Private, for-profit health insurance companies are self-contradictory. They cannot pursue profits - try to make as much money as possible - and support necessary health care. I know this from first-hand experience.
Years ago, when our son was a little boy, he contracted a type of pneumonia that did not respond to the usual courses of antibiotics. After several rounds and weeks of fever on and off and on, his doctor decided to admit him to the hospital. You can imagine how upset my wife and I were. As we were talking about this, in the doctor's office, we heard him talking to our insurance company - Empire Blue Cross Blue Shield. "No, no, he's a professor. They're not those kinds of people. This is legitimate, I can assure you," our doctor said to Empire on the phone. (I was professor then not at Fordham.)
This went on for about 10 minutes. Finally, our doctor got Empire's agreement. By this time, we had walked out into hall, and he saw that we had heard the conversation. He shook his head sadly, and said, this is what you have to go through....
And I couldn't help thinking - let's say I hadn't been a professor. Let's say we were "those kinds of people" - people who had been paying premiums, but for some reason were not held in high regard by the insurer. Our son's hospital bills would not have been covered?
Our son did finally get an antibiotic that worked in the hospital. But my wife and I learned an important lesson about health insurance that day: the companies that provide it it are mainly in for the money. Accordingly, they do anything they can to limit their expenses. That's just good business.
I had actually learned this about insurance companies (actually, a car company that provided warranties) years earlier, when I was driving a new Oldsmobile to another school. The car up and died on the highway - the engine expired. When I got on the phone, later that day, to the car warranty company, I was treated to "do you have any proof that you were driving your car safely"? I replied that unless Oldsmobile which had happily taken my money for the car and the warranty now paid for the car's repair, and I was assured within an hour that this would happen, I would go to the media and tell them about their shoddy way of doing business. And I would have - but some supervisor called me back 10 minutes later and apologized for the first conversation. "He was only doing his job," he said of the first guy I had talked to. Exactly. Of course he was, and that was the problem. Just good business. Limit expenses.
The car was aggravating. The repairs were just about money, for me as well as Oldsmobile. But health coverage obviously can be a matter of life and death.
We can no longer afford to leave such matters in the hands of people and companies whose main goal is not to protect health but make a profit. I'm all in favor of making money. Profit and capitalism continue to do great things. But they've failed in this country to give adequate health care, even for people they accept in their plans.
It's time to break loose from these hopelessly conflicted, oxymoronic for-profit health insurers. And vote out of office anyone who opposes this long overdue, humane, clearly rational reform.
Government programs are certainly not flawless. But at least they don't work against their own stated goals.
20 comments:
Excellent post, Paul, and all too true. I also have had a number of experiences like that: insurance companies cancelling policies because I actually submitted claims, refusing to insure my daughter because she had an "above-average" history of claims, and then hospitals refusing to treat her because she had no insurance!
Years ago I also worked for a health insurance company and a third-party administrator and know first-hand how hard they work to NOT pay for healthcare costs incurred by their customers.
It's a horrible comment on the U.S. that we're the only industrialized nation to not have universal healthcare coverage.
Joan
Funny, Paul this is what I do for a living. I work for a broker who handles small group insurance. I handle all the problems with claims. I'm very good I get things paid most would give up on but it's like pulling teeth. You really have to know how to work the system just to get a fair shot. I do not know the answer to Healthcare coverage but something has to change
Paul, the gist of what you're saying is that insurance in general is bad. Do you really believe that? At its heart, insurance is a way for people to hedge against risk, thereby expanding the range of actions and possibilities open to them. You put a little into it and, God forbid, you can take a lot out; since the time of Venetian merchant ships, it has allowed humanity to spread our wings farther than our conservative natures allow. Is it not that insurance itself is bad but that maybe there are some rotten companies out there -- or that perhaps we as customers occasionally expect more than we are entitled to (just as we grow livid when service is less than perfect in a restaurant, check-out counter or with IT help)? What if you hadn't been driving safely in your Oldsmobile? Doesn't the insurance company have a right to know? And if your auto insurance were state-run, as you seem to be implying it should've been, do you think the government employees would've let you off the hook easier? Have you ever tried to argue with a policeman, or with the Post Office? The latter are no more reasonable than FedEx if a person is in need; and they only have incentives to be less so, since they need your business less :)
Regarding the unfortunate could-have-been incident with your son, I agree that companies should never base decisions on doctors' claims that people are "good" or "bad" -- they're supposed to make rational decisions based on objective evidence, and if somebody is paying into health coverage, they should be given the care they're owed. If your insurer really wasn't doing that, it's a big problem. But I don't think the problem goes so deep to justify saying that "for-profit insurance is evil." Just as when Macy's wrongly denies me the ability to return a pair of pants, I don't say that "for-profit retail is a contradiction." Instead, I seek some redress and/or take my business elsewhere. What I took from your anecdote is that your insurer may use bad and irresponsible practices and that either 1) people shouldn't purchase its plans, or 2) people should report its violations to state regulators. (So what company is it? :P )
(cont.)Those options are only worth anything when there is a healthy, competitive market -- something that historically we only get with for-profit companies, regardless of what the product is. Ideally, there would be a strong Better Business Bureau for insurers to make sure people get what they are paying for. If there isn't, that is what I would like to see Congress bring about. But to use that ultimately harmless anecdote as a jumping-off point to argue that insurance as a business is a "contradiction"? I would have to argue that if you want to see bad practices embraced on a grand scale and feel you have no recourse to switch companies or complain, you should ask for a state-controlled monopoly on health insurance. While state regulators have no reason not to be on our side when there's a violation by insurers of our rights as a patient, what happens if we have state-controlled insurance? Do we appeal for help from the same people that have violated our rights? Or, like Locke, do we "appeal to heaven"? Not only does nationalization of the industry result in a loss of competition but it brings about a fundamental conflict of interests -- the cops and the robbers suddenly play for the same team.
There are clearly problems with the system -- doctors shouldn't be paid on commission for expensive tests, people should get the same tax incentives if they buy insurance individually that companies get, and exclusion by an insurer because of pre-existing conditions, refusal of treatment and outrageous out-of-pocket expenses should all be regulated. But to say that private health coverage is a contradiction and that we need a state-controlled insurer? I fear that in that scenario your anecdotes may not be minor annoyances or "what if"s but that we may see deeper conflicts of interest, less ability to choose a more-palatable plan, and fewer chances at reform when an (extremely costly) entitlement is that much more politically entrenched ...
Dan, yes, the gist of what I'm saying is that all for-profit insurance is self-contradictory, because the pursuit of profits entails limiting expenses which leads to denial of warranted services.
But in the case of insurance other than health care, the only issue is money - the insurer risks money to get insurance, on the expectation that the insurer will receive more money in the event of a warranted claim. That was the case in my car example.
That would also be the case in your Macy's example.
But health insurance is different - obviously - because people's lives are literally at stake.
(I mentioned the insurance company in my post: Empire Blue Shield Blue Cross.)
Dawn - if only all people working in health insurance companies, at all levels, were as compassionate and dedicated as you.
This article is clearly written by someone who has never worked for, with or under the government. Never been in trouble with the IRS? SSA? FBI? Let's just say that if you think you have a hard time getting help from private insurance companies, just WAIT until a government plan kicks in! They have ABSOLUTELY NO incentive to help you!!!! I am living proof! Not only do I work for the gov't, I have also been screwed by the Gov't, as has my family, and guess what?!? Unlike you, I HAD NO recourse!!!! I couldn't just hop down to the local news station - they are untouchable & they know it! People are mercenaries everywhere & when they can work within a system where there is no fault or consequence, watch out! If you were ever a supervisor in a gov't system, you'd know it is impossible to fire anyone. At least in a private scenario, they can be held liable-
I have several very happy stories on that account and thanks to increasinly excellent (and private) consumer watch groups, it gets better all the time.
Peace, Paul & I sure hope you know what you are doing.
"This article is clearly written by someone who has never worked for, with or under the government."
Grant, you're just babbling nonsense. My father was an attorney who worked for the City of New York for 40 years - so I know all about what it's like to work for the government.
You can't answer the logic of my post, so you resort to ad hominem retorts. A typical ploy, and indicative of the weakness of your position.
I thought Dan said it articulately enough, and was merely adding an additional point.
I can give you an example- at my last place of gov't work, we had an employee that was stealing from the gov't (& from the American taxpayer) and guess what? because of the way the system works, no one can do a thing about it! I'm only trying to express the frustration of someone with an opposing view. I haven't been doing this as long as you, and therefore cannot possibly have "ploy" - as you evidently have of dismissing someone & their arguements. Civility only suits you when it serves your purpose, eh?
I dismissed you and your arguments - unlike my responses to Dan - because you led off with ad hominem arguments, as I indicated above.
And here's a clue: I treat people with civility when they engage in rational discourse, not ad hominem arguments.
Try reasoning and arguing rationally, rather than speculating on people's backgrounds when you know nothing about them, and then playing the victim when you're called on it.
Isn't there a better way to fix the problem? The federal government can't handle Medicare & VA health care as it is. Patients are denied care and wait to see their doctors much longer than people with private insurance. Public option is not the answer. I think almost all Americans believe that we need health care reform, but this insane 1,000 page bill full of additional taxes for businesses and fines if you chose not to be insured is crazy.
I find it interesting that the focus of the comments here seems to be on what awful health insurance administrators the government would be. The government may produce incompetent administrators -- we've all heard plenty of anecdotes about "govmint workers" all our lives -- but for the millions of people who are denied or priced out of insurance by the for-profit insurance companies, even inept insurance administration would be better than what they have now: either no healthcare, or financial ruin due to high medical costs.
Here's an interesting article that summarizes the history of attempts, starting with Truman's, to universalize healthcare in America. While it presents a definite opinion that you or your readers may object to, it also shares a lot of factual information about the U.S. brand of "healthcare" and healthcare "insurance" that is quite fatal to many: Killing Grandma: How the Democrats Lost Control of Health Care.
anon: actually, even most Republicans regard Medicare as a big success.
Thanks for posting that link, Joan. I'm in favor of Obama's approach, rather than single payer, because I want to protect people who are happy with their current health care (paid for by employers, etc).
But I strongly support the public option, and the article you cite makes many excellent points.
And, in view of the self-contradictory nature of for-profit health care insurance, I expect that options other than the government will increasingly become co-op and non-profit in the future.
I'm sorry that I made you feel this was a directed, emotional attack, and it probably was emotional; it has been a stressful few years. I appreciate all the posts for more information. Here is one I have to add:
http://www.john-goodman-blog.com/keeping-score/
All I can tell you is that, in general, and based on my 17 years in government service, I cannot support a bill that includes more gov't intervention. I happen to work for an agency with one of the best, if not the best reputation for service & we still get it unbelievably wrong. I can contrast it with the experience of many others (several of my family members work for insurance companies, one owns an insurance company). My uncle (company owner) is an outstanding human being & did not get into the business to rape & pillage the unfortunate. I just happen to believe the best way to hold people accountable for their own actions is to ensure they have a stake in their own destiny- gov't workers do not. This was intended to specifically address your assertion that private insurers were self-contradictory. They cannot remain in business if they do not serve the people they support well, therefore, they are held accountable. Gov't employees are under no such restraint.
Peace -
Thanks, Grant.
Just to be clear: I'm not in favor of government involvement in our lives, except with it's absolutely necessary.
My analysis of the contradiction between pursuit of profit and provision of health care was not meant to show that government is great or desirable as a health care provider but rather, to paraphrase what Churchill said about democracy, that it is the least worst alternative.
I hope you were able to read Mr. Goodman's article. I read the one Joan posted, and i feel cheated- she told us that it was a history of health care since the time of Truman when in fact, it was full of ad hominem attacks that will only further divide the debate. If you read Mr. Goodman's article, you might disagree with it's ideas, but I don't think you can accuse him of unfair, unreasoned attack. Joan, shame on you for posting that propaganda. You, it appears very intentionally, just effectively called most of my family evil money grubbers, which couldn't be further from the truth. I hope perhaps you just didn't read the entire article.
The main point of the article Joan recommended was how the Democrats have done a poor job of presenting health care reform to the American people. As I said above, I don't agree with everything in the article, but it was a fine, powerful piece, an I'm glad Joan gave us the link to it.
You on the other hand are starting to verge on insult again.
I don't know you or your family from Adam or Eve, and I stand by everything I said about the contradiction between pursuit of profit and provision of health care.
As for your language and attitude, I'm going to leave your comments here as a record for everyone to see - a record of the poor quality of some of the opponents of health care reform. But don't be surprised if I don't respond to you any further.
Finally, the problem with Goodman's article is that he doesn't address the fact that millions of Americans have no health care insurance.
Grant J., I don't know who you are and you give us no way to find out, but you obviously did not read my comment in which I included a link to the article you are railing against. I said the article "summarizes the history of attempts...to universalize health care" and then presents opinions that not everyone may agree with.
As for your uncle whom you say is the owner of an insurance company -- if he is indeed the only owner, then his company is clearly not one of the multinational corporations that administer the vast majority, if not all, of the private healthcare coverage provided to U.S. residents. You seem to be lumping all types of insurance-related businesses, from family-owned independent agencies, to companies that provide property/casualty/liability insurance, to self-employed insurance agents, into the category of "insurance companies," when the discussion here is specifically about for-profit healthcare insurance providers. If there is a healthcare insurance company with the size and power of, say a Blue Cross-Blue Shield, that is owned by one person who cares about his individual customers as you say of your uncle, I'd sure like to know about it so I can send all my uninsured friends there.
The concept of insurance, where a group of people pool their resources to provide a safety net for all, is a fine one (as Dan pointed out). The problem, as I see it, is that the idea has been twisted and bent so much over the years that this safety net is now full of holes and not even accessible to many.
Paul: I agree wholeheartedly -- we need to take the "for profit" factor out of our health care. it runs counter to fostering good healthy outcomes for all Americans.
there is a difference between car insurance and heath insurance. you choose to buy a car, a person does not choose to have leukemia. your health is NOT A COMMODITY.
it has been my experience that insurance companies are exemplary when it comes to accepting and cashing premiums checks, but not so much when it comes to claim payments.
unfortunately mired in the 2009 Summer of Ignorance and Misinformation,
/jimy_max
Jimmy - great to see you and your intelligent comments back here in Infinite Regress!
Paul -- i recently read a good piece by Paul Krugman in the New York Times on the world's approach to health care
( http://www.nytimes.com/2009/08/17/opinion/17krugman.html?_r=1 )
the money quotes:
- "Every wealthy country other than the United States guarantees essential care to all its citizens."
- "At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies."
Canada can do health care for all its citizens but we can't. 40 years ago we put a man on the moon and we still can't figure out a national health care system. For the past 6-7 years we have waged two dishonest wars in Iraq & Afghanistan spending $10+ BILLION A MONTH. my friendly abacus calculates that revenue stream could have been more wisely channeled to solve many of our current problems, including funding national health care --- but i digress ....
why is it that this kind of simple information that Krugman highlights is not widely distributed and become part of the health care reform lexicon?
instead we get loony wingnuts parroting their well rehearsed but totally irresponsibly untrue chants of "death panels", "Obama wants to kill grandma", the absurdly asinine "I want the government to keep their hands off my Medicare" (for the uninitiated, Medicare is a SINGLE-PAYOR GOVERNMENT PROGRAM) and "Obamacare = socialism" banners as the soundbites of the so-called health care debate.
why?
besides health care reform, we need some serious health care Education.
just my .02's,
/jimy_max
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