Health Care's Private Bureaucrats

Republicans like House Minority Leader John Boehner continually inject fear-mongering into the health care debate by saying the current reform bill would “put bureaucrats in charge of medical decisions rather than patients and doctors.”

If the idea of a middle-man getting in the way of you and your doctor scares you, you should be very afraid of the way private health insurance works today.

Private health insurance is a business, and businesses make profits by cutting costs. When you have a chronic illness, you are a big cost on the balance sheet of your insurance provider.

Meet chronic-cost and general-drag-on-company-profits Maureen Kurtek:

Kurtek was denied a medically necessary treatment, one that her doctors had given her six times previously, for 53 days while her new insurance company’s “bureaucrats” determined whether she should get it or not. In the meantime, the delay brought her to the brink of death, and her health and quality of life were damaged forever.

Industry whistleblower Wendell Potter testified in front of the Senate Committee on Commerce, Science and Transportation about how endemic this denial of care is within the industry.

Companies will use a tactic called rescission, where they find loopholes within your policy to deny care and take away your coverage right when you need it the most, or suddenly jack up premiums to “purge” you from the plan. An investigation by the Energy and Commerce committee found that three insurers “canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.”

Aetna even spent $20 million in premiums to create a high-tech computer system dedicated to cutting the sickest and costliest from the rolls.

There is no use in asking or expecting the insurance companies to play nicer. They are under tremendous pressure from Wall Street investors to keep their costs at specific rates, or else quarterly projections go sour and stock prices tumble.

Right now there is a middle-man standing between patients and doctors, and that middle-man has billions in profits to worry about along with the well-being of any one patient.

Congress has to set new rules for the industry. The America’s Affordable Health Choices Act would end the deadly practice of rescissions and establish new consumer protections against abusive insurance practices. There will also be a clear, guaranteed list of benefits.

This health care debate is not just about the 47 million (and growing) Americans without health insurance. It’s about insurance actually meaning something, and getting the care you paid to make sure would be there for you.

Views expressed on this page are those of the authors and not necessarily those of Campaign for America's Future or Institute for America's Future