Insurance Companies

Insurance Industry Plays The Victim, Admits To Rationing Care For Profit

Brian Dockstader — Fri, 28 Aug 2009 12:08:42 -0400

♫No one knows what it's like
      To be the bad man
      To be the sad man
      Behind blue eyes

      No one knows what it's like
      To be hated
      To be fated
      To telling only lies

The New York Times ran an article this morning that has been sparking some commentary in the blogosphere. In a piece that was essentially The Who's "Behind Blue Eyes" put to paper, we were presented with a sad tale of how we should feel sorry for the insurance industry, who are, in fact, the real victims of the health care debate.

I, for one, was wondering when someone would have the courage to stand up for the little guy, the Stephen Hemsley's of the world.

Most reactions to this piece focused less on the overall theme of playing the victim and more on the admission contained therein (emphasis mine):

"I believe we're getting the pushback because we are standing up for what we believe in," said Cheryl Tidwell, 45, Humana's director of commercial sales training. "We believe there's a better way to control costs by controlling utilization and getting people involved in their health care."

Now we know they aren't talking about controlling costs to the customer, since health insurance premiums have skyrocketed far above the pace of inflation, the vast majority of personal bankruptcies in this country now come as a result of medical costs, and since it isn't unheard of for an insurance company CEO to pull in $819,363 every single day of the year, or to be sitting on over $744 million in stock options, or to retire with a $73 million golden parachute. The insurance industry also spares no expense in throwing hundreds of millions of dollars into their lobbying blitzkrieg against health insurance reform. Suffice to say, these "savings" aren't being passed on to consumers.

So they are controlling their costs, to maximize their profit. And how do they admit to controlling costs? By "controlling utilization". What does that mean exactly? Well we know what "control" means. It means they, the insurance company, makes decisions. It means the insurance company has the power, all the control.

So what about "utilization"? The utilization of what exactly? Well there are two types of "utilization" that the insurance industry likes to control, because controlling them just so happens to keep their costs down, and their profits plump:

Insurance Utilization: This is the type of "utilization barrier" that effects nearly 50 million Americans. The premise is that if you can't afford to give the insurance industry their pound of flesh, or if you are sick enough that the insurance industry doesn't make a big enough profit in treating you, you don't get insurance, period. This keeps their costs down. Your costs? Who cares? All that matters is that insurance companies don't have to let you "utilize" their product--health insurance.

Treatment Utilization: You can't go to this hospital, you have to go to this one in your "network". You can't get this treatment because it isn't listed on the approved list from your insurance company. Woah, you are really sick, are you sure you never had headaches before? Ever? Do any of those sound familiar? This is where the insurance industry controls which treatments you get to utilize, if any at all, based on their cost-benefit analysis. If it doesn't benefit their bottom line, they don't sign on the dotted line. And then you don't get your treatment. By controlling the "utilization" of treatment, they are making all the decisions. And they are right, it does keep costs down: their costs. (Oh, did I mention that the CEO of insurance industry giant CIGNA "earned" over $120 million in compensation in the last five years alone?)

So that, in a nutshell, is what the euphemism "controlling utilization" actually means. And they control utilization constantly. Millions of Americans are denied coverage for specific illnesses or treatments every year, and millions more are denied any coverage at all.

The funny part is that when these very same people make up horror stories about what will supposedly happen if we even get the option of choosing public health insurance, they call this exact same thing RATIONING.

Get it? When the private insurance industry refuses to cover you, or makes decisions about what treatments they will and will not allow you to receive, that is called "controlling utilization" (and that happens in the real world, every day). Yet when the government will supposedly pull the plug on grandma, even though she is already on (and would continue to be on) Medicare, and is most certainly not being forced into death now nor would she ever be, that is called rationing care (and socialism, Nazi eugenics, death panels, and I'm sure about every other thing liars can dream up to spoon-feed gullible people--oh, and this rationing is only happening in fantasy land).

So that was the little gem buried in the NYT puff piece about what a hard knock life it is for the insurance industry--they admitted that they ration care, right now, and have been for as long as they've been doing business.

But perhaps my favorite part of the column is where they really get out the violins for employees of these insurance companies, to get us to see that they aren't monsters, or in their words, "We are human beings, too." It is really fit to be in the Merchant of Venice (daydream sequence begin):

Hath not a[n insurance industry employee] eyes? Hath not a[n insurance industry employee] hands, organs, dimensions, senses, affections, passions; fed with the same food, hurt with the same weapons, subject to the same diseases, heal'd by the same means, warm'd and cool'd by the same winter and summer as a [human] is? If you prick us, do we not bleed? If you tickle us, do we not laugh? If you poison us, do we not die? And if you wrong us, shall we not revenge? If we are like you in the rest, we will resemble you in that.

*Tear* Beautiful. I hope they do a remake of Evita next.

But of course this is all a straw man, because this anger at insurance industry greed isn't directed at the employees of these mega corporations, who are by all accounts just trying to make a living by doing what they are told. They are, after all, just doing their jobs. It isn't their fault that their job is to decline people coverage to save the company money. That is the one and only goal of a corporation, is it not? They are accountable to their investors, their shareholders, and no one else.

That is the bottom line--The corporation is a beast designed for a single purpose: to make profit and make people (investors) rich. And these employees, the ones being humanized so beautifully in this NYT column, are just cogs in the wheel, and if they refused to do it some other person (faceless bureaucrat, to use the hypocritical language of the conservatives) would fill their spot in an instant. And to their credit, many former employees of the insurance industry, haunted by the things there were made to do in the name of profit, have come forward and spoken out against insurance industry practices, like Dr. Linda Peeno in this ad from American's United for Change:

So no, it isn't about the little people, it is about the entire beast. Has anyone suggested that these people, the employees themselves, are evil? Do reformists think that these people, or even the executives in charge, get up in the morning with the goal of killing people and ruining lives? Of course not. They do what they do best: maximize profit, at all costs. The human lives destroyed are just collateral damage. Some of them, mostly those at the very top, are very much okay with this, and defend it vigorously. Others are haunted and find that they can't bring themselves to keep doing it.

This isn't about them, it is about an industry that is indeed evil, if not in intention, undeniably in effect. Just because a corporation is made up of people, are we not allowed to blame the whole?

That is the funny thing about the concept of "corporate personhood"-- corporations have long fought to enjoy all the rights and benefits of being treated as a living, breathing person, but without any of the costs, like mortality, and now, apparently, blame.

The Private Health Insurance Industry is Killing the U.S. Economy

OurFuture.org Staff — Tue, 28 Apr 2009 16:04:45 -0400

Fifteen years ago the private health insurance industry told Congress and the nation that it could fix the health care mess if government got out of the way. The insurers said that they would control costs for American families and businesses and improve the quality of care. The American people, American business and the Congress aren't about to buy that line again.

The result of leaving health care reform to the insurance industry is that health insurance premiums have gone up six times faster than wages in the past nine years. Those dollars are buying skimpier health coverage with high deductibles and caps on benefits, resulting in more and more insured people being forced into medical bankruptcy. Businesses that are struggling to meet health care costs in a global economy and dropping coverage, so much so that now one out of three Americans under the age of 65 has been uninsured at some time in the past two years. Health care eats up 16 percent of our economy, up from 11 percent when the nation decided to leave the private insurance in charge.

The insurance industry and their defenders on the ideological right are resorting to the same tired name-calling that worked for them in the past: "government-run" health care. It's a desperate attempt to fend off a sensible government role in making health care affordable to our families, businesses and nation. This time it won't work. The President and leadership in Congress—and the American people—support a two-pronged role for government. One, set rules so that the private insurance industry can't continue to put profits before our health. Two, offer a choice of private insurance or a public health insurance plan, so people aren't stuck only with private insurance.

The fact is that if private insurers controlled health care inflation as well as Medicare has over the past decade, businesses and families would see much lower premiums than they do today. Between 1997 and 2006, per enrollee spending in private insurance grew 59 percent faster than spending in Medicare. And Medicare has the tougher job, because it cares for the most expensive population: the elderly and those with serious disabilities.

One reason that private insurers have gotten away with skyrocketing premium increases is that they have a near monopoly across the nation. According to data from the American Medical Association, in virtually every metropolitan area in the country (96 percent) the insurance market is dominated by so few insurers so as to be considered "highly-concentrated." A public health insurance option coupled with a regulated private insurance market will break the stranglehold a handful of companies have on the insurance market. Most importantly, under these reforms consumers will be able to vote with their feet when their health care plan—public or private—doesn't work for them.

In fact, the main argument that the industry and the right has with offering the choice of a public health insurance option is that too many Americans will choose it. If private insurers are really more efficient than government, they shouldn't have any trouble competing with a public health insurance plan. It's the height of irony that the defenders of free markets are opposed to competition. But when it comes to health care, which is a public good, public insurers really are more efficient.

There is broad agreement that America's health care system does not deliver the value we need. Today, private insurers have little incentive to develop sophisticated disease management programs, since such programs may attract sicker patients into their plan. And when care improvements are achieved, private plans have no incentive to share best practices with industry competitors. A new public health insurance plan would create a mechanism for the development of innovative and transparent payment mechanisms, the expansion of quality incentives, and the adoption of evidence-based protocols. As the Veterans Health Administration and Medicare have proven capable of doing, a new public health insurance program could lead the way in advancing electronic medical records, creating incentives for greater integration of delivery systems, and establishing improved measures of quality.

The American public gets it. In a national survey of voters taken last year, four-out-of-five voters (79 percent) said that the insurance industry puts profits before people. A Kaiser Family Foundation poll released this week found that two-thirds (67 percent) of U.S. residents "strongly" or "somewhat" favor establishing a public health insurance option "similar to Medicare."

Polling by Lake Research Partners this January found that the public believes that the choice of a public health insurance option will lower costs, improve quality, and increase competition. The poll paired the strongest conservative attacks—"rationing", "government bureaucracy", losing private health insurance and being dumped into a public plan—against the arguments for the choice of a public health insurance plan. In every case the public favors the pro-public health insurance option, in most cases by margins of better than two-to-one. For example, 61 percent agree that a public health insurance plan will be better able to control costs by using its purchasing power to drive competition. Voters reject by wide margins claims that a public health insurance plan will limit access, with 66 percent of voters agreeing that a public health insurance plan will provide an affordable option with a wide choice of doctors.

The question before Congress is whether it will follow the will of the American people. Or, instead, bow to the private insurance industry and other interests that stand to lose if reforms are passed to really make health care more affordable. The president and congressional leadership share a strong commitment to reforms that will guarantee good, affordable coverage for all, with a choice of private or public health insurance. We know opponents will use scare tactics across the country and a huge corporate lobbying presence inside the Beltway to block reform. Progressive leaders in Congress and Health Care for America Now will be working hard to keep the American public engaged in this fight over the next months. Our success will be the hallmark of a new era in American politics in which the public good is put ahead of corporate excess and greed.

Rep. Jan Schakowsky is an Illinois Democrat representing the state's 9th District. Richard Kirsch is the national campaign manager for Health Care for America NOW! This article originally appeared in The Huffington Post.

NEW VIDEO CALLS HEALTH INSURANCE INDUSTRY’S BLUFF

Toby Chaudhuri — Mon, 04 Aug 2008 00:00:00 -0400

WASHINGTON – The health care industry is blatantly failing to deliver on its promise to listen to people’s ideas about how to create high-quality care for every American, according to a new Internet video produced by the Campaign for America’s Future for a coalition of hundreds of groups working to fix our nation’s broken health care system.

As part of the insurance industry’s new “listening tour,” the industry-funded Coalition for An American Health Care Solution launched a hotline for individuals to share ideas about how to improve and expand the health care system. Unfortunately, calls to the hotline go straight to an answering machine. In response, the Internet video asks, “What else would you expect from the health care industry?”

The video was produced for the Health Care for America Now coalition, which was launched last month. Between now and Election Day, the groups plans to spend $25 million in paid media and have 100 organizers in 45 states.

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**NOTE: To view the Internet video, please visit http://tinyurl.com/6o6fep.**

“CALLING THEIR BLUFF”
Internet Video - 50 sec.

ONSCREEN: The health insurance companies say they want to hear from you… They’ve even launched a hotline for you to share your input… Call now! 1-800-289-1136. They say they want to listen to your thoughts on health care. [Dial tone, phone dials number.] Oh Really?

MESSAGE MACHINE: Thank you for calling the Coalition for an American Health Care Solution. No one is available to take your call right now, so please leave your name phone number and a short message.

CALLER: Hey, this is Bob from Detroit. This is the fifth time I’ve called you today. I’ve heard you’ve started some listening tour. But if you really want to listen, pick up the phone.

ONSCREEN: What else would you expect from the health care industry? Fight Back. HealthCareForAmericaNow.org Produced by Campaign for America’s Future.

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