Dirty Tricks of the Private Healthcare Industry

[ARubberChickenWithAPulley]

I would imagine that most if not all corporate lobbyists are trying to protect their profits. They're entirely entitled to do this, so long as they do it honestly!

Absolutely. And many other groups aside from corporations are protecting economic interests (though not "profit" in strict Wall St. terms.)

Maybe I'm cynical, but I think "honest" is a relative term in politics. All political groups engage in spin... at what point that becomes dishonest, I don't know. Perhaps "honest" should be replaced with "legal."

 

[Rolfe]

While I'm sure the boundary is far from clear, the barefaced lying that is going on with regard to the quality of healthcare provided in European countries and indeed Canada is not hard to characterise.

Rolfe.

 

[Ducky]

In 2003 I worked for a bank. I had insurance through a major provider here in the midwest in the US. I began having back pain. I went to see doctors I picked from that insurer's list of approved/in-plan list and they never once took imaging. I went back and went back until the pain was so severe one day I went to the emergency room twice in a 48 hour period. They gave me pain meds and said I needed physical therapy. I did the physical therapy and wound up back in the emergency room with severe back pain and numbness beginning in my legs. They took a CT of my lumbar spine (the problem was in the thoracic) determined I was having either some sort of muscular pain or was trying to scam for drugs and sent me on my way.

Then I lost my job and found myself doing temp work and the insurance ran out. I had to go to a sliding scale pay clinic here in the twin cities that made a deal to get an MRI for me at very low cost. This was now a year after initial back pain symptoms started. They found that t-9 had been completely obliterated (you can see pictures of this in the Swift article I wrote for Randi.) I was then instructed to go to MinnCare, a government sponsored program to get health care to the poor. I was told that I could not make more than 500 dollars a month to qualify for the coverage to have my operation, thereby effectively forcing me to not file for unemployment when I told my temp agency I had cancer and they let me go.

I had my surgery. It was done by some of the best doctors in the US, and cost an absolute fortune (most of which was covered my minncare.) After the surgery I had to have radiation and regular checks with bone marrow biopsies and imaging and blood work. Each visit costs literally thousands of dollars. On Jan 1, 2005 MinnCare handed my coverage off to a private insurer, the same one I had when working for the bank. Since the doctors I had now were not the doctors I had on file with the private insurance company 2 years prior they refused to pay for any of my radiation treatments or follow up exams. I could not afford to have a physical therapist help me learn to walk again, I did that on my own. All this time I had gone deeply into debt and was living off kindness of others and what little credit I still had.

The reason they stopped coverage? The original doctor had not referred me to any of those that actually did their job.

I am still fighting debt collectors over medical costs they refused to cover. I am still in a monstrous amount of debt despite earning a decent living now as an IT professional. I make a decent living and can't afford to fix or replace my ailing and trashed 10 year old jeep.

By the time I learned these things might be actionable by attorney, it was too late per Minnesota law to do anything about it (or so I was told by the attorneys I saw.)

Anyone who thinks Private insurance doesn't pull shenanigans is simply wrong. I have been all but bankrupted by this BS, all to live through cancer and a major operation on my spine.

To top it off, I have to sneak in through work group insurance policies because I have a pre-existing condition. So much for choice. The events of the last 5 years have cost me enough to consider bankruptcy.

So it's piss off and die or go bankrupt for the non-rich in this country. And the insurance company does not have the insured's best interests at heart. I am now also limited in amounts of meds per 90 days I can have for pain, etc. This is to keep me from being addicted to not having pain, apparently. If I shop around to other doctors, I break the law. If I tell people I have back pain they look at me as though I am trying to score drugs like some common street addict.

It's broken. The whole system is broken and costs way too much. I don't know what the answer is but it sure as hell is not the status quo.

 

[Shalamar]

In 2003 I worked for a bank. I had insurance through a major provider here in the midwest in the US. I began having back pain. I went to see doctors I picked from that insurer's list of approved/in-plan list and they never once took imaging. I went back and went back until the pain was so severe one day I went to the emergency room twice in a 48 hour period. They gave me pain meds and said I needed physical therapy. I did the physical therapy and wound up back in the emergency room with severe back pain and numbness beginning in my legs. They took a CT of my lumbar spine (the problem was in the thoracic) determined I was having either some sort of muscular pain or was trying to scam for drugs and sent me on my way.

Then I lost my job and found myself doing temp work and the insurance ran out. I had to go to a sliding scale pay clinic here in the twin cities that made a deal to get an MRI for me at very low cost. This was now a year after initial back pain symptoms started. They found that t-9 had been completely obliterated (you can see pictures of this in the Swift article I wrote for Randi.) I was then instructed to go to MinnCare, a government sponsored program to get health care to the poor. I was told that I could not make more than 500 dollars a month to qualify for the coverage to have my operation, thereby effectively forcing me to not file for unemployment when I told my temp agency I had cancer and they let me go.

I had my surgery. It was done by some of the best doctors in the US, and cost an absolute fortune (most of which was covered my minncare.) After the surgery I had to have radiation and regular checks with bone marrow biopsies and imaging and blood work. Each visit costs literally thousands of dollars. On Jan 1, 2005 MinnCare handed my coverage off to a private insurer, the same one I had when working for the bank. Since the doctors I had now were not the doctors I had on file with the private insurance company 2 years prior they refused to pay for any of my radiation treatments or follow up exams. I could not afford to have a physical therapist help me learn to walk again, I did that on my own. All this time I had gone deeply into debt and was living off kindness of others and what little credit I still had.

The reason they stopped coverage? The original doctor had not referred me to any of those that actually did their job.

I am still fighting debt collectors over medical costs they refused to cover. I am still in a monstrous amount of debt despite earning a decent living now as an IT professional. I make a decent living and can't afford to fix or replace my ailing and trashed 10 year old jeep.

By the time I learned these things might be actionable by attorney, it was too late per Minnesota law to do anything about it (or so I was told by the attorneys I saw.)

Anyone who thinks Private insurance doesn't pull shenanigans is simply wrong. I have been all but bankrupted by this BS, all to live through cancer and a major operation on my spine.

To top it off, I have to sneak in through work group insurance policies because I have a pre-existing condition. So much for choice. The events of the last 5 years have cost me enough to consider bankruptcy.

So it's piss off and die or go bankrupt for the non-rich in this country. And the insurance company does not have the insured's best interests at heart. I am now also limited in amounts of meds per 90 days I can have for pain, etc. This is to keep me from being addicted to not having pain, apparently. If I shop around to other doctors, I break the law. If I tell people I have back pain they look at me as though I am trying to score drugs like some common street addict.

It's broken. The whole system is broken and costs way too much. I don't know what the answer is but it sure as hell is not the status quo.

Thats quite a story, and it is unfortunate that you had to go through it. And no-one should. Ever. And there are those on this board who do think that what happened to you IS JUST FINE.

I cannot wait for full, true, universal Health care for everyone in the USA.

 

[fullflavormenthol]

I did. Perhaps you should as well. Insurance covers the entire insurance industry, not just health insurance. In fact, the single biggest spender is USAA, which is in auto and property insurance (as well as banking and a few other things).

If you look at the "Health" sector which seems to group them in a way that makes a bit more sense, you get Pharmaceuticals at 82 million, Hospitals and Nursing Homes at 36 million, Health Professionals at 25.7 million, and Health Services/HMOs at 24.6 million. As a sector, they still come out behind.

Seems to me you are trying to argue that the medical insurance companies don't really lobby, and you use a sample of numbers to attempt to prove this. When shown wrong you say, "Well, wait...um no what I really want you to look at is that HMO's are numbered fourth in the ranked list of the number two sector spending money to lobby."

The issue was health insurance companies, but if you really want to throw HMO's into the mix; and stop and consider the cross over in the private insurance industry. Well than the point stands that the insurance/HMO industry spends a lot to lobby congress to kill anything that would hurt their business. The business of getting people to pay them money, and then dropping them at the first sign of trouble. (Which holds true for all insurance really.)

Brings me to my point is that insurance is grouped as an industry, and that makes it hard to know what the medical insurance companies spend. Blue Cross/Blue Shield spends a lot. HMO's are a different story all together, because they don't fit the traditional medical insurance model.

 

[ARubberChickenWithAPulley]

Seems to me you are trying to argue that the medical insurance companies don't really lobby, and you use a sample of numbers to attempt to prove this. When shown wrong you say, "Well, wait...um no what I really want you to look at is that HMO's are numbered fourth in the ranked list of the number two sector spending money to lobby."

Uh... yeah. My pointing out that the insurance companies spend millions on lobbying is trying to prove that they don't lobby

The actual health insurance companies in the insurance category make up a little more than 8 million out of the 61 million in the insurance sector in 2009, so that didn't do much for you. So I looked at HMOs, and even they rank awfully low on the list of lobbying spenders.

The issue was health insurance companies, but if you really want to throw HMO's into the mix; and stop and consider the cross over in the private insurance industry. Well than the point stands that the insurance/HMO industry spends a lot to lobby congress to kill anything that would hurt their business.

My point is that of course health insurance companies spend a lot on lobbying -- and so do the rest of the groups involved in healthcare. And, in fact, the other groups in healthcare spend as much, or more than health insurance.

Brings me to my point is that insurance is grouped as an industry, and that makes it hard to know what the medical insurance companies spend. Blue Cross/Blue Shield spends a lot. HMO's are a different story all together, because they don't fit the traditional medical insurance model.

Well, you can pick out the health insurance companies and groups off the list. AHIP at 3.9 million, BC/BC at around 4 total, then you have Cigna at 720k, Anthem at 108k, and I suppose you can include the "National Association of Health Underwriters" at 500k. A little over 8 million out of the 61 million. This contrasts with the 36 million in the 'Hospitals and Nursing Homes' category which is almost all actual hospitals, and the 25 million spent my health professionals, and the 82 million spent by pharmaceutical companies. Heck, combine health insurance with HMOs and that just puts them ahead of Health Professionals and still behind hospitals and pharmaceutical companies.

 

[Ocelot]

That people should be more concerned with the dirty tricks politicians use to gain power, including using rhetoric to pound the heads of "those who oppress us"?

Gasp! Look over there!

By the way, that article gets down on its knees to sympathize with the guy "watching the industry slam Sicko". Even some health care nationalization supporters around here acknowledge it's a hack piece. So the (note, not "my") answer to "thoughts?" is "another hack piece."

Why is it so easy to make these "hack" pieces? and what has genetic fallacy got to do with any of this?

 

[Rolfe]

I just watched it last night. I see no reason to characterise it as a "hack piece". It simply, quite openly, does the opposite of what the free-marketeers have been doing for decades. Their SOP is to cherrypick a few nasty situations where a universal healthcare system has failed someone, and then pretend that this is the normal standard of care in these countries. Then they compare this straw man to the experience of those in the USA for whom nothing has going wrong (and of course there are many such people). Bingo, the American Way is the best.

Moore goes looking for the cases where the US insurance industry has failed its clients. And on the way there he demonstrates to us that the system is set up so that all the incentive is for the industry to do exactly that. Then he looks at the ordinary, normal standard of care in universal healthcare systems, and on the way there he demonstrates that these systems are set up in order to deliver care, not deny it.

I think this deserves a thread on its own (the 2-year-old threads on the film are pretty useless), so I'll maybe reserve the question "in what way is this a hack job?" for a new thread, to avoid derailing this one.

Rolfe.

 

[Tricky]

In 2003 I worked for a bank. I had insurance through a major provider here in the midwest in the US. I began having back pain. I went to see doctors I picked from that insurer's list of approved/in-plan list and they never once took imaging. I went back and went back until the pain was so severe one day I went to the emergency room twice in a 48 hour period. They gave me pain meds and said I needed physical therapy. I did the physical therapy and wound up back in the emergency room with severe back pain and numbness beginning in my legs. They took a CT of my lumbar spine (the problem was in the thoracic) determined I was having either some sort of muscular pain or was trying to scam for drugs and sent me on my way.

Then I lost my job and found myself doing temp work and the insurance ran out. I had to go to a sliding scale pay clinic here in the twin cities that made a deal to get an MRI for me at very low cost. This was now a year after initial back pain symptoms started. They found that t-9 had been completely obliterated (you can see pictures of this in the Swift article I wrote for Randi.) I was then instructed to go to MinnCare, a government sponsored program to get health care to the poor. I was told that I could not make more than 500 dollars a month to qualify for the coverage to have my operation, thereby effectively forcing me to not file for unemployment when I told my temp agency I had cancer and they let me go.

I had my surgery. It was done by some of the best doctors in the US, and cost an absolute fortune (most of which was covered my minncare.) After the surgery I had to have radiation and regular checks with bone marrow biopsies and imaging and blood work. Each visit costs literally thousands of dollars. On Jan 1, 2005 MinnCare handed my coverage off to a private insurer, the same one I had when working for the bank. Since the doctors I had now were not the doctors I had on file with the private insurance company 2 years prior they refused to pay for any of my radiation treatments or follow up exams. I could not afford to have a physical therapist help me learn to walk again, I did that on my own. All this time I had gone deeply into debt and was living off kindness of others and what little credit I still had.

The reason they stopped coverage? The original doctor had not referred me to any of those that actually did their job.

I am still fighting debt collectors over medical costs they refused to cover. I am still in a monstrous amount of debt despite earning a decent living now as an IT professional. I make a decent living and can't afford to fix or replace my ailing and trashed 10 year old jeep.

By the time I learned these things might be actionable by attorney, it was too late per Minnesota law to do anything about it (or so I was told by the attorneys I saw.)

Anyone who thinks Private insurance doesn't pull shenanigans is simply wrong. I have been all but bankrupted by this BS, all to live through cancer and a major operation on my spine.

To top it off, I have to sneak in through work group insurance policies because I have a pre-existing condition. So much for choice. The events of the last 5 years have cost me enough to consider bankruptcy.

So it's piss off and die or go bankrupt for the non-rich in this country. And the insurance company does not have the insured's best interests at heart. I am now also limited in amounts of meds per 90 days I can have for pain, etc. This is to keep me from being addicted to not having pain, apparently. If I shop around to other doctors, I break the law. If I tell people I have back pain they look at me as though I am trying to score drugs like some common street addict.

It's broken. The whole system is broken and costs way too much. I don't know what the answer is but it sure as hell is not the status quo.

I wish this were just a fable with a moral, Ducky, instead of a real-life tragedy.

I think it is telling that those who have dealt extensively with insurance companies are those most eager to go to a government health-care system. And it doesn't seem to be just a case of "the grass is always greener". Citizens of countries with government health care don't seem eager to go to private insurance. At what point does this become obvious to Americans? When the lobbyists run out of money?

 

[Corsair 115]

The AMA is also, at best, skeptical of a government run option as well, though they are willing to consider some form of it...

Much of what's going on in the U.S. in regards to health care reform and the issue of a universal health care plan resembles some of what went on in the province of Saskatchewan back in 1962 when a universal health care system was brought in. Doctors were bitterly opposed to the plan, so much so in fact that they went on strike. In the end, the strike fizzled as it had little support from the public.

Just three years later, most doctors were in favour of the system, as the fears raised about the plan were shown to be unfounded.

 

[Rolfe]

In Britain, in 1948, the hospital consultants wer also bitterly opposed to the NHS. In the end, they were bought off - both with very good salaries, and with the right to continue to run their private practices alongside their NHS work so long as they fulfilled their contractural obligations to the NHS. Bevan said at the time that he had "stopped their mouths with gold".

Fortuitously, this worked extremely well. It means nowadays that consultants don't have to choose between private or NHS work, they do both. In fact, a consultant's reputation in his private practice depends on the seniority of his NHS post. Thus the NHS gets the services of the best surgeons and they don't decamp to lucrative private-only practice. And the citizens get a choice about whether they want to take up their right to their free NHS treatment, or pay to go private.

The medical profession in Britain just shakes its head in disbelief about what happens in America. Then drives away in its Mercedes to spend a weekend on its yacht. All for about 8% of GDP.

Rolfe.

 

[kellyb]

I wish this were just a fable with a moral, Ducky, instead of a real-life tragedy.

I think it is telling that those who have dealt extensively with insurance companies are those most eager to go to a government health-care system. And it doesn't seem to be just a case of "the grass is always greener". Citizens of countries with government health care don't seem eager to go to private insurance. At what point does this become obvious to Americans? When the lobbyists run out of money?

Well, the UK rations via NICE.
Insurance companies ration (apparently primarily) by "pulling a Ducky" on the ill in the US. Worst case scenario, if the reform doesn't pass, as more and more people get "Duckied" or are unable to afford insurance and join the ranks of the uninsured, public opinion could turn so fervently that it creates civil unrest eventually.

But I don't think that'll happen. I think the reform is going to pass whether the public likes it or not. The insurance companies supported Obama, not McCain.

http://www.opensecrets.org/news/2009/02/special-interests-to-listen-ca.html

In what appears to be a strategic move, the health sector has been shifting its campaign contributions toward Democrats. In the 2008 election cycle, an unprecedented 54 percent of the recently Republican-leaning sector's nearly $162.3 million in contributions went to Democrats. Compare that to the last presidential election, in 2004, when Republicans collected 61 percent of the $123.7 million that the health sector gave. Obama collected $18.7 million from the sector, compared to the $7.3 million that his opponent, Republican Sen. John McCain, got (McCain, however, accepted only public financing for the general election, while Obama continued to raise private funds).

And this might be why:

http://abcnews.go.com/Politics/PersonalFinance/Story?id=5926400&page=1

Senate Majority Leader Harry Reid, D-Nev., pressed for passage, with the alarming news that one of the country's premier insurance companies was about to go bankrupt if the crisis was not quickly resolved.

"We don't have a lot of leeway on time," Reid told reporters in the Capitol. "One of the individuals in the caucus today talked about a major insurance company -- a major insurance company -- one with a name that everyone knows that's on the verge of going bankrupt. That's what this is all about."

Maybe the great experiment with the "Ducky Method of Rationing" doesn't save money in the long run after all. It might just be that some numbers have been crunched, and it's more profitable to be Blue Cross in the UK or Germany than it is in the US.

This might be a more appropriate speculation for the CT forum, though.

 

[boooeee]

And this might be why:

http://abcnews.go.com/Politics/PersonalFinance/Story?id=5926400&page=1



Maybe the great experiment with the "Ducky Method of Rationing" doesn't save money in the long run after all. It might just be that some numbers have been crunched, and it's more profitable to be Blue Cross in the UK or Germany than it is in the US.

This might be a more appropriate speculation for the CT forum, though.

That article was dated October 2008, and has really nothing to do with health insurance.

 

[Ducky]

Well, the UK rations via NICE.
Insurance companies ration (apparently primarily) by "pulling a Ducky" on the ill in the US. Worst case scenario, if the reform doesn't pass, as more and more people get "Duckied" or are unable to afford insurance and join the ranks of the uninsured, public opinion could turn so fervently that it creates civil unrest eventually.

But I don't think that'll happen. I think the reform is going to pass whether the public likes it or not. The insurance companies supported Obama, not McCain.

http://www.opensecrets.org/news/2009/02/special-interests-to-listen-ca.html




And this might be why:

http://abcnews.go.com/Politics/PersonalFinance/Story?id=5926400&page=1



Maybe the great experiment with the "Ducky Method of Rationing" doesn't save money in the long run after all. It might just be that some numbers have been crunched, and it's more profitable to be Blue Cross in the UK or Germany than it is in the US.

This might be a more appropriate speculation for the CT forum, though.

Side note: This is the first time when I have seen 'pulling a ducky' used in some reference to me that wasn't referring to doing naughty porno-style things...

 

[Tricky]

Side note: This is the first time when I have seen 'pulling a ducky' used in some reference to me that wasn't referring to doing naughty porno-style things...

**sigh** Glory days.

 

[jimbob]

Well, the UK rations via NICE.
Insurance companies ration (apparently primarily) by "pulling a Ducky" on the ill in the US. Worst case scenario, if the reform doesn't pass, as more and more people get "Duckied" or are unable to afford insurance and join the ranks of the uninsured, public opinion could turn so fervently that it creates civil unrest eventually.

It already is [EDIT: Strikethrough moderately] common:

I think something similar has been posted but it still is worth asking JdG:

MarketWatch:Illness And Injury As Contributors To Bankruptcy

ABSTRACT:

In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9–2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.

So 75% of the medical bancrupcies did initially have health insurance at the beginning of their illnesses. I suoppose they must have fecklessly decided to stop their insurance during treatment.

There is a better way, and it uses less public money than the US system, as well as the obviously nescessary private expenditure in the US system.

My overwhelming argument is moral, and luckily the UK population also vote for this, but there is also an argument from self-interest.

It is cheaper for me, and it is a public good. I haven't been robbed, but still pay for the police. I haven't caught SARS*, but still pay (more-or less willingly) taxes for the NHS. I haven't used social services, but again I pay taxes for them, as they protect the vulnerable.

 

[wackyvorlon]

Each gives according to his means, receives according to his need. Dangerous thought, that

The inefficiency of the private health system is amazing. You know, as a canadian, I don't think I realized how bad things were in the US until seeing Sicko. I also didn't appreciate our system as much as was due. Now, I cherish it. When I read the horrible mistreatment Ducky has received, and the tales of many others in his place, I think, there but for the grace of god go I.

 

[dudalb]

Each gives according to his means, receives according to his need. Dangerous thought, that

Question is who decides how much are the "means" and what is the "Needs".
This sounds too much like the Marxist Meme "From Each According to His Ability,To Each According To His Needs" and we have seen how well THAT works in reality.

 

[Toke]

dudalb,
Saying that Marx got that one right is not endorsing the whole program.

 

[wackyvorlon]

This sounds too much like the Marxist Meme "From Each According to His Ability,To Each According To His Needs" and we have seen how well THAT works in reality.

It seems to work very well when it comes to healthcare, mind. The fundamental problem is that the most profitable thing is not always the right thing. Even in the US, a great deal is run by the government. The police, road construction and maintenance, etc. Public transit runs in the same category, too. If run for profit, these services would fall to pieces - but they are necessary.

The free market is not magic.