Obama's False Friends of Health Reform
I'm hoping President Obama realizes that some of the folks who've been currying favor with him are not, as they claim, bringing "solutions" to the health care reform table. Most Americans -- especially those who voted for him -- want nothing to do with the kind of "reforms" they are peddling.
If you watched the president's televised Q&A on ABC last Wednesday night, you probably noticed that one of the people in the audience was Ron Williams, the chairman and CEO of Aetna, Inc., the nation's third largest health insurer, and currently one of the most profitable. But there are a few things that you should know about Williams.
Back in the '90s, Aetna set out on an acquisition binge in its quest to become the biggest health insurer in the country. It got there by the end of the decade after spending billion of dollars for several competitors. By 1999 it had 21 million health plan members, the most any insurer had ever had at the time.
But, as often happens after buying sprees, Aetna soon came down with a bad case of buyers' remorse. As it turned out, some of the customers it had paid top price for were not as profitable as Wall Street analysts and the big institutional investors who owned most of Aetna's stock expected. When they took a closer look at what Aetna had bought, investors started deserting the company in droves. As a result, the company found its stock price in a free fall.
As the Wall Street Journal reported on August 13, 2004, Aetna's pretax profits as a percentage of revenues began falling dramatically after peaking at about 12 percent in 1998. By 2001 the company was a basket case as far as Wall Street was concerned. It had to do something, and fast.
Probably the most important thing it did to turn itself around was recruit Williams from rival WellPoint, the ambitious for-profit company that was gobbling up Blue Cross and Blue Shield plans from coast to coast.
As the Journal reported, Williams promptly ordered a $20 million revamp of Aetna's data systems. Health care analyst Joshua Raskin told the Journal that the new system that emerged from that investment, which Aetna dubbed the Executive Management Information System (EMIS for short), was "the single largest driver of the Aetna turnaround." Why? Because it helped Aetna "identify and dump unprofitable corporate accounts." How did it do the dumping? By jacking up premiums to unaffordable levels.
By the time the dumping -- or purging, as it is frequently called in the industry -- was done, Aetna had shed eight million of its 21 million members. It shrank so much that by the time it emerged from the Ron Williams-led turnaround, it had fewer members than when the company started out on its multi-billion dollar buying binge.
While Aetna was shedding those eight million men, women and children, by the way, it also reportedly shed 15,000 of its employees. Wall Street likes it when insurers dump employees, too, because the workers who don't get the ax have to assume the responsibilities of their laid-off colleagues. That theoretically boosts productivity, which Wall Street likes. And reducing the payroll leaves more money for profits.
The health insurance industry and its allies are working hard right now to convince you that the creation of a public insurance option would put a government bureaucrat between you and your doctor. As the 2004 Wall Street Journal article makes it clear, however, EMIS was at its heart a system that put corporate bureaucrats between people and their doctors. Here's what it saId:
Mr. Williams says EMIS helps him ferret out creeping costs so Aetna can react quickly. Sitting in his first-floor office in Hartford overlooking the Aetna parking lot, he taps on his keyboard to see whether some of the health insurer's members are visiting emergency rooms too much for nonemergency reasons, such as for the flu or a sprained ankle.
Did that send a chill up your spine like it did mine? And know this, if Aetna's CEO can keep an eye on your trips to the doctor, so can the CEOs of all the other big insurers.
The insurance industry claims that this time it really and truly supports legislation to reduce the number of people without insurance, that they've changed so much since 1994 -- when they said the same thing but did everything they could behind the scenes to kill reform -- that you can and should believe them now.
The next time you hear someone from the industry talking about how much they are committed to reform, remember that just a few years ago, the CEO of one of the biggest health insurers was the mastermind behind a business strategy that cost thousands of workers their jobs and millions of other people their insurance coverage. That's the real "solution" the industry is bringing to the table -- and the kind of reform Wall Street can really get behind.
Ron Williams has been richly rewarded by Aetna's board of directors for leading the company back to a level of profitability suitable to Wall Street. They tapped him to succeed Jack Rowe as CEO when Rowe retired in 2006. And they rewarded him with compensation totaling nearly $65 million over the past two years.
(Rowe, by the way, was paid $22.2 million in 2005, his last full year as CEO. He played a big role in hawking the high-deductible plans that Aetna and the other big insurers are now trying to push us all into. He claimed that Americans enrolled in managed care plans have been too sheltered from the real costs of health care and that we need to have more "skin in the game," by which he meant that we should have to pay a lot more out of our own pockets when we go to the doctor and pick up our prescriptions, even if we have health insurance. The median family income in the United States is just $50,000, which means that most of us already have a lot more skin in the game than Dr. Rowe and Ron Williams will ever need to.)
The insurance industry's two biggest lobbying groups -- America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association of America -- warned members of Congress in a joint letter a few days ago that the creation of a public insurance option would unravel the country's employer-based system.
As they say where I come from, that dog won't hunt.
It is the insurance company executives -- in their never-ending quest to meet Wall Street's profit expectations -- who are doing the unraveling by purging employers whose workers have the audacity to file claims when they get sick or injured.
A final point about Ron Williams: Not only are he and his fellow CEOs trying to kill the idea of a public health insurance option -- a central part of candidate Obama's health care proposal -- but he is the leading advocate of an idea Obama rejected and which differentiated his proposal from Hillary Clinton's -- the imposition on all of us of an "individual mandate." Many insurance executives were wary of such a mandate because they don't like the government mandating anything, especially those pesky state mandates that force them to include certain benefits in the policies they sell. Advocates of an individual mandate eventually brought the skeptics, including many of AHIP's board members, around to their way thinking by persuading them that insurers could make billions more in profits if every American had to buy an insurance policy from them. Now you know the real reason behind AHIP's shift from neutrality on the issue to full-fledged support. It's all about the money.
Wendell Potter is the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin.
Comments
Great One Sided Article
Wow.
"While Aetna was shedding those eight million men, women and children, by the way, it also reportedly shed 15,000 of its employees. Wall Street likes it when insurers dump employees, too, because the workers who don't get the ax have to assume the responsibilities of their laid-off colleagues."
-You fail to mention the men, women, and children quite likely got coverage elsewhere. You also fail to mention the 15,000 employees shed probably didn't retire. They got a job somewhere else(and health coverage). Who would have thought?
-Regarding Wall Street, you fail to mention that investors generally applaud ANY layoffs assuming the business is going in the right direction. Investors want the workers of a solar panel company to be more productive. I don't see how this is any different.
"he taps on his keyboard to see whether some of the health insurer's members are visiting emergency rooms too much for nonemergency reasons, such as for the flu or a sprained ankle"
-Is it wrong for the head of a life insurance company to sit tapping his keyboard hoping that 80% of his policy holders don't die? This is how insurance works. See link, http://en.wikipedia.org/wiki/Insurance .
What is wrong with a CEO getting paid millions of dollars? This person is the face of a company representing thousands of employees. Should he not be compensated for leading a company to generate billions in profits? Should the CEO of Caterpiller or Disney not be compensated for their work?
Just think of how many health insurance workers will be laid off if we go to socialized medicine. 15,000 workers will seem like nothing.
God Bless the USA
Great One Sided Article
I am never quite sure why heaping praise on predators and predatory behavior by industry types comes accompanied by the sign off: "God Bless the USA" . Should the majority of patients/citizens who are being fleeced by this industry (and likewise the credit card industry) feel ourselves unpatriotic? What should WE invoke? "God Bless The Sheep", "Long Live Mutton"?
And the loss of health insurance jobs may mean they will shift to productive employment in industries that are lean and where the profits come from value provided not "gotcha".
Most of us know we are being ripped off by now: the ones who deny it profit from it or are paid to ignore the glaring truth.
PJR MD
Ron Williams God Bless America
I could not agree with you more about God Bless America which is abused with politicians alike. Just what does it mean? Never could figure that out. Personally if you think what is happening to American is a God blessing us. I would beg to disagree. I too am not a sheep and fall for the stupid saying. Maybe if we created a heaven on earth then Jesus would appear. So far the ideas we have expound had not worked.
"Great One-Sided Article"
As a victim of the health insurance industry and a proponent of universal, single-payer, tax-supported Medicare For All, at least I have the guts to sign my name when I comment on a blog post.
Everyone who loves this country enough to want to improve it can join us in Washington D.C. on July 30 for the Single-Payer Rally and Lobby Day in celebration of the 44th birthday of Medicare. Details at www.healthcare-now.org.
We are not talking tractors.
We are not talking tractors. Next time you have a heart attack, go shopping for an emergency room the same way you would a tractor. Please! When you have a loved one or even yourself purged from an insurance carrier or denied a life saving or pain relieving proceedure, Im sure you will be singing praises to the corporation that just made you a statistic.
A universal non profit insurance pool will eliminate at least two unnecessary cost of health insurance, Share holder profits and excessive executive compensation.
Obama's False Friends of Health Reform
You gotta wonder three things:
- Who does "Anonymous" work for? (I have a hard time believing ANYBODY who doesn't have the integrity to attach their name to a comment.)
- Where is the EVIDENCE that the 15,000 people laid off got another equal paying job and health insurance?
- I have been on Medicare/TFL for several years, have had over $130,000 in REAL CLAIMS, and NO ONE has mentioned that I am a problem. Which for profit insurance company would have kept me on?
The vast majority of the American public, approaching 90% in polls, WANTS a public option. And, there is a good reason. The crooks (literally) in the health insurance business will do anything to keep their unconscionable profits and benefits. If you don't believe that, watch Bill Moyers. The MSM are afraid to tell the truth.
I hope their days are numbered . . . .
.
Self interest and denial from on-line lobbyist
I applaud that finally an insider has come out. Such must have been the courage of the German soldiers to end Hilter's rule at Valkyrie . We are facing the kind of tyranny from Corporate for profit Insurance companies as the Germans faced. Then again we see the black shirts spouting the party line, lying to the people, using fear, propaganda and misinformation to spread their hold on America's future.
I have faith in the American people and the power of social networks to rip the veil away and see the tyranny behind these greedy corporate captains We will rise up as a people against the tyranny.It is not just the Iranian people who live under a theocracy but also the american worker under the theocracy of corporate power.
And this must end.
Health insurance? No! Municipal Medical Departments? Yes!
"Is it wrong for the head of a life insurance company to sit tapping his keyboard hoping that 80% of his policy holders don't die? This is how insurance works."
Which is precisely why insurance should have never got into medicine to begin with. As I say in my own article in the Johnsonville Press, on the broader topic of "Fatherly Governance":
"Health care has no business being a business. Health care is an almost exclusively local emergency and preventative service. To require that it meet business objectives is both absurd and cruel. Yet that is precisely what health insurance has done."
My alternative, as my subject line suggests, is Municipal Medical Departments or MMDs. These would operate alongside the fire and police departments, providing service directly (call it the "no payer" or "direct provision" model) to all comers. Instead of being primarily concerned with cost-cutting, the MMDs would be concerned with healing the sick and injured. Nonetheless, because MMDs will also not be concerned about profits and retaining executives producing those profits, they will be providing medical service at a significantly reduced cost.
The doctors will be on the staff, at hospitals, clinics and for house calls, relieved of the burden of billing, claims and the threat of litigation from so-called "malpractice" suits. Their education will be provided through expanded state medical colleges (with the role of the police and fire academies) and internships at the hospitals. Cost savings in paying for doctors will thus be immense with MMDs. The beneficiary of that will be the taxpayer, since the establishment of the MMDs will have shifted the cost of medical care from the patient to the local and state governments.
A company with sound
A company with sound governance must adhere to a code of ethics! A good company faces ethical dilemma when confronted by tough decisions such as what is in the best interest of shareholders and what is best for the wellbeing of its stakeholders! There is a huge difference between the two. Companies that take into consideration the best interest of both shareholders and stakeholders do not necessarily need to lay off employees and lay the burden on those it spares! Companies that have the capital and the power to slash jobs and reward CEOs with big bonuses need to look at their own weaknesses in being incompetent by not being able to innovate and create value for their shareholders and not by being indifferent to those employees who gave all they could to their companies by working hard and investing time and energy in keeping their companies profitable. Moreover, companies do well when their employees do well. CEOs' compensation should be based on how well a company does by promoting its goods and services to its customers who make the largest and the most important component of its stakeholders, including its employees. Now that's ethics at work! Outside a sound corporate governance and solid ethical conduct, GREED becomes King and ruthless PROFITEERS rule by DECREE!
Great one sided article by God Bless the USA
Dear God Bless,
Who are you trying to kid. First you use the "Rovian" tactic of giving a name that makes any detractor seem unpatriotic. I am a taxpayer, voter, veteran, husband and father of two grown children. America is by the people and for the people. Not for the corporation and against the people. When healthcare is a service and not a business then you will see true changes in the health of the American people. You obviously need a good dose of getting screwed by the system and to spend a little time in fear that you will lose all you have worked for all your life because of a medical condition that threatens your well being and your livelihood. The insurance companies filled a necessary slot in the history of our civilization but have gone awry. The time for them to go is now. All of those good employees you are so worried about (ha) can be put to good use in the area of medical communications and to provide better healthcare rather than working in the healthcare denial system. I am sure they would feel better about going to work each day and maybe work harder for their clients knowing that they are contributing to the well being of their fellow travelers rather than just pushing paper unitl Friday comes. You are obviously insulated from the realities that most of us face every day. Either that or you just dont care. Your time is done, buddy. Give it a rest. You are either a fool or a tool. Not believing there is a better way or putting dollars before people. The earth is no longer flat and you are no longer relevant.
Do you think socialized
Do you think socialized medicine runs itself? Sure there will be lots of people laid off in the private sector but some of them (or the equivalent) will have to be hired by the government. The difference is that there will be only one computer system for all of them to learn and no chance for fraud since all physicians will input their data into the same system (no doctor hopping getting multiple prescriptions). Also there will be no need to repeat tests that the last physician did because the results will be all in the same system. Socialized medicine works. All modern westernized countries use it and they are a lot healthier than we are at much less cost. Do a little traveling and find out. Better yet, take up residence in Canada, Germany or England like I did. Or pick another European country of your choice. Their health care systems are so far ahead of ours that the differences will shock you!
socialized medicine
Medicare and HMO's are the worst systems possible. Americans have amuch greater recovery and life expectancy rate than any country in the world. I agree with you that the insurance companies should not be in the business of making profits and awarding CEO's outragious salaries and benefits etc. My husband had an experience with a HMO when he was paralized and could not walk. He needed a wheelchair and the operator at the HMO told him no they would not get him one and he asked what was he supposed to do and the answer was he could crawl on the floor if needed, but that they would not pay for a wheelchair. On the other hand Medicare did get him a wheelchair but then his father was diagnosed with alzheimers by his long time doctor; father in his 80's, did not test for any other reason his dad was having trouble with memory. He ended up dying of a brain tumor. Medicare doctors are paid bonuses for not doing tests on their elderly patients. So it will be interesting to see what gov't. coverage will do for the over 70 group who are getting larger every year. I believe that those who can afford to pay for their own medical care should do so and not receive Medicare coverage. They can afford multimillion dollar condos and homes but have the gov't. pay for their health care. Shame on them and on American senators and congressmen to allow this to happen. They don't care about anybody else in this country. We also should not be supporting those people who are in this country illigally, in any way. They do not pay taxes, social security etc. and neither do their employers. And I will hope and pray that God will continue to bless America.
Canadians live longer than Americans, on average
(Linda Cosgrove Spence ) "Americans have a much greater recovery and life expectancy rate than any country in the world."
You really need to check out the facts instead of relying on hear-say you may have been given by someone else. In fact, Canadians live longer, on average, than Americans do... and have for some time.
Why do Canadians outlive Americans? Well... It may have something to do with the fact that the general health of the U.S. population is lower than in most industrialized countries.
Likely got coverage
Likely got coverage elsewhere? Have you tried applying for coverage with a pre-existing condition lately? And got a job somewhere else? With the unemployment rate the way it is, I doubt that many of them were able to find another job. And even if they were lucky enough to get hired, I'm sure their compensation isn't the same as their former job. You have some of the most terrible logic I've seen in years. You seem to think that capitalism is the only way to do anything. The nature of capitalism is to take as much as possible with giving as little as possible. Do you really think that model applies that well to something like healthcare? Conservatives bitch about the amount of drug addicts out on the streets and the country's demand for drugs, but do you think these ppl can afford drug rehab? Locking addicts in jail won't do anything but drain the state's money and turn them into real criminals.
Health Care Reform
Perhaps Americans should organize and hold a nationwide boycott of the healthcare insurance industry. Quit buying insurance from them and lining the insurance companies, medical industry, and pharmaceutical industry's pockets. They act like own Americans, we're their property, and they can screw us. Meanwhile, they line their pockets with the billions in insurance premiums people pay.
Mr. Potter Thank you for
Mr. Potter
Thank you for coming forward and vocalizing the truth about what goes on in the health insurance industry.
I hope they listen to you.
Dr. Christine Eady
Health care reform
I am a RN. I have been employed in many different clinical settings over the last 35 years. I have also been employed as a case manager for very large health plans. I certainly could recount single cases where I felt extremely conflicted - walking a fine line between patient advocacy and corporate earnings. I feel very strongly health plans should not be publically traded. But I think it woud be foolish to throw away the baby with the bath water. There are many examples of efforts on the part of health plans to deliver quality health care. I believe the health care reform that is in play now in Congress should look to a private-public enterprise of which there are many examples around the country. It seems obvious any attempt to provide health care services to an additional the 40 million people is a enormous undertaking and it will take many years to be fully implemented. I would hate to see some of the health plans and their successful programs be disgarded and the wheel once more re-invented at great cost.
Delivery of Health Care
"There are many examples of efforts on the part of health plans to deliver quality health care."
Insurance companies and other health plan administrators don't deliver any health care. They are financing funnels who charge money to either administer a plan for a corporation sponsoring a health plan, or to deny coverage to boost profits of an insurance company.
Insurance companies aren't practicing doctors, don't perform operations or don't practice medicine. Insurance companies serve no purpose in health care except to add costs and deny needed care to make additional profits. They add nothing to health care except for providing a vastly overpriced financing method.
Kudos, Foon the Elder!
Don't hold back now... tell us what you really think. Great posting! The health insurance industry is comprised of bloodsuckers, parasites, and do nothing to elevate the health care people receive. They siphon off the profits that would otherwise be cost-savings and better care.
But Insurance Itself is the Problem
Even if the insurer was Mother Teresa and all of the staff saints, insuring medical care would be a disaster. It comes down to economics, which I will try to make as simple as possible.
When medical care is treated like a market, as with insurance, it does not respond to price signals well. The prices can go up to a unbearable level without a drop in demand. Only when the price goes beyond that breaking point, and only if the doctor or an intermediary fails to adhere to the Hippocratic oath, only then does demand start to shrink. The introduction of insurance does not change the factors determining those threshold prices for the patient. So an increase in the fees which the doctor or hospital presents in a bill to an insurer will have no effect on demand until the out-of-pocket expense to the patient approaches those same thresholds. Thus 80% coverage (20% copay) insurance causes the market for a medical procedure to increase the medical costs fivefold (500%) so that there is no change in patient out-of-pocket expenditure.
Thus, both the present circumstance (private insurance) and the Obama plan (public insurance) fail to address the reason why medical costs are so high: insurance. Note that both require that employment pay those inflated costs. The private insurers get their premiums through benefit packages which companies make available to their employees, now increasingly mandated. The public insurers get theirs through mandatory Medicare payroll deductions and, if that fails, through the income tax payroll deductions. Thus, both approaches will cause the collapse of our health care system as unemployment worsens.
See my site for an alternative providing real health care reform.
Thanks,
CPK
False Friends
FINALLY!! Someone unafraid to reveal the truth about the money-driven medicine business a.k.a. health care industry. It's shameful. Also, I read the CNN article about your efforts to address the misinformation some groups are spreading in their TV commercials relating Canada's health care failures to Obama's plan for health care reform. The first time I saw the ad, I started screaming at the screen. What a scare tactic! Keep up the excellent knowledge sharing on your blog. Thank you!
Thank you, thank you, thank
Thank you, thank you, thank you!
Health Plans
Mr. Potter,
I know it has become very popular to make disparaging remarks about health insurance plans. However, I find your comments to be unbalanced at best.
Rarely, do we hear about the good deeds of a health plan such as the work of their diligent nurse case managers and disease management nurses who assist members in meeting their health care goals. This often involves helping members navigate through an often complex and confusing health care system. Members are often assisted with health care needs as they transition through levels of care, including home health care, durable medical equipment arrangements and specialty consultations.
Quality departments of these maligned health plans, spend much time and money on member health initiatives promoting preventive screenings, monitoring the quality of care of practitioners and health delivery organizations, credentialing practitioners, along with collecting their member's opinions about health plan performance, just to name a few.
And in response to your chills, health plans not only monitor over-utilization of services, such as ER visits but, also under-utilization of services.
The cost of health care is increasing every year and many preventable medical errors continue to occur, costing patients and their families dearly in setbacks to recovery and additional anguish, sometimes resulting in death. The cost of these errors is astronomical.
I for one, believe that healthcare reform is going to need all parties at the table for a solution.
One final note:
I had a very good friend a few years ago who found herself in an untenable situation. After working a good portion of her lifetime as legal secretary, she was diagnosed with rheumatoid arthritis and breast cancer. She became disabled due to the progression of her disease.
She eventually was going to lose her health plan (this plan by the way, covered her after her COBRA coverage should have ended) She had already lost her home having to move in with a family member. She applied for Social Security Disability and was immediately denied. I am told this is common when applying for SS disability.
However, being a legal secretary, she was meticulous with her paperwork and kept copies of the paperwork each time she applied and carefully organized these documents for those who would be required to review them. To her frustration, she was required to send in her meticulous documentation (which included her medical records) on three different occasions because someone with Social Security had misplaced them.
Finally, after her long struggle, she was approved about two weeks before she died.
I can't help but wonder if this is the kind of thing we can look forward to with a public health plan. I sure hope not.
Some documents to back up a few of my statements here:
http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf
http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2005/May/Five-Years-After--To-Err-Is-Human---What-Have-We-Learned.aspx
http://www.ncqa.org/
You said: "I can't help but
You said: "I can't help but wonder if this is the kind of thing we can look forward to with a public health plan. I sure hope not."
Why wonder about it???? If it really is that bad, people will OPT for the CHOICE of one of the wonderful plans offered by private insurance companies and make the CHOICE to leave the public plan.
healthcare reform now
"I can't help but wonder if this is the kind of thing we can look forward to with a public health plan. I sure hope not."
This is what already happens in the system we have now. That's the point! If we had universal, non profit health insurance in this country your friend would not have gone through this ordeal in the first place. I really don't understand how it is that you don't see that.
It's Not Only CIGNA - Aetna Does the Same
Thank you, thank you, thank you for exposing the unconscionable actions of the hypocritical health industry Bureaucrats. I worked for Aetna for over 25 years and as my career progressed I saw more and more behavior that was not only unethical, but worse - immoral. The number crunchers meet every month to review medical costs in every state, regions of the state, and cities. They use the information to re-work coverage limits, often resulting in a previously covered condition being "phased out" for the coming year. They sure know how to play "The Street" through private, non-public meetings with investors and analysts (can you say RICO?????). Actual projections of medical costs and medical trends are hidden by actuarial games. The finance officers are expert at hiding true results. If a detailed, thorough, independent federal investigation of these bastards isn't conducted - and not just Aetna but the WellPoint’s, Cigna's, Humana's, et al - the American people will still get the same old song and dance year after year. If anything, medical coverage has gotten worse over the past 10 years as the ability of these people to manipulate more and more sophisticated databases leads to more negative changes in what people think they are getting for their benefits. They’re already gearing up for an all out assault on the proposals for national health coverage….. just wait and see what they do. If you think they were bad when the Clinton’s were in office, you’ll be amazed at the soft spoken but vicious attacks that are already “in the can” and ready to be released. Watch out America!
Thank you Mr. Potter. You are doing the right thing.
Anonymous who speaks about Cigna and Aetna is SO accurate. Please fellow Americans, take off your blindfolds. Don't you understand that you cannot believe EVERYTHING that you read and see in the news? I know that you are afraid of big changes. Who isn't? But letting yourself be manipulated by those who have the most to lose if we adopt a system that provides care for all is not patriotic. Don't you see that FEAR (false evidence appearing real) is being used to trick you? I expect greedy, corporate entities to fight healthcare reform because they stand to lose so much power and even more $. But I really was expecting my fellow Americans to not side with them or buy into their fear tactics. Please, please, please open your eyes!!!!
Like Ethics of ENRON Energy Futures Traders
Let me tell you and your readers about a private life and health insurance company located in Senator Charles Grassley's home state of Iowa. Back in 1972-1973, that company would not "touch me with a ten-foot colonoscope" with respect to selling me any health insurance product, but would sell me life insurance at grossly inflated rates. That same company would issue my wife a limited benefit health insurance product, but with her kidney condition weaseled out even no company would underwrite her for life insurance because of her polycystic kidney disease. That company was American Republic Insurance Company, headquarters in Des Moine Iowa. In my opinion, that company deserves to be "crowded out" of existence, Senator Chuck Grassley not withstanding.
One year later when the policy was to be replaced, the company agent, in exasperation, told me of an article that appeared in one of their company publications in which the underwriters were chortling over how "cute and clever" they were in that it would issue health insurance for a skydiver but not life insurance! Remember those videos from the Michael Moore movie, "The Smartest Guy in the Room" in which ENRON energy traders were giggling with glee over how they enjoyed robbing their grandmothers?
If the f-word Republicans succeed in blocking any public insurance option, then, at the very least, a Federal Emergency Review and Adjudication Board be setup that could provide expedited reviews and reversals of all claims request and post claims underwriting actions. This would help effectively shut down the "death boards"!
BTW, there is one problem with the name AFLAC. It rhymes with Ex-lax, which some people feel aptly describes their products!
going to the ER?!?
He was constantly checking "to see whether some of the health insurer's members are visiting emergency rooms too much for nonemergency reasons, such as for the flu or a sprained ankle" ?
I am upset. My health care provider kept _sending_ me to the emergency room! Go to the doctor with a sprained ankle? They'd say, "we need an X-ray, but we can't do that here, send him to our ER." I had an infection that needed lancing? "You'll have to have that lanced, down in the ER, we don't do that here."
I was not going to the ER, my doctor/hospital was sending me!
We can't have that kind of Big Brother monitoring, who knows what false conclusions they'll draw from that kind of data?
thank you
I work for another giant insurance company, and I want to thank you for speaking out. The article about you on CNN.com nearly brought me to tears -- you are saying the things I've been trying to convey to friends and loved ones about the insurance industry and the way the US health care system is set up. Thank you. You were very brave to do this.
strategy versus plans
You seem to be one of the key individuals who realizes that companies who are raking in profits on health care aren't going to be interested in reducing everyone's health care cost at the expense of their profits. No one in Congress or the Administration seems to think that will be an obstacle, as a result we get all these absurdly detailed health care plan proposals when what we really need is a health care strategy for winning what will be a war with the profiteers. My strategy: Fight FUD with facts. Before we try to make a plan, we ought to find out where all the dollars actually go. Everyone has a pet political dogma driven theory about it, but no one has any facts. The first thing we need is the legislation and research required to track all the health care dollars. Then put 'em on a big chart with direct patient benefit on one axis and cost on the other. Now you can form a plan to attack the items high on cost and low on patient benefit - keep repeating the process forever. Details of strategy can be found at http://home.att.net/~Tom.Horsley/health.html
Only thing unraveling...
is the lining on the pockets of these misanthropes.
Thanks for posting numbers like these, Wendell. Sooner or later, the "$2T savings" over ten years among the insurers will dawn on people as the kind of figure that indicates a complete overhaul is in order for this institutionalized theft from the American public.
Thanks
Dear Wendell,
I just wanted to say thank you. I am a graduate student (attending on scholarships, loans and part-time jobs) who has been unable to afford insurance since I was dropped form my father's policy several years ago. I have suffered greatly for this, from just 'dealing' with cavities and ear-infections to an accident where I broke my right thumb and was never able to receive any medical care for it.
It feels terrible, having one's own body at the mercy of these ruthless, profit-motivated CEOs; Everyday that goes by when my thumb aches, I can't help but feel that the only reason I could not obtain treatment was because someone had to find a way to make money off my bad luck, and since I had no money to give, I got no treatment. If I lived in Canada or Britain, no problem, but in the greatest nation in the world so many of us are left to suffer for the sake of nothing other than greed.
Health insurance in America today is, at best, no different than extortion: you pay the guys in charge or you pay the price. Not enough dough? Too bad. At worst, it is not far removed from someone putting a gun to your head and demanding money; sooner or later than debilitating accident or that terminal disease is coming, and if you haven't paid your dues, America is going to sit by and watch you die.
Anyway, what I meant to get at was a thank you. Thank you for fighting for me. Thank you from all in my situation. We need you. In some cases, our lives depend upon you. You're a strong man for following your heart on this and doing the right thing. Keep fighting the good fight.
wellness
we can no longer trust board members and CEO'S of the health care giants. once again we are forced to rebuild a part of life which we enjoy. we shall use federal law to be a vehicle for this transition of power. to regulate health. the hand off of the money that funds insurance companies to pay for doctors,hospital, etc... must be swift in transaction as so that it the transaction doesnt effect or disturb the nature of its existence. ( the wellness of American people ) . the employer based system is a large asset for funding Americas largest health care system. personal accounts will follow the employer based accounts. first in regard too medical, vision, dental, long and short term disability, life, etc... the American people the average mid class tax payer shall have the final say in who regulates health care. it is vital to begin this new division of the federal government as soon a possible ( know ). Mr. Ron Williams should re-think the direction he is taking his investor. the American public will reach a point in a deep recession that they will drop health coverage all together. we cant wait for the big collapse. as this will threaten millions of lives.
Thank you for all you're
Thank you for all you're doing.
About high deductible health plans tied to HSAs: We have one, and deposited $5606 last year; $6000 this year, and pay $660/mo to Humana for health insurance. It is a fantasy to expect mothers like myself to spend that money on ourselves. That money is an asset of my family, which includes my husband and three children, and I would no more spend that money on myself than the man in the moon. "America's Health Insurers" should think again about whether HDHPs encourage me to better manage my health care dollars to keep myself healthier. In my case, is encourages the opposite--a highly conservative use of those funds which I would never voluntarily use on myself when I have three children who may need braces or who may fall and need urgent care for a broken bone.
Yes, keep the trumpets blaring
What you are doing is great and courageous. Our whole business financial system has become not a capitalist system of supply and demand, but a system of manipulation and greed. Our health care system is right at the top of that system.
From a consumers aspect, one of the most obvious ways that the health care providers do that is to limit ones knowledge of costs. Let's say I go to the doctor and he wants to perform a needed procedure. My doctor will tell me how much he will bill the insurance company or how much how much he will bill me without insurance. If I then call my insurance company to ask how much their negotiated rate is with the doctor for that procedure, they will not tell me. They say I must have it done first then they will tell me the cost. They take away my ability to make an informed choice of whether or not to use my insurance for that procedure. That is NOT free market, that is manipulation and deception.
BTW, I am 43, and VERY healthy, and have barely ever used my insurance. Anthem raised my rates 40% this year. When I called to ask why, they said that management wasn't telling them why. Then the customer service rep said, "I think it's because we need to buy doctors new equipment." She REALLY said that. I laughed out loud.
One more unrelated point. Being married to a European and having many friends abroad, the only people I hear complaining about a single payer system are people who have never had it. EVERY person I know who has had government sponsored health care has nothing but fine things to say about it. The ONLY complaints I hear from them are minor things about waiting for an appointment... JUST LIKE HERE!
People, stop being manipulated, like a bunch of sheep, by these companies' agendas. WE MUST NOT SIT DOWN AND LET THIS OPPORTUNITY PASS WITH A WATERED DOWN HEALTH CARE REFORM BILL. The compromise IS a public option.
Life and Health Insurance
Dear Mr. Potter,
Thank you for your honesty. I used to be a life and health insurance agent and worked for three different companies at different times. When I discovered the dishonesty and outright lies (not to mention rampant forgery by agents and the "churning and burning" of agents by companies) I could not continue working in the insurance business. I was raised to be an honest person and to try to treat others the way I'd want them to treat me. I was ridiculed by other agents and demeaned by company managers for being naive and even irresponsible. "There's no room for honesty in a commission driven business" I was told. "You'll never make it," they said.
I wish that you'd also confirm the truth to people about the life insurance industry in your blog. It seems that the general public is, tragically, still in the dark about it too.
One of the people who responded to your blog, "Obama's False Friends of Health Reform," clearly applauded the industries' deceptive ways and strongly implied that you were the one being deceitful by not telling all of the truth as he saw it.
The surest way for evil to continue and succeed is for good people to do nothing. Finally, you are doing something.
Health Insurance Trolls?
I can't help but be suspicious of some of the above comments. Reading through some of them made me think that they were posted by people employed as public relations people by the insurance companies themselves. PR Watch ought to see if their IP addresses actually have origins from the offices of insurance companies.
Re: Health Insurance Trolls
I SOOOOOOO agree with you!!! I had the very same thought when watching the YouTube videos on this...
Regarding the first post in this thread
It is noteworthy that the first comment in these messages was from "Anonymous", on the attack immediately. This suggests Health "Care" Incorporated already has legions of minions patrolling the web for the purpose of preemptive strikes and damage control.
Counterstrike:
http://www.youtube.com/watch?v=7QwX_soZ1GI
From PBS, July 10.
Public Health Insurance
Wendell, congratulations on your new official position as the "insurance industry whistleblower". I wish you would stick to the facts and not interject judgement on your idea of the utopian solution which sounds more and more like communism to me.
The current systems is a disaster specifically because the government started meddling in what should have been a free and transparent system consisting of lots of players and competition. COMPETITION is what keeps a checks and balances on price and quality. In a free market, especially one like healthcare where people care tremendously about the price and quality of service, poor and expensive service providers would have long ago gone out of business and been replaced by a range of options for consumers at any price. Want decent/cheap medical care? There would have been the "Wal*Mart" of medical care. Want luxury top rate service? There would have been the Neiman Marcus of medical care. Unfortunately right now all that exists is expensive medical care because the only way hospitals can compete is by getting the latest and greatest shiny gadgetry to attract so-called consumers that, once insured, have no skin in the game. It's an all-you-can-eat-buffet and the ones binging the most are the ones for which the service is prepaid by government (medicare) or by private enterprise (private insurance).
Unfortunately, the same government that you know advocate control and dispense all of our medical care consists of the very same 535 Congressmen that sold out Americans in favor of the current crony capitalist system that benefits insurers at the expense of consumers and doctors. Who benefits from the forced medicare participation scheme? www.aetnamedicare.com does. I would love it if I was the CEO of industry that swayed government policy so that everyone had to buy my "insurance" and the government guaranteed payment. And then I dispensed that money to "vendors" (doctors) who were forced, under threat of prosecution I might add, into providing their services at a price they would otherwise refuse to work if not threatened. (Isn't forced service akin to slavery? or theft?)
We need to get govt OUT of the business of medical care not more into it. They're already in the business of educating our children much to the detriment of US intellect in comparison to other nations.
Competition provides a better checks and balances than any government could. And any scheme the government comes up with is sure to be devoid of competition which leads to great inefficiency and cost. One need only look to education to see proof of that. They only way the govt school system "works" is by collecting revenue from people that don't even consume the service -- every property owner whether they have kids or not and whether they use the school system or not -- pays big time! Govt has to "zone" because some schools are so crappy they wouldn't have a single customer if people had free choice.
If you really think the government is going to come in and create more freedom, more choice, better quality and lower prices, you are myopic my friend.
COMPETITION is what keeps a
So, how's life tucked away there in John Galt's hidden valley?
Like the corporate sharks wouldn't do just about anything to avoid real, honest-to-goodness competition. The industry has all those lobbyists crawling all over Capitol Hill because they want government out of the way so they can all compete with each other to bring us all the best care at the lowest cost. Sure.
If government has anything to do with why competition among for-profit providers hasn't maximized quality and minimized costs for health care consumers, it's because the industry wants it that way.
Well, I just had cataract removal and lens implantation in my left eye on Medicare. I can see better now, and it's legal for me to drive a car with that eye alone.
But you know what? Medicare will pay for my other eye as well, so I'm going to "binge" and get that one done, too. Too bad if you don't like that. :-)
We are the last nation without a national health structure
We are the last industrialized nation without a national healthcare structure. Why is this still a partisan issue? Remember that modern national plans are much more progressive (see Netherlands) than Hillary's Plan of the early 90's, using the government to regulate the insurance company while maintaining a privatized health system.
I am often frustrated with the tunnel vision of Americans. They often ardently refute the argument that health care can be a "right". Why can't it be a "right"? Why can't we take care of our own? Remember, education has only become a "right" in recent history. Up until a few hundred years ago, only the rich could afford private tutors for their children. But yet, as Americans building a nation, we knew the importance of a good education and made it accessible.
For many years, America has been the trend setter in democracy and industrialization. Let us not fall behind the rest of the world on such an important matter.