« The Commander-in-Chief in His Labyrinth | Main | Trust but Verify »

April 22, 2010

Comments

Well it serves them right for not filling out their insurance application correctly, and not reading the contract from front to back and consulting their attorney on any matters they didn't understand and/or required legal expertise, and not reading each amendment to the contract that the company issued from front to back and consulting their attorney on any matters they didn't understand and/or required legal expertise, and not disclosing that their third-cousin on their mother's side once thought she had breast cancer but turned out to only be heartburn but how does Wellpoint know for sure, and also for not disclosing that they were going to get breast cancer in advance.

In fact I believe these women should count themselves lucky that Wellpoint didn't charge them for the costs of canceling their policies, including overhead, interest, R&D and production on the software algorithm, eletricity for the computers to run the sofware algorithm, and the bonus for the electrical engineers that wrote the algorithm in the first place (Hey Jim, what are you working on? Oh, Code that picks out all the insureds who file a claim for breast cancer and then cancels their policy with us. Keep up the good work!).

Because all those Republicans had a goal to protect recission.....

Actually the worst kind of snark, but perfectly stated as the way that healthcare reform is immediately, permanently protected from much, if any, improvement. Any change will be greeted with this kind of lie, as bad as any death panel lie.

Marty, what was the Republican plan to outlaw rescission?

Remind me.

Also, if it was there goal, why didn't they use any of Bush's 8 years to go for it. Especially when they also controlled both houses.

Remind me.

Actually the worst kind of snark, but perfectly stated as the way that healthcare reform is immediately, permanently protected from much, if any, improvement.

Some actual, real-life Republicans have been running on repealing the bill. And then "starting over", but so far I've not seen a explanation of that other than:
1)use the free market!
2)chickens!

Now, some other Republicans have (more quietly) suggested improvements. Caveat, so far the improvement Ive seen mentioned most often is repealing the individual mandate (ie breaking the entire premise of the bill), so Im not sure Id call it an improvement per se. At least they're talking.

But let's not confuse the latter group with the former. Some people are calling for a repeal of the entire bill, not just modifying it and keeping what they consider to be the good parts. This would allow rescission to occur as they did before the bill was passed. That is not snark, and it certainly is not a lie.

Marty: but perfectly stated as the way that healthcare reform is immediately, permanently protected from much, if any, improvement.

Not at all, Marty. The chief improvement your present healthcare system needs is the introduction of a public option, free for all to buy who wish.

Republicans who wish to go one better than Obama and improve his healthcare bill by introducing that option, will of course find that their largest donors tend to dry up... "WellPoint Inc has been the second-biggest PAC donor so far, with $796,000. Though it has distributed money to both Republicans and Democrats, its spending has tilted in favor of the GOP The group has given $23,000 to three Republican party groups, and $11,000 to three Democratic party groups. WellPoint has reported spending $730,000 in lobbying efforts during the first half of the year on bills related to several insurance bills"

And in an oligarchy, what is the point of a corporate citizen spending all that money if it can't buy the healthcare system it needs? Who cares about these individual cancer patients? Are they big donors? Why, one of them is living on food stamps - and they expect their needs to be catered for by their government over the needs of Wellpoint? Where do they think they're living - the UK?

When I hear the claim "Most Americans are happy with their health care coverage", I think of stories like these. And they say I, as a foreigner, am not entitled to speak about a system I haven't tried.

I say they haven't tried it either, unless they are in that minority who have actually come to need significant health insurance (more than a savings fund could have given them).

Marty, what was the Republican plan to outlaw rescission?

Remind me.

This?

A health insurance issuer may nonrenew or discontinue health insurance coverage of an individual in the individual market based only on one or more of the following: [...] (2) Fraud The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage, including intentional concealment of material facts regarding a health condition related to the condition for which coverage is being claimed.

(Length and breadth of "changes" to laws addressing rescission in the widely-lauded GOP "alternate plan" from last year in bold italics.)

I for one find such Republican efforts entirely consistent with a steadfast opposition to rescission, and nothing resembling an effort to protect it.

*cough*

When I saw the headline, I assumed you were going to write about Sue Lowden's pay-your-doctor-with-chickens health plan.

Apparently the advantages of a cash economy (and many disadvantages of barter) have completely escaped candidate Lowden. I also assume she has given no thought to the ratio of chickens per MRI or chemotherapy treatment.

I say they haven't tried it either, unless they are in that minority who have actually come to need significant health insurance (more than a savings fund could have given them).

I think that's about right. The best way of understanding it is to think of them as health care marketing organizations. They make money by attracting patients, not by treating them. So health care plans concentrate on things that seem patient friendly, like providing a wide choice of doctors and the latest high tech medical gadgets. They also have to provide good day to day care, because most people use that and will notice if it's bad. But they have little incentive to provide great care for rare but expensive illnesses; they only have to do well enough to avoid bad PR.

Also, so long as so many Americans are willing to regurgitate as an unquestioned and uncontested statement entirely meaningless but very patriotic claims about how the US's rotten, stinking health care system is better than anywhere else, that's really all their marketing departments need.

And they say I, as a foreigner, am not entitled to speak about a system I haven't tried.

Why not? We speak about other countries' systems all the time.

But they have little incentive to provide great care for rare but expensive illnesses

Breast Cancer is rare-but-expensive?

elm: it was an allusion to Lowden

There's a parallel situation developing with homeowners' insurance. Granted, it's not as evil as screwing over sick people who paid their premiums for years, but the result is people who suddenly find their homes worthless for stupid reasons.

Take me, for example. I live in a structure that meets code and is structurally sound. Yet, because I live on the edge of an earthquake zone (and who doesn't?) and the insurance carrier suddenly decided not to cover pole foundations, I suddenly found that after years of giving them money my insurer wouldn't cover my home.

And neither would any other insurer.

My inclination was to just go without insurance but my husband finally got us insured through Lloyds.

People with water views are being bullied by insurers to pay for unnecessary, expensive and bad-for-the-environment bulkheads. People in tornado areas are getting dropped by their carriers and finding that they can't get new insurance.

If you think the point of isurance is to provide the customer with help when it is needed in exchange for paying years of premiums when the help not needed, then you are wrong. The point of insurance is to provide the executives with big salaries now and the hell with the customer.

Wonkie,

The point of property-casualty insurance is to provide coverage for certain losses, in exchange for premiums that allow the insurer to profit (typically by investing the premiums, IIUC) and be able to pay claims. It's a contract.

Sadly, it tends to be a very long convoluted contract that hardly anybody reads and fewer understand. The reason for that is that basically since the inception of insurance, people have been fighting over what the contracts really mean. There is an absolute TON of insurance coverage litigation out there (and it's mostly state-level, meaning on any given issue it's possible to have multiple interpretations by various state courts), arguing over what each and every clause in the policy means. I work in a certain subset of complex claims. In my job, I've reviewed policies from the 1950s-present. The 50s policies are a few pages long, reasonably simple, and don't have a long list of defined terms. The current ones? They're huge, complicated and have lengthy definitions sections. Why? Clarity and simplicity are in tension. "Plain English" is a disaster when it comes to a contract. And this is why you basically have to be a lawyer or an experienced insurance person to properly interpret the policies. It sucks, but it's that way for a reason. And I've no idea how to fix it.

An insurer absolutely has to charge enough such that they will have sufficient reserves available when "the big one" hits. Or, in some cases, they simply decide that X is not something they can profitably cover (nuclear power plants, pollution, etc). At that point, the government can step up and either: a) provide the insurance (flood, spill fund); or b) via regulation/statute, require insurers to cover X (well, there is also c - rewrite insurance policies via judicial fiat, which happens often).

That said, yeah, our CEO made like 20 mil last year. More relevant, I would think, is the industry's profit margin as a whole. I don't know what that is - for all I know, it's really high...

On the OP itself - recission should be very, very rare. Only in the case of MATERIAL misrepresentation, really. The burden should be fully on the insurer to prove that the insured did something nefarious. Can't prove it? Can't cancel the policy, sorry.

It is clear to me, thanks to many articles I've read online, that recission in the health insurance industry was out of control. An algorithm that ordered automatic fraud investigations if you get sick? Awful. The clear intent is to avoid paying a covered claim. I am glad that such things are coming to an end.

Thanks for the comments Rob, but I think the situation for me in my neighbors is pretty simple. Our insurer just announced that they no longer wanted us as customers. No one else wanted us either. We never filed a claim of any sort. We weren't booted off for some obscure clause that we could have known about. Our neighbors with the 40,000. bulkhead that they had to buy to get insurance were in the same boat: their insurer didn't want their business because of the very remote possiblity that a hundred years from now erosion will get at their foundation. It didn't matter that a geologist said that their house was safe for as long as the house itself can be expected to last.

I don't know what the solution is. I just site this as an example of how the profit motive doesn't necessarily lead to a good product. maybe there isn't enough competition between insurers.

Iirc some years ago credit card companies tried to shed customers that behaved too responsibly and thus were not profitable enough. My father also had informal discussions with bank employees that told him that people like he were loathed by the bankers for not buying the heavily advertised products (that the bank profits off) but those that made most economic sense for him.

They can't even get a nude negro law passed, but they pass this health care garbage. Unbelievable.

The comments to this entry are closed.

Blog powered by Typepad