When I first joined Daily Kos, I was so naive. I had always thought that politics was about ideas, and that votes were a way of getting feedback from the public about those ideas. Today I see that much of politics is actually about power struggles. Yikes. Political experts are brilliant at taking words and stringing them together in ways to imply promises that are never actually made, and also twisting them to distort the context of what another speaker is trying to say. What can one do about it? Some guy once said “Be the change you want to see in the world”; I believe in that shit, so I try to follow his advice.
I am writing this diary so that those who truly want to accurately understand my views about health CARE reform, and where they come from, can do so. The topic of this essay does not usually get much airtime — for some reason, corporate owned media would rather run stories about strippers and sex scandals than those about how America’s health CARE system is failing many of it’s citizens, and how elites are getting rich in the process.
I’ve learned a lot about this topic through the school of hard knocks; the process has been enormously painful. Our health CARE system totally sucks. I’m trying to fight to make it better for others, especially for our children and grand-children. Their futures seem so bleak … I’m getting older, but all things considered I’ve had a pretty great life; I see so many winds blowing to fill their lives instead with crushing poverty and misery, it breaks my heart.
Ignorance is Bliss What is the single most important metric that drives for-profit health insurance companies? The price of its company stock. Seriously. Metrics such as mortality rates, life expectancy at birth, five-year survival rates for breast and colorectal cancer, etc., are merely fodder for marketing. YOUR HEALTH is in THEIR hands … does that bother you?It took me a while, but I finally came to realize that the main objective of for-profit insurance companies has little to do with “making sick people well”, as I had always assumed. For a long, long time, I was ignorant of this because I was “fat and happy”, so to speak. I worked for a large corporation and enjoyed the benefits that come to those who have the very BEST insurance. It is beautiful and awesome: one does not have to worry about things like pre-existing conditions; one pays a “relatively” small price out of one’s paycheck, and then relatively small copays when care is obtained. Over time, I watched the price I had to pay for each of those things rise: the deduction from my paycheck, the size of my copays, and then all of a sudden there was a new “deductible” that got added, and started to slowly rise each year. I bitched and moaned like everyone else about the increases. I had no idea how wonderful my situation was compared to other human beings in the country. The words rescind or rescission were meaningless to me, because I had never been subject to them. FYI, the words rescind insurance mean to retroactively cancel or void an insurance policy; the idea was that if one was discovered to have been dishonest when applying for insurance, the company had the right to void it any time.
My life took a significant turn for the worse on the day my company announced they would no longer be subsidizing retiree health insurance. They were phasing out this benefit in a grandfathered way, so that those who were retired or “on the cusp of retirement” would continue to receive it. I had worked for them for almost 25 years, and was achingly close to the line in the sand that they drew … but still on the wrong side. Frankly I was shocked, stunned, and angry to be losing such an important benefit, having worked so hard, so long, and so well for this company. I remember how they spun the news with Orwellian corporate-speak: it was a “great thing” for employees because it would “allow the company to remain competitive”. Never-mind that we were a Fortune 50 company, but whatever.
At the time I was convinced the company was cutting back in this area merely to increase their own profits; nobody had received much of a raise for years, and other benefits had been slowly cut over time too, but in much less significant ways. I had not yet realized that raises had been so slim because the money that could have been going to employees in raises was INSTEAD going to health INSURANCE companies to pay for our insurance benefits. In truth I had been receiving (invisible-to-me) “increased compensation” in the form of subsidized insurance, the company had been (mostly) eating the cost of rate increases. Another way of saying this, however, is that during those years the benefits of my labor had significantly been going to the insurance company instead of to me in the form of a raise.
The best slave is a slave that doesn’t know he’s a slave.
For those of you who work for large companies and have relatively good health INSURANCE, let me ask
are you also getting good raises and/or other forms of compensation on a regular basis? will you have subsidized retiree health insurance when you retire?If the answer to either of these question is no, I submit to you that you too have been harmed in significant ways by for-profit insurance companies. Back in the day, subsidized retiree health insurance was pretty much a standard benefit; I suspect that is no longer true. Think about that for a moment .. is your own situation better or worse because of it? Are you planning on working until you are covered by Medicare? Have you given up any dreams of early retirement? If not, how are you planning to pay for health INSURANCE during the gap years when you are no longer covered by your employer? Do you clearly understand how high your premiums will be at that time?
Life after the Company Insurance Benefits Run OutAgain, I thought my employer was the bad guy when they took subsidized retiree health insurance away from me just as I was nearing the age when I would need it. A severance package was being offered, I decided to take a risk to leave the company and find another job with the hope that I could work long enough to qualify for a new company’s retiree benefits. However, I first wanted to take time off because long hours of work while being the mother of a young child had worn me down. I felt burned out. I needed a sabbatical, I thought, and was even proud of creatively finding a way to obtain one (since they had never been offered by my employer). But my timing SUCKED, SUCKED, SUCKED … little did I know that the stock market was going to crash in a few short months. Who can predict when a hundred year flood will actually strike?
The crash of 2008 came when I was just tipping my toes into the water trying to get a job. Hiring stopped, everyone was terrified that the global economy was going to collapse. I am not kidding, it seems forgotten today but I swear that this was true. I stopped looking because why keeping running full-speed into brick walls over and over again? What good would THAT do? When companies finally WERE hiring again, it had been a few years and only then did I realize what had happened: I had become a long-term unemployed person without quite realizing it. I thought I was just waiting out the recession .. I had learned new technologies, developed working prototypes that I could show and DID show to prospective employers; I was told my package looked great but I was missing “recent paid work experience,” which turned out to be a showstopper. I couldn’t get a paid job unless I had a paid job. Catch-22. The day I realized this was not a good one for me, to put it mildly. Thoughts of suicide at some point in the future crossed my mind; frankly they still linger with me today.
Let me connect this back to our health CARE system, though. Older workers have a huge strike against them, which is beyond their control and which makes them unattractive to employers: their age. I worked in high-tech, I could master any technology, but I could not change my age or the fact that I belong to a demographic group that generally requires more health CARE than my colleagues who are much younger. Everyone in my family was relatively healthy (still are), but the way the pricing of small business insurance works, everyone in the company can be at risk if a small number of employees have significant health issues: the cost sky-rockets. Essentially the company starts to look like a small high-risk pool to the insurance companies, so the price goes up for everyone.
As I see it, because of the wildly increasing price of health insurance
The benefit of subsidized health insurance in retirement is getting to be difficult or impossible to provide, even by employers who truly value their employees Older workers face huge obstacles in employment that younger workers are not saddled with. If you lose your job when you are older and don’t find one quickly, you are pretty much fucked.For those of you who work for large companies and have relatively good health INSURANCE, let me ask
are you confident that you will have your current job until you are covered by Medicare? are you confident that you will be able to find another job if you happen to lose the one you have now? how old are you? Are you aware that age discrimination in hiring is illegal, but it still happens anyway and is difficult to prove?Eventually the medical benefits that came with my work separation ended. I don’t know how it happened, as I had paid for insurance all of my fucking life, but somehow in the transition I had to apply for insurance on the private market. All of those “proof of coverage” forms I had gotten and carefully filed away? Didn’t count for squat. My hatred of insurance companies began at that time, having to fill out forms-designed-by-Satan that were then required for private insurance. The forms basically asked you to identify any and all types of illnesses that you and those in your family have had for the last ten years. The nice sales reps told me to “just focus on the major stuff”, but the legal words on the forms said that I had to specify every single incident. The insurance companies used those forms, of course, to deny compensation for any pre-existing conditions.
I maintain that anyone who has only had large biz or small biz insurance coverage does not know how LUCKY they are that they NEVER had to fill out one of those forms. To get a SMALL TASTE of what the experience was like, check out this clip (3:37). Remember there were PAGES and PAGES and PAGES of the stuff ...
https://www.youtube.com/watch?v=2H9ufue_1uI
x YouTube VideoCan Not Understand Insurance Application
Published on Jun 29, 2009
Don Hamm, CEO of Assurant Insurance admits to Bart Stupak (D-MI U.S. Representative) he is unable to understand his own company's application.
House Committee Oversight and Investigations
Witnesses testified about the practice of "post-claims underwriting," which occurs when insurance companies cancel individual health insurance policies after providers submit claims for medical services.
A Glimpse into the Hearts of Insurance CompaniesLucky for me, around this time health care reform was hot and the CEO’s of the big insurance companies were giving testimony on capital hill about their nefarious company practices. Does anybody other than me remember what these CEO’s said?
Blue Cross praised employees who dropped sick policyholders, lawmaker says
Executives of three of the nation's largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, [emphasis mine] despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.
Watching this testimony was amazing, Congress and the CEOs were actually playing chicken with each other right in front of everyone, kind of like dogs trying to see who could pee highest on the tree. Congress peeps, especially the Republican ones, were trying to give executives some cover with an “admit your sins, and promise to go forward and sin no more” tactic, but the CEOs were not buying it. No, they stood their ground, looked the Congress peeps right in the eye, and essentially said “we are going to continue our sinning, you cannot make us stop” as politely as they possibly could.
The hearing on the controversial action known as rescission, which has left thousands of Americans burdened with costly medical bills despite paying insurance premiums, began a day after President Obama outlined his proposals for revamping the nation's healthcare system.
An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.
It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses. [emphasis mine]
The executives were REFUSING to end the practice of rescission. Why? Because they were making too much fucking money by doing so. Their scam was to collect premiums from an insured for years and years and years, and then when the insured was diagnosed with certain illnesses, like cancer, they would assign people to scour the original insurance application to detect any possible discrepancies. If they found that the insured had not reported some minor incident, even by accident and/or without any fraudulent intent, they would use that as an excuse to retroactively void the policy so they would no longer be liable for expensive treatment that was now required for the insured.
The silver lining in all of this is that the the heartless souls of these corporations were revealed for all the world to see. They were shown to LITERALLY value $$$ over the LIVES OF HUMAN BEINGS, or as described by Wendell Potter,
“for-profit insurers [have hijacked] our health care system and put profits before patients,”
One of the most famous incidents of rescission involved Robin Beaton, a retired nurse from Waxahachie, Texas, who was diagnosed with an aggressive form of breast cancer in 2008 (see below). As I recall, she had not reported a visit to the doctor for toe fungus; her insurance company actually used that as an excuse to rescind her coverage and deny treatment for BREAST CANCER.
Note that the victims of rescission were persons who did not obtain insurance through their employer but instead bought it on their own. They were being treated extremely cruelly, but most of the rest of us were completely ignorant about what had actually been going on. I find our collective ignorance on this topic to be almost as shocking as the treatment the victims had received. I believe we lacked awareness because we were in a different “health INSURANCE silo” than that of those who were victimized. Keeping up with the changes in our own silo is difficult enough, right? Understanding what is going on in silos other than our own … who in the world has time for that?
Let me wrap this up with a short clip from Wendell Potter and Robin Beaton (1:58), and then a few final words.
https://www.youtube.com/watch?v=vgz1crsj8jg
x YouTube VideoAs we continue our conversation about health care reform, in my view there are two key aspects we must never lose sight of:
1) COST CONTROL
When a strong cost control mechanism does not exist, people will DIE and/or people will go BANKRUPT in order to obtain health CARE. These scenarios simply do not happen in other countries. Why on earth do we allow them to happen here?
Reforms that do not address cost control are like somebody taking an aspirin in an attempt to cure their cancer. Sure it might “help,” but it is a token and superficial solution that does not address the heart of the problem. Mostly these reforms are just bright shinys put out on behalf of for-profit insurance companies; they serve to distract us and have us fight among ourselves.
The logical approach to cost control is to limit excessive profits of players such as for-profit insurance companies; other players such as pharmaceutical companies are also in dire need of reform, but that is a subject for another diary. In order to accomplish this objective, however, politicians must be willing to stand up to these powerful corporations, who will fight with all of their might to keep and increase the amount of OUR lovely money flowing into their pockets.
2) THE ROLE OF FOR-PROFIT INSURANCE COMPANIES
In order to enact meaningful cost controls, we must confront the reality that “for-profit insurers [have hijacked] our health care system and put profits before patients.” Insurance companies do not provide health CARE: they are not doctors, hospitals, or drug-makers. They are merely middle-men who administer a bureaucratic product; the administration of Medicare, in comparison, is accomplished at a TINY FRACTION of the cost. These middle-men happen to also serve as gatekeepers to a life and death service, however, so they sit in a very lucrative position; they are actively exploiting our human fear of death, illness, and associated expenses for their own financial gain.
For-profit health insurance is an example of predatory capitalism — vultures who actually make money at the expense of others. Their existence is a moral stain on our country .. we as a nation are bystanders who watch business people ruin lives for the sole purpose of maximizing profits, and most of us never speak of it.
Believe it or not, there was a time not so long ago when health insurance in the U.S. was NON-PROFIT. Guess what? Health insurance was also much more affordable at that time. Coincidence? Of course not.
Finally, politicians who obtain campaign contributions from for-profit insurance companies are tainted, at best. Remember, these companies are laser focused on their own financial well-being instead of on the well-being of those who have entrusted THEIR LIVES to them. Never forget how Robin Beaton was treated by Blue Cross. I urge you to consider the source of each politician’s campaign contributions when you consider their position on health CARE reform.