In the memo from Randy Brown, WellPoint's chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. "Your cost per paycheck will probably increase," the memo said.Hard times for everyone, but I have to point out -- if you make pens, you usually get some free pens. If you're a cook, free soup. I get free database access. My partner gets free textbooks. Shouldn't insurance employees have, you know, particularly good insurance? Or maybe the legal fees, top-level salaries, and lobbying expenditures (they made the exceptional step this year of phoning 3 million of their own customers with a push-poll robocall opposing reform) are getting a little bit too expensive for Wellpoint to cover?
Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
Tuesday, October 6, 2009
Yeouch
Thought I'd be working today, but had to share this. I've seen more than a few insurance industry employees supporting their industries in the debate over the public option. That's their prerogative, but this news kind of indicates that they shouldn't necessarily picture themselves as members of a big corporate 'family'.
Saturday, October 3, 2009
How Much is Too Much?
The long-awaited second part of Professor Reinhardt's article on insurance costs and loss ratios was posted yesterday. In the first part, he explained that it's not just insurance company profits that drive the cost of insurance up: they have considerable overhead and costs, sometimes reaching, sometimes passing 15%.
That article, though, was about the group market. When you insure a large group, risk is distributed more widely and you can do things like look at historical data, rather than give individual physicals, and cut out a great deal of brokering and marketing. For the individual non-group market, which is especially important now that Fox News is reporting that 149 million Americans are unemployed, overhead is much, much higher. How high? I say I say, how high?
-- So high that insurance lobbies fought 2008 state laws that tried to restrict their 'loss ratio' (i.e. the percentage of income that they pay out in care) from going below 70%.
-- So high that they claim that 55 to 60% is average -- which means that for every dollar you give them, you have purchased the right to get two quarters and a dime's worth of health care.
-- So high that small firms, who buy insurance for fewer than 10 people at a time, pay up to 18% more in premiums than large firms.
-- So high that three fourths of all families who shop for individual health insurance policies end up buying nothing.
That's hiiiiigh. Forgetting your debit-card at the grocery store while you're buying a bag of Doritos and a 2-liter bottle of Squirt high.
A public option would allow the government to create one large group out of this terribly underserved part of the population. These people have money; they need and deserve insurance -- although opponents of reform like to blame the victim ("I don't want to pay for somebody else's..."), these people would be happy just to have a deal similar to those who are covered by large companies. Large companies, I would add, that almost all started as tiny businesses, or groups of freelancers -- if we continue to unfairly punish customers on the individual or small-group market, we may not even have the next generation of innovative large businesses -- the financial and health risk won't be worth striking out on one's own.
But a 55% loss ratio (let's call it a 55% care ratio) makes insurance industries big financial players with a lot of money to throw around, and this is why we have Blanche Lincoln channeling Ronald Reagan in the Senate Finance Committee. 45% of our premium dollars are more than enough to buy a little democracy.
EDIT: but not all the democracy: progressive stalwart Shakesville transcribes this exchange between White House spokesman Robert Gibbs and ultrajournalist Helen Thomas, who has been asking him whether Obama will veto a health care bill without a public option over and over again for over a week.
That article, though, was about the group market. When you insure a large group, risk is distributed more widely and you can do things like look at historical data, rather than give individual physicals, and cut out a great deal of brokering and marketing. For the individual non-group market, which is especially important now that Fox News is reporting that 149 million Americans are unemployed, overhead is much, much higher. How high? I say I say, how high?
-- So high that insurance lobbies fought 2008 state laws that tried to restrict their 'loss ratio' (i.e. the percentage of income that they pay out in care) from going below 70%.
-- So high that they claim that 55 to 60% is average -- which means that for every dollar you give them, you have purchased the right to get two quarters and a dime's worth of health care.
-- So high that small firms, who buy insurance for fewer than 10 people at a time, pay up to 18% more in premiums than large firms.
-- So high that three fourths of all families who shop for individual health insurance policies end up buying nothing.
That's hiiiiigh. Forgetting your debit-card at the grocery store while you're buying a bag of Doritos and a 2-liter bottle of Squirt high.
A public option would allow the government to create one large group out of this terribly underserved part of the population. These people have money; they need and deserve insurance -- although opponents of reform like to blame the victim ("I don't want to pay for somebody else's..."), these people would be happy just to have a deal similar to those who are covered by large companies. Large companies, I would add, that almost all started as tiny businesses, or groups of freelancers -- if we continue to unfairly punish customers on the individual or small-group market, we may not even have the next generation of innovative large businesses -- the financial and health risk won't be worth striking out on one's own.
But a 55% loss ratio (let's call it a 55% care ratio) makes insurance industries big financial players with a lot of money to throw around, and this is why we have Blanche Lincoln channeling Ronald Reagan in the Senate Finance Committee. 45% of our premium dollars are more than enough to buy a little democracy.
EDIT: but not all the democracy: progressive stalwart Shakesville transcribes this exchange between White House spokesman Robert Gibbs and ultrajournalist Helen Thomas, who has been asking him whether Obama will veto a health care bill without a public option over and over again for over a week.
Monday, September 28, 2009
The Loss Ratio and Insurance Industry Profits
John Rockefeller is in the Senate Finance Committee right now hammering away in the speech that everyone needs to hear most -- that health insurance companies are bleeding our benefits dry, and that a strong public option is the best solution to the problem.
Most of what I learned about health insurance industry profits, I learned from a single person's writings -- Uwe Reinhardt, Princeton economist and opinion writer for the New York Times. My favorite article on the topic, so far, is this one -- it breaks down the way to answer the question "how much do insurance companies make" in a comprehensive way.
This is important because an insurance company -- and we saw GradMed claim that they don't even collect this data for themselves or the insurance companies that they broker -- will never share this information with potential customers. They are forced by law, however, to share it with potential investors, and that's where Professor Reinhardt comes in. I've seen pictures, but I picture him with a monocle and a handlebar mustache. Egads, he says.
Insurance industry profits -- that's the amount that the company takes out of the economy, free and clear -- usually hang between 3 and 6%, which is not exceptional for most kinds of industry. What is exceptional, though, is the amount in marketing and administrative expenses that the company spends. Keep in mind that, unlike buying a cell phone, where you give a guy some money and he gives you a cell phone, insurance companies essentially take your money and then give it back -- the product you get is the insurance company holding your money, and the money of many others, for you, and then reorganizing it to pay for the medical care of the people that need it. So these costs become extremely important: the money taken out of your premiums, and the money that's left, determines what kind of coverage you get.
Not much of a product, true. But it's even less of a product when the insurance companies are only paying out 84.4% (in Reinhardt's example, Wellpoint in 2008) of the premium money that they've collected. That's an 84% loss ratio -- to the insurance companies, GradMed included, the company has lost 84% of "its" money (actually your money, but held by the insurance company). 84% loss for them means 84% care for you.
Where does the money go? Profits are substantial, but don't explain the whole picture. The rest is marketing -- GradMed paying alumni associations to run advertisements, insurance executives googling their products and leaving dodgy comments, TV ads, newspaper ads, etc. etc. etc -- as well as 'administrative costs', which covers the salaries of the people who work in the insurance industry. What seems absolutely true to me is that even if these costs aren't considered profit on the company's 10-K, they are profit: the company investing in its own future enrichment through advertising, and directly profiting the people who make up the company through salary and benefits.
You have to hand it to them, though. Taking 15% off the top of your health care dollar: not too shabby as a con game. A strong public option would also have administrative costs, but estimates for Medicare put their administrative cost at between 3% and 8% (and their profits at ZERO, where they should be), which is nowhere near the expense and waste we're experiencing with private insurance.
UPDATE: The Rockefeller public option amendment was just defeated, 8 to 15. Democratic senators voting against it were Conrad of North Dakota, Lincoln of Arkansas, Nelson of Florida, and Carper of Delaware.
DOUBLE UPDATE: The Schumer public option amendment was also defeated, 10 to 13. A slightly weaker option, it picked up Thomas Carper and Bill Nelson, but Kent Conrad and Blanche Lincoln (who was wearing an enormous green lapel pin that said "BLURGH") still voted against it. No Republicans, of course, voted for the amendment or even bothered making serious arguments about the bill -- it all seemed to have been posturing for the general senate debate, and insistence on this new weird "defend Medicare" attitude they've all suddenly come to after decades of trying to slash Medicare.
Most of what I learned about health insurance industry profits, I learned from a single person's writings -- Uwe Reinhardt, Princeton economist and opinion writer for the New York Times. My favorite article on the topic, so far, is this one -- it breaks down the way to answer the question "how much do insurance companies make" in a comprehensive way.
This is important because an insurance company -- and we saw GradMed claim that they don't even collect this data for themselves or the insurance companies that they broker -- will never share this information with potential customers. They are forced by law, however, to share it with potential investors, and that's where Professor Reinhardt comes in. I've seen pictures, but I picture him with a monocle and a handlebar mustache. Egads, he says.
Insurance industry profits -- that's the amount that the company takes out of the economy, free and clear -- usually hang between 3 and 6%, which is not exceptional for most kinds of industry. What is exceptional, though, is the amount in marketing and administrative expenses that the company spends. Keep in mind that, unlike buying a cell phone, where you give a guy some money and he gives you a cell phone, insurance companies essentially take your money and then give it back -- the product you get is the insurance company holding your money, and the money of many others, for you, and then reorganizing it to pay for the medical care of the people that need it. So these costs become extremely important: the money taken out of your premiums, and the money that's left, determines what kind of coverage you get.
Not much of a product, true. But it's even less of a product when the insurance companies are only paying out 84.4% (in Reinhardt's example, Wellpoint in 2008) of the premium money that they've collected. That's an 84% loss ratio -- to the insurance companies, GradMed included, the company has lost 84% of "its" money (actually your money, but held by the insurance company). 84% loss for them means 84% care for you.
Where does the money go? Profits are substantial, but don't explain the whole picture. The rest is marketing -- GradMed paying alumni associations to run advertisements, insurance executives googling their products and leaving dodgy comments, TV ads, newspaper ads, etc. etc. etc -- as well as 'administrative costs', which covers the salaries of the people who work in the insurance industry. What seems absolutely true to me is that even if these costs aren't considered profit on the company's 10-K, they are profit: the company investing in its own future enrichment through advertising, and directly profiting the people who make up the company through salary and benefits.
You have to hand it to them, though. Taking 15% off the top of your health care dollar: not too shabby as a con game. A strong public option would also have administrative costs, but estimates for Medicare put their administrative cost at between 3% and 8% (and their profits at ZERO, where they should be), which is nowhere near the expense and waste we're experiencing with private insurance.
UPDATE: The Rockefeller public option amendment was just defeated, 8 to 15. Democratic senators voting against it were Conrad of North Dakota, Lincoln of Arkansas, Nelson of Florida, and Carper of Delaware.
DOUBLE UPDATE: The Schumer public option amendment was also defeated, 10 to 13. A slightly weaker option, it picked up Thomas Carper and Bill Nelson, but Kent Conrad and Blanche Lincoln (who was wearing an enormous green lapel pin that said "BLURGH") still voted against it. No Republicans, of course, voted for the amendment or even bothered making serious arguments about the bill -- it all seemed to have been posturing for the general senate debate, and insistence on this new weird "defend Medicare" attitude they've all suddenly come to after decades of trying to slash Medicare.
GradMed III: Revenge of the Sith
So about a week ago, taking time out from advocacy for the public option, I did a review of an insurance broker called GradMed. They sell temporary, non-renewable insurance that doesn't cover any pre-existing conditions to recent college graduates. The way they sell it is by paying royalties to university alumni associations, and then pretending that it is the alumni association that 'sponsors' the GradMed program.
I pointed out that if you get sick while on a 30-day GradMed policy, the second your policy runs out, you're essentially screwed: GradMed won't let you buy another policy, and no other insurance company will cover you, either. I think I probably said something like AVOID GRADMED LIKE THE PLAGUE. Review complete! Good blogger.
I was pretty much convinced that I'd done my civic duty, hopefully let some people know what I thought about a product, and that was that. But GradMed appeared. Almost immediately, and in a big way: over the days after my review, they logged over six hours on the site, viewed each of my tiny little blog's 50-something entries more than once, and did so from somewhere between three and five different IP addresses. This struck me as a pretty poor use of man-hours paid for by the insurance premiums of unemployed college graduates, and I said so. Their page views dropped off a great deal -- but curiously, the number of hits I got from suburbs around their offices increased quite a bit, and I actually got my first few Tor nodes visiting the blog -- a novel use for an anonymity service that I thought was reserved for antigovernment protesters abroad and child pornography afficionados.
At this point, I felt like detonating. I had asked them a series of questions that they were ignoring, but they were still running around trying to sniff out information about me, viewing my profile, looking a great deal at some pictures I took of a local rally. I was rolling up my sleeves and getting ready for, well, you know, midnight deer-fighting:
Two things happened, though -- first, I got a (heavily solicited) letter from internet president Ze Frank that essentially said not to get obsessed with these people, because they're an economics-only operation, and will boringly continue to protect their financial interests, which is not something any real person wants to read about. Second, though, GradMed came back to the comments and tried to sort of whitewash their names. And I couldn't be angry. These people are symptoms: they're the runny mucus that shows that the system is ill.
The epiphany moment, for me, came in question two -- I had asked them to share their "income-to-benefits ratio" with me, a comparison of the money they take in through premiums, and the money they pay out in health benefits. They, predictably, declined to do so, but took the opportunity to haughtily correct me: "I can tell you that what you are referring to are loss ratios." Loss ratios -- these are not only people who consider fulfilling their contractual obligation to pay for the health care of the sick and injured a loss, but see absolutely nothing wrong with that thinking. They've internalized the values of their industry to the extent that they've stopped thinking, exactly, about what 'loss' is, and who's losing. Likewise with their refusal to disclose how much of a kickback alumni associations get every time a student signs up with GradMed -- "Our compensation to associations is protected by contract. " Of course -- a silly question to ask. If they shared the way they sink our premium dollars into marketing, we'd know that sending them money is a massive waste of resources, and we would stop sending checks. We'd probably also think twice about supporting our alumni associations. Thus the secrecy in the contract. It's logical, right?
It's the plight of the parasite: like every other corporation, this one has evolved a culture that serves the survival of the company. But we -- and by this, I mean you, me, recent college graduates, health care providers -- don't want this company. We're harmed by it. Piece by piece, state by state, we're trying to pull it loose from the open sore it's feeding from. But it doesn't know it's a parasite. It acts in self defense just like any other animal would, and it cares about itself and thinks it's a good parasite, a hard-working parasite that does exactly what a parasite's supposed to do:
(Insurance companies actually share risk among large groups of people, which can be interpreted as a kind of service, and so they aren't quite as parasitic as brokers -- more like those little birds that eat bugs off of hippos, at least if they're run right.)
The answer is not to face up to these people and convince them they're wrong -- at some level, I think, they already know that what they do isn't really helping matters much. The answer is to just pinch them off at the sucker and drop them back into the lake. Through legislation, through boycott (although it's not actually a boycott when you refuse to buy a service because it's worthless), through education. I'm so glad that most of the reform legislation in Congress outlaws the use of pre-existing conditions to deny people insurance, and although I'm sure the fine people at American Insurance Administrators, part of USI Affinity, subsidiary of the USI Group, whole broker for GradMed, will be very sorry to clean out their desks and go back on the job market, we'll all be better off in the future for it.
PS: I also had the chance to hang out with blog stalwart mattlo this weekend, and he, in his outwardly reserved but fundamentally hot-blooded Midwestern way, allowed as how he didn't feel so sorry for the GradMed crew, and how even his job, which he enjoys just fine, is not quite as cushy as sitting in an office reading our blog (he has to sit in an office and do real work). So for all the mattloes of the world, here's thirty seconds devoted to unrepentant pushback. The GradMed IP address that has, now, over 90 visits to the blog is 12.104.97.211, which apart from a few fake Wikipedia entries/commercials/some spam, hilariously has also been used to create a large genealogy website for the Sawn family which is run by a gentleman named George (that's their guestbook). A tiny bit of googling shows that one likely (although I'm sure there's a lot of unprotected computer-sharing in the office organism) visitor to the blog is therefore George Sawn, CFO of Univers Workplace Benefits, subsidiary of USI Holdings, whole owner and operator of USI Affinity, parent company of American Insurance Administrators AKA GradMed. You can get in touch with him at gsawn@sawnfamily.com, if you feel like it or if you think y'all are related.
I pointed out that if you get sick while on a 30-day GradMed policy, the second your policy runs out, you're essentially screwed: GradMed won't let you buy another policy, and no other insurance company will cover you, either. I think I probably said something like AVOID GRADMED LIKE THE PLAGUE. Review complete! Good blogger.
I was pretty much convinced that I'd done my civic duty, hopefully let some people know what I thought about a product, and that was that. But GradMed appeared. Almost immediately, and in a big way: over the days after my review, they logged over six hours on the site, viewed each of my tiny little blog's 50-something entries more than once, and did so from somewhere between three and five different IP addresses. This struck me as a pretty poor use of man-hours paid for by the insurance premiums of unemployed college graduates, and I said so. Their page views dropped off a great deal -- but curiously, the number of hits I got from suburbs around their offices increased quite a bit, and I actually got my first few Tor nodes visiting the blog -- a novel use for an anonymity service that I thought was reserved for antigovernment protesters abroad and child pornography afficionados.
At this point, I felt like detonating. I had asked them a series of questions that they were ignoring, but they were still running around trying to sniff out information about me, viewing my profile, looking a great deal at some pictures I took of a local rally. I was rolling up my sleeves and getting ready for, well, you know, midnight deer-fighting:
Two things happened, though -- first, I got a (heavily solicited) letter from internet president Ze Frank that essentially said not to get obsessed with these people, because they're an economics-only operation, and will boringly continue to protect their financial interests, which is not something any real person wants to read about. Second, though, GradMed came back to the comments and tried to sort of whitewash their names. And I couldn't be angry. These people are symptoms: they're the runny mucus that shows that the system is ill.
The epiphany moment, for me, came in question two -- I had asked them to share their "income-to-benefits ratio" with me, a comparison of the money they take in through premiums, and the money they pay out in health benefits. They, predictably, declined to do so, but took the opportunity to haughtily correct me: "I can tell you that what you are referring to are loss ratios." Loss ratios -- these are not only people who consider fulfilling their contractual obligation to pay for the health care of the sick and injured a loss, but see absolutely nothing wrong with that thinking. They've internalized the values of their industry to the extent that they've stopped thinking, exactly, about what 'loss' is, and who's losing. Likewise with their refusal to disclose how much of a kickback alumni associations get every time a student signs up with GradMed -- "Our compensation to associations is protected by contract. " Of course -- a silly question to ask. If they shared the way they sink our premium dollars into marketing, we'd know that sending them money is a massive waste of resources, and we would stop sending checks. We'd probably also think twice about supporting our alumni associations. Thus the secrecy in the contract. It's logical, right?
It's the plight of the parasite: like every other corporation, this one has evolved a culture that serves the survival of the company. But we -- and by this, I mean you, me, recent college graduates, health care providers -- don't want this company. We're harmed by it. Piece by piece, state by state, we're trying to pull it loose from the open sore it's feeding from. But it doesn't know it's a parasite. It acts in self defense just like any other animal would, and it cares about itself and thinks it's a good parasite, a hard-working parasite that does exactly what a parasite's supposed to do:
(Insurance companies actually share risk among large groups of people, which can be interpreted as a kind of service, and so they aren't quite as parasitic as brokers -- more like those little birds that eat bugs off of hippos, at least if they're run right.)The answer is not to face up to these people and convince them they're wrong -- at some level, I think, they already know that what they do isn't really helping matters much. The answer is to just pinch them off at the sucker and drop them back into the lake. Through legislation, through boycott (although it's not actually a boycott when you refuse to buy a service because it's worthless), through education. I'm so glad that most of the reform legislation in Congress outlaws the use of pre-existing conditions to deny people insurance, and although I'm sure the fine people at American Insurance Administrators, part of USI Affinity, subsidiary of the USI Group, whole broker for GradMed, will be very sorry to clean out their desks and go back on the job market, we'll all be better off in the future for it.
PS: I also had the chance to hang out with blog stalwart mattlo this weekend, and he, in his outwardly reserved but fundamentally hot-blooded Midwestern way, allowed as how he didn't feel so sorry for the GradMed crew, and how even his job, which he enjoys just fine, is not quite as cushy as sitting in an office reading our blog (he has to sit in an office and do real work). So for all the mattloes of the world, here's thirty seconds devoted to unrepentant pushback. The GradMed IP address that has, now, over 90 visits to the blog is 12.104.97.211, which apart from a few fake Wikipedia entries/commercials/some spam, hilariously has also been used to create a large genealogy website for the Sawn family which is run by a gentleman named George (that's their guestbook). A tiny bit of googling shows that one likely (although I'm sure there's a lot of unprotected computer-sharing in the office organism) visitor to the blog is therefore George Sawn, CFO of Univers Workplace Benefits, subsidiary of USI Holdings, whole owner and operator of USI Affinity, parent company of American Insurance Administrators AKA GradMed. You can get in touch with him at gsawn@sawnfamily.com, if you feel like it or if you think y'all are related.
Saturday, September 26, 2009
Don't Know How She Sorts It
I just watched this short documentary, about a cook at the Sigma Nu frat house at Ole Miss:
Here's the math of Leasse William's life, from the whiteboard talk in the documentary:
She makes $10/hour, and works 50 hours a week, nine months a year, and either works minimum wage or gets unemployment (the income is about equal) for the other three. Her taxes (yes, people at this income level pay taxes!) are $3600, and her health insurance, which she buys on the private market, costs $2400/year. This leaves her about $14,200 in take-home pay, which is near the Louisiana poverty line -- and that already includes the possibility of government-subsidized unemployment benefits.
Now, poverty is a systemic problem, and it's not clear whether it can be simply fixed by legislation, more consideration shown to employees by employers, an insistence on racial equality, or any other individual undertaking. But the absolutely back-breaking cost of medical insurance is something we can fix with legislation, and the legislation is in Congress right now, in the form of the public option amendments to the Baucus bill.
Leasse's problem isn't just that her insurance is expensive -- it's that she doesn't have any extra resources to fight her insurance provider to protect her coverage. If, let's say, she wakes up bleeding from the nipple one morning and her insurance company refuses to cover it as an emergency, she's not going to be able to do what any smart person would want to: lawyer up and spend a couple of days making angry, pointed phone calls. She's back to work, if she can work, ten hours the next day. Every dime that insurance providers and brokers like the GradMed people (who don't provide real health insurance and wouldn't insure anybody in this documentary, but who seem like good representatives of the industry to me) steal and waste -- every bit of that $2400 a year that goes into marketing, salaries, profit, obsessive rereading of "Dying for a Public Option" -- comes out of the money that Leasse is setting aside for her own care, and it's money that she frankly doesn't have in the first place. Those costs are passed along to her in the form of claim denials, copays, coinsurance, and rescission.
And this doesn't just cost Leasse. Medical bankruptcy would put her right on unemployment (which her job seems to expect her to collect already), eventually on welfare (if she's lucky). This couple in a recent PBS NOW episode, like many others with chronically ill children, limits their own income so that they can qualify for Oklahoma state child health benefits, because their asthmatic daughter may need an expensive operation to repair her damaged lungs at any time. From a purely practical perspective, we are wasting the country's resources, both human and financial, by dumping them into the insurance industry.
And it doesn't just cost money. Our system of health insurance is unjust. It punishes those who can least afford it, and enriches those who do not deserve it and haven't earned it. Instead of strong citizens united for the common good, it creates fear and division and resentment. We can do better. We're so close to making a change for the better.
Ten Dollars an Hour from Ben Guest on Vimeo.
Here's the math of Leasse William's life, from the whiteboard talk in the documentary:
She makes $10/hour, and works 50 hours a week, nine months a year, and either works minimum wage or gets unemployment (the income is about equal) for the other three. Her taxes (yes, people at this income level pay taxes!) are $3600, and her health insurance, which she buys on the private market, costs $2400/year. This leaves her about $14,200 in take-home pay, which is near the Louisiana poverty line -- and that already includes the possibility of government-subsidized unemployment benefits.
Now, poverty is a systemic problem, and it's not clear whether it can be simply fixed by legislation, more consideration shown to employees by employers, an insistence on racial equality, or any other individual undertaking. But the absolutely back-breaking cost of medical insurance is something we can fix with legislation, and the legislation is in Congress right now, in the form of the public option amendments to the Baucus bill.
Leasse's problem isn't just that her insurance is expensive -- it's that she doesn't have any extra resources to fight her insurance provider to protect her coverage. If, let's say, she wakes up bleeding from the nipple one morning and her insurance company refuses to cover it as an emergency, she's not going to be able to do what any smart person would want to: lawyer up and spend a couple of days making angry, pointed phone calls. She's back to work, if she can work, ten hours the next day. Every dime that insurance providers and brokers like the GradMed people (who don't provide real health insurance and wouldn't insure anybody in this documentary, but who seem like good representatives of the industry to me) steal and waste -- every bit of that $2400 a year that goes into marketing, salaries, profit, obsessive rereading of "Dying for a Public Option" -- comes out of the money that Leasse is setting aside for her own care, and it's money that she frankly doesn't have in the first place. Those costs are passed along to her in the form of claim denials, copays, coinsurance, and rescission.
And this doesn't just cost Leasse. Medical bankruptcy would put her right on unemployment (which her job seems to expect her to collect already), eventually on welfare (if she's lucky). This couple in a recent PBS NOW episode, like many others with chronically ill children, limits their own income so that they can qualify for Oklahoma state child health benefits, because their asthmatic daughter may need an expensive operation to repair her damaged lungs at any time. From a purely practical perspective, we are wasting the country's resources, both human and financial, by dumping them into the insurance industry.
And it doesn't just cost money. Our system of health insurance is unjust. It punishes those who can least afford it, and enriches those who do not deserve it and haven't earned it. Instead of strong citizens united for the common good, it creates fear and division and resentment. We can do better. We're so close to making a change for the better.
Wednesday, September 23, 2009
Gradmed: Spending Your Insurance Dollars Wisely
Since my previous post on how exploitative, dishonest, and useless GradMed Health Insurance is, I've had an enormous spike in traffic from the fine folks at GradMed -- since last Friday, they've viewed my blog pages seventy-one times -- have viewed the blog more than four times as much as I have over the same period, an astonishing amount considering that there are only fifty-two pages here -- and spent almost six hours on the site. I've been chatting with them in the comments about the way in which they're negligent in selling a product that even they don't consider a real insurance solution to penniless graduates. They say, "If someone knows that they will need more permanent coverage, many alumni associations sponsor a renewable major medical program through us as well...", neglecting to recognize the fact that everyone needs permanent coverage whether they know it or not, and that the non-permanent coverage they sell only creates pre-existing conditions that are life-long uninsurables.
It didn't occur to me until I was sitting at my desk, procrastinating on my own project, to ask the question: what the hell are these people doing wasting their time at this tiny blog? I mean, look at the drapes. This isn't exactly the Hilton.
So I drilled down into their data a little bit. They found the blog by doing a blogsearch (not a Google search, mind you, but Google's specific search for blogs alone) for "GradMed" and finding my post from there. At that point, the employee that found the site passed it on to another employee, and then spent about the next hour surfing the site and crafting a comment. They checked again at the start of work Monday, and then again about halfway through the day. Since the start of business Tuesday, they stayed on the site continuously until lunch, refreshing or clicking a link at least once every fifteen minutes.
So who is this person? They identified themselves as "Customer Service" in their comment, but it seems clear that one of the things they do on the blog is fighting the war for GradMed on the information front: the IP address that left the comment on my blog is the perpetrator of at least three vandalism reverts on Wikipedia, one of which was an article created to publicize the USI Consulting Group -- GradMed, as far as I can tell, is a subsidiary of USI Insurance Services, a division of USICG.
But none of this is as important as why we care about all this as insurance customers. GradMed/USI doesn't provide care, of course; but they also don't provide insurance. They organize marketing for insurance that they then obtain from state insurers -- they're insurance brokers dealing with alumni associations. But this whole group -- the alumni association, USI, and the insurer -- gets paid with the money you and I send in as premiums. Every billable minute (and all the GradMed access to this site has come during working hours) that they spend promoting, marketing, giving greasy answers to straightforward questions, and making up fake and poorly structured Wikipedia pages is a dollar of your premium money that doesn't get paid in benefits. I am sure that the people at USI consider this good business: I consider it legal embezzlement from America's limited health care resources.
People say that government bureaucracy is inefficient and I agree, it can be -- but it's nowhere near as bad as being a 22 year-old recent graduate, broke, unemployed, and forced to pay for an insurance broker to surf our hooptie blog.
We need a public option to help get the profit motive out of health insurance. The waste and the lies have to stop.
It didn't occur to me until I was sitting at my desk, procrastinating on my own project, to ask the question: what the hell are these people doing wasting their time at this tiny blog? I mean, look at the drapes. This isn't exactly the Hilton.
So I drilled down into their data a little bit. They found the blog by doing a blogsearch (not a Google search, mind you, but Google's specific search for blogs alone) for "GradMed" and finding my post from there. At that point, the employee that found the site passed it on to another employee, and then spent about the next hour surfing the site and crafting a comment. They checked again at the start of work Monday, and then again about halfway through the day. Since the start of business Tuesday, they stayed on the site continuously until lunch, refreshing or clicking a link at least once every fifteen minutes.
So who is this person? They identified themselves as "Customer Service" in their comment, but it seems clear that one of the things they do on the blog is fighting the war for GradMed on the information front: the IP address that left the comment on my blog is the perpetrator of at least three vandalism reverts on Wikipedia, one of which was an article created to publicize the USI Consulting Group -- GradMed, as far as I can tell, is a subsidiary of USI Insurance Services, a division of USICG.
But none of this is as important as why we care about all this as insurance customers. GradMed/USI doesn't provide care, of course; but they also don't provide insurance. They organize marketing for insurance that they then obtain from state insurers -- they're insurance brokers dealing with alumni associations. But this whole group -- the alumni association, USI, and the insurer -- gets paid with the money you and I send in as premiums. Every billable minute (and all the GradMed access to this site has come during working hours) that they spend promoting, marketing, giving greasy answers to straightforward questions, and making up fake and poorly structured Wikipedia pages is a dollar of your premium money that doesn't get paid in benefits. I am sure that the people at USI consider this good business: I consider it legal embezzlement from America's limited health care resources.
People say that government bureaucracy is inefficient and I agree, it can be -- but it's nowhere near as bad as being a 22 year-old recent graduate, broke, unemployed, and forced to pay for an insurance broker to surf our hooptie blog.
We need a public option to help get the profit motive out of health insurance. The waste and the lies have to stop.
Monday, September 21, 2009
Sunday, September 20, 2009
Olympia Snowe and the Audacity of Cost Control
Over five hundred amendments were suggested to the Baucus bill today, which is frankly a little bit disappointing -- I had hoped that one of the other committee bills would be getting more attention for the simple reason that most of them are better bills.
There's one amendment that I'm really interested in, though -- Olympia Snowe's amendment to create a public health plan as a 'safety net' if insurance costs don't decrease in the coming years. This isn't, I don't think, as good as having a public health option -- but it's certainly better than the Baucus bill itself, which does nothing to control costs. One of the things that the bill reflects, though, and I think that this is the reason that this amendment is canny and smart, is that insurance industry costs are under the control of the insurance industry.
It's pretty simple, but it's something that those that insist on the free market don't usually get. When an insurance company has a monopoly, or an 'agreement' with the competition, or when it simply realizes that people can be persuaded, shamed or tricked into paying more money for fewer services, that insurance company will raise rates. This is not the invisible hand: this is someone coming to a meeting with a PowerPoint that ends, "...so if nobody figures out what we're doing, then we can safely raise premiums by 9% in the next year." What limits this -- even in the current system -- is government. We regulate what is fair and unfair to do. The most profitable attitude for an insurance company would be to promise you a bunch of stuff, take your premiums, and then never pay for a dime of your care. And that happens -- except when we make it illegal.
The triggered public option would be another kind of regulation for insurance companies. It would require them to keep costs down, which they have the power to do, and if they failed, it would punish them by opening government competition. In doing so, it would insure that costs were at or below some particular level.
Unfortunately, a triggered public option wouldn't create (absent the trigger) an insurer that people could trust -- it would be fairly easy for insurance companies to keep profits high by surreptitiously cutting benefits every time they cut costs. There's simply no good way to get your health insurance from an entity that has shown itself to be overwhelmingly untrustworthy. Additionally, the 'trigger' part of the public option is just a bone thrown to those untrustworthy industries. If the public option is effective in keeping down costs, and if it can ensure that people pay a rational amount for their health insurance, then why don't we have it now?
All that having been said, there's been a lot of talk about Senator Snowe being an important moderate, and I have to say this amendment really does represent something in between the two sides. This is a very large, very rarely traveled, and very necessary territory in the Senate debate, and the people of Maine should be proud of their representative for having the courage to go there.
There's one amendment that I'm really interested in, though -- Olympia Snowe's amendment to create a public health plan as a 'safety net' if insurance costs don't decrease in the coming years. This isn't, I don't think, as good as having a public health option -- but it's certainly better than the Baucus bill itself, which does nothing to control costs. One of the things that the bill reflects, though, and I think that this is the reason that this amendment is canny and smart, is that insurance industry costs are under the control of the insurance industry.
It's pretty simple, but it's something that those that insist on the free market don't usually get. When an insurance company has a monopoly, or an 'agreement' with the competition, or when it simply realizes that people can be persuaded, shamed or tricked into paying more money for fewer services, that insurance company will raise rates. This is not the invisible hand: this is someone coming to a meeting with a PowerPoint that ends, "...so if nobody figures out what we're doing, then we can safely raise premiums by 9% in the next year." What limits this -- even in the current system -- is government. We regulate what is fair and unfair to do. The most profitable attitude for an insurance company would be to promise you a bunch of stuff, take your premiums, and then never pay for a dime of your care. And that happens -- except when we make it illegal.
The triggered public option would be another kind of regulation for insurance companies. It would require them to keep costs down, which they have the power to do, and if they failed, it would punish them by opening government competition. In doing so, it would insure that costs were at or below some particular level.
Unfortunately, a triggered public option wouldn't create (absent the trigger) an insurer that people could trust -- it would be fairly easy for insurance companies to keep profits high by surreptitiously cutting benefits every time they cut costs. There's simply no good way to get your health insurance from an entity that has shown itself to be overwhelmingly untrustworthy. Additionally, the 'trigger' part of the public option is just a bone thrown to those untrustworthy industries. If the public option is effective in keeping down costs, and if it can ensure that people pay a rational amount for their health insurance, then why don't we have it now?
All that having been said, there's been a lot of talk about Senator Snowe being an important moderate, and I have to say this amendment really does represent something in between the two sides. This is a very large, very rarely traveled, and very necessary territory in the Senate debate, and the people of Maine should be proud of their representative for having the courage to go there.
Wednesday, September 16, 2009
The Baucus Bill
First, a little stock music: as was pointed out in this Metafilter comment, Humana, Aetna, Cigna and UnitedHealth all had a stock gain of more than 3.5% after Senator Max Baucus announced his bill.
I waited most of the day to write about this because I was honestly not sure how the bill would sort out, and I wanted to look at the Chairman's Mark (Baucus' first draft of the bill for negotiation) myself before I jumped in all aggravated with the riot elbow. I've been pretty sure for the last two months that whoever Baucus is representing, it's not Americans -- but this bill seems, all in all, to be pretty clear proof. A rundown:
An insurance mandate for individuals. That means that if you don't buy insurance, you'll be fined by the federal government. This is a major money-maker for insurance industries, who want federal laws to force new customers into the market. Democrats should hate it because it punishes people who are already lower-middle class and have it hard enough; Republicans should hate it because it's a government intrusion into something that should probably be an individual decision.
The free-rider policy. This forces businesses who employ individuals receiving government health insurance services (i.e. Medicaid or other subsidized health services) to pay a fee towards defraying that cost. Ezra Klein has been excoriating it all day -- for the simple reason that it makes businesses less likely to hire low-income employees. If you could hire a high school kid for $7.25 an hour or a mother of three for $8 an hour (because her children are Medicaid recipients), which would you do? This policy expressly reinforces the cycle of poverty. Whether you're on the left or the right, it's a loser.
An end to the use of pre-existing conditions as a means by which insurance companies can deny insurance. This is a good thing, but the insurance companies are likely to raise rates to counteract lost profits caused by having to actually insure sick people. Call it a wash: we'll get more, but it'll come out of our pockets, not out of the insurance companies'.
Medicaid and Medicare expansion and subsidies. This is the bill's method of addressing what drives much of our desire for reform -- the tens of millions of uninsured Americans left out of our current system. It's also, I think, President Obama's key demand: insure the uninsured, and increase national health. The question is how much we will pay to get this, and how we'll do it; Senate Republicans have treated almost any expenditure in this direction as completely nonnegotiably unacceptable. I would also point out, to opponents of the public option, that in its absence what we are getting is an expansion of the considerably more government-centric single payer system that is Medicaid and Medicare.
No cost containment. This is President Obama's other big request -- a way by which we can slow or stop the double-digit yearly increases in health costs that are throttling industry and household finances. A public option -- government competition -- is the best way to control these costs; in its absence, many have suggested regulations on executive pay, profit-taking, coverage maximums, or other insurance industry mechanisms that enrich individuals at the expense of the country. The Baucus plan has neither -- and in this respect, fails entirely to get to the root of the problem. This is why the bill is so popular with the insurance industry and its stockholders: it maintains the gravy train, as is pointed out in this NYT "Room for Debate" brief.
All in all, as much as I want some kind of reform, I can't get behind this bill, which is why I'm glad, I guess, that it has no Republican support (and, as 538.com points out with much better prose, not much Democratic support, either). Back to work, Senators.
I waited most of the day to write about this because I was honestly not sure how the bill would sort out, and I wanted to look at the Chairman's Mark (Baucus' first draft of the bill for negotiation) myself before I jumped in all aggravated with the riot elbow. I've been pretty sure for the last two months that whoever Baucus is representing, it's not Americans -- but this bill seems, all in all, to be pretty clear proof. A rundown:
An insurance mandate for individuals. That means that if you don't buy insurance, you'll be fined by the federal government. This is a major money-maker for insurance industries, who want federal laws to force new customers into the market. Democrats should hate it because it punishes people who are already lower-middle class and have it hard enough; Republicans should hate it because it's a government intrusion into something that should probably be an individual decision.
The free-rider policy. This forces businesses who employ individuals receiving government health insurance services (i.e. Medicaid or other subsidized health services) to pay a fee towards defraying that cost. Ezra Klein has been excoriating it all day -- for the simple reason that it makes businesses less likely to hire low-income employees. If you could hire a high school kid for $7.25 an hour or a mother of three for $8 an hour (because her children are Medicaid recipients), which would you do? This policy expressly reinforces the cycle of poverty. Whether you're on the left or the right, it's a loser.
An end to the use of pre-existing conditions as a means by which insurance companies can deny insurance. This is a good thing, but the insurance companies are likely to raise rates to counteract lost profits caused by having to actually insure sick people. Call it a wash: we'll get more, but it'll come out of our pockets, not out of the insurance companies'.
Medicaid and Medicare expansion and subsidies. This is the bill's method of addressing what drives much of our desire for reform -- the tens of millions of uninsured Americans left out of our current system. It's also, I think, President Obama's key demand: insure the uninsured, and increase national health. The question is how much we will pay to get this, and how we'll do it; Senate Republicans have treated almost any expenditure in this direction as completely nonnegotiably unacceptable. I would also point out, to opponents of the public option, that in its absence what we are getting is an expansion of the considerably more government-centric single payer system that is Medicaid and Medicare.
No cost containment. This is President Obama's other big request -- a way by which we can slow or stop the double-digit yearly increases in health costs that are throttling industry and household finances. A public option -- government competition -- is the best way to control these costs; in its absence, many have suggested regulations on executive pay, profit-taking, coverage maximums, or other insurance industry mechanisms that enrich individuals at the expense of the country. The Baucus plan has neither -- and in this respect, fails entirely to get to the root of the problem. This is why the bill is so popular with the insurance industry and its stockholders: it maintains the gravy train, as is pointed out in this NYT "Room for Debate" brief.
All in all, as much as I want some kind of reform, I can't get behind this bill, which is why I'm glad, I guess, that it has no Republican support (and, as 538.com points out with much better prose, not much Democratic support, either). Back to work, Senators.
Monday, September 14, 2009
GradMed Insurance Review
This morning I was looking at reports that in nine states of our fine Union, a history of domestic violence is considered a pre-existing condition and is therefore a reason to be denied coverage. Not worth commenting on: you get it. We live in a Franz Kafka story. "I've been beaten, may I see a doctor?" "No, you cannot see a doctor, because you have been beaten. We only allow those who have not been beaten to see doctors."
The subtler, more widely exploitative insurance industry practice that I really want to talk about is an insurance company called GradMed. Students that are right out of college are some of the people most likely to be uninsured -- there's often a long unemployment period after graduation, people are generally healthy, and there's not a lot of money to go around. It would seem like this is a perfect time for insurance corporations to step in and provide...well, about the worst decision a young person can make.
GradMed is marketed through the alumni associations of various colleges (this is the part of a college that, once you graduate, sends you all kinds of mail asking for donations). They pay colleges for the right to use the school's insignia and to market directly to their students -- and I made sure to call participating colleges to make sure that this is the system. Let me be specific: the 'sponsorship' that colleges engage in is an exchange of student trust and marketing opportunities for cash royalties. No school oversees, manages, or contributes to the insurance fund in any way.
But whatever -- schools raise money all the time. Schools need all the cash they can get -- marketing to their graduates is one of the many ways they raise it. Right? Not when the policy is the most exploitative insurance contract I have ever seen. Once you select your college at their website (pick any: the policies are all basically the same) they outline a short-term (30-180 days), medium-deductible policy that pays 100% of some claims above $5,000 dollars. Here, though, is the kicker, copied straight from the site:
What happens to a person duped into a short-term, non-renewing insurance policy? This article from Time is a pretty good example -- a man signs up for several policies in a row with Assurant, and is never uninsured, but as soon as he was diagnosed with kidney disease, it is labeled as a pre-existing condition and he is denied coverage. The whole article is summed up by Karen Pollitz, project director of Georgetown University's Health Policy Institute and a leading expert on the individual-insurance market. "These short-term policies are a joke," she says. "Nobody should ever buy them. It is false security that is being sold. It's junk."
People talk about government waste, inefficiencies in Medicare, how slow the Post Office is, etc. -- but there is no comparison between those programs and the crimes of large, powerful corporations who put their full efforts into screwing people out of their paychecks. Part of me wants to call a series of alumni associations and complain -- but this is a completely legal product and they're not the real culprit for allowing it to be marketed -- the real culprit is the sociopaths in the board room who dream up this stuff in the first place, and the foot soldiers who hawk it to schools and young people who don't know better. At the heart of things, the real culprit is the system, which puts our health in the hands of the greedy.
To sum up, AVOID GRADMED LIKE THE PLAGUE. VIRTUALLY NO ONE SHOULD EVER BUY IT.
Edit: After I published this review, I had several entertaining and eye-opening run-ins with the people at Gradmed, which I describe in this entry and then in this one. Although they do nothing to protect your health or insure you in the event of illness or injury, they are very serious about marketing.
The subtler, more widely exploitative insurance industry practice that I really want to talk about is an insurance company called GradMed. Students that are right out of college are some of the people most likely to be uninsured -- there's often a long unemployment period after graduation, people are generally healthy, and there's not a lot of money to go around. It would seem like this is a perfect time for insurance corporations to step in and provide...well, about the worst decision a young person can make.
GradMed is marketed through the alumni associations of various colleges (this is the part of a college that, once you graduate, sends you all kinds of mail asking for donations). They pay colleges for the right to use the school's insignia and to market directly to their students -- and I made sure to call participating colleges to make sure that this is the system. Let me be specific: the 'sponsorship' that colleges engage in is an exchange of student trust and marketing opportunities for cash royalties. No school oversees, manages, or contributes to the insurance fund in any way.
But whatever -- schools raise money all the time. Schools need all the cash they can get -- marketing to their graduates is one of the many ways they raise it. Right? Not when the policy is the most exploitative insurance contract I have ever seen. Once you select your college at their website (pick any: the policies are all basically the same) they outline a short-term (30-180 days), medium-deductible policy that pays 100% of some claims above $5,000 dollars. Here, though, is the kicker, copied straight from the site:
If you need GradMed beyond the end of your first coverage period, depending on your state of residence, you may apply for additional periods of coverage.So if you have any condition which in any way lasts longer than your coverage period, you're dumped. And you're absolutely fucked because now you can't get real insurance because you have a pre-existing condition. And we are expected to pay for this -- the quote I got for a fictitious 21-year old St. Louisan was over $100/month. Even the testimonial on the website is a freaking train wreck -- as upbeat as she may sound, the student is still negotiating for her costs to be covered, and still has mobility problems from her accident that doubtlessly need physical therapy.
Any condition which may have occurred under the first policy will be treated as a pre-existing condition under your next policy. A pre-existing condition is a condition for which an insured was treated or received medical advice during the 12-month period immediately preceding the effective date.
What happens to a person duped into a short-term, non-renewing insurance policy? This article from Time is a pretty good example -- a man signs up for several policies in a row with Assurant, and is never uninsured, but as soon as he was diagnosed with kidney disease, it is labeled as a pre-existing condition and he is denied coverage. The whole article is summed up by Karen Pollitz, project director of Georgetown University's Health Policy Institute and a leading expert on the individual-insurance market. "These short-term policies are a joke," she says. "Nobody should ever buy them. It is false security that is being sold. It's junk."
People talk about government waste, inefficiencies in Medicare, how slow the Post Office is, etc. -- but there is no comparison between those programs and the crimes of large, powerful corporations who put their full efforts into screwing people out of their paychecks. Part of me wants to call a series of alumni associations and complain -- but this is a completely legal product and they're not the real culprit for allowing it to be marketed -- the real culprit is the sociopaths in the board room who dream up this stuff in the first place, and the foot soldiers who hawk it to schools and young people who don't know better. At the heart of things, the real culprit is the system, which puts our health in the hands of the greedy.
To sum up, AVOID GRADMED LIKE THE PLAGUE. VIRTUALLY NO ONE SHOULD EVER BUY IT.
Edit: After I published this review, I had several entertaining and eye-opening run-ins with the people at Gradmed, which I describe in this entry and then in this one. Although they do nothing to protect your health or insure you in the event of illness or injury, they are very serious about marketing.
Sunday, September 6, 2009
Sunday Shorts
A few entertaining links I've run across this week. I'd write more, but I just accidentally had some double-strength coffee and I am flipping the hell out inside.
First, momentously, Auto-tune the News 8 is out, and features Sen. Chuck Grassley, who for a brief time was considered a reasonable, moderate voice on health care in the Senate, but is in fact a total woop-the-loo. He shows up at 2:00, but the whole video is fun:
Also, from the Onion: Man Succumbs to 7-Year Battle with Health Insurance.
And Ze Frank on the "Health Care Argument" at Time.com here: he does a better job than I do pointing out that the health care industry shouldn't be treated like a regular business. Also, cereal-box vasectomy.
First, momentously, Auto-tune the News 8 is out, and features Sen. Chuck Grassley, who for a brief time was considered a reasonable, moderate voice on health care in the Senate, but is in fact a total woop-the-loo. He shows up at 2:00, but the whole video is fun:
Also, from the Onion: Man Succumbs to 7-Year Battle with Health Insurance.
And Ze Frank on the "Health Care Argument" at Time.com here: he does a better job than I do pointing out that the health care industry shouldn't be treated like a regular business. Also, cereal-box vasectomy.
Thursday, September 3, 2009
Late Game Gunk
Let's say you're a fence-sitter. You like fences -- you're from Arkansas and they've got a lot of them, and you like to sit on them. No problem! You can be a Senator; you can be a senior senator. All you have to do is make statements that hedge and shift. Arkansas has a lot of hedges, too, often placed directly adjacent to fences.
All you've got to do is watch out that you don't get pushed off the fence by a fire-hose intensity gush of insurance industry money. This will be delivered with particular force, since your previous health care advisor now works for Blue Cross/Blue Shield.
And if you do drop off, Lord forbid, the fence? Make sure you don't get embarassing, money-green gunk all over your nice clothes, Senator.
The price of one senator to vote against legislation that will save lives, money, and prevent human suffering -- especially in her home state of Arkansas, where 20% of the state is uninsured? That price is apparently $325,350.
Her move today to come out strongly against the public option in the late days of the debate is a live-action dramatization of this cartoon -- by waffling for months instead of choosing a policy and negotiating for it (the attitude of several more principled senators who are also not firm 'yesses' on the public option -- those who are pulling for their own plans), she helps ensure that no reform at all passes this year.
What a shame! You know how hard it is to get gunk off a nice silk suit.
EDIT: Forgot to give you fine people a way to contact the Senator with advice on repairing expensive fabrics. There's still time to apply stain stick before the grease soaks all the way through!
DOUBLE EDIT: You can donate to an ActBlue campaign to run a pressure advertisement pushing Senator Lincoln to represent her constituency here.
All you've got to do is watch out that you don't get pushed off the fence by a fire-hose intensity gush of insurance industry money. This will be delivered with particular force, since your previous health care advisor now works for Blue Cross/Blue Shield.
And if you do drop off, Lord forbid, the fence? Make sure you don't get embarassing, money-green gunk all over your nice clothes, Senator.
The price of one senator to vote against legislation that will save lives, money, and prevent human suffering -- especially in her home state of Arkansas, where 20% of the state is uninsured? That price is apparently $325,350.
Her move today to come out strongly against the public option in the late days of the debate is a live-action dramatization of this cartoon -- by waffling for months instead of choosing a policy and negotiating for it (the attitude of several more principled senators who are also not firm 'yesses' on the public option -- those who are pulling for their own plans), she helps ensure that no reform at all passes this year.
What a shame! You know how hard it is to get gunk off a nice silk suit.
EDIT: Forgot to give you fine people a way to contact the Senator with advice on repairing expensive fabrics. There's still time to apply stain stick before the grease soaks all the way through!
DOUBLE EDIT: You can donate to an ActBlue campaign to run a pressure advertisement pushing Senator Lincoln to represent her constituency here.
Sunday, August 30, 2009
Specifically, Women
The public option is good for society at large -- it would vastly decrease the number of uninsured in America, reduce reliance on expensive emergency-room treatment, and compete with health insurance companies that use monopoly market shares to abuse the health and finances of regular Americans. It's for everyone. HOWEVER, there are some groups that, because they're treated particularly unfairly in the present system, would receive particular benefits from a public option.
Specifically, women.
Whether or not you think one parent should stay at home and take primary responsibility for child rearing, it still happens quite a bit, and happens disproportionately to women -- and I think everybody agrees that neither men nor women should be forced into marriage, or kept from leaving one that s/he no longer wants to be a part of. There are a lot a lot a lot of reasons for this, but let's radically oversimplify them all into just one: your spouse has become abusive or presents a danger to your children. No left-right issues about saving the family, or religion, or anything else. Time to get out.
Now, we fortunately live in a society where it is possible -- not easy, or even particularly likely, but possible -- for a parent who lives and works at home to get a divorce, get child support, find a job, get an apartment, find child care and whew. Survive. It's a lot of work, and we still lack lots of critical services, but it's a big improvement over earlier times when women leaving a marriage encountered nothing but resistance and judgment. What is, however, practically impossible for that woman to get -- the most regressive part of the way our society treats stay-at-home parents -- is health insurance.
Divorced spouses and their children are eligible for COBRA -- which means that they have the right to be charged 102% (no kidding -- the insurance companies have the right to raise the cost of their plans by 2% for COBRA enrollees) of the cost of the insurance that they just lost by getting divorced. What this means is that if you don't want any gap in coverage (which is when your health problems become 'preexisting conditions,' and therefore uninsurable), you are responsible to pay the full premium for you and your children in cash the moment you ink your divorce papers. Congratulations! You have escaped a loveless and destructive marriage. Please send a $1200 check to Wellpoint Corporation....
Thirty-six months later, this insurance runs out whether you can pay for it or not. And COBRA is for the lucky ones -- people whose spouses worked at a business with 20 or more employees. If your spouse worked in the restaurant industry, you're just out of luck. And keep in mind that while it may be worth it for many women to go without health insurance for a brief period just for the benefits of avoiding Johnny, the presence and needs of children makes this problem life-or-death, damned if you do, damned if you don't.
All of this applies, less frequently but in the exact same way, for any men who get their insurance through their spouse, as well -- whether they're caregivers for children or not. If you've been at home with paralyzing nerve damage from a car accident, getting your insurance through Janie, and Janie starts disappearing for entire weekends with Tom, you're probably better off just pretending you don't know. You need Janie: you depend on her. More precisely, you depend on her insurance because our system of insurance is a joke.
But there are more indignities and injustices in our present health care system that specifically target women: the Truth-o-Meter at politifact.com measures claims about the health care debate, and one of the only statements it has completely verified is that it is nearly impossible for women who are pregnant to get health insurance. This, to me, seems like blunt, no-brainer proof that our system is designed for the profit and convenience of health insurance companies, and works at the expense of people.
Add to this the fact that a public option -- because it would be purchasable by an individual, at reasonable cost -- would ease the suffering and difficulty of thousands of people in nontraditional, nonmarriage relationships, gay and otherwise, by offering the opportunity for each American to get affordable insurance, whether or not they are married, whether or not they are employed by large businesses.
Specifically, women.
Whether or not you think one parent should stay at home and take primary responsibility for child rearing, it still happens quite a bit, and happens disproportionately to women -- and I think everybody agrees that neither men nor women should be forced into marriage, or kept from leaving one that s/he no longer wants to be a part of. There are a lot a lot a lot of reasons for this, but let's radically oversimplify them all into just one: your spouse has become abusive or presents a danger to your children. No left-right issues about saving the family, or religion, or anything else. Time to get out.
Now, we fortunately live in a society where it is possible -- not easy, or even particularly likely, but possible -- for a parent who lives and works at home to get a divorce, get child support, find a job, get an apartment, find child care and whew. Survive. It's a lot of work, and we still lack lots of critical services, but it's a big improvement over earlier times when women leaving a marriage encountered nothing but resistance and judgment. What is, however, practically impossible for that woman to get -- the most regressive part of the way our society treats stay-at-home parents -- is health insurance.
Divorced spouses and their children are eligible for COBRA -- which means that they have the right to be charged 102% (no kidding -- the insurance companies have the right to raise the cost of their plans by 2% for COBRA enrollees) of the cost of the insurance that they just lost by getting divorced. What this means is that if you don't want any gap in coverage (which is when your health problems become 'preexisting conditions,' and therefore uninsurable), you are responsible to pay the full premium for you and your children in cash the moment you ink your divorce papers. Congratulations! You have escaped a loveless and destructive marriage. Please send a $1200 check to Wellpoint Corporation....
Thirty-six months later, this insurance runs out whether you can pay for it or not. And COBRA is for the lucky ones -- people whose spouses worked at a business with 20 or more employees. If your spouse worked in the restaurant industry, you're just out of luck. And keep in mind that while it may be worth it for many women to go without health insurance for a brief period just for the benefits of avoiding Johnny, the presence and needs of children makes this problem life-or-death, damned if you do, damned if you don't.
All of this applies, less frequently but in the exact same way, for any men who get their insurance through their spouse, as well -- whether they're caregivers for children or not. If you've been at home with paralyzing nerve damage from a car accident, getting your insurance through Janie, and Janie starts disappearing for entire weekends with Tom, you're probably better off just pretending you don't know. You need Janie: you depend on her. More precisely, you depend on her insurance because our system of insurance is a joke.
But there are more indignities and injustices in our present health care system that specifically target women: the Truth-o-Meter at politifact.com measures claims about the health care debate, and one of the only statements it has completely verified is that it is nearly impossible for women who are pregnant to get health insurance. This, to me, seems like blunt, no-brainer proof that our system is designed for the profit and convenience of health insurance companies, and works at the expense of people.
Add to this the fact that a public option -- because it would be purchasable by an individual, at reasonable cost -- would ease the suffering and difficulty of thousands of people in nontraditional, nonmarriage relationships, gay and otherwise, by offering the opportunity for each American to get affordable insurance, whether or not they are married, whether or not they are employed by large businesses.
Friday, August 28, 2009
Friday Short
Quick because I have to make dinner and I spent all afternoon taking the 212 bus to go watch pure light. (Note: also not a euphemism. Admission cost me $8.)
By my count, there are three reasons we make an industry public (i.e. give the government significant power over it). 1) when the thing the industry sells is absolutely necessary for survival and people who need it will pay any amount of money for it (i.e. water, perhaps electricity). 2) when the item or items it sells are a finite resource that has to be shared (water, roads + highways). 3) when the nature of the industry is such that a monopoly corporation in that industry would have too much control over the nation (defense, the post office).
Health insurance clearly fits all three categories: the vast majority of us rely at some point or another on some form of health care; we have come to the point where we realize that this is not an infinite resource that we can continue sinking 15% of our GDP into funding it; and increasing monopolization and control by large health insurance companies (Wellpoint, United, Blue Cross) has meant that they, not us, are setting national health policy.
The public option for national health insurance, because it would be operated by the government, would be more socialist than the current system. That's true. But no more socialist than our water system -- and you'll still be able to buy the bottled stuff if you want it.
EDIT: PS -- a veterans' organization is in the news today for defending their own socialized medicine against flat out lies by opponents of the public option (in this case Republican National Committee Chairman Michael Steele).
By my count, there are three reasons we make an industry public (i.e. give the government significant power over it). 1) when the thing the industry sells is absolutely necessary for survival and people who need it will pay any amount of money for it (i.e. water, perhaps electricity). 2) when the item or items it sells are a finite resource that has to be shared (water, roads + highways). 3) when the nature of the industry is such that a monopoly corporation in that industry would have too much control over the nation (defense, the post office).
Health insurance clearly fits all three categories: the vast majority of us rely at some point or another on some form of health care; we have come to the point where we realize that this is not an infinite resource that we can continue sinking 15% of our GDP into funding it; and increasing monopolization and control by large health insurance companies (Wellpoint, United, Blue Cross) has meant that they, not us, are setting national health policy.
The public option for national health insurance, because it would be operated by the government, would be more socialist than the current system. That's true. But no more socialist than our water system -- and you'll still be able to buy the bottled stuff if you want it.
EDIT: PS -- a veterans' organization is in the news today for defending their own socialized medicine against flat out lies by opponents of the public option (in this case Republican National Committee Chairman Michael Steele).
Thursday, August 27, 2009
Mailsack
Surprisingly fat mailsack this morning, raising two very discussable questions.
First, from a debonair conservative gentleman: why put the government into health insurance? Why not simply legalize cross-state competition in the insurance market, and enact tort reform?
My answer is that while the two reforms could be useful, neither will nearly be enough to manage costs and provide more care. While cross-state competition (which I mentioned in this post) would certainly make the industry more competitive and could drive down prices, it would also likely increase a problem already acute in the current system: localities that are difficult or unprofitable to serve could still have one or two large for-profit insurers, and it has been pretty conclusively proven that the insurance industry will shake down communities where there is little competition in the attempt to maximize profits. The only difference for these citizens would be that they'd now be dealing with a much larger corporation, and one unregulated by state law. To see what the possible changes/efficiencies from a plan like this might be, consider insurance costs in extremely large states (since we would essentially, where insurance is concerned, be making the country one big state market) -- for example, this argument by Governor Schwarzenegger that California's health care system is broken, in part because of unstoppably rising costs. That's a big, unified market -- but costs are still out of control, and people are still uninsured, and the state and taxpayers are still footing the bill for insurance industry profits. The Terminator, who is not exactly a socialist, is exactly right when he says that Californians already pay a 'hidden tax' to provide care for the uninsured -- it's just done in the most inefficient, secretive, dehumanizing way possible.
Tort reform, although it could also help control costs, would have an even smaller impact. Several states (and there are conservative thinkers in favor of tort reform that believe that a state solution, instead of a national one, would be best) have made significant strides towards reform, foremost among which is Texas. There are some positive indicators that their reform has helped increase numbers of doctors in the state, and decreased the cost of malpractice insurance, but Texas still has four of the top ten most expensive health care markets in the nation, 25% of its citizens are uninsured, and its costs increased 6.1% in 2007. Maybe, it stands to reason, a combination of a national health insurance market and tort reform would decrease costs, but Texas is a pretty large state, too -- its GDP is the size of Canada's.
Long story short, a national health insurance market and tort reform might both be great, but neither is more than a small and incremental improvement to a system which is methodically and swiftly bankrupting and sickening America. The insurance industry, in my opinion, will allow the passage of both types of reform -- neither is likely to cut into their profits in a significant way, and backing them will make the industry look like it cares about us while it blocks the reform we need -- a government-run health insurance option for all Americans.
That brings me to the other piece of mail that was lodged in my bulging mailsack -- an east-coast liberal contrarian/grammarian who wants to point out the difference between health care and health insurance. The public option is a government provision to provide health insurance -- what we are debating, in most cases, is reform to the national system of health insurance -- basically, who pays for treatment, and not who delivers medical care. I'm roundly guilty of confusing the two, because I think that one of the reasons me and mine have received such poor health care during our young adulthood is because we had completely shoddy, or no health insurance. But he is right that even though health insurance might affect health care, we are actually engaged in a very unsexy movement to ensure equitable and affordable health insurance. "National Health Care" in the Canadian or British sense, where government owns the overwhelming majority of care providers, is not under consideration by either house of Congress and makes up no part of the current debate.
First, from a debonair conservative gentleman: why put the government into health insurance? Why not simply legalize cross-state competition in the insurance market, and enact tort reform?
My answer is that while the two reforms could be useful, neither will nearly be enough to manage costs and provide more care. While cross-state competition (which I mentioned in this post) would certainly make the industry more competitive and could drive down prices, it would also likely increase a problem already acute in the current system: localities that are difficult or unprofitable to serve could still have one or two large for-profit insurers, and it has been pretty conclusively proven that the insurance industry will shake down communities where there is little competition in the attempt to maximize profits. The only difference for these citizens would be that they'd now be dealing with a much larger corporation, and one unregulated by state law. To see what the possible changes/efficiencies from a plan like this might be, consider insurance costs in extremely large states (since we would essentially, where insurance is concerned, be making the country one big state market) -- for example, this argument by Governor Schwarzenegger that California's health care system is broken, in part because of unstoppably rising costs. That's a big, unified market -- but costs are still out of control, and people are still uninsured, and the state and taxpayers are still footing the bill for insurance industry profits. The Terminator, who is not exactly a socialist, is exactly right when he says that Californians already pay a 'hidden tax' to provide care for the uninsured -- it's just done in the most inefficient, secretive, dehumanizing way possible.
Tort reform, although it could also help control costs, would have an even smaller impact. Several states (and there are conservative thinkers in favor of tort reform that believe that a state solution, instead of a national one, would be best) have made significant strides towards reform, foremost among which is Texas. There are some positive indicators that their reform has helped increase numbers of doctors in the state, and decreased the cost of malpractice insurance, but Texas still has four of the top ten most expensive health care markets in the nation, 25% of its citizens are uninsured, and its costs increased 6.1% in 2007. Maybe, it stands to reason, a combination of a national health insurance market and tort reform would decrease costs, but Texas is a pretty large state, too -- its GDP is the size of Canada's.
Long story short, a national health insurance market and tort reform might both be great, but neither is more than a small and incremental improvement to a system which is methodically and swiftly bankrupting and sickening America. The insurance industry, in my opinion, will allow the passage of both types of reform -- neither is likely to cut into their profits in a significant way, and backing them will make the industry look like it cares about us while it blocks the reform we need -- a government-run health insurance option for all Americans.
That brings me to the other piece of mail that was lodged in my bulging mailsack -- an east-coast liberal contrarian/grammarian who wants to point out the difference between health care and health insurance. The public option is a government provision to provide health insurance -- what we are debating, in most cases, is reform to the national system of health insurance -- basically, who pays for treatment, and not who delivers medical care. I'm roundly guilty of confusing the two, because I think that one of the reasons me and mine have received such poor health care during our young adulthood is because we had completely shoddy, or no health insurance. But he is right that even though health insurance might affect health care, we are actually engaged in a very unsexy movement to ensure equitable and affordable health insurance. "National Health Care" in the Canadian or British sense, where government owns the overwhelming majority of care providers, is not under consideration by either house of Congress and makes up no part of the current debate.
Monday, August 24, 2009
AHIP's Army
I had thought that the insurance industries were satisfied with direct lobbying and cash donations ($133 million in the last quarter!) in order to unfairly sway reform bills towards corporate profits, but apparently they're instructing corporate employees to attend town halls in an attempt to simulate the existence of a pro-insurance company constituency, and they have 50,000 shills walking in lockstep. I'd dismiss this as conspiracy if the effort wasn't large enough to be a matter of public record.
I've met a lot of people who don't support a public option or who don't support reform, but I've never heard anyone rationalize that opposition by saying good things about the health insurance industry. Unless, of course, (and this includes Joe Lieberman) they are PAID by the health insurance industry.
I've met a lot of people who don't support a public option or who don't support reform, but I've never heard anyone rationalize that opposition by saying good things about the health insurance industry. Unless, of course, (and this includes Joe Lieberman) they are PAID by the health insurance industry.
Saturday, August 22, 2009
Awakening?
A short link round-up, today, because oddly -- and I maybe have to chalk this up to more thoughtful parts of the media taking a little bit longer to mull over complicated issues like health care -- there seems to be an awful lot of really good writing about national health care reform in the electrowebs today.
First, a super-brilliant post on Metafilter demonstrating that some of the most untrue stories about health care reform come, in fact, directly from health insurance companies and related industry media organs. The post has links to a John Stewart interview with the originator of the "death panels" story, who one day later resigned from the board of directors of Cantel Medical.
Second -- and I'm not ashamed to say I look to a movie critic as a moral touchstone -- Roger Ebert made a pair of posts (part one, part two) that, among other things, point out that the "end" of the public option caused a big gain in health insurance industry stocks, compare "death panels" to the slogan "king of beers", and find the ethical roots of communally shared health care in Matthew 25, verses 31-46. It's kind of a tour de force.
Third -- Andrew Sullivan has collected and archived his posts on health care, which include the "views from your sickbeds" -- stories of what it's like to go through critical illness with American health insurance.
Finally, this op-ed by Gail Collins isn't as good as some of the stuff above, but she makes the point that the 'Gang of Six' that has been responsible for slowing down reform directly represents 2.77 percent of the American people. Thanks, guys! Allowing a small elite to paralyze reforms that serve the majority was exactly what James Madison had in mind when he argued for a bicameral legislature.
First, a super-brilliant post on Metafilter demonstrating that some of the most untrue stories about health care reform come, in fact, directly from health insurance companies and related industry media organs. The post has links to a John Stewart interview with the originator of the "death panels" story, who one day later resigned from the board of directors of Cantel Medical.
Second -- and I'm not ashamed to say I look to a movie critic as a moral touchstone -- Roger Ebert made a pair of posts (part one, part two) that, among other things, point out that the "end" of the public option caused a big gain in health insurance industry stocks, compare "death panels" to the slogan "king of beers", and find the ethical roots of communally shared health care in Matthew 25, verses 31-46. It's kind of a tour de force.
Third -- Andrew Sullivan has collected and archived his posts on health care, which include the "views from your sickbeds" -- stories of what it's like to go through critical illness with American health insurance.
Finally, this op-ed by Gail Collins isn't as good as some of the stuff above, but she makes the point that the 'Gang of Six' that has been responsible for slowing down reform directly represents 2.77 percent of the American people. Thanks, guys! Allowing a small elite to paralyze reforms that serve the majority was exactly what James Madison had in mind when he argued for a bicameral legislature.
Sunday, August 16, 2009
German National Treasures
This source from yesterday's globetrotting survey of world health policies has the following line in it. It describes the German system of national health insurance:
But they speak up -- the same tired, racist fears that poor or illegal immigrant children will steal health care from our embattled system -- and we stay silent, and we never remind anyone that there are sick little kids out there, and we never make the argument that it is always a good thing to give health care to any child, and that treating children who are placed into the system under false pretenses is the right thing to do, especially when it allows us to offer care for all American children.
Every stingy measure we pass to exclude certain children from public health care -- tests of citizenship, proof of parental income -- creates paperwork and increases the likelihood that some children won't make it through the process of getting covered. The humanitarian -- hell, the human system -- is that anyone under 4' gets free healthcare that we all pay for. The system would, ideally, be a reverse version of this:
Image thanks to
More on my thoughts on this new co-op compromise tomorrow.
"...premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility."So, whereas 0% of German children suffer without healthcare, 11% of US children were uninsured at some point in 2007. I spent a little bit of time last week leaving comments in conservative territory, and I can pretty much ventriloquize what they'd say about the statistic above: forget them, they're illegal fucking beaners (this is really how they talk on their own blogs, although some do use rudimentary code language -- I'll spare you a link to the sites themselves). And although I think the 'fuck beaners' crowd is just a slim little minority in the US today, can the rest of us honestly say as a group that we consider our children to be 'national treasures'? The far right has the advantage of ignorance and race hate -- operating under the assumption that all uninsured children are of other, detested groups (although wrongly -- 7% of white children were uninsured last year), they have deluded themselves into thinking that no child they care about is going without yearly checkups, or worse, without lifesaving care. The rest of us don't really have those illusions to excuse inaction.
But they speak up -- the same tired, racist fears that poor or illegal immigrant children will steal health care from our embattled system -- and we stay silent, and we never remind anyone that there are sick little kids out there, and we never make the argument that it is always a good thing to give health care to any child, and that treating children who are placed into the system under false pretenses is the right thing to do, especially when it allows us to offer care for all American children.
Every stingy measure we pass to exclude certain children from public health care -- tests of citizenship, proof of parental income -- creates paperwork and increases the likelihood that some children won't make it through the process of getting covered. The humanitarian -- hell, the human system -- is that anyone under 4' gets free healthcare that we all pay for. The system would, ideally, be a reverse version of this:
Image thanks to
More on my thoughts on this new co-op compromise tomorrow.
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