Murray Waas, award-winning investigative journalist, reports that “Insurer [Wellpoint] targeted breast cancer patients to cancel“:
… None of the women knew about the others. But besides their similar narratives, they had something else in common: Their health insurance carriers were subsidiaries of WellPoint, which has 33.7 million policyholders — more than any other health insurance company in the United States.
__
The women all paid their premiums on time. Before they fell ill, none had any problems with their insurance. Initially, they believed their policies had been canceled by mistake.
__
They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators.
__
Once the women were singled out, they say, the insurer then canceled their policies based on either erroneous or flimsy information. WellPoint declined to comment on the women’s specific cases without a signed waiver from them, citing privacy laws.
__
That tens of thousands of Americans lost their health insurance shortly after being diagnosed with life-threatening, expensive medical conditions has been well documented by law enforcement agencies, state regulators and a congressional committee. Insurance companies have used the practice, known as “rescission,” for years. And a congressional committee last year said WellPoint was one of the worst offenders.
__
But WellPoint also has specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies, federal investigators told Reuters…
__
Many critics worry the new law will not lead to an end of these practices. Some state and federal regulators —- as well as investigators, congressional staffers and academic experts — say the health care legislation lacks teeth, at least in terms of enforcement or regulatory powers to either stop or even substantially reduce rescission.
__
“People have this idea that someone is going to flip a switch and rescission and other bad insurance practices are going to end,” says Peter Harbage, a former health care adviser to the Clinton administration. “Insurers will find ways to undermine the protections in the new law, just as they did with the old law. Enforcement is the key.”
[…] __
During the recent legislative process for the reform law, however, lobbyists for WellPoint and other top insurance companies successfully fought proposed provisions of the legislation. In particular, they complained about rules that would have made it more difficult for the companies to fairly — or unfairly — cancel policyholders.
__
For example, an early version of the health care bill passed by the House of Representatives would have created a Federal Office of Health Insurance Oversight to monitor and regulate insurance practices like rescission. WellPoint lobbyists pressed for the proposed agency to not be included in the final bill signed into law by the president. They also helped quash proposed provisions that would have required a third party review of its or any other insurance company’s decision to cancel a customer’s policy.
__
The new law does leave open the possibility of reform in this area, these sources say. The reason, they say, is that much of the new legislation is essentially a roadmap, with regulations to be decided later…
[…] __
A senior Obama administration official said he remained confident that mandatory third party reviews of rescissions is not entirely out of reach.
__
“It might take some wrangling with the insurance industry, some strong-arming, maybe even use of the presidential bully pulpit,” he said on condition of anonymity.
By all means, read the whole thing… it will infuriate you all over again. I guess we’d better hang on to Tim F’s list of Congressional phone numbers, because it looks like we’ll need them in the near future.
(Hat tip to commentor Brachiator for the link — and the irresistable title.)
Cat Lady
I hate identity politics with the heat of a thousand suns, but the CEO, Angela Braly, doesn’t know anyone in her circle who has or has had breast cancer? How do you promote that policy as a woman, in particular? And that picture of her looks like if their algorithm doesn’t kill you, she’ll strangle you with her own hands.
Jeebus, these people are amoral fucktards.
Jack
The irony.
cleek
i blame Obama. and especially Rahm.
if they hadn’t written the bill, we’d have universal health care for everyone, with ponies for doctors and nurses to ride around on.
RAHHHMMM!
dmsilev
@Jack: Picture me sitting here rolling my eyes. Now, as a homework assignment, please explain how this is Obama’s fault.
dms
Persia
@Cat Lady: That’s not identity politics, that’s just common sense. I can’t think of many men who couldn’t list someone they knew who’d had breast cancer off the top of their heads; no one in my family could.
Also, what infuriates me is that there are still people who are surprised by articles like this. Really?
Omnes Omnibus
@cleek: Have you considered blaming Michele Obama?
dmsilev
@cleek: I thought the doctors and nurses would ride around on carriages pulled by teams of chickens. That being how they are going to get paid, they may as well get some use out of them.
dms
ed
Monsters.
ChockFullO'Nuts
Infuriate is not the word. In fact there is no word for the depth of anger that I feel about this situation.
As if this insult and injury were not enough, these same malfeasants then take money from the profits they make by screwing their policyholders and use it to attack reforms aimed at dealing with this problem, funding astroturf fake populist, fake grassroots “concern” over imaginary death panels to discredit HCR.
There is no word to describe the evil that these people represent. It’s beyond Orwellian.
I honestly believe that these motherfuckers should be in jail.
geg6
@dmsilev:
Because he’s a political Barry White who hypnotized the entire Democratic Senate caucus into his evil plan to fuck over all the women. Just ask Jack and his PUMA friends.
Rick Taylor
I guess I don’t understand our healthcare bill then. I thought a big part of the purpose for it was it would end excluding covering people with pre-existing conditions; presumably that would include ending cutting off people who were being covered. And the price we were paying for this was everyone had to get coverage one way or another.
Violet
I can’t even say how angry this makes me. This is wrong on every level.
GregB
Yet this story won’t really generate much outrage in the larger picture. I don’t know why. It’s not even a death panel. This is a corporate assassination panel.
cleek
@Omnes Omnibus:
i hadn’t. but now that you mention it…
but what’s her motive?
fame? fortune? fans? gold records? world tours? her name in lights?
did she sell her soul to Peter Murphy ?
cleek
it’s as if the InsCo’s are daring Congress to write a tougher bill.
Pigs & Spiders
@Rick Taylor: The bill is fairly strong when it comes to requiring insurance companies to extend coverage to kids with pre-existing conditions but fairly weak when it comes to preventing them from dropping you when you develop conditions later in life.
dmsilev
@geg6: Ah yes, that explains a lot. Though you did forget to mention Rahm Emanuel’s Pen1s of Doom, which was Obama’s primary means of enforcing his demands.
dms
Omnes Omnibus
@cleek: It’s all on the Whitey tape.
TJ
Once again, I’d like to thank the Dems for leaving everyone at the mercy of these sociopaths with basically no recourse.
geg6
OT, but the Birther army MD just got court marshalled. Can some of our military commenters explain the seriousness of these charges?
http://tpmmuckraker.talkingpointsmemo.com/2010/04/group_court_martial_charges_brought_against_birthe.php?ref=fpblg
WereBear
As someone whose SO battles a chronic illness, I can tell you there’s a very good reason why sick people are targeted for profit and exploitation in our society; they are vulnerable.
They are in no position to make great big noisy fusses; it’s all they can do to get through the day. Those without an advocate are even worse off.
paradox
Well, here were are all alone with our for-profit healthcare insurance industry, the rest of the industrialized democracies don’t use the model.
It’s too bad we can’t start over from scratch… President Obama said of the insurance companies. I’ve no bone to pick at all, what’s done is done, but I’m still a little curious as to what “starting over from scratch” really entailed.
Why not? The insurance companies could get a pay-off for exiting the industry, then finito. Happens all the time in capitalism, except most companies never get a payoff for failing.
Uloborus
@Pigs & Spiders:
Yeah, but ‘later in life’ is ‘after you’re on Medicare’ and it specifies no enforcement agency because it doesn’t have to – it just falls under the aegis of industrial regulation in general. Just about every bloody industry that exists is regulated.
Although a specific ‘We’re watching you’ agency would improve matters, I’d say.
RSA
I’m just relieved that it wasn’t government bureaucrats making these decisions. Tyranny, you know.
RedKitten
But…but…but…the almighty free market! Can’t these women just go elsewhere to another insurance company who will take on policyholders who already have breast cancer, and won’t refuse to cover it as a pre-existing condition?
Irregardless
An MBA presented his idea to panel of his colleagues about the issue of cancer patients affecting the bottom line and how to resolve it. It was probably filled with nice clean graphs, pie charts and math, PVs and NPVs. The idea was seen as good and was approved. Is this a death panel?
A bunch of software guys were given requirements and set about making an efficient algorithm to achecive the MBAs dream. There was probably a project manager, the algorithm was revised and tested a number of times to make it efficient. There was a final meeting where the final version was presented by the coders to their manager and approved. A date for launch was set. Is this a death panel?
The algorithm went through its business and made a list of clients recently diagnosed with cancer to be “investigated for fraud”. This list was probably passed on the a committee that went through the list and approved the investigations. Is this a death panel?
When the inevitable findings of fraud came back, a panel went through the list and approved the policy cancellation. Was this a death panel?
Another bonus committee went about its business of issuing bonuses to employees based on the total dollar amounts saved. Was this a death panel?
A woman picks up her mail and learns that she would not get the medicine and treatment she needs to stay alive.
Which panel killed her?
kay
@Rick Taylor:
“The new law does leave open the possibility of reform in this area, these sources say. The reason, they say, is that much of the new legislation is essentially a roadmap, with regulations to be decided later.”
There’s two ways to regulate. There’s legislation, and then there’s agency rule-writing, the administrative end. The historical reason for “agencies” was that Congress could not be “experts” in areas like health and the environment, so Congress would pass framework and agencies would rule-write.
People who want the language in the bill argue that agencies are “captured”, and the rule-writing process isn’t transparent. People who argue that agencies should rule-write argue that Congress shifts with the wind, is influenced by lobbyists, and agencies are more stable.
There are good arguments on both sides. We’re having the same discussion re: finance reform.
There’s a political calculation too: do you want the executive branch or Congress writing what are essentially regs?
FoxinSocks
Also, I think the part of the reform bill regarding recissions hasn’t taken full effect yet.
But yes, I read this yesterday and was nearly in tears. My mother had breast cancer (she’s doing fine now), but she had been told that if she had waited even a couple of more weeks for the surgery, her outcome would have been far different.
If you read the article, one woman had a very aggressive tumor that was about 2cm. Wellpoint informed her that they were dropping her coverage 2 days before her operation, and in the 5 months it took for her to fight to finally get the surgery she so desperately needed, her tumor grew to 7cm and now even though she’s had the surgery, she’s not expected to live. That’s not just a death panel, that’s murder. How are these CEOs not in jail?
Chyron HR
This is a vile practice, and if we start hearing about incidents of rescission (that are not subsequently overturned) occurring after March 22 I will be outraged, but I don’t see how even a supermajority in the Senate could pass a bill that changes the past.
Quackosaur
@paradox:
In what political environment do you think Congress would legislate insurance companies out of existence? I’m not saying it’s not technically possible, but with the people we have to work with, you may not see that there are significant roadblocks to such actions in BOTH parties.
If you think people are crying about “government soshulism” now…
Warren Terra
I don’t understand Anne’s closing comment, or TJ’s, etc. The Affordable Care Act DOES ban this practice, AND it makes it moot by eliminating Preexisting Conditions – albeit it hasn’t yet started.
Hypnos
This means that there was a board meeting where a bunch of C-level executives openly stated and agreed on the fact that their company should start looking for ways to drop people who developed breast cancer – the “fuck off and die already” policy, I’d venture. And then some programmer had to go and set up the algorithm that found reasons to drop the aforementioned cancer patients. And then some other people had to go and actually rescind the policy.
And at no point through all of that anyone had a shred of moral decency – nobody managed to gather what was left of their conscience to stand up and say “I will not do this, this is wrong”. What the fuck. What the fuck is wrong with that. How can these people look at themselves in the mirror each morning?
“I didn’t do anything. I was obeying orders. And anyways I was just writing train schedules. Cargo wasn’t my problem.”
Omnes Omnibus
@geg6: Missing movement is like AWOL on steroids. Failure to obey an lawful order is fairly self-explanatory, and hard for Lakin to argue against. Dereliction of duty is more or less failing to do the things you are supposed to do as soldier.
His defense seems to be predicated on the fact that he believes Obama is illegitimate as president and therefore any order he gives is not a lawful order. He has two problems; first, no court martial is going to accept that reasoning or even allow him to put on evidence to suppoert it, and, second, even if they did, he did not receive his orders personally from Obama. Moreover, he has obeyed other orders during Obama’s presidency, so the question becomes, why disobey this one?
I really think he is looking a prison sentence.
Ogami Itto
In defense of WellPoint, did the women mention that they had breasts when they originally purchased their insurance? And if they didn’t, isn’t that fraud?
Let’s not unfairly demonize the insurance companies. ;-/
Warren Terra
I can’t see Congress doing anything, but it sounds to me like grounds for individual and class-action suits, maybe criminal fraud, and an AG might sue for money their state spent caring for victims.
Face
It’s getting to the point where some of these cancer patients will almost explode in anger, and likely take their anger out on Wellpoint execs or employees.
If they dropped my wife in such a situation, I’d almost have to be physically restrained from physical violence I’d be so furious.
geg6
@Omnes Omnibus:
Well, that would certainly be my hope.
My oldest brother went AWOL back when he was in the Navy (back in the Vietnam era while he was a medic at the Philly Naval Yard). He was subsequently diagnosed with bipolar disorder, but not until after he spent 6 months in the brig. He was eventually able to get an honorable discharge, but it was touch and go.
Omnes Omnibus
@Ogami Itto: Were they asked?
WereBear
@Hypnos: And is it me, or is it just more sick that they didn’t target, say prostate cancer?
paradox
All right, Quackosaur. Congress is bought, again, it always seems to be the final answer.
Not to bewail the terrible cruel world, right, but the reality that we all basically accept–and flippantly dismiss anyone who questions it–is that Congress represents industry and the insurance companies, not the little people of the United States.
Most of the time, the institution is not completely lost, not hardly. It’s just striking how many times the little people get left out of the end results, the democracy model should perform better than it is, but for a variety of reasons is not. Not all of those factors are Congress’ responsibility, either.
geg6
@FoxinSocks:
I could be wrong, but I thought it was supposed to take effect by July 4.
Cat Lady
Angela Braly is also a
death eaterRepublican. Shocking, I know.gnomedad
@RedKitten:
The free market works just fine; they have to do shit like this to stay competitive. That’s why we need regulations.
The rescission thing is a police state tactic — make sure everybody is guilty of something (via forms too complex and intrusive to fill out “correctly”) and then go after who you want when you want.
kay
It’s bad timing for Wellpoint, because Sebelius (well, her agency) is right now writing the regs that will administer the new law.
kay
And, Sebelius was the Kansas state insurance commissioner, so she probably knows insurance regulation very well, and her agency will be writing the regs.
geg6
OT, but not really since chickens are now such a large part of our conversation about health care here in the good ol’ USofA…
More creative uses for chicken:
h/t Sully
J.W. Hamner
As someone who writes algorithms for a living… I have trouble understanding how the person(s) who wrote the “Breast Cancer Rescission 2000” can sleep at night.
Yeah, I know, that’s what they’re paid to do… have to feed their kids, etc… but still. I’d at least like to entertain the possibility that I’d quit, even if that vastly overestimates the depth of my character.
celticdragonchick
@Hypnos:
Exactly. I don’t think that Godwin rules apply here, since what the insurance execs did here amounts to mass murder via official policy.
I have no doubt they eat cheerios, drive the kids to school and attend ballet recitals. They just help kill their own neighbors during office hours.
Elie
@GregB:
Our people have not stood up for themselves in a long time… its so sad really.
So much of our culture and education is around learning obedience and submission to authority rather than free thinking and self activation. Think of the school systems sending kids home for using Ibuprofen or wearing political t-shirts.
The union movement has been largely killed or suppressed and many of the informal “democratic” type organizations such as the PTA even, have diminished membership these days. Esp for the right wing in this country, obedience and conformity are everything — overriding all other rational thought and decision making about reality. Our entire culture has been shaped by winner take all, the strong dominate the weak thinking for over 2-3 decades. Note also the frequency of bullying these days.
All this to point out that this sort of abuse follows when the larger society or community is passive and un-engaged. I think that is also a large part of why the right hates Obama so much — they don’t even want people to wake up a little bit.. who knows what can happen once you let real thought happen?
celticdragonchick
@Face:
I have to agree. If this happened to my spouse or child, my helicopter door gunner days would get revisited and applied to somebody in the chain of command who wrote the death sentence for my loved one.
At some point, a price needs to be paid for these fuckers to understand that what they are doing is wrong, and we now see that the usual legal remedies are simply not protecting us peons at all. What is so tragically farcical is that these are also the people who have managed to bamboozle the tea party idiots into protecting them and enabling them to keep killing for profit.
Little Dreamer
@geg6:
He has enough training, time, and medals to be an officer in a not so “well regulated militia”, which (I’m sure) is what he really wants, after all.
Mnemosyne
@paradox:
We can’t because it’s not just the insurance side of the industry that’s for-profit. The entire goddamned industry is for-profit, including hospitals, doctors and pharmacies.
Getting rid of for-profit insurance while everything else remains for-profit would leave us in worse straits than we already are. The top-grossing for-profit hospital had revenues of $3.4 billion. How many of those billions do you think their investors and stockholders are going to give up for the general good?
Randy P
As my daughter put it, we’re seeing not just villains but moustache-twirling, cartoon villains. It’s really amazing. “So, you think you foiled me with your Health Care Reform, eh? Well, my lawyers tell me I can drop 10 million orphans with pre-existing conditions between now and 2014. Nyaah-ahh-ahh!” “Well, well, let’s just cancel the insurance of some widows with breast cancer. See how they like that. Mwaah-ha. Mwaah-ha. Mwaah-ha-ha-ha-ha!!!”
Not that Angela Braly has a moustache. So far as I know.
kay
@Elie:
I didn’t know until last week that parents were asking physicians to hold off on diagnosing autism, because they were afraid the kid would be dropped from the policy.
Little Dreamer
@J.W. Hamner:
Apparently, you’re not a whore, as true whores don’t have a conscience. They will do ANYTHING for money.
Rosalita
@Warren Terra:
if they’re still alive…
celticdragonchick
@geg6:
That looks pretty bad. I’m not sure if it will get him prison time, but he will likely be stripped of his rank and get a bad conduct discharge. The dereliction of duty is especially damaging. That might get you landed in prison…although I am not sure if anything will result in an actual dishonorable discharge.
cleek
@J.W. Hamner:
SELECT p.ID, p.Name from PolicyHolders As p
Inner Join Claims c on c.ID = p.ID
Inner Join DiagnosisCodes dc on dc.Code = c.Diagnosis
Where dc.Diag = ‘Breast Cancer’ and DateDiff(c.Date, Date()) < 100
i'm sure there are fancy GUIs to make this easy enough for a stone-hearted bean-counter to do.
Capri
This is what I’d like to see – Give the companies a reasonable amount of time to decide whether an application is fraudulent. I’d say 6 months, but could understand up to a year. If they haven’t come up with anything within that time period, they can no longer “discover” problems when the person gets sick.
After that, the only way a company can drop someone for anything said on their application is via a law suit alleging breach of contract. The insurance co. will have to prove in a court of law that the person undertook a deliberate course of action with the aim of deceiving the company. If the company loses their suit, they continue to cover the person and pay that person’s court costs.
gwangung
@Mnemosyne: Personally, I never thought the current effort was the end. It was only a beginning and a wedge to start on the other industries.
And, honestly, I’ve always thought it was a clear losing strategy to take on ALL the offenders at the same time. One step at a time. Face one foe at a time. Divide and conquer.
asiangrrlMN
I’m empty of any emotion other than sadness over this situation. It just–fucking sucks.
Mnemosyne
@gwangung:
Oh, I’m definitely not despairing, and it would have been insane to try and tackle every branch of the industry in a single go.
I’m just tired of people acting like the insurance companies are the one-and-only problem and if we got rid of them, everything would be hunky-dory and we’d all get a pony from the grateful hospitals and doctors. In fact, things would be even worse since the for-profit hospitals would get to charge us directly once we got rid of the middleman for them.
What we need is non-profit healthcare, not just non-profit insurance. Focusing all of our attention on the malfeasance of insurance companies will leave us open to getting screwed by all of the other bad actors in healthcare.
Corpsicle
@geg6: Wouldn’t that make the chicken a rooster? I’m sure that making homosexual men eat cocks will solve the problem.
DBrown
What don’t you people get about FOR PROFIT corp. health care? First, they must make a profit (by law) and second, maximize VALUE for investors (read let the sick die quickly with as little cost as possible) – then the CEO, his bottom feeding assoc. & lawyers along with the golden shower horde (Directors) make $$$$$ and everyone else is SCREWED. Capitalism is all about profit and of course, best health care system in the world – not.
As for anyone believing that the system could be taken down with a payoff – right; kill this money making cow? Short of the standard gold plated (read screw the taxpayer) military contracts that rightwingers demand and get, health care is the next best thing. Never happen in this universe.
kay
@Mnemosyne:
It got so big, as a segment of the economy, and the allied professions and techs are such good jobs. A two year degree and a decent wage, in health care, to replace all those manufacturing union jobs. Who wants to kill that golden goose?
This is going to take a while to turn around.
Comrade Dread
I’m going to say the Inferno was wrong. Hell has eight levels.
The level below Satan and Judas will house insurance company executives and Wall St. douchebags.
Quiddity
Evan Bayh’s wife is on the board of WellPoint. What does she have to say about this?
Violet
What value do health insurance companies add to the system? Any? Everyone I’ve asked the question of can’t come up with any value that comes from insurance companies.
celticdragonchick
@Quiddity:
Something along the lines of : “I gots mine! Where’s yours?!”
Zifnab25
Maybe I’m missing something, but how does a universal insurance mandate work if your carriers can deny you service? If an insurance company drops your policy, you’ll have to either reapply or go to another insurance company. Can you be blacklisted when you’ve got a federal mandate to purchase?
The only three paths I see out of this are 1) Drop the mandate, 2) Block the rescission, or 3) Create a public option to pick up all the uninsured.
kay
@Zifnab25:
The mandate is conditioned on ability to purchase a policy, and “affordability”, (along with “exceptions” having to do with extraordinary circumstances) so it drops out automatically if insurance companies don’t deliver.
That’s the carrot.
Elie
@kay:
I shake my head but totally believe you. We are not empowered and we are taught not to be.. in fact, folks get angry with you if you try to assert your right to question…
As in this case, we also perversely help to enforce our own injustice…because the loss would be potentially so great..
People are slowly waking up though…slowly
Quackosaur
@paradox:
My comment has little to do with whether Congress-critters are bought off by industry interests. Rather, they don’t support dismantling and reconstructing entire sectors of the economy (whether it would make sense in the long-run or not). They don’t want to face the inevitable attack ads that would appear saying that Congress-critter X took your job and gave it to some evul government bureaucrat (or, just took your job, which no longer exists).
Large numbers of people in this country, much to their detriment, reflexively oppose anything that even looks like government intervention into things like healthcare. Incumbents won’t become/stay popular by eliminating private sector jobs by fiat, especially if they provide payoffs to industry fat-cats and stockholders (given past history, little of which would trickle down to the typical worker). If you want the government to implement single-payer/NHS/whatever, try and convince your Congress-critter that former healthcare industry workers won’t blame them for their lack of jobs.
Uloborus
@Capri:
Actually, that’s part of this new law. One of the things in it is that if you want to drop someone for fraud, you actually have to prove deliberate fraud. Currently insurance companies are using ridiculous excuses – and I mean *ridiculous* – to justify the ‘fraud’ label.
On a general note: Having worked in health care, I frequently defend doctors as being *mostly* more concerned with their patients than money. They want to make good money like the rest of us do, but they get pissed when money gets in the way of patient care. But every doctor I know also fumes about how hospitals exploit patient care for money. And they fume about being maneuvered by insurance company or health care company regulations into not being able to provide the services the patient can get cheaply. The whole system really, really is pretty fucked on every level. Systemic insurance reform will be a nice start, at least.
Remember, it can be done – everybody else in the developed world has done it. Some of them with this basic system, of mandating insurance policies, then regulating the crap out of the industry.
kay
@Elie:
I had a person tell me that very matter of factly. They have a huge online network, autistic parents, so they plot strategy together.
I’m so goddamned glad they’re working as a team. They’ll need it.
Warren Terra
Zifnab, I don’t get it. A public option only for those actually needing care is a fiscal nightmare. Without a mandate, Guaranteed Issue and ending Preexisting Conditions would bankrupt the insurers.
Elie
@gwangung:
THIS
It IS just beginning and we do have to strategize how to take it on.. agree completely.
kay
@Elie:
Not “autistic parents”, although they may also have an online network, who knows?
The parents of autistic children, is what I meant.
Zifnab25
@DBrown:
In all fairness, this decade has been nothing if not glutted with short term thinking. I have no problem believing that today’s CEOs would happily sell out their successors for a quick billion bucks.
The current insurance system is unsustainable. The businesses are making money by ditching clients. What other business does that? It’s a death spiral.
@Violet:
They are supposed to allocate risk. The country has functional insurance companies. Medicare is the perfect exam. The job of Medicare is to weigh the cost of care, and the risk of occurrence, to determine the price for service. But Medicare overhead ranges in the 3-6% field. Wellpoint gets into the 30% range easy.
It’s not so much as insurance companies serve no purpose as it is that they serve a very vital service, and they know it, so they’re price gouging us.
Sentient Puddle
@geg6: I know you’ve already got a few replies on this one, but I’ll highlight one extra part:
A General Court-Martial is the most serious kind, similar to being tried in federal court. The range of possible punishments is wide, and I don’t know what general guidelines they lay down for things like dereliction of duty, but my guess is, at a bare minimum, we’ll see at least a year in prison and dishonorable discharge.
kay
@Uloborus:
I think the up-front transparency provisions for hospital billing will be huge. You’re going to be able to compare hospitals on price, before entering one.
Uloborus
@Zifnab25:
By the time the mandate comes into effect, rescission for adults is also blocked. You’re not allowed to deny someone insurance for anything but a legal breach like fraud (and current fraud definitions will no longer cut it), and you’re not allowed to alter pricing for anything but age.
I think people are getting confused because it’s only the blocking descriminating against precondition conditions for children part that’s *immediately* implemented. The rest is parceled out later as the law comes online.
EDIT: To Kay, above – cool! Really, that’s the thing, isn’t it? The bill is so damn big, you can’t know everything in it. The industry needs a fuckload of regulating. A lot of needed stuff is in this bill.
Elie
@kay:
Yeah… we all have to start thinking about how to keep them from cutting the weak apart from us — overriding the isolation with contact and combined action through information sharing — that is urgently needed — but must be learned and reinforced. People always seem to have a sense of being in danger when they actually stick up for themselves or others. Sad but true… but we can learn the courage these parents have
Warren Terra
To clarify: the law blocks Rescission except in case of fraud – and if they do assert fraud and manage to kill your policy, then Guaranteed Issue means they cannot refuse or delay your new policy.
kay
@Elie:
Autism is interesting to me, because those are some activist parents. I think the internet makes that easier. They’re incredibly plugged in, and they keep a wary eye out for just about every threat.
aliasofwestgate
@kay:
I’m a pharmacy technician. I spend more time on the phone arguing with insurance agencies on my patients behalf than i do much of anything else. A solid 60% of our time, or higher is spent doing this. I may work for a for profit chain, but i’m doing the work for my patients. I’m certainly not getting paid well enough for my efforts either. Not when i’m still under 10$ an hour. It’s a great job, and i do love it and my patients. I’m pretty sure that my wage is among the ‘higher’ of them nowadays but it’s STILL not a living wage. I have roommates because cost of living is absolutely insane! Where in 2004, i could have supported myself on it.
But do NOT blame the honest techs doing their jobs for their corporation’s greed. More often than not, they’re getting underpaid while working their asses off ‘negotiating’ with insurance policy wonks on their patients’ behalf.
kay
@Uloborus:
I think the administrative rule writing by HHS is going to be make or break. They can destroy it, or they can really strengthen it. I have to trust Kathleen Sebelius on that, because I have never experienced this BIG a law that went to rule-writing, and I don’t know anything about it at the federal level, although I understand the state process.
We’re all going to be like environmentalists, who focus almost exclusively on environmental agency actions (and inaction) and “rule changes”, because those BIG environmental laws, like Clear Air and Water are older law, and the “law” part is established.
We’re just starting. It’s like the 1970’s in environmental law.
aliasofwestgate
My comment is stuck in moderation. *looks at it* what’d i do?
Zifnab25
@Warren Terra: Once a Public Option is created, anyone would presumably be allowed to join it.
But you could compare it to the Separate But Equal laws in the South during the mid-20th Century. States were legally required to provide complimentary facilities to citizens. You couldn’t build a white school without a black school, for instance. This case was highlighted in Texas, when a black prospective law student was refused admittance to the UT Law School on segregationist grounds. The courts ruled that the student was required to receive complimentary education, so the South Texas School of Law was built. Once constructed, anyone – white or black – was allowed to join it. And the school continues to this day.
If you’ve got a mandate from the federal government requiring individuals purchase health insurance, a savvy court could conclude the burden is on the government to ensure individuals are insured and, therefore, require a government-sponsored health insurance program to either accept the individual (if it already exists – say Medicare) or be created. That would then open the floodgates.
ChockFullO'Nuts
@Zifnab25:
I think the one suggested by Obama was subsidized coverage from an exchange made available by the government.
aliasofwestgate
@kay: Don’t blame the techs for their jobs. Majority of the technicians today are retail ones in retail pharmacies. Their employers tend to short change their wages every time they turn around, and overcharge for the drugs that the techs and pharmacists dispense.
RedKitten
@gnomedad:
That was kind of my point. It was a jab against the glibertarians who think that an unregulated free market would miraculously provide coverage for everybody, because an insurance company would HAVE to spring up to serve the giant market of uninsured people.
cliff
Wellpoint: murder and extortion for profit since 1996
Ella in NM
More and more I wish that I could put myself and my entire family in a state of suspended animation, only to be awakened when this country is finally past this seriously fucked up time in history.
Silver Owl
I guess the only requirements nowadays to be a CEO is to have a high homicidal streak or a propensity to commit fraud, both is a double bonus.
Today’s corporations really needs to take murder out of their business models. They are infested with sociopaths.
frankdawg
Minneapolis StarTribune had a tiny article buried in the middle of the news section this AM. A congressional committee report is out suggesting that health care costs are going to rise because of the bill. My guess is that these for-profits will gladly insure everyone as long as they are allowed to charge whatever they want (we’ll see how the rate board works) & the gov. picks up some, or all, of the rate.
I expect the syphilitic pustule and his friends on Fox will pick that up & be crowing that they told us so no matter what the details mean.
kay
@frankdawg:
It’s deceptive. Health care costs were going to rise. The one and only question was by how much. If the increase is less than the predicted increase without reform, it’s working. How well it will “hold down” costs is (again) the one and only question. I don’t think anyone on earth knows how well it is going to work. It’s complicated, to say the least. States have been screwing with it for 20 years, and they haven’t figured it out.
Every single member of Congress knows that, and so does every governor.
Uloborus
I would like to chime in on Alias’s comment. It is another example of how the insurance industries are actually responsible for a chunk of the ‘provider care’ costs. They really just are pretty horrible.
kay
@aliasofwestgate:
I don’t blame the techs. I had occasion to have almost daily contact with a woman who was training to be an x-ray tech, and as far as I’m concerned, she earns every penny.
Jesus. Nightmare, that training.
WereBear
If we have a sick family member or friend, it’s tough to think long term, but I think that will be the true flower of this legislation.
Just think of what President Obama said at the very beginning; this is not the time to tear out 1/6 of our economy.
However, just as a bonsai is trained, we can start imposing actual regulations on the rampant virus of a health care system, and whittle it down to where they are begging to be put out of business.
We have to starve the beast; to kill it would be to kill people, too.
kay
@aliasofwestgate:
No, I agree. My one and only point was you need specialized training so need a decent wage, and that the techs and allied professions are “good jobs” at a time when we don’t have we whole lot of those.
I think it’s a dilemma.
"Fair and Balanced" Dave
@celticdragonchick:
Failure to Obey a Lawful Order carries a max penalty of Dishonorable Discharge, forfeiture of all pay, and up to 2 years confinement for each count (Larkin is facing 3 counts).
Dereliction of Duty falls under same Article of the UCMJ (Uniform Code of Military Justice) as Failure to Obey. The max penalty is 6 months confinement and a Bad Conduct Discharge.
Missing Movement carries a max penalty of forfeiture of all pay, up to 2 years confinement, and Dishonorable Discharge.
Mnemosyne
@Violet:
They allow you to pre-negotiate discounts with healthcare providers. Without insurance, you would show up in the emergency room with a heart attack and told, “That will be $2,000, please. Cash or credit?” Because, as I have mentioned before, our whole damn system is based on profit, and the hospital needs to make a profit, too.
When I was doing my reading-up for the healthcare bill, I was struck by the fact that the US and Japan reached the same crossroads in the 1980s with rapidly rising costs, people losing coverage, etc. Japan took the road of non-profit healthcare and they have a perfectly fine system based on people buying private insurance from non-profit companies and going to non-profit hospitals. The US took the road of for-profit healthcare and allowed non-profit companies like Blue Cross/Blue Shield become for-profit and, well, you see the results.
mss
IANAL, and all that, but I’d like to see a district attorney at least consider the possibility of charging the relevant Wellpoint executives and computer programmers with around ten thousand counts of attempted murder. The motive is among the oldest on the book: they did it for the insurance.
White collar murder may move a bit slower, but it still leaves a dead body, you know.
TaosJohn
Just another reason I’ve completely abandoned politics after almost 50 years. Haven’t been to this site in months, for example, and visit almost no others. Will not be voting in national elections ever again.
Health care reform? Hahahahaha. I would rather play with rattlesnakes. At least they tell the truth!
WereBear
Precisely! How the hell do they get away with that? How did it become a situation when killing one person for money is the electric chair, and killing thousands for money is the comfy chair?
Origuy
@mss: I’d be willing to bet that the programmers are out of the US jurisdiction. Probably some of the other people in the process are as well. A lot of the claims-handling as well as software development has been offshored.
mss
@Origuy: Fair enough. I’m confident the orders originated in an American jurisdiction, at least. If we have to get the State Department involved to apply for extradition of coders who were “just following orders”… Hey, it’s my fantasy of justice actually applied to a white collar situation.
Catsy
@ChockFullO’Nuts:
I wish this was hyperbole, but “evil” is exactly the word that comes to mind here.
This is a business model based on mass murder. I’ve been on the fence about abolishing for-profit health insurance for a while, but I’m done: this industry is evil and should not be allowed to exist in a civilized society. We don’t regulate hit men or death camps, we outlaw them.
Get rid of them. All of them. Nationalize health insurance, abolish for-profit insurance, and prosecute for murder anyone who knowingly and fraudulently conspired to deny coverage to anyone who died as a consequence.
Mnemosyne
@TaosJohn:
Yes, because the fact that WellPoint was canceling cancer victims’ insurance policies in 2006 is proof that the healthcare bill that just passed was useless, presumably because it did not incorporate a time machine so Congress could go back and prevent these patients’ policies from being canceled.
/eyeroll
You don’t have to keep following politics, but you should at least try to keep track of time so you don’t become one of those people who insists that Obama declared war on Iraq back in 2003.
Brachiator
@Mnemosyne:
Actually, the Japanese case, like that in many other countries, is a little more complicated. I liked this recent blog post by Andy in Tokyo which corrected a simplistic reading of the Wikipedia entry on health care in Japan:
And the Wikipedia entry for Health Care in Japan (maybe correcting earlier entries) notes this:
This is still far superior to the atrocities that insurers like WellPoint get away with, where the “invisible hand” of the free market operates more like a death grip.
Mnemosyne
@Catsy:
Because for-profit hospitals won’t pull exactly the same kind of shenanigans with patients? We already have problems with for-profit hospitals dumping patients who can’t pay. What makes you think they’ll magically stop doing stuff like that if the only thing removed from the system is for-profit insurance?
I understand being angry, but I’m more of a cold rage person, myself. I prefer to try and take down the whole damn thing than focus solely on the one piece that’s making headlines right now.
Mnemosyne
@Brachiator:
Silly me — I shouldn’t have tried to compare the choice that the two countries made in the 1980s without a full discourse on the current weaknesses of the entire Japanese healthcare system.
geg6
@Mnemosyne:
This. Fuck yeah, this.
We’ve had the PUMAs here today blaming Obama and now this jackass.
I just wish I had that time machine these idiots seem to think Obama should be using to clean up all the messes he made while he was out for joy rides in it, like our failed health care system, our failed financial and housing markets, our failed foreign policy, and all the other things that are fucked up in this country.
And when he’s done with that, he can take out his magical persuasion hat and make the House and Senate and SCOTUS do exactly everything that all PUMAs and Firebaggers want and then jump in the time machine and make it retroactive.
twiffer
this, as well as the case against blue cross for cancelling the policy of a kid who contracted aids (amongst hundreds of thousands of others).
the sad thing is it doesn’t surprise me. insurance, all insurance, operates on this core set of principles (i suspect the list tags aren’t going to work):
where x > y, you give us y dollars for n number of years so that if i event occurs, we pay for it up to the value of x
the value of y is a direct proportion determined by probabilty of i occurring and the value of x
should i actually occur during the coverage period, we will try like fuck to not actually give you x dollars, instead we will give you x – [whatever we can get away with, preferably a value equal to x].
Brachiator
@Mnemosyne:
Yeah, you’re right, you shouldn’t have, because your statement “and they have a perfectly fine system based on people buying private insurance from non-profit companies and going to non-profit hospitals” is an oversimplification of the current situation.
@ geg6:
That’s odd. I’m the jackass that helped inspire this thread because I was so outraged by WellPoint.
I’ve had friends and family members who have suffered terribly — scream in pain suffering where the only thing you can do is hold them and try to help them ride out the agony — because they couldn’t afford medicine, couldn’t afford medical care, had to battle unnecessary delays in getting diagnoses and treatment.
I backed Obama on health care reform — and put my money where my mouth is — even while recognizing that his plan is neither perfect nor the final word. I appreciate any post or comment that leads to thinking about solutions.
But misplaced, lame-ass snark is just weak.
Lurker
@Mnemosyne:
For what it’s worth, we also have problems with non-profit hospitals dumping patients who can’t pay.
Despite this, I still think the non-profit, integrated Kaiser Permanente system has less incentives for evil than fee-for-service health insurers and for-profit providers.
Anne Laurie
@aliasofwestgate: Your comment got moderated because the spam filter hates the word ‘pharma@y’. Sorry! Stuff like this is why ‘FYWP’ is in the Lexicon… along with ‘Moderation (your comment is in)’.
Catsy
@Mnemosyne:
Since at no point did I argue any of the above or imply that the abolition of for-profit insurance was the sole solution to our broken system, you’re getting straw all over the floor and making yourself look pretty silly.
For-profit health insurance needs to be abolished because it is a business model that centers around mass murder.
For-profit hospitals: for all their flaws, not so much.
Mnemosyne
@Catsy:
Depends on the hospital. We have some real winners here in Los Angeles. Of course, the worst of the worst was non-profit hospital.
I’m afraid I don’t share your optimism that if we just get rid of the insurance companies, everything else will be cake. For-profit hospitals are way too addicted to their profits to give them up easily and if we don’t do healthcare reform the right way, we’ll find ourselves in the exact same situation, only people will be telling horror stories about the hospitals that refused to treat them and not the insurance companies that refused to pay.
Mnemosyne
@Brachiator:
Sigh. All right. Yes, although the US and Japan took separate routes when healthcare costs started to be overwhelming in the 1980s, the Japanese system isn’t perfect and has some ongoing problems with financing and coverage.
Of course, every health system in the world — including France — has ongoing problems with financing and coverage, so we should probably bring that up whenever we compare systems.
JWW
So what’s your point,
I don’t but my insurance from “Dave” on the nearest corner. I do a little research.
I don’t buy motor oil that is $.75 cents a quart, dog food @ $5.00 for 100 lbs, coffee @ $.10 a pound. Why? Sorry you were stupid enough to bring up such a subject…
Catsy
@Mnemosyne:
And again, if you could point to where I expressed such enthusiasm, you might have a point.
I am saying: we should outlaw X because it is evil.
You are reading: if we outlaw X then we will have a healthcare pony and everything will be awesome.
One does not follow from the other.
mclaren
Insurance companies represent only a small part of the problems with America’s broken health care systems. For-profit hospitals, doctors who act as individual businesses by setting up their own imaging labs and blood work labs and then charge the hospitals (where they work, or where they have buddies) grotesque amounts of money for those services, and the medical devicemakers who manufacture cheap simple devices, often made from inexpensive vacuum-formed plastic, and then charge insane amounts of money, are all part of the problem.
The problem goes even deeper than medical devicemakers and doctors and for-profit hospitals who are all colluding and connected by non-disclosure agreements that hide prices and sweetheart contracts that lock in one overpriced supplier to the exclusion of all others. The problem even goes deeper than giant health insurance cartels that monopolize entire states and shut out competition and then raise their premiums relentless because they know customers have no choice but to pay.
The problem goes all the way down to nurses, who are absurdly overpaid, and orderlies, who are ridiculously overpaid. Everyone in the American health care system slurps out of a giant trough of money because the money is just endless and everyone takes a taste. Nurses with an A.S. degree straight out of the nursing program start at $59,000 per year in New York State. That’s ridiculous. Orderlies get paid $15 per hour for pushing wheelchairs and emptying bedpans. Orderlies do a less demanding job than the typical McDonalds counter cashier but gets paid more than twice as much.
Profit must be stripped out of the entire American health care system in order to reform it, but at this point it’s probably too late. American have let the system fester for too long. Too many decades have passed for all the medical device salesmen and imaging lab technicians and blood work technicians and doctors performing unnecessary but lucrative bypass and stent surgeries and the for-profit hospitals that rake in a fortune for $10 cotton balls and $1200 disposable surgical implements (which cost 3 cents and $40 repsectively) to give up their fantastically lucrative crony kleptocracy now.
The general public is now starting to wake up to the fact that the health care “reform” bill won’t reform much of anything, since it does nothing to increase price transparency throughout the medical-industrial complex. Medical costs will actually skyrocket even faster, now that the vampiric health insurance companies have a captive market of helpless victims who are forced to buy insurance by the government. All those sweetheart contracts locking in high-priced suppliers and nondisclosure agreements prevents hospitals or doctors from revealing prices are still in place and the current health care “reform” does nothing about any of that, so the situation will just get worse.
The entire health care system will probably have to collapse and fall apart before we get real reform. Alas, that seems to be what we’re headed for, and in the foreseeable future. At the rate the overall health care costs (which have little to do with insurance premiums) are rising, most Americans won’t be able to afford health care within the near future.
The health care crisis is embedded within a series of even larger crises too. The big reason why most people defend the current health care system is that it’s one of the few bastions of decent middle-class professions left in America. You can get a decent income as a nurse without getting into $150,000 worth of debt by going to an Ivy League college and getting a masters or a doctorate, and that’s one of the few professions left where that’s true. Medical device salesmen make excellent money without needing a college degree. Medical imaging technicians have starting salaries around $48,000 per year for doing a job that only requires an A.S. degree, or at most, a simple 4-year degree from a nondescript state college.
America has been destroying all our high-paying jobs by outsourcing ’em to Chinese PhDs, and if you look at any graduate program in an elite American university in the hard sciences, you’ll see it’s got almost 100% foreign-born students. Asians, people from India, people from China, almost no Americans in those graduate courses. Electrical engineering masters and doctoral courses, a sea of Asian faces. Materials science, molecular biology PhD programs, same deal, Chinese student after Chinese student. Virtually no American-born students left in those programs. The Americans are all going to law school or getting MBAs.
So until America stops outsourcing all its high-wage high-skill jobs overseas, it’s not going to solve its health care crisis. The solution to our broken health care system is to remove the profit from the system, but if we do that while continuing to outsource all America’s high-wage jobs to Chinese PhDs and Indian PhDs, we’re not going to have any middle class jobs left in America.
We’ll turn into a nation of dog groomers and xerox clerks with no high-paying middle class jobs left at all.
People have been preaching “get an education” for 30 years now, even since the auto workers lost their high-paying assembly line jobs to robots in the 1980s. Getting an education isn’t the solution, because our society needs only so many people with masters and doctorates. There are in fact far too many PhDs in most fields graduating from American universities right now, and that situation keeps getting worse.
What America needs is to generate high-paying blue collar jobs that don’t require a PhD at an Ivy League university. We don’t seem to be able to do that anymore. Until we fix that situation, we can’t fix our broken health care system because it’s one of the last bastions of high-paying blue collar jobs in American society.
russell
IMO the sick sad truth is that there just isn’t enough money to be made in health insurance to generate an ROI that will support a publicly traded company.
The public, through Medicaid and Medicare, have already taken old people, really poor people, and people with any of a variety of specific nasty illnesses out of the mix.
Private insurers are asked to cover the rest.
And it appears that they are unable to get that done without screwing people over. Not because it inherently can’t be done, but it can’t be done in a way that throws off big enough numbers to make Wall St investors happy.
Personally I call that a market failure, and IMO it’s time give up the illusion that any horsing around in the “marketplace” is going to solve it.
There’s just not enough money to be made in health insurance to (a) cover the costs of people actually getting sick, and (b) return enough money back to private investors to keep them happy.
Nancy Irving
“Before they fell ill, none had any problems with their insurance.”
These are (or rather were) some of the overwhelming majority of Americans who–“before they fell ill”–were “happy with their current insurer,” as we are constantly told.
Some of them might even have joined the Tea Party, had tragedy not intervened.
It’s a measure of our achievement in passing HCR, that only a small minority of Americans, those with life-threatening illnesses, can really understand how f*cked-up our “market-oriented health care solutions” really were.