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.

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:

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.

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.

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:

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.

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.

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.

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.