Insurance Horror Stories

[Rebecca Tucker]

Wow. Very scary.
Although it's truly a catch 22, the last paragraph of this letter suggests 
that we adopt the system that is already failing in Canada and Europe. When 
I was working rotary-wing medical transport in Montana, 51% of our in-house 
patients were Canadians who couldn't get elective and even some necessary 
treatments on their own side of the border. Waiting lists for "elective" 
surgeries was so long (I was told 6 months by some) that people were ending 
up with greatly increased morbidity factors due to physical deterioration 
over the wait time. Although our system is flawed and insurance companies 
are getting fatter while the working person suffers, do we really want to 
roll over for another flawed system? Just as oil companies are now being 
scrutinized for their gluttony and profit margins, so should our insurance 
providers by scrutinized. However, although the concept of placing caps on 
profit margins goes against the core principles of capitalism, insurance 
profit should be visited. It never did set well with me that untrained, 
non-medical business people were making fat bucks on the backs of our 
nations sick and injured AND our healthcare professionals. The people who 
really should be making the profits for their investment in education and 
service should be the ones giving the service. Unfortunately, those who work 
for HMOs/PPOs/POSs/etc., have their incomes slashed to the bone for the 
Insurance Companies gains. I can't count the number of ER docs I've known 
over time who have ended up in bankruptcy due to the mess with HMO 
reimbursements.
Rebecca
----- Original Message ----- 
From: "Robert Smith" <rfsmithmd at comcast.net>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Friday, September 22, 2006 1:04 AM
Subject: RE:Insurance Horror Stories


> NYTimes. I know, I know, it's the most liberal newspaper in America.
>
> September 22, 2006
> Op-Ed Columnist
> Insurance Horror Stories
> By PAUL KRUGMAN
> "When Steve and Leslie Shaeffer's daughter, Selah, was diagnosed at age 4
> with a potentially fatal tumor in her jaw, they figured their health
> insurance would cover the bulk of her treatment costs." But "shortly after
> Selah's medical bills hit $20,000, Blue Cross stopped covering them and
> eventually canceled her coverage retroactively."
>
> So begins a recent report in The Los Angeles Times titled "Sick but 
> Insured?
> Think Again," which offers a series of similar horror stories, and 
> suggests
> that these stories represent a growing trend: more and more health 
> insurers
> are finding ways to yank your insurance when you get sick.
>
> This trend helps explain something that has been puzzling me: why is the
> health insurance industry growing rapidly, even as it covers fewer
> Americans?
>
> Between 2000 and 2005, the number of Americans with private health 
> insurance
> coverage fell by 1 percent. But over the same period, employment at health
> insurance companies rose a remarkable 32 percent. What are all those extra
> employees doing?
>
> Now we know at least part of the answer: they're working harder than ever 
> at
> identifying people who really need medical care, and ensuring that they
> don't get it. In the past, they mainly concentrated on screening out
> applicants likely to get sick. Now, it seems, they're also devoting a lot 
> of
> effort to finding pretexts for revoking insurance after they've already
> granted it. They typically do this by claiming that they weren't notified
> about some pre-existing condition, even if the insured wasn't aware of 
> that
> condition when he or she bought the policy.
>
> Welcome to the ugly world of American health care economics.
>
> Health care is poised to become America's largest industry. Employment in
> manufacturing, which once dominated the economy, has fallen 18 percent 
> since
> 2000, to 14.2 million. Meanwhile, employment in the private health 
> services
> industry has risen 16 percent, to 12.6 million. Another 1.3 million people
> are employed at government hospitals. So we're quickly approaching the 
> point
> at which more Americans will be employed delivering health care than are
> employed producing manufactured goods.
>
> Yet even as health care becomes the core of the American economy, our 
> system
> of paying for health care remains sick, and is getting sicker.
>
> Because everyone faces some risk of incurring huge medical costs, only the
> superrich can afford to be without health insurance. Yet private insurers
> try to refuse coverage to those most likely to need it, and deny payment
> whenever they can get away with it.
>
> The point isn't that they're evil or greedy (although you do wonder how 
> the
> people who cut off the Schaeffers can look themselves in the mirror). The
> fact is that cruelty and injustice are the inevitable result of the 
> current
> rules of the game. Blue Shield of California is a nonprofit insurance
> provider, yet as a spokesman put it, if his organization doesn't follow 
> the
> for-profit practice of selectively covering only the healthiest people, 
> "we
> will end up with all the high-risk people."
>
> Now, before you panic about the state of your own coverage, you should 
> know
> that the horror stories in The Los Angeles Times article all involve
> individual insurance; if your coverage comes via your employer, you're
> reasonably secure against sudden cancellation.
>
> But employment-based insurance is in rapid decline, as employers balk at 
> the
> cost and more and more companies adopt Wal-Mart-style minimal-benefit
> policies. That's why many people are turning to individual insurance - 
> only
> to find out, in some cases, that they didn't get what they thought they 
> paid
> for.
>
> And here's the thing: it's all unnecessary.
>
> Every other wealthy nation manages to provide almost all its citizens with
> guaranteed health insurance, while spending less on health care than we 
> do.
> And there's no mystery why: we're paying the price for pointless,
> destructive reliance on private insurers. Medicare, which is a universal
> health insurance program for older Americans, spends less than 2 cents of
> every dollar on administrative costs, leaving 98 cents to pay for medical
> care. By contrast, private insurance companies spend only around 80 cents 
> of
> each dollar in premiums on medical care; much of the remaining 20 cents is
> spent denying insurance to those who need it.
>
> If we had a universal system - Medicare for everyone - there would be no
> more horror stories like those reported by The Los Angeles Times. And we'd
> almost certainly spend less on health care than we do now.
>
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