by Robyn Blumner
Editorial Cartoon by David Horsey
This is a problem-solving moment for government.
President Barack Obama and the Democratically-led Congress are rolling up their sleeves, sharpening pencils and trying to deliver health-care changes that cover many more people, provide a safety net for the rest of us and won't bankrupt our nation the way the current system most assuredly will.
Meanwhile, with little to offer beyond raspberries from the sidelines, Republicans have consigned themselves to the spoiler role.
Their answer to the health-care crisis gripping this country (and the answer of a handful of insurance-industry-beholden Senate Democrats) is to throw themselves bodily in the way of a public option in order to protect the rapacious profits of the private health insurance industry.
But what we have learned about free-market health insurance is that even when one can get an individual policy, it is often like having no insurance at all.
A standard in the industry is to look for ways to reap premiums, then skip out on promised benefits. This is what the status-quo Republicans are fighting to retain.
A public option is a necessity because it is the only way to temper the demonstrable amorality of private insurers. If companies have to compete with a government plan that doesn't treat customers like they are a gambler's easy marks, the companies will have to reform or wither.
Rescission is when a person with individual health insurance has their coverage yanked just as they get sick. This industry practice is known as "post-claims underwriting" and is widespread even where there are laws against it, such as in California.
Among its many victims is registered nurse Robin Beaton, 59, who told a subcommittee of the House Energy and Commerce Committee this month of her ordeal at the hands of Blue Cross Blue Shield.
After she was diagnosed with an aggressive form of breast cancer, the company canceled her policy. Beaton says that the company "took my high premiums," but once she filed a cancer claim, they searched "high and low" for a reason to rescind her policy.
Blue Cross found a notation written on her dermatologist's chart that seemed to indicate something precancerous.
It didn't matter that her dermatologist called the insurer to say it was just acne. Beaton also had inaccurately recorded her weight in applying for coverage and failed to mention that in the past her heart would beat fast when she was upset. She said that Blue Cross noted these lapses as possible bases for rescission.
A double mastectomy scheduled to save Beaton's life was postponed until she could find other insurance or pay for the operation herself -- an impossibility on both counts.
Beaton said it took direct intervention by her congressman to get Blue Cross to reinstate her policy.
Insurance companies employ people who do nothing but search through a customer's medical history once an expensive claim is filed, looking for misrepresentations or discrepancies, even unintentional ones, in the insured's application.
According to the committee's investigation, at least 19,776 policies were rescinded between 2003 and 2007 by the three insurance companies that testified at the hearing -- WellPoint Inc., Assurant Health and UnitedHealth Group.
The moves saved them at least $300 million.
Policies are canceled for failing to disclose information even when a patient didn't know what a doctor had written on their medical chart. Rescissions occur even if an omission is unrelated to the policyholder's current ailment.
Assurant automatically initiates an investigation into the policyholder's medical history if a claim is made for one of 2,000 diagnosis codes. For WellPoint, it's 1,400.
When top executives of the three insurers were asked by subcommittee chairman Rep. Bart Stupak, D-Mich., if they would vow to limit rescissions to cases where there had been an intentional fraudulent misrepresentation, they all answered "no."
Dumping the sick is simply too good for business.
Private insurers are squealing about the possibility of a government option, but they brought this on themselves through their greed and predation.
We can't trust them to do what's right when we get sick. Now it's their turn to feel a little sick themselves.
America's Hospitals Can't Afford Healthcare Cuts
by Rich Umbdenstock
Rich Umbdenstock is president and CEO of the American Hospital Association. We must not lose sight of the fact that we will need good healthcare policy changes -- not just payment cuts -- if we hope to find long-term solutions to the healthcare challenges vexing America: 46 million uninsured, an aging population, an epidemic of obesity and chronic disease and the need for a more coordinated system of care.
Healthcare Reform Estimates Have Democrats on Defensive
by Kent Garber
The inciting spark was the Congressional Budget Office's released of preliminary estimates on the costs of the two main Senate bills. Kennedy's was tagged at $1 trillion. The other, being developed by Finance Committee Chairman Max Baucus, would cost $1.6 trillion.
Uwe Reinhardt: Plain Talk on Healthcare Reform
by Bernadine Healy M.D.
If there were a Straight Talk Express for health economists, Princeton professor Uwe Reinhardt would be the engineer. Born in Germany and raised in Canada, Professor Reinhardt has personally experienced medical systems in different countries. Over the past 25 years, he has become a critical voice in the debate about reforming America's healthcare system.
Employers to Make Deeper Cuts in 2010 Health Coverage
by Martha Lynn Carver
Look for employers to cut more deeply than ever into health care coverage for their workers in 2010. Companies are getting walloped by higher than expected costs just when they can least afford it.
When Healthcare Reform Hits Grandma
by Bernadine Healy M.D.
Obama has laid the groundwork for a massive overhaul of America's healthcare system into a more publicly managed, cost-conscious enterprise that focuses more on wellness than sickness. Driving most government outlays, however, are the many millions of Americans, particularly the elderly, with extremely resource-intensive chronic diseases.
However, what's tried and true, is the government's power to restrict reimbursement and change medical behavior. Medicare, which covers virtually all of the elderly, can say "No" to expensive treatments. That's great if the care is unnecessary. But you can't always tell if you're not at the bedside.
Government-run Healthcare Insurance-Program Sure to Backfire
by Phil Gingrey, M.D.
My fear is that creating a government-run health insurance plan wouldn't guarantee quality care by physicians -- in fact, it will not guarantee care at all. The quality of care in a government-run health plan may seem irrelevant to those individuals who are happy with the coverage they currently have -- after all, President Obama promised during his campaign that, "If you like the plan you have, you can keep it." But most individuals don't really have their own health coverage -- they get it from their employers.
Obama's Uphill Battle to Reform Healthcare
by Kent Garber
President Obama stood at a podium flanked by six healthcare leaders and announced what he called "a watershed event in the long and elusive quest for healthcare reform." Obama, by almost any account, had just scored what appeared to be a major concession from several of the country's biggest healthcare players.
Healthcare Industry jobs
Find your next job in the Healthcare Industry. Search Healthcare jobs from thousands of job and career search sites.
(c) 2009 Tribune Media Services, Inc.