The best healthcare in the world

 

Meet six-year-old Madison Leuchtmann. Madison was born with bilateral artesia, meaning she was born without ear canals. She needs a hearing implant in order to recognize sounds. Without it, she could lose her hearing.

Madison's family has health insurance, but their insurer, Cigna, refuses to cover the $20,000 cost of the implant. The company claims that the device is not medically necessary. Madison's pediatrician, Dr. Randall Clary, disagrees, saying, “This is obviously medically necessary. You have a child that has no ear canals!”

In addition, as reported by Think Progress, Cigna said in a written statement to the local news station Fox 2, “It is not unusual for commercial benefit plans to exclude hearing assisted devices.” Get it? There's nothing unusual about this situation. This is standard operating procedure.

But there is a silver lining in this horrible mess: At least it's an employee of a for-profit health insurance company -- and not a government bureaucrat -- coming between this six-year-old girl and her doctor.

It seems that if you need to use your health insurance, having health insurance is not much different than not having it. And remember, Cigna is doing this while the nation's attention is focused on the for-profit health insurance industry, and while legislation that could put them out of business is being crafted in Congress.

Imagine what Cigna and other for-profit insurance companies will do when no one is looking.

Why do we always have to shame these amoral scumfucks into doing the right thing? That this is a necessary and oft-repeated step in the process of getting healthcare is evidence that the for-profit health insurance system Just. Doesn't. Work.

Just a reminder

Of what kind of amoral, thieving shitbags we are up against in the healthcare fight.

This committee has concluded an investigation into the practice of health insurance rescission, and results are alarming. Over the past five years, almost 20,000 individuals, insurance policyholders have had their policies rescinded by three insurance companies who will testify today; Assurant, UnitedHealth Group, and WellPoint.

From a review of case files, the committee has identified a variety of abuses by insurance companies, including conducting investigation with an eye toward rescission in every case in which a policyholder submits a claim relating to leukemia, breast cancer, or any of a list of 1,400 serious or costly medical conditions. Rescinding policies based on alleged failure to disclose a health condition entirely unrelated to the policyholder's current medical problem.

Rescinding policies based on policyholders' failure to disclose a medical condition that their doctors never told them about. Rescinding policies based on innocent mistakes by policyholders in their applications. And rescinding coverage for all families for -- excuse me, rescinding coverage for all members of a family based on a failure to disclose medical condition of one family member.

The investigation has also found that at least one insurance company, WellPoint, evaluated employee performance based in part on the amount of money its employees saved the company through retroactive rescissions of health insurance policies. According to documents obtained by the committee, one WellPoint official was awarded a perfect score of five for exceptional performance based on having saved the company nearly $10 million through rescissions.

These practices reveal that when an insurance company receives a claim for an expensive, life-saving treatment, some of them will look for a way, any way, to avoid having to pay for it. This is eerily similar to what we found last year in our investigation of long term care health insurance policies where unscrupulous sales people would sell policies to seniors, then change or revoke the policies once the enrollee was locked into a plan and making payments.

The companies who engage in these rescission practices argue that they are entirely legal, and to an extent they are. But that goes against the whole point of insurance. When times are good, the insurance company is happy to sign you up and take your money in the form of premiums. But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitment and stand with you in your time of need.

Instead, some of these companies use a technicality to justify breaking its promise, at a time when patients are too weak to fight back.

Some people offer firsthand accounts of their dealings with their insurance companies:

In its rescission letter, Blue Cross said it would have never accepted me for coverage if it had known that I had polycystic ovaries. This letter was the first time I had ever heard about this condition.

I later learned that polycystic ovaries, or PCOS, as it is known, is a diagnosis of exclusion and very difficult to prove. Doctors often proceed on suspicions of a person having it without actually having proven it.

This is what happened in my case. My doctor suspected I might have PCOS, wrote it down in her notes, then told me she was prescribing glucophage for weight management. I never knew what she wrote down in her notes because she never told me.

After I was rescinded, I had two of my doctors write letters to Blue Cross telling them this, but they didn't care. They just wrote back that they were upholding their decision to rescind.

After being rescinded, I showed my original application to my sister and her husband, both radiologists, to ask them what I could have possibly done wrong in filling out the application. They felt that the application was worded in such a way as to be purposefully confusing and that it asked the same question in multiple ways to trip people up. I'm a college graduate, and no dummy, and I still couldn't make sense of Blue Cross' tricky application.

The worst part about my rescission is that I have been unable to get insurance anywhere else. I applied for individual insurance through Blue Shield. But on their application, they ask if the applicant has ever had insurance rescinded. When they learned that I had, they informed me that they would not accept me for coverage.

Every insurance company asks if you've ever had health care coverage rescinded. For the rest of my life I will never be able to get individual coverage again because of Blue Cross.

And

Can you imagine having to walk around with cancer growing in your body with no insurance? It's the most terrible thing in the world to not have anybody to turn to, not have anywhere to go. So I just can't even say how bad it was.

The sad thing is Blue Cross and Blue Shield took my high premiums the very first time I ever had a claim, the very first time, and was suspected of cancer. They took action against me searching high and low. They turned over every single thing they could in my medical history to pull out anything that would cause any suspicion on me, so they didn't have to pay for my cancer.

Contact your representatives and tell them you aren't going to accept snake oil disguised as meaningful healthcare reform.

Self explanatory

Exactly whom do you represent, Mr. President?

From the Houston Chronicle's Nick Anderson, by way of Crooks & Liars.

Domestic violence

In the world of for-profit health insurance, it's a pre-existing condition.

Under the cold logic of the insurance industry, it makes perfect sense: If you are in a marriage with someone who has beaten you in the past, you're more likely to get beaten again than the average person and are therefore more expensive to insure.

And if you're married to someone who has sex with you, you're more likely to become pregnant than the average person, so pregnancy can be considered a pre-existing condition. And if you have a job that sometimes involves danger or hazards, you're more likely than the average person to be injured at work, so your job can be considered a pre-existing condition. And if your lifestyle involves playing sports or riding a bicycle, you're more likely to be injured than the average person, so physical activity can be considered a pre-existing condition. And if you walk down the street, you are more likely to be struck by a car or trip on uneven sidewalk, so walking can be considered a pre-existing condition.

With no government oversight, these amoral, thieving pricks can call anything they want a pre-existing condition, and nobody is going to stop them. And if you do get sick or injured and somehow manage not to have your case classified as a pre-existing condition, they can simply cancel your policy. It's called recission, and it happens every day, usually right after somebody has the nerve to get sick and rack up some serious medical bills.

And, if you're like most people and find the fact that health insurance companies consider domestic violence a pre-existing condition particularly reprehensible, you might be interested in knowing who helped them with this particular cost-saving measure:

In 2006, Democrats tried to end the practice. An amendment introduced by Sen. Patty Murray (D-Wash.), now a member of leadership, split the Health Education Labor & Pensions Committee 10-10. The tie meant that the measure failed.

All ten no votes were Republicans, including Sen. Mike Enzi (R-Wyoming), a member of the "Gang of Six" on the Finance Committee who are hashing out a bipartisan bill. A spokesman for Enzi didn't immediately return a call from Huffington Post.

I think it would be appropriate at this time to stop pointing out which state congresspeople pretend to represent when it's getting clearer every day that they only represent the interests of their largest donors (I doubt very much that the people of Wyoming think it's a good idea to allow health insurers to consider domestic violence a pre-existing condition). Perhaps Sen. Mike Enzi (R-United Healthcare) would be more accurate. It certainly would explain their positions and votes better.

Meanwhile

While Washington conspires with lobbyists to deprive the American people of meaningful healthcare reform ...

The Census Bureau reports that the number of people lacking health insurance rose to 46.3 million in 2008.

That's up from 45.7 million in 2007, due to a continuing erosion of employer-provided insurance. Still, the level remained just below the peak of 47 million who were uninsured in 2006, because of the growth of government insurance programs such as Medicaid for the poor.

The nation's poverty rate increased to 13.2 percent, up from the 12.5 percent in 2007. That meant there were 39.8 million people living in poverty. It was the highest rate since 1997.

Is it any wonder that the insurance industry is pushing so hard for a mandate?

Blue dogs

Seeing a lot of green.

As the Obama administration and Democrats wrangled over the timing, shape and cost of health care overhaul efforts during the first half of the year, more than half the $1.1 million in campaign contributions the Democratic Party's Blue Dog Coalition received came from the pharmaceutical, health care and health insurance industries, according to watchdog organizations.

The amount outstrips contributions to other congressional political action committees during the same period, according to an analysis by the Center for Public Integrity, a nonprofit watchdog organization. The Blue Dogs, a group of fiscally conservative lawmakers, successfully delayed the vote on health care overhaul proposals until the fall.

"The business community realizes that (the Blue Dogs) are the linchpin and will become much more so as time goes on," former Mississippi congressman turned lobbyist Mike Parker told the organization's researchers.

On average, Blue Dog Democrats net $62,650 more from the health sector than other Democrats, while hospitals and nursing homes also favor them, giving, respectively, $5,680 and $5,550 more, according to the Center for Responsive Politics , a nonprofit organization that tracks the influence of money in politics.

The contributions came at a time when health care and pharmaceutical companies were mounting a campaign against a government-run public health insurance option, fearing cost controls and an impact on business. The Blue Dogs' windfall also came at a time when the 52-member coalition flexed its muscle with both the White House and the Democratic leadership in the House of Representatives as an increasingly influential bloc in the health care overhaul debate.

At the same time, many Blue Dogs were also rubbing shoulders with health care and insurance industry executives and their lobbyists at fundraising breakfasts and cocktail receptions that cost upward of $1,000 a plate, according to public information compiled by the nonprofit Sunlight Foundation, which advocates greater government transparency. Since 2008, more than half the Blue Dogs have either attended health care industry fundraising receptions or similar functions co-sponsored by lobbyists representing the health care and insurance industries.

In June, as Rep. Mike Ross, D- Ark., who heads the coalition's task force on health care, publicly expressed the Blue Dogs' misgivings about the Democratic leadership's efforts, the former pharmacy owner was feted at a series of health care industry receptions. Ross has received nearly $1 million in campaign contributions from the insurance and health care industries over his five-term career, according to the Center for Responsive Politics. Calls to Ross' office weren't returned.

And we are supposed to believe that blue dogs are fighting the meaningful healthcare reform that so many Americans need so badly based on some selfless, genuine concern about costs. I guess the fact that they are protecting the interests and profits of health industries at the exact same time they are receiving piles of money from those industries is just a coincidence.

It appears the only costs they are concerned about are the costs of their next campaign.

Politicians putting self-interest ahead of the national interest. Who'da thunk it?

Obstruction

Republicans are slowing work on the healthcare bill in the Senate HELP committee by objecting to their own amendments.

An insider speaks

On Bill Moyers Journal, Wendell Potter, former head of corporate communications for CIGNA, spells out exactly what the for-profit healthcare industry is up to. HINT: It has to do with protecting their profits at the expense of our health.





Click here to read the transcript.

Reach out

Have you contacted the White House and told the president not to cave on healthcare reform today?

The argument against universal healthcare

summed up nicely.

H/t Susie, from whom I totally stole this.

Quote of the day

Well, duh.

“It seems that Pfizer’s No. 1 priority is to sell lots of Lipitor, by whatever means necessary, including misleading the American people.” — John Dingell, D-Mich.

Hey, at least he isn’t hassling the NFL over bullshit at the behest of his biggest campaign donors, like some people.