health Care Not Socialize". Ignoring the lack of proper grammar, we got the point. It turned out to have been sponsored by the Dallas Association of Health Underwriters-basically insurance sales people who sell plans to employers.

I had never seen Congressman Hall speak and I was impressed. His entire biography was read out loud as his introduction and from most of the folks attending he received a greeting appropriate for a hero. Then he feted Bush who he felt was a "great" President and trashed Obama. That got the crowd aroused with feelings of righteous indignation and anger. Then he turned folksy and went into what I can only describe as a Will Rogers mode telling funny jokes on himself and others just to show he wasn't really a mean person. When he finally spoke at all to the issue at hand, Health-Care Reform he began to paint it as essentially a back door approach to introducing a communist style of socialism to America. A woman behind me stood up to shout that "this isn't a communist country!".

It was at the point that I spoke out loud to interrupt the flow of jingoism and misinformation that was emanating from the stage. I shouted that I objected to the whole premise of calling it a community forum to share information about the details of the coming Health-Care Reform legislation with only representatives of the insurance industry allowed to present. In turn I was shouted back at by the audience and I must say that the congressman was polite. When I asked why other stakeholders in the process of reform weren't invited he just didn't respond to my question. Then several more democratic activists stood up to speak with more direct criticisms, like the perception that the insurance brokers were just afraid of losing their jobs and they were willing to destroy the mission to provide insurance to the poor to save them. Chaos ensued for a short while then the next speaker was introduced.

Reid Rasmussen, a former citizen of Canada, was next to speak. There wasn't much he said that wasn't a distortion of the facts. He intimated that when Hillary Clinton proposed over hauling health care that "he heard" "someone" suggest that her proposal was simply to adopt the Canadian model of a government run health care system. Then without a skip in his rapid fire banter he inferred that President Obama was proposing the same thing. In fact no such thing has been proposed by Obama and no such proposal has been considered in either the Senate's Finance or Health, Education, Labor and Pensions Committees where the legislative proposals for heath care reform are being considered.
A proposal has been made to offer a public plan option as part of a wide range of health insurance programs.

In the time I was there the only constructive information I heard was from the second speaker, Ron Dobervich. He spoke about ways in which consumers can be more assertive and informed about their care. He advocated that people keep a copy of all of their medical records, shop for lower prices for procedures and negotiate with physicians about their fees. He gave a very accurate map of the wide variance in prices for health care within a given city. I left at this point but many more brave democrats spoke out that night after me. So what started out to be a marketing plan by insurance salespeople actually turned into a real town meeting.

Single Payer Health Care

As a physician I have always been skeptical about "socialized medicine" of any kind. I assumed that it would lead to long waiting times, scarcity of resources, poor medication availability and lack of choice in health care providers. But I have been studying the health care plans of many developed nations around the world and have come to the conclusion that our current system is simply unsustainable. My reasons are as follows:

We spend more of our national gross domestic product on health care than any other nation in the world.




Our Government Spends Less Per Capita on Health care Than Any Other Nation
(In other words, we each pay more of the bill than citizens in other countries do)



We Have Poorer Health Care Outcomes Than 36 Other Countries



To be Continued....

Speaking of Healthcare

Both Hillary and Barrack are strong advocates, as I am, of reimbursing preventive services as part of health care reform in the United States. Unfortunately, the economic realities of such a policy are not positive. It is easy to assert, as each of them does that preventive services saves money because we all like to hear that message. But in a today in a closer examination of that issue a Washington Post story reveals how preventive services mostly drive up costs, even though thsy save laws. It is all about the statistics of prevention whereby a fairly large number of people have to be screened with preventive tests to prevent one person from actually getting the disease. Not that prevention is always more costly than the disease. Quitting smoking, for instance, does prevent significant disease and early death in a cost effective way. But other measures can be more costly not less in the long run. I think this article is helpful because it describes how complicated the health care debate is in just one fairly straightforward area, prevention. There are no simple answers in the debate on health care in our country. If you think universal health care coverage is the answer ask someone from Canada or England. We Americans are spoiled by the degree of access most of us have to high priced technologies like CT scans , MRI's and sophisticated lab tests. The ultimate future of health care in our country is going to involve ever increasing costs which still continue to grow at rate many times that of inflation. It is true that insurance companies are greedy and that most doctors are too. On the other hand people continue to demand antibiotics for colds that are expensive and do nothing for them. As an example of such behavior multiple randomized controlled trials have shown that sinusitis cannot be diagnosed by symptoms or a physical exam alone. No matter how much ugly stuff is coming out of the nose it does not mean you necessarily have sinusitis. Only a CT scan of the sinuses can tell for sure. Only then are antibiotics truly indicated though they may not shorten how long you have your symptoms at all. I know, I know, your symptoms are much worse, you're different except not really. Medicine is now a science and the most well trained doctors practice it that way. The rest would rather write you the Rx you don't really need than to have to fight with you. Then when you get the expensive medicines that you are prescribed how many of you take them until they are all gone? Imagine the billions of dollars that could be saved by not wasting that medication. So you see, we are all part of the problem of substandard heath care in our country. The answer is to make every player in the game more accountable. In other words, yes the drug companies and insurance companies are evil but on the other hand most of us are lazy and avoid doing the simple things we can do to prevent our own illnesses. I think this simply points out what experience tells us, from the outside of every issue the answers look easy but from the inside where the details reside every issue is more complicated. The best most of us can do is to get educated, talk to people who are knowledgeable and try to make informed responsible decisions. Rhetoric is easy, taking real actions on our own behaves is hard.