Health Insurance Industry Still Wants To Cancel Sick People's Coverage

[Disclaimer]

I haven't stirred the ol' OR political pot in a little while.

If this isn't a glaring indication of everything that is wrong with profit-driven private health insurance, I don't really know what is.

We can debate private/public health insurance all day long (Seriously, we could, I enjoy it and I know how to use Google super good ), but for me, the issue really boils down to "Are you born with the right to have health care? / Do you value human life?"

If yes, then health care needs to be provided to everyone, regardless of cost and therefore shouldn't be profit driven.

If no, then you may need to do some re-evaluation of your stances on other political issues like abortion and the legal system, because I find those often in conflict, if you don't value health/life.

http://consumerist.com/5294757/insurance-industry-still-wants-to-cancel-sick-peoples-coverage

As the federal government debates health care reform, the health insurance industry has some news for us. They're not going to stop canceling people's policies after they get sick. Nope. No way.

Rescission, or cancellation of a health insurance policy after coverage is in

place, can happen when insured people give incorrect or incomplete

information when applying for insurance. This can be outright fraud, or

something as simple as a woman forgetting to mention taking acne

medication in the past when she's diagnosed with breast cancer.

Companies are happy to collect premiums until their customers get

sick—then they investigate, and cancel the policy if they can.

In testimony to Congress today, CEOs of major health insurance

companies admitted that their companies will not limit rescission to

cases of clear fraud.

"When times are good, the insurance company is happy to sign you up and

take your money in the form of premiums," said Rep. Bart Stupak

(D-Mich.). "But when times are bad . . . some insurance companies use a

technicality to justify breaking its promise, at a time when most

patients are too weak to fight back."

"I think a company does have a right to make sure there's no

fraudulent information," said Rep. Joe Barton (R-Tex.). "But if a

citizen acts in good faith, we should expect the insurance company that

takes their money to act in good faith also."

Late in the hearing, Stupak, the committee chairman, put the

executives on the spot. Stupak asked each of them whether he would at

least commit his company to immediately stop rescissions except where

they could show "intentional fraud."

The answer from all three executives:

"No."

It's sort of the GM private jets moment of the health care debate, isn't it? Only the stakes are much higher.

Health insurers refuse to limit rescission of coverage [LA Times]

[siggywiggy]

i agree, but without "winners" and "losers" all competition is thrown out the window which will result in poor health care for everyone. I believe everyone should have health care. If a "good doctor" gets the same amount of pay as a "poor" doctor where is the incentive.

Every business, every working individual is in it for the money. Profit is everything to every economy. If you take from the wealthy and give to the poor in any situation, it will only cause problem.

solution: IDK I don't know how you can have both health care for everyone individual and keep the competitive nature within the business.

I think health care industry would be much more affordable if the amount of law suits and insurance fees were cut to a minimum. Those 2 things have ran up costs in almost every industry.

just my 2 cents and some ramblings

[Disclaimer]

What are we competing for? Japan has public health and they're ranked #1 in world.

Your idea of a 'good doctor' and mine may be different. How often have you selected a doctor based on his med school credentials? Is a doctor that has a 4.0 from OSU equal to a doctor that has a 3.0 from Harvard? What if the OSU doctor has performed 3000 procedures in his lifetime and the Harvard one is fresh out of school? Doctors are certified to practice or not, so if it's all a big pass/fail, then 'good' and 'poor' are subjective and based on your personal preference alone.

I don't understand why, in the area of personal health care, your socioeconomic status matters. We're all people, rich, poor, black, white.... It's not like we're taking from the rich and giving to the poor, we're just making sure everyone is treated equal. That's not to say that if someone wants to use their social status to gain some additional pull outside a basic public care system they should have every option to use that, if they want - they can subject their health care to the private sector and pay what they're willing to pay if they think they can get 'better' treatment.

There's flaws in any system, public, private, hybrid - we just need to figure out which one optimizes our personal and societal health. That is the goal of health care right?

Edited June 19, 2009 by JRMMiii

[InyaAzz]

Create a system where the Dr's and institutions are rewarded for keeping you HEALTHY. My .02

[Uncle Punk]

The federal government is here to provide national defense and infrastructure. I don't need them to provide anything else. State and local government have a different role but still they have nothing to do with being responsible for me. Healthcare is NOT a right; if you value your health then it is your responsibility to pursue what happiness it gives you. This healthcare crisis is once again another problem brought on by the governments own need to social engineer. The government creates regulations that forces insurance providers to pass the costs of the regulations on to everyone. How would you like it if auto insurance companies passed on the cost of high risk drivers on to you? They currently do but they are also allowed to penalize risky behavior. Currently the auto insurance industry has the ability to rate their risk of insuring you on several factors and can charge you based on your risk. The government is not forcing them to give their services away. Driving is no more of a right than healthcare is. When a business is forced to give away services without compensation because if they don't the government will take away their ability to do business you get this problem. There are much deeper topics to this problem than just this but all of them point back to government intervention.

This is the internet and none of us are going to solve any problems here but the constant need of our federal government to social engineer is the reason for most of our problems. I don't comment in a lot of these threads because they rarely stay on topic and I can understand why. There are several other areas of our economy that the government has fucked up right now which goes to my point of its inability to do things correctly but bringing them into this topic although it reinforces the argument takes it off topic.

[gsxrnurse]

Holy crap, I could go on for hours about this (but I won't).

One of the incentives of being employed is so that I personally have health care coverage. It's pretty awesome when I get to take care of the patient who doesn't work (but was capable of it) and the bill is paid for by the government. This means that I'm busting my ass to keep them alive, getting my paycheck and my taxes are taken out which pays for their hospital stay. So basically I get to pay for them to be there AND I have to take care of them. Maybe if some of these people didn't smoke they wouldn't get pneumonia and COPD and require life support via the ventilator.

Once again, I just want to quit my job and have you guys pay for my food stamps and get all the free health care that I want. I want to eat lobster and hamburgers and all the greasy shit that I please and follow it up with a couple of cigarettes because I could give two shits, I know I'm taken care of.

[Disclaimer]

I'm all for the whole "personal responsibility" thing Tod, seriously.

But, we don't live in a society where everyone subscribes to that. I'm not sure of this 'social engineering' aspect you keep talking about - I think I get your point though. I just don't understand why some 'social engineering' as you put it is a bad thing. 99.99% of the time, cooperation in a society will yield better results than competition.

http://www.charleswarner.us/articles/competit.htm

(Just happened to be the first link I pulled off Google)

COMPETITION VS. COOPERATION

By Perry W. Buffington, Ph.D.

Which works better, competition or cooperation? The answer,

without equivocation, is cooperation. Although most people are

surprised by this, scientists have repeatedly verified it in

hundreds of studies since the late 1800s. Yet big business, the

educational system, the health-care community, and most parents

continue to encourage competition, almost totally neglecting the

power of cooperation. None of these groups realizes that

unabated competition may be costing billions of dollars in sales

and overall decreases in human achievement. Furthermore,

researchers have shown that too much competition may cause poor

health. Yet we continue to hold the cherished belief that

competition (not cooperation), to paraphrase Sigmund Freud, "is

the royal road to success."

If in fact competition brings out the "beast" in us, then

research demonstrates that cooperation surely brings out the

"best" in us. This finding has been held in virtually every

occupation, skill, or behavior tested. For instance, scientists

who consider themselves cooperative tend to have more published

articles than their competitive colleagues. Cooperative

businesspeople have higher salaries. From elementary grades to

college, cooperative students have higher grade point averages.

Personnel directors who work together have fewer job vacancies

to fill. And, not surprisingly, cooperation increases creativity. Unfortunately, most people are not taught cooperative skills.

The article continues for those interested....

So, in effect, if the gov't uses regulation to FORCES cooperation, the system, in theory, will be better. Granted there's a lot of mixed messages in that last statement (Forced cooperation?? Yea, oxymoronic, I know), but we need to start somewhere to get everyone on the same page.

But, this still falls back on you don't believe that people have a right to medical treatment and care. Can you elaborate on your reasoning why so I have something more to address?

[InyaAzz]

Holy crap, I could go on for hours about this (but I won't).

One of the incentives of being employed is so that I personally have health care coverage. It's pretty awesome when I get to take care of the patient who doesn't work (but was capable of it) and the bill is paid for by the government. This means that I'm busting my ass to keep them alive, getting my paycheck and my taxes are taken out which pays for their hospital stay. So basically I get to pay for them to be there AND I have to take care of them. Maybe if some of these people didn't smoke they wouldn't get pneumonia and COPD and require life support via the ventilator.

Once again, I just want to quit my job and have you guys pay for my food stamps and get all the free health care that I want. I want to eat lobster and hamburgers and all the greasy shit that I please and follow it up with a couple of cigarettes because I could give two shits, I know I'm taken care of.

I approve this message.

[Disclaimer]

K,

Sucks to be in your spot, on the front lines. I'm sure it's frustrating.

But, since you've got the firsthand knowledge, do you think those people actually WANT to be in the hospital, away from their own couch, bed, TV, privacy? I'm just asking. Do they have some compelling reason that they enjoy being in a hospital, or does being there get them out of some other obligation that the system needs to fix?

I guess my view of healthcare is how I view my leathers. I didn't buy them hoping I use them. I don't buy health insurance hoping I use it. Even if it was free, why would I want to spend my time in a place with a bunch of other people? Maybe I'm completely missing a lot of these ulterior motives people have for WANTING to be a hospital or urgent care facility?

[InyaAzz]

I don't want to speak for said nurse, but I think she was just venting on the fact that we have to foot the bill for people who don't bother to do the bare basics in taking care of themselves. And then, these people show up in a hospital or DR's office require expensive medical care (free for them) when all they had to do was put down the cheeseburgers or stop smoking.

I guess maybe I'm off topic...since I was agreeing with her and it probably has little to do with your OP Justin. Now I'm just ranting.

[siggywiggy]

The federal government is here to provide national defense and infrastructure. I don't need them to provide anything else. State and local government have a different role but still they have nothing to do with being responsible for me. Healthcare is NOT a right; if you value your health then it is your responsibility to pursue what happiness it gives you. This healthcare crisis is once again another problem brought on by the governments own need to social engineer. The government creates regulations that forces insurance providers to pass the costs of the regulations on to everyone. How would you like it if auto insurance companies passed on the cost of high risk drivers on to you? They currently do but they are also allowed to penalize risky behavior. Currently the auto insurance industry has the ability to rate their risk of insuring you on several factors and can charge you based on your risk. The government is not forcing them to give their services away. Driving is no more of a right than healthcare is. When a business is forced to give away services without compensation because if they don't the government will take away their ability to do business you get this problem. There are much deeper topics to this problem than just this but all of them point back to government intervention.

This is the internet and none of us are going to solve any problems here but the constant need of our federal government to social engineer is the reason for most of our problems. I don't comment in a lot of these threads because they rarely stay on topic and I can understand why. There are several other areas of our economy that the government has fucked up right now which goes to my point of its inability to do things correctly but bringing them into this topic although it reinforces the argument takes it off topic.

^^^what he said

i still say there must be winners and losers. Who isn't getting healthcare? Why do you care? If someone can't afford it, perhaps they could have disciplined themselves when they were younger; or perhaps they could grow a pair and go do some intensive labor. Is it my responsible to take care of them if they can't take care of themselves.

I believe america has become lazy and our thought pattern has changed to "lets all live in a perfect world" its not going to happen.

I am not saying everyone is in this category, some people can't work, some people have accidents, outside influences that they cannot control. If the government didn't take all of our money and determine who they think should get it perhaps we would take care of our own. TOO MUCH Government Interference.

[SAMBUSA]

"Do you smell something Rabbit?"

[Uncle Punk]

I will agree that cooperation works best in some cases; however that depends if it comes about naturally or artificially. If you don't cooperate with others people who do will put you out of business quickly. If the government makes you do things that defy logic they can, have and are putting businesses out of business. Insurance is a form of cooperation that has a very good track record of its value to the masses. National defense is another that we can’t do by ourselves, our highway system is another. (Except for the Amish, I hate those fuckers using our roads but that’s a whole different rant.)

If healthcare wasn't socially engineered the way it is now competition would make it look much different than it does now. I don't think as many people would be without it either. Someone would come up with a business model that will fill the voids where there is money to be made. When people start to look at healthcare as a form of their own happiness and make it a priority for themselves instead of a government handout costs would be easier to control. Go back to my auto insurance parallel, if I could drive anyway I wanted caused as much damage as I could sustain and the government paid my premiums how long do you think it would take for the system to be broke.

Healthcare insurance is a business if you think you can do a better job than the companies currently in business go right ahead but I guarantee you will be back here complaining about the government’s involvement not allowing you to make any money. If you were responsible for making the decisions some of these companies are making you might be making the same decisions if you are responsible for your company’s bottom line. Remember insurance is a business and you can take your business elsewhere. If you make enough wrong decisions another company will come along and give you what you want if they can make money doing it.

[Disclaimer]

Someone would come up with a business model that will fill the voids where there is money to be made. When people start to look at healthcare as a form of their own happiness and make it a priority for themselves instead of a government handout costs would be easier to control. Go back to my auto insurance parallel, if I could drive anyway I wanted caused as much damage as I could sustain and the government paid my premiums how long do you think it would take for the system to be broke.

The bold statement rings true in almost everything....except healthcare. Explain to me how, if someone's net worth is $500,000, yet they need $2M worth of oncology to beat colon cancer, how is anyone going to make money on that?

The auto insurance analogy isn't the greatest, I see the point, but there's a few key differences.

1) You don't get dropped from your auto insurance if they find out had an accident (The whole point of the OP was insurers that take your money up until you have an issue, then find some way to cancel your coverage)

2) Cars are material possessions within the means of affordability, versus medical treatment where 5 days in the hospital could send you to the poor house.

3) You make the false assumption that just because the gov't is paying for your coverage (which you pay for indirectly) that people would go around causing accidents just because they can. Just like if the gov't was paying for your health insurance, that you'd spend 23 hours a day in a hospital "just because you can".

Healthcare insurance is a business if you think you can do a better job than the companies currently in business go right ahead but I guarantee you will be back here complaining about the government’s involvement not allowing you to make any money. If you were responsible for making the decisions some of these companies are making you might be making the same decisions if you are responsible for your company’s bottom line. Remember insurance is a business and you can take your business elsewhere. If you make enough wrong decisions another company will come along and give you what you want if they can make money doing it.

My question is... should healthcare BE a business? Healthcare is a completely different animal than other insurance. And when my life is on the line against some bureaucrat businessman's bottom dollar - I don't want him to be able to write me off. The profit motive to NOT treat me > the motive to keep me healthy.

[SAMBUSA]

:D:D

[John]

The federal government is here to provide national defense and infrastructure

IMO they are here to provide social order and basic security.

locke said that without government, people live in the "state of nature". hobbes described the state of nature as "a war of all aganist all" where life is "solitary, nasty, brutish and short"

the main problem with the state of nature is there is no protection of your property, your liberty or even your life from anyone else. "the strong do what they can and the weak suffer what they must."

hamilton wrote "Why has government been instituted at all? Because the passions of men will not conform to the dictates of reason and justice without constraint.”

thomas paine: "Society is produced by our wants, and government by wickedness; the former promotes our happiness positively by uniting our affections, the latter negatively by restraining our vices. The one encourages intercourse, the other creates distinctions. The first is a patron, the last a punisher. Society in every state is a blessing, but government even in its best state is but a necessary evil."

[Uncle Punk]

Shit. I should have known better than to get involved in an internet discussion about politics. I am bored and need a job more than I need to write a thesis. You win on wearing me down on shear volume. We will be able to point counter point each other all day. We can also bring logic into the discussion from outside sources not related to healthcare but it will all be moot. I can rebuke your assessment of my failed analogy but you are correct it will not address your OP.

If you have a contract with an insurance company you have the legal right to make them honor it. If said company fights all of its obligations and wins unfairly their business will go away to a competitor who honors its contracts. You are free to take your business elsewhere. Government’s role is to see that the contracts both parties agree upon are handled correctly. This is why we have a republic country not a democratic one. (Explaining what that means and how it applies will take forever and I ain't gonna.)

Merely stating that I don’t believe it’s the government’s role to provide our healthcare is not what you’re looking for but that’s as simple as it gets. If the government is responsible for our healthcare are they also responsible for our deaths? If so I want to sue them for allowing my grandmother to die from natural causes, the government is responsible for it damn it where’s my money? You want more absurd, should they be responsible for our births?

[gsxrnurse]

But, since you've got the firsthand knowledge, do you think those people actually WANT to be in the hospital, away from their own couch, bed, TV, privacy? I'm just asking. Do they have some compelling reason that they enjoy being in a hospital, or does being there get them out of some other obligation that the system needs to fix?

I'm pretty sure the guy that came in during my last shift with a closed skull fracture and blood alcohol content of 0.37 would have rather been at the bar, you're right! Instead he got the government to spend $1200 on the ICU bed, just for the room I mean, that he slept in while he got to watch 96 channels on a flat screen tv.

[John]

times are changing. last time i was in a hospital, they had FIVE channels on a piece of junk TV.

[Disclaimer]

Shit. I should have known better than to get involved in an internet discussion about politics. I am bored and need a job more than I need to write a thesis. You win on wearing me down on shear volume.

It's all good, I thought we were having a good debate. I like hearing others' views and opinions.

If you have a contract with an insurance company you have the legal right to make them honor it. If said company fights all of its obligations and wins unfairly their business will go away to a competitor who honors its contracts. You are free to take your business elsewhere. Government’s role is to see that the contracts both parties agree upon are handled correctly.

I agree, the problem lies with the fact that when it's time for a profit driven company to execute their insurance service on your behalf, it's no longer there. When you need contract enforcement and execution, you didn't have the ability to shop around. You can switch insurance companies until the cows come home, but when you end up in a accident or find out you have cancer, the insurance company you're with wriggles out of paying the bills - so what competition wants to win your business when you've got health bills and obligations over your head now? Therefore, you end up holding the bag, like a sucker, paying for insurance the whole time that you thought would be there for you, and it's not. Not only that, but now that you KNOW you have medical conditions, you're required to disclose them to your next insurer, raising your premiums or just flatly getting denied coverage. You don't know how good your insurance company is until your time of need. It's not like you can test drive how your insurance would handle emergency medical situations, other than to get INTO one. And what do they care, they're a business in it to make profit. The only way I know how to make profit is to have more money coming in than have going out. Inflow = premiums, Outflow = medical disbursements. So, business 101 says to make profit you need to collect more premiums and lower disbursements, by denying payment for coverage and care that you've contracted them to provide. It's a racket to pay someone for something that you never receive the benefit of.

Merely stating that I don’t believe it’s the government’s role to provide our healthcare is not what you’re looking for but that’s as simple as it gets.

And that's perfectly fine, you're entitled to that opinion - I just like to get to the deeper questions, like why do you feel that way? For me, it's not so much that I want the gov't to run it, it's that I don't trust a private business to run it ethically, because ethics is in severe contrast to the entire business model.

[dmagicglock]

jrm maybe the U.S. isn't the right country for you? You're all for the GM buyout, pro union, and you want nationalized healthcare? I'd suggest finding a place to live in like cuba or Venezuela, maybe even China?

healthcare is not a right plain and simple, because you can't provide someone healthcare without imposing on the rights of someone else who has to provide it for them. If you really want to reform the healthcare system and make it work, here's a couple of changes I would suggest.

Tort reform: Trial lawyers drive up the costs of insurance for everyone, because if a doctor makes a mistake, trying to save some worthless schmucks life, they want to sue him for 100 million dollars... Lets say they don't make a mistake and just "misdiagnose", they still want to sue them for 100 million dollars. So doctors lose 1/3rd of their earnings for malpractice insurance, and insurance companies drive up costs due to lawsuits.

Defensive medicine: I've heard figures anywhere from 100 to 200 BILLION dollars are spent on this every year. This means doctors are spending tons of your money, and insurance money ordering tests that they normally wouldn't order just to rule things out and prevent them from getting a lawsuit. The supreme leader obama recently said that defensive medicine needed to stop, but he wouldn't concede on tort reform because it wasn't fair to some people... blah Here's a nice breakdown in the case of an OBGYN because some people like figures

If that OB-GYN must pay a medical liability premium of $200,000 each year (which is the rate in Florida), $2,000 of the delivery cost for each baby goes to pay the cost of the medical liability premium.

Prescription drug care costs:

Everyone bitches about how expensive prescriptions are... Well nobody realizes the average cost to bring a drug to market is 600 million dollars. So the drug company has to make up that opportunity cost for profit and reinvestment into other drugs. Also the FDA (government organization) has a stranglehold on the endless approval process for drugs. The average time from development to market for a drug is around 17 years I believe? By then most of the patents on the drugs are up and even when renewed, the companies have few years before generics are available and kill their profits to cover their overhead.

So if you want the healthcare system fixed, reform it, don't REPLACE it... I'm tired of people wanting to have a hand out and think the government should provide them with anything more than sovereignty.

Edited June 20, 2009 by dmagicglock

[Disclaimer]

Ohh, I see what you did there. List all the evil commie countries with nationalized care, then suggest I group with them because my views are obviously not those of an AMERICAN. The classic "If you don't like how things are, you can just 'geeeeeeet out' " argument.

But, you could've listed other countries with forms of nationalized care, like Japan - of which you're ok with riding one of their motorcycles manufactured there in their 'commie healthcare' system. ZOMFG! You're supporting that!?

http://en.wikipedia.org/wiki/Universal_health_care

Universal health care is implemented in all but one of the wealthy, industrialized countries, with the exception being the United States.[1][2]

Top 10 healthy countries map

http://www.mapsofworld.com/world-top-ten/world-top-ten-healthy-countries-map.html

Funny how we also have one of the poorest health indexes of that group and highest costs out of that group too. Hmm, efficient much? Less health, higher cost. Sounds like a winning formula. (/sarcasm)

So, even if you don't believe everyone has a RIGHT to healthcare, the private system is still much less efficient. When is inefficiency better?

I'm in agreement with tort reform and stopping "defensive medicine" because of fear over litigation. I'm not sure about drug cost reform, I don't take any drugs, so it really doesn't affect me, but I think that if I did, I'd kind of want some oversight of some neutral 3rd party that indicates the drugs I'm using are safe to use. The problem with that and any other scientific method is the only way to observe long-term effects, is to test long-term. Accelerated testing in these instances isn't possible.

Regardless of the slight jab at me and your other ideas in your post, no one has addressed the OP and shown any information that would prove why our healthcare and private health insurance system is better than a nationalized system?

Edited June 20, 2009 by JRMMiii

[dmagicglock]

sorry for the jab, in all due seriousness, check out this interview with ron paul on healthcare, he brings up a lot of good points, especially how health insurance, really isn't following the insurance model. Love him or hate him, he has an informed opinion because before he was a politician he was a doctor for many years.

http://www.youtube.com/watch?v=foXQbmZxWYY

[dmagicglock]

Also that map used an old system of measuring average life expectancy of a healthy person at birth. Well that is one dynamic trying to measure qualitative data, not quantitative data. The new WHO measures average life expectancy of person's years of healthy life. Simple measures like that do not take into account things like deaths from War (japan hasn't been to war in over 50 years), life styles... do American's drink more, have more drug use, exercise less, etc than japan? Are American's genetically predisposed to more medical conditions than Japanese? The truth is I don't know, but to measure a complex healthcare on one statistic seems... Incomplete judgement at the least. Regardless of the quality of your healthcare, if people do not choose to lead healthy lifestyles I'm sure its going to skew the stats.

[dmagicglock]

Americans are unhealthy because they live shitty lifestyles. It has nothing to do with health care or economic status. The fastest growing health risk amongst the "poor" in this country is obesity. Being a fat' date=' lazy bastage isn't caused by poor health care, but it will most certainly lead to health problems.[/quote']

haha plus 1, I heard rush ranting about this the other day, we're the only country in the world where our poor people suffer from obesity... pretty sad.