Health care: It’s sickening

Posted on January 29, 2010


You’re probably as sick of hearing about “health care” — particularly the bloated, ineffective, ingratiating handjob to the insurance lobby and Big Pharma that the Senate is trying to pass off as health care.  But I’m sorry, I just have to put in my two cents (for which your average medical insurance company would charge $87.49).

I recently dropped my employer-provided health insurance.  I’d had it for four years and it was a good plan; prompt, efficient, not ridiculously expensive … or so I thought.   Back in September, I discovered that the $186 per month I thought I’d been having deducted after-tax from my pay was actually $186 PER PAYCHECK.  $372 a month for a $187 coverage plan that was available directly from the provider’s competitors online.  So when the renewal period rolled around in November, and having found out that as of January 1st, my employer was going to jack my cost up to $508 a month, I opted out of the insurance, effective December 31st.

So then I began shopping some of my former provider’s competitors and their “save a ton of money” commercials.  I found three plans I liked, cost-wise, coverage-wise and deductible-wise.  So, I applied.

Not more than an hour after I submitted my application online, the Internet service company called me to confirm the application.  I was pleased with such quick turn-around.  But after that call … that’s when the “bloated, ineffective racket” kicked in.

The company I applied with (for legal and professional reasons, I won’t name the company. But suffice to say, the company name rhymes with “Screwmana”) contacted me the next day to inform me that even though their online application clearly states that electronic signatures are accepted for the application, they would have to physically mail me a printed copy of my application for me to sign, in 19 different places, on the documents.  They said it was because of the space and period in my last name.  I’ve encountered this kind of nuisance in the past where computer systems gagged on punctuation included in surnames, so I didn’t think much about it, signed the forms, and mailed them back.  Two days later, I had the pre-scheduled telephone walk-through of my application. It was a dull, routine call … up to the point where the woman asked me to confirm my height and weight.

The woman said that my medical records, obtained from my current primary physician, indicated that about 7 months ago, I weighed approximately 38 pounds more than what was declared on my application.  I explained that I dieted over the summer and fall, and lost that much weight. “Oh,” she said, with a foreboding pause. “That’s going to require us to increase your premium by 50 percent.”

Instantly incredulous, I asked her to repeat herself, and she confirmed.  “Yes, our policies dictate that if an applicant has lost a significant amount of weight within 12 months prior to the application being submitted, it requires a premium increase if they haven’t maintained that weight loss for a full year.”

Even more incredulous, I let the woman know how ridiculous that sounded from the applicant’s perspective. The Screwmana Insurance Company has a standing policy that if you LOSE WEIGHT (i.e., get HEALTHIER) within a year of applying for insurance with them, they’re going to penalize you with a ludicrously high premium hike.  I would have literally been better off – from an insurance application perspective – if I’d stayed fat.

But that begged the logical follow-up question:  If I still maintained that weight loss after a full year, would my premium be reduced back to the initial amount I applied for?

“Well, our policy dictates that we’d review your case at that time and decide whether you would be eligible for a premium decrease,” she said.  In other words; don’t hold your breath because we’ll find some other equally asinine loophole to keep sticking you with jacked-up premiums.

But regardless of how asinine this policy codicil was, the monthly premium was still less than half what I was going to be paying for insurance through my employer in the new year. So, I proceeded with the application, confident that the weight loss would remain in effect for another five months.

So that brings us to Saturday, when I received an email from the online processor that ScrewMana had denied my application, with no reason given.

Cut to Monday morning, and an increasingly irritated phone call to the ScrewMana customer service line.

A very matter-of-fact “service representative” informed me that ScrewMana had determined that I was ineligible for coverage under the plan I initially applied for.  Why, you may ask?  “Well, sir, it seems that according to your medical records, you were treated by your doctor for six different ailments or conditions over the past two years.  He was right.  I had been treated for six different problems:  A sinus infection, low-grade high blood pressure and cholesterol, a nagging allergy-induced cough, an ingrown toenail, and a Viagra prescription.  These afflictions are apparently more risky than ScrewMana is willing to cover.

So what Mister Matter-of-Fact was telling me was that “We’re not going to give you insurance if you’re actually going to USE it.”

He was happy, and even dare I say, excited, to inform me that even though this application had been denied, I could still apply for ScrewMana’s Premium-Plus Plan … for only $954 a month, for a man of 46 years in my “deteriorating” condition.

Never mind the intricate spinal surgery I had in 2006 where three discs at the base of my neck were removed and the vertebrae fused.  I was a health risk because I clipped my toenail incorrectly and wanted better sexual performance through the wonderment of modern chemistry.

These, according to ScrewMana, are “excessive health problems” not so much by their severity, but because of the frequency of my visits to the doctor — six times in two years.

Is the health insurance business a racket? Yes, literally. And this is why the shameless pandering to robber baron corporations posing as “health providers” is such an egregious … and bloody obvious … tactic to do nothing more than plump up insurance company profits.

And do you know who’s to blame?   Believe it or not, the downfall of the American health insurance system falls squarely on the shoulders of former President Richard M. Nixon.

In 1973, Nixon did a personal favor for his friend and campaign financier, Edgar Kaiser, then president and chairman of Kaiser-Permanente.  Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be.  And which insurance company got the first taste of federal subsidies to implement HMOA73 … *gasp* … why, it was Kaiser-Permanente!   What are the odds?  It’s all right here to read for yourself:

And to perfectly cement HMOA73 as the profiteering boondoggle that it actually was, the law Nixon mandated also included clauses that encouraged medical providers to not CURE afflications, but to PROLONG them by only treating the symptoms.

There’s no money to be made in CURING sickness.  But the sky’s the limit when it comes to forcing people to endure repetitive doctor visits, endless (and often useless and redundant) tests, and … of course … let’s not forget the ever-increasing demand for American-made prescription drugs!

Have you noticed recently that the words “prolonged coma” and even DEATH have wormed their way into the fast-spoken side-effects list of just about every new drug you see on television or hear on the radio?  Death!  From the medicine that’s supposed to cure you!  You know what?  I’ll take restless legs over DEATH.

So it’s an arms race between insurers, who deploy software and manpower trying to find claims they can reject, and doctors and hospitals, who deploy their own forces in an effort to outsmart or challenge the insurers. And the cost of this arms race ends up being borne by the public, in the form of higher health care prices and higher insurance premiums. Of course, rejecting claims is a clumsy way to deny coverage. The best way for an insurer to avoid paying medical bills is to avoid selling insurance to people who really need it. An insurance company can accomplish this in two ways, through marketing that targets the healthy, and through underwriting: Rejecting the sick or charging them higher premiums.  See the pattern?

Like denial management, however, marketing and underwriting cost a lot of money. McKinsey & Company, the consulting firm, recently released an important report dissecting the reasons America spends so much more on health care than other wealthy nations. One major factor is that we spend $128 Billion a year in excess administrative costs, with more than half of the total accounted for by marketing and underwriting – costs that don’t exist in single-payer systems.

And this is just part of the story. McKinsey’s estimate of excess administrative costs counts only the costs of insurers. It doesn’t, as the report concedes, include other “important consequences of the multi-payor system,” like the extra costs imposed on providers. The sums doctors pay to denial management specialists are just one example. But the larger problem isn’t the behavior of any individual company. It’s the ugly incentives provided by a rigged, and now federally backed scam system in which giving care is punished, while denying it is rewarded.

American health care:  It’s enough to make you sick.