Archive for the ‘Insurance Companies in the News’ Category

Much to say in Mid May

Monday, May 19th, 2008

I’ve been on a brief sabbatical and a lot has happened in the two weeks since I’ve last written for this web log.

A patient suffering from Hepatitis - C recently died because he wasn’t placed on the organ transplant list. One reason given was his use of medical marijuana. The doctor used his pot smoking as one of her reasons for declining to enroll him. If it was a moral decision it was wrong. If it was a medical decision the doctor had to make a choice. Who should have access to the limited supply of donor organs? The discussion about the morality of drug use and the socially destructive ‘war on drugs’ is not the purview of this web site but I do have an opinion I wish to share about transplants in general.
There are very few organ donors even though many people die with perfectly good working organs. (If they die of head trauma, their heart, lungs, kidneys, and liver are still alive and functional.) Unless these people have given their advance permission to use their organs, or unless the person with power of attorney for the deceased person’s estate gives permission, these organs die with the individual. Far more organs and organ tissue is wasted than donated. Organ donation should be automatic. There would be less, if any organ shortage for those requiring transplants and the cost would drop measurably. It would lower the prices for transplants, thus giving insurance companies less of a reason to decline covering transplants. (I knew there was a tie in to universal health coverage here.) Any one with religious objections such as Christian Scientists or worshipers of ancient Egyptian gods could opt out of the donation program but they would have to carry a card saying “I am not an organ donor….”

A May 4th story in the New York Times explains that it is not only the growing numbers of uninsured feeling the pinch of health care but the insured also cannot afford to be ill. Insurance was supposed to absorb the cost of illness so as to not destroy the finances of the individual who becomes sick or their family. Employers too are feeling an economic impact. Private insurers seem to be covering a smaller and smaller percentage of medical expenses while making increasing profits. People are paying obscene amounts of money in order to stay well. I am convinced the rash of medical bankruptcies has hurt the overall economy nearly as much as has the mortgage crisis and will continue to damage the economy until we have a national single payer health insurance system.

The next bizarre story is about a gentleman who kept getting billed for a service performed after the death of his wife. This relates to the transplant issue that opened this story. The Seattle Cancer Care Alliance had continued to look for bone marrow to transplant into the woman who had leukemia. She died as a result of a reaction to chemotherapy. They were unaware of her death and the insurance company refused to pay for the services rendered since the patient was deceased.

There were two stories about insurance companies abuse of the Medicare system.
States have requested Congress to allow them to regulate the insurance industry. Many people are buying into private Medicare plans that provide less overall coverage than the government run Medicare plans. The states can currently do little to regulate the industry or mediate insurance disputes between HMO and other insurance  providers and individuals.
With the above lack of regulation in mind the second story is about aggressive marketing. Insurance salesmen deceive the elderly or disabled into believing they are better off joining a private plan. they are using their access to the Medicare lists to cold call Medicare recipients and sell them on privately run Medicare programs. I know of people who have received Pfizer drug marketing pamphlets in government Medicare statements. This is using tax money to provide private enterprise free access to our homes. All the evidence shows that privately run programs are less efficient than publicly run programs. Check out the book Bleeding the Patient by Dr. David Himmelstein, et al, for details on this phenomena.

There have been stories comparing the health plans of the candidates. I’ve written some on that before so I won’t go into too much detail. However, the Seattle Post-Intelligencer (P-I) headline “Democrats’ health care plans follow U.S. tradition” demonstrated the need to bring the discussion about a national single-payer health insurance system into the mainstream. Americans need to know there is a better alternative to privately run health insurance. we need to demand that the candidates support HR676 as the only viable health care option.

There was a Seattle P-I story on the growing number of chronic pharmaceutical users in the USA. Although much of the increase in people using medicine is due to the worsening public health resulting from the American diet, a vast part of the problem is direct to the public advertising by the pharmaceutical companies. Combined with deceptive marketing to physicians, people are being over prescribed medications of dubious value. Melody Petersen’s book Our Daily Meds goes into detail on the subject of the big drug advertising blitz. Petersen and her book were featured on Bill Moyers recently and is discussed by Alison Rose Levy on the HuffingtonPost blog.

David Myers, who has the blog Discuss Race, sent me this story; Ethel Long-Scott, is the Executive Director of the Women’s Economic Agenda Project and wrote in the Black Commentator web log that, “Our nation is being presented with an amazing opportunity right now.”
It is a worthwhile read.

John McCain’s Health Care Nonplan

Thursday, May 1st, 2008

John McCain’s market approach to health care is a fiasco waiting to happen. We already know from Nixon’s White House recordings (after the tone) that discloses the original concept that Health Management Organizations will be to collect payments from employers and individuals without providing benefits to those insured. It is the primary method by which HMOs make a profit as presented to John Erlichman by Edgar Kaiser founder of the infamous Kaiser Permanente HMO. The marketplace provides this incentive. The idea that shifting the burden of insurance cost from the employer to the employee “to foster competition” is irrelevant with such a business plan in place. What will the private insurers compete for?

McCain plans to provide a $5000 tax credit to families in order to pay for insurance. This does a whole lot of good for those people who make $5.85 per hour minimum wage. Since $5000 is nearly half the yearly wages of $12168 for a 40 hour work week, these people won’t receive more than what their current tax refund already is. The tax credits don’t help them one iota.

McCain plans to help the poor by providing some money to the states to administer. However, his plan calls for state administered insurance “pools” so that chronically ill, injured, and older people can be covered. Basically, the states will be “contracting” with insurance companies who will then administer the state programs. This smacks of privatizing Medicare and Medicaid. It has been demonstrated time and again that privately run programs cost more and provide less than non-profits or Medicare.

The McCain plan is like a wolf in sheeps clothing. The wolves are the HMOs. The rest of us are being fleeced.

(Read Bleeding the Patient for a great analysis of the private health care industry.)

New Tier Four Prescription Rates.

Monday, April 14th, 2008

Health insurance companies and HMOs are now charging a percentage of the cost of prescription drugs rather than a fixed fee. This means that instead of paying only $10 to $30 they are spending 20 to 33 percent. This is a huge difference. Not only are uninsured people going to go without needed medicines, even those with insurance will no longer be able to afford their meds. These are people who will generally suffer the most from lack of medication as they are the people with the most debilitating illnesses.

The New York Times story describes a woman who is purchasing a multiple sclerosis drug with a co-pay of $20 using the insurance provided by Kaiser Permanente. She is now paying more than 15 times that amount. If you’ll recall, Kaiser Permanente is the HMO whose plans were discussed by Richard Nixon (there will be a few second whistle) and John Ehrlichman. Their whole business model is to make a profit by collecting insurance premiums paid by both employees and employers while not providing services. This is another example of that unethical behavior.

The insurance companies have justified their change of rates and the addition of what they are calling Tier 4 as a response to employers complaints about the high cost providing health care. Many companies leave the US because of the high cost providing health care. The reality is that HMOs are making profits in ever greater numbers in study after study. However, it has also been shown that HMOs give poorer care dollar for dollar nor do the insurers want you to know this fact.

In the new book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drug, author Melody Peterson states that the material expenses of producing most medications are approximately 10% of the total retail cost paid by the consumer.

It is bad enough that pharmaceutical companies charge exorbitant prices but now insurance will cover much less of the cost of prescriptions. So now we have both the HMOs and the pharmacuetical companies ripping off the consumer while we have no recourse but to bite the financial bullet or suffer from lack of medication.

Here is another reason to remove the profit motive from health care.

Miles Mogulescu tells it like it is.

Tuesday, April 8th, 2008

The Huffington Post has a multi-part posting by Miles Mogulescu describing the Democratic distancing from a single-payer system. Miles does a good job of describing the political environment. He states that any plan that involves private insurers is doomed to failure. He also points out that about 30% of current health care costs is administrative due to billing paperwork.

What wasn’t mentioned is that the insurance companies and HMOs are also corrupt. The folowing excerpt from a proposed platform plank in Washington State say it all.

The Washington Post reported on February 8th 2008 that Merck Pharmaceutical paid a $650 million fine for defrauding the Medicaid system. Carrie Johnson, Washington Post staff writer, states, “Prosecutors say the drug maker gave pills to hospitals at virtually no cost to hook poor patients on expensive medicine. When the patients left the hospital, they often continued taking the drugs, but with the government footing the higher bill.”
On January 16th 2007, Premera Blue Cross asked a judge to seal documents that disclosed it defrauded Medicare by using it to pay insurance claims. On August 26th 2006, the New York Times reported that the California State Attorney General filed charges against 39 drug companies suspected of defrauding the state by overcharging for medicines.
When former Republican President Richard M. Nixon first introduced HMOs to the American people in the 1970s, those who had developed the business structures knew they were taking client funds and profiting by not providing services. It is obvious that private insurers or Health Management Organizations cannot be involved in any successful health care system. The current United States health care system, using private insurers, is not only ineffectual and inefficient but it is corrupt, as well.

Links to Miles Mogulescu’s posts are below.

Part 1: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-a_b_67836.html
Part 2: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_70848.html
Part 3: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_75070.html
Part 4: http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_84862.html

Part 5:

http://www.huffingtonpost.com/miles-mogulescu/why-not-single-payer-par_b_94239.html

Widening Coverage Gap Between Rich and Poor

Tuesday, April 8th, 2008

I know I’m playing catch up here but I wanted to make sure this information was available. We know it is not a surprise that there is a coverage gap. Poor people cannot afford insurance. This is described in the first article. It follows that the wealthy who can afford insurance will have an earlier diagnosis of cancer and a lower death rate from the disease.

The links below will take you to the stories. Contact me if a link is broken. I have the articled saved.

http://query.nytimes.com/gst/fullpage.html?res=940DE4D9103BF930A15750C0A96E9C8B63&sec=&spon=&pagewanted=print

New government research has found ”large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades….

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February 18, 2008

A nationwide study has found that the uninsured and those covered by Medicaid are more likely than those with private insurance to receive a diagnosis of cancer in late stages, often diminishing their chances of survival….

Insurers Force Patients Into Medicare

Wednesday, April 2nd, 2008

In case you are curious as to why Medicare is “going broke”. We know it is because the surplus once in the Trust Fund was squandered but this is what happens to the rest.

http://www.nytimes.com/2008/04/01/business/01disabled.html?_r=1&oref=slogin&pagewanted=print

April 1, 2008

Insurers Faulted as Overloading Social Security

The Social Security system is choking on paperwork and spending millions of dollars a year screening dubious applications for disability benefits, according to lawsuits filed by whistle-blowers.

Insurance companies are the source of the problem, the lawsuits say. The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program….


SinglePayerHealth.org