interesting for all the people saying we should rely on the private insurance companies my families doctor was forced out of 2 practices by the efforts of insurance compnies because they felt he wasn't billing enough and spending too much time with his patiants
Domestic Violence: A pre-existing condition? So Congress is almost on the ball. What are they, three weeks slow? At least. This is, like so many other aspects of the health care reform issue, something that should have been taken care of long, long ago. Oh, right. They tried. Well, two years ago. On September 14, Huffington Post's Ryan Grim reported: With the White House zeroing in on the insurance-industry practice of discriminating against clients based on pre-existing conditions, administration allies are calling attention to how broadly insurers interpret the term to maximize profits. It turns out that in eight states, plus the District of Columbia, getting beaten up by your spouse is a pre-existing condition. Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you're more likely to get beaten again than the average person and are therefore more expensive to insure. In human terms, it's a second punishment for a victim of domestic violence. In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed. All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill. A spokesman for Enzi didn't immediately return a call from Huffington Post. At the time, Enzi defended his vote by saying that such regulations could increase the price of insurance and make it out of reach for more people. "If you have no insurance, it doesn't matter what services are mandated by the state," he said, according to a CQ Today item from March 15th, 2006. (boldface accent added) And this just in, from CNN's Alan Silverlieb: Top House Democrats on Tuesday slammed insurers who claim that domestic violence is a pre-existing condition that can be used to deny coverage to battered women. They pledged to incorporate a ban on the practice in the health care reform legislation winding its way through Congress. Forty-two states have passed such a prohibition, according to a recent report from the National Women's Law Center. Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Wyoming and the District of Columbia have not, however. "Think of this," House Speaker Nancy Pelosi said. "You've survived domestic violence, and now you are discriminated [against] in the insurance market because you have a pre-existing medical condition. Well, that will all be gone." The ban would be part of a broader prohibition against the use of pre-existing conditions to deny care, a component of all the reform bills now under consideration. Washington Sen. Patty Murray, a Democrat, told CNN that she heard about the issue several years ago while talking to women who trying to escape abusive relationships. One of the women "told me that she did not report her domestic violence because her health insurance company would drop her. I [initially] didn't believe" the woman, Murray said. Murray introduced an amendment banning the practice in 2006 but was unable to get the measure approved. One Republican opposed to the amendment, North Carolina Sen. Richard Burr, argued that it's "deplorable to deny coverage to victims of domestic violence. However, states should be responsible for regulating insurance markets." (boldface accent added) There is some confusion about how often this limitation is invoked. Judy Waxman, Vice President of the Women's Law Center, said she had no current examples. Still, though, it seems absurd to have a policy in place to punish victims of crime. And when the excuses are states' rights (to punish crime victims) and capitalism (we can't afford not to cancel these people), it really seems that those who would protect this deplorable practice of the insurance industry are simply rubbing victims' noses in it. Despite the Congressional vow to fix the problem, it doesn't seem too much to ask for some sort of investigation in order to find out how many people have actually been hurt by the practice. It's easy enough to denounce capitalism, or even to turn the point of the WLC having no current examples back on the industry—how can you say it will cost too much when there are no current examples, which equals zero increase in costs to close this ragged gap?—but we need to figure out just what the impact actually is and has been. As Shelley Senterfitt, of the Georgia Coalition Against Domestic Violence suggested, "We have to go further and take affirmative steps to reach out to battered women who may have been denied coverage to let them know the landscape has changed and there may be insurance options available to them". In the interests of accuracy, though, Grim corrected his own article to note: Scratch the Tar Heal state from that list. North Carolina insurance commissioner Wayne Goodwin had his staff research the state's law and his attorneys concluded that insurers in that state would not be allowed to use domestic violence as a pre-existing condition. Group plans were specifically forbidden from using it thanks to a 1997 law, he said. For individuals and non-group plans, it's more complicated. "Though there is not a specific statute for individual plans or non-group plans, there is another statute that our attorneys here tell us addresses this issue. For example, North Carolina law defines what a preexisting condition is. Now, here in North Carolina, it says a preexisting condition means - quote - those conditions for which medical advice, diagnosis, care or treatment was received or recommended within a one year period immediately preceding the effective date of the person's coverage." Domestic violence, he said, doesn't met the state's definition of a medical condition and so can't be used as a pre-existing condition._____________________ Notes: Grim, Ryan. "When Getting Beaten By Your Husband Is A Pre-Existing Condition". Huffington Post. September 14, 2009. HuffingtonPost.com. October 6, 2009. http://www.huffingtonpost.com/2009/09/14/when-getting-beaten-by-yo_n_286029.html Silverleib, Alan. "Democrats vow to ban domestic violence as 'pre-existing condition'" CNN. October 6, 2009. CNN.com. October 6, 2009. http://www.cnn.com/2009/POLITICS/10/06/domestic.violence.insurance/index.html
It is funny really, now that the CBO estimates the Senate version will save almost a 100 billion dollars over the next 10 years, Republicans are now changing their tune on the virtue of CBO numbers. When the CBO numbers said Democrat healthcare reform would cost 900 billion over the next 10 years, Republicans were touting CBO numbers as equlivant to Gospel truth... apolitical, unbiased, etc. But now that the CBO numbers support the Democratic position, the CBO estimates are not reliable and cannot be trusted. It is funny to watch the very same senators go on and on over the virtues of the CBO numbers one day, and a few days later decry them as unreliable when they do not support their cause. Please Register or Log in to view the hidden image! If you were a comedy writer, you just could not write better comedy! The sad thing is some folks take this stuff seriously.
Something is wrong with that story. True insurance companies don't care how much unbilled time a doctor gives to his patients. It must have been some sort of medical practice that objected to their salaried doctor generating insufficient revenues per hour and this medical practice must have been billing patients directly and or billing insurance companies and or Medicare and or billing some other type of paying entity like perhaps a HMO.
Sounds logical to me. If I ran an insurance company I would only want insure people who don't need insurance. If I ran a bank I would prefer to lend to people who don't need loans. If I am a Wall Street firm let me gamble and if I win I keep the profits and if I lose the taxpayers pay for my losses so that I live to gamble yet another day. Give me all of the profits and none of the risks. Staying with a spouse that beats you is a preexisting condition. Being the kind of person who marries the kind of people who beat their spouses is a preexisting condition. Liking to eat donuts is a preexisting condition. Even if a person lost all their excess weight the fact that they were fat in the first place means that they will likely get fat again and therefore be more likely to get health problems before they are old enough to be past on to Medicare. One thing people misunderstand is the idea that fat people and smokers cost more in health insurance money. Actually fat people and smokers probably cost less money in health dollars over their lifetime because they die younger. Old people cost more money than young people per year. People in their last year of life consume one third of all the money spent in the USA on medical care. The fat and the smokers cost the private insurers more money and save Medicare money because the private insurers don't insure old people but Medicare does not have to pay as much for fat people and smokers who die younger. The risk of insuring old people was passed onto the taxpayers. Being old is a preexisting condition which explains why self employed almost old people in their 50s are expected to pay about $8,000 a year for insurance even when their only preexisting condition is their age.
The logic of capitalism Indeed. That's the logic of capitalism. Money first, people second. Question: Economic theory: Is it a tool to help humanity, or is it a cause for humanity to serve?
You don’t have health insurance; you just think you do. http://seekingalpha.com/instablog/441648-loren-steffy/21335-you-dont-have-health-insurance The article makes the point insurance that goes away the minute you lose your job was not insurance by the definition of the word word "insurance" but rather it is just employer paid for health care. COBRA which is supposed to be useful between jobs is only useful if you can make the payments. If you don't have sufficient savings you can't make your COBRA payments. Also COBRA has a time limit. If I understand the situation correctly about half of the people who are insured by their employers will if they get seriously sick or get hit by a car and get seriously injured then they will lose their jobs and lose their insurance. This would make a stat I got from another article make more sense. That article says that the average insured person's insurance pays $1,000 a year extra to pay for the uninsured. This seemed strange because the uninsured are 10 to 20 percent of the country depending mostly on whether Illegal immigrants are counted. The uninsured whether legal or illegal tend to be a younger population than the insured. Those uninsured who actually pay their bills pay the highest rates of anybody and are billed 2 to 3 times more than the insured are for the same procedures at hospitals because the insurance companies get discounts from the cash rates. So how could the uninsured cost so much when they avoid having anything to do with doctors. The traditional answers are that the uninsured get sicker before they seek help and that the uninsured go to the expensive emergency rooms for basic care because Emergency rooms are not allowed to deny penniless people care. But I think another answer has been overlooked. All those insured people who got sick and therefore lost there insurance are also part of the uninsured. I bet those insured people who got sick and therefore lost their insurance are actually the most expensive segment of the uninsured because they are sick and using health care.
My son had a private insurance with Blue Cross while going to college. They kept raising the premium every six months to the point that in his final year, he could not afford it. It was cheaper to pay the doctor directly than have the insurance. If Blue Cross a supposedly non-profit does that, imagine what others do. Now, we will have forced insurance to force more consumers as the consumption is down in this country.
Interesting comments, if everyone is mandated to have healthcare insurance it should reduce overall insurance costs as the risk would then be distributed over a broader base of insurance premium payers. Two, you brought up an interesting observation with respect to private insurers versus cooperative insurance carriers, there is no difference in pricing. So that tends to go against the insurers claims that they will not be able to compete against a non profit run government insurance system.
Why? risk has nothing to do with costs. The cost is what a company can charge and get away with it. Long ago, I audited a large health care company for the government and they were fined. Now, that company set up computer logic to bill the government higher rates for 5 years and got away with it until got caught. The upper management made millions while the company paid a token fine. The computer logic (Business Rules) are written by programmers and rarely the risk manager gets involved after the original program is set up. I know, I have written many such logics.
You are right kmguru, market always determines price regardless of cost. I should have said insurers have the freedom to reduce costs in order to compete for market share. And it is because market structures are so skewered in favor of the industry because of government special interest legislation, that costs/prices are so high. That is why the industry model must change going from few suppliers and many buyers to many suppliers and fewer payers.
This is like the Jews and Palestine fights. You can not settle from the middle of an event. They always want to go back 4000 years. That is why peace is impossible. Health Care has the same issues. The costs are high because: 1. Few doctors controlled by AMA 2. MD education is puposefully expensive 3. Hospital structure is gold plated like Nuclear power plants. Too many unnecessary regulations in the name of safety. Do you know that Pencils (a metaphor) in Nuclear Power Plants have to be nuclear certified at $5 a piece? 4. The drug discovery really does not cost much. Each drug has 5000 variations. The companies milk the drugs for years and cheat from each other. I worked at Abbott Lab, (and have a degree in BioChemistry) so know how the drugs are made. 5. Insurance companies want to make same profit as Life Insurance where people live longer and hence more profit. 6. People eat crap laced with pesticides and herbicides that accumulate in fat deposits and cause all shorts of health problems. More fat (Obese) the more poision in your system. There are 100s of these issues that influence American Health Care. The market structure is a small part of it.
I agree with your reasons, but all of them are part of the industry market structures they have created around themselves over the years in order to insulate them from competition and market forces, e.g. abuse of patents where the government is an active participant, see project Shark Fin. If this were truely a competitive industry, we would not be seeing these kinds of abuses. Nor would we be seeing this perpetual imbalance between supply and demand. And the traditional Republican solution to the problem, throwing more money at it; removing what little barganing power is in the system by making each individual responsible for negotiating with insurance providers for their insurance coverage and giving individuals tax breaks to make healthcare more affordable, and now requiring everyone to buy healthcare insurance but do nothing to make the industry more competitive, only make the issue worse and the business more profitable for healthcare providers. I once worked in an office building shared with an administrative arm of a large insurance company. The differences in offices was telling. Our offices were very nice, but spartan by comparison with those of this insurance company. I worked at that time for a tech company in California.
Thanks and I think this article published by New Hampshire Public Radio, illustrates the point. The average percentage of premium dollar retained for administrative expenses and profit is 15 percent for New Hampshire. But if you are an individual purchaser of healthcare insurance, 40 percent of your healthcare dollar is retained for administrative expenses and profit. Is it any wonder why the insurance industry wants everyone to be required to buy healthcare insurance but no more competition? http://www.nhpr.org/node/27042
Yes...that is part of the problem. The whole process need to be overhauled. Capitalism is all about "Production" of stuff that you can export or do import. Health Care should not be a part of that though production of drugs can be. Today this is more like Insurance Care than Health Care. The society creates an environment where even transplant Japanese get sick. Therefore the society should pay for it the same way after the disintegration of the nuclear family, the government pays to the elderly.... In this area I am a Leftist and proud of it. Please Register or Log in to view the hidden image! Interesting article: http://www.salon.com/news/feature/2009/09/03/india/index.html
Rape survivors: Uninsurable? Have you been raped? Don't lose your health coverage; you might not get it back. Perhaps that sounds like a sick political barb, but unfortunately it looks like sound advice. Cirrhosis, Huntington’s Chorea, Parkinson’s Disease, and now rape: perfectly valid reasons for denial of health insurance coverage. One of these things is not like the other, and while womens’ health groups have tried to raise awareness via the web for years, it remains largely unknown that such denial of services is de rigueur within the corporate machine of American health care. (Tan) Now, I know. An art blog is probably not the best place to start on this one, but here's the thing: I'm not happy with the original source article. Not for its content, but rather because I'm tracking a security issue with the host. It will probably turn out to be nothing, but for now I'm curious as to why it's slipping through my OSX safeguards; this is new behavior for my computer. Having thus disclaimed my concerns, and urging readers to be mindful until we have a satisfactory answer, on to the source and the health care issue. Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month's worth of anti-AIDS medicine. Only later did she learn that she had made herself all but uninsurable. Turner had let the men buy her drinks at a bar in Fort Lauderdale. The next thing she knew, she said, she was lying on a roadside with cuts and bruises that indicated she had been raped. She never developed an HIV infection. But months later, when she lost her health insurance and sought new coverage, she ran into a problem. Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free .... .... Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted. Susan Pisano, spokeswoman for the health insurance industry's largest trade group, America's Health Insurance Plans, said insurers do not discriminate against victims of sexual assault and ordinarily would not even know if a patient had been raped. "These issues you are bringing up, they deserve to be brought up," said Pisano. "People who have experienced rape and sexual assault are victims and we want them to be in a system where everyone is covered." Turner's story about HIV drugs is not unusual, said Cindy Holtzman, an insurance agent and expert in medical billing at Medical Refund Service, Inc. of Marietta, Ga. Insurers generally categorize HIV-positive people as having a pre-existing condition and deny them coverage. Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. "It's basically an automatic no," she said. (Ivory; See prior warning about this link) I think everyone can pretty reasonably imagine the condemnation I might visit upon the health insurance industry and American capitalism, so we can skip it. I will update on the security issue; there's more to the article, but I'm not pulling it up until I figure out the problem. ____________________ Notes: Tan, Melissa. "The Pre-existing Condition of Rape". The Rumpus. October 23, 2009. TheRumpus.net. October 23, 2009. http://therumpus.net/2009/10/the-pre-existing-condition-of-rape/ Ivory, Danielle. "Rape Is a Pre-Existing Condition? The Heartlessness of the Health Insurance Industry Exposed". AlterNet. October 21, 2009. AlterNet.org. October 23, 2009. http://www.alternet.org/healthwelln...ess_of_the_health_insurance_industry_exposed/ (Achtung! See prior note regarding security issues and this link.)
That is reprehensible. Lieberman has now said he will filibuster any plan that includes a public option. Sen. Joe Lieberman (I-Conn.) said Tuesday that he’d back a GOP filibuster of Senate Majority Leader Harry Reid’s health care reform bill. Lieberman, who caucuses with Democrats and is positioning himself as a fiscal hawk on the issue, said he opposes any health care bill that includes a government-run insurance program — even if it includes a provision allowing states to opt out of the program, as Reid’s has said the Senate bill will. "We're trying to do too much at once," Lieberman said. “To put this government-created insurance company on top of everything else is just asking for trouble for the taxpayers, for the premium payers and for the national debt. I don’t think we need it now." Lieberman added that he’d vote against a public option plan “even with an opt-out because it still creates a whole new government entitlement program for which taxpayers will be on the line." His comments confirmed that Reid is short of the 60 votes needed to advance the bill out of the Senate, even after Reid included the opt-out provision. Several other moderate Democrats expressed skepticism at the proposal as well, but most of the wavering Democratic senators did not go as far as Lieberman Tuesday, saying they were waiting to see the details.
Is Lieberman now the Great White Hope of the Republican Party? If he does not vote with the Democrats on procedural issues perhaps he should caccus with the Republicans or Independents (which is his official affiliation).
