Things you need to know

Knowledge is Power. So here's a bit of education for you about Health Insurance Companies.

First, from NavyBlueWife at Fire Dog Lake telling me something I didn't know:

The Sunday morning political talk programs were filled to the brim with health care reform discussions, and central to these discussions is the idea that the insurance industry needs competition. Competition, in the form of a public option or in health care cooperatives, is supposed to level the playing field and bring down premiums for all Americans while providing as close to universal coverage as we can do right now.

There's just one itty bitty, teeny weeny problem. The insurance industry has federal IMMUNITY from competition!

The federal government has not been able to attack the insurance companies through federal anti-trust laws for over 60 years. Under the McCarran-Ferguson Act passed in 1945, insurance companies (and Major League Baseball!) are specifically excluded from federal anti-trust laws as long as the state regulates in that area, and federal anti-trust laws will apply ONLY in cases of boycott, coercion, and intimidation.

Under the McCarran-Ferguson Act, Big Insurance is allowed to collect and SHARE data with each other about claims. With this information, Big Insurance can fix prices, set coverage requirements, outline conditions for coverage denials (like pre-existing conditions), and many, many more.

That's right, folks! Big Insurance can plot together to bring us all down!

This problem is one of the biggest when it comes to creating insurance industry competition, and not one single major news outlet, pundit or other talking head has covered it as of my publishing. In fact, the only time where I saw anti-trust regulation brought up was a minor squawking by Big Insurance. They claimed that they actually would be in trouble under the anti-trust laws if they were forced to work together to reduce costs to consumers. But the laws don't apply, so what's the problem, Big Insurance?? Read more at link

This is information on how Blue Cross/Blue Shield was formed and how it became a for profit company. h/t to Crank Bait at Sam Seder Show Blog:

Dr. Justin Ford Kimball, a Baylor University administrator, is generally recognized as the originator of Blue Cross. Kimball noticed that among the university hospital's unpaid bills were those of a disproportionate number of local school teachers. In 1929, he addressed this problem by organizing a plan in which teachers could be covered for a three-week hospital stay in a semi-private room by prepaying as little as 50 cents a month. The first group health plan was off the ground when 1,250 Dallas-area teachers enrolled at once.

Other groups of Dallas employees joined the program, and it began to attract attention across the United States. Similar plans sprang up in Iowa and Illinois. Like the Dallas prototype, those plans involved only one hospital. In the early 1930s, plans were created that offered customers a choice of different hospitals in their communities. California, New Jersey, and New York were among the first locations for programs of that type. The Blue Cross name and symbol were developed in 1934 by E. A. van Steenwyk, a pioneer of St. Paul, Minnesota's group health plan. By 1935, there were 15 Blue Cross plans in 11 states. The following year, the American Hospital Association (AHA) created the Committee on Hospital Services to oversee the growing batch of Blue Cross organizations nationwide. The Committee's early leader was C. Rufus Rorem, who had been involved with the AHA for several years. By 1938, there were 38 Blue Cross plans in the United States, with a total enrollment of 1.4 million. In comparison, only about 100,000 people were covered for hospitalization by private insurance companies at that time.

Meanwhile, a similar movement had begun for covering the costs of physicians' services. In the Pacific Northwest, a few lumber and mining companies had begun making arrangements to pay doctors a monthly fee for providing their employees with health care services. The first of these plans appeared in Tacoma, Washington, in 1917. The first modern Blue Shield plan was established in 1939 in California. Modeled on the earlier programs, the California Plan enabled its customers to receive physician services for $1.70 a month. Only those with income under $3,000 a year were eligible for the program. The medical societies of other states began to develop similar programs, and in 1946 the first handful of such plans banded into a national group called the Associated Medical Care Plans, overseen by the American Medical Association (AMA). This group informally adopted the Blue Shield as its symbol two years later, and it eventually became known as the Blue Shield Association.

Between 1940 and 1945, the number of Blue Cross plans operating nationwide grew from 56 to 80, and enrollment increased from 6 million to 19 million. Blue Shield's enrollment was approximately 3 million. This growth was largely due to the wartime emphasis on fringe benefits as a way to increase wages without boosting salaries. In 1946, Rorem resigned as executive director of the AHA commission overseeing Blue Cross plans, and was replaced by Richard M. Jones, whom Rorem had hired as head of public relations. The organization's name was then changed to the Blue Cross Commission.

In 1948, Blue Cross and Blue Shield agreed to merge. The move was blocked by the AMA, however, on the grounds that such cooperation between hospitals and physicians could lead to actions in restraint of trade. Nevertheless, the Blues began working together around that time on public policy issues, while remaining independent, competing entities. To facilitate their continued growth, both Blues set up nonprofit agencies to coordinate the activities of their member plans. The Blue Cross Commission established Health Services, Inc. (HSI), a stock insurance company, to coordinate national enrollment in Blue Cross plans and to act as an underwriter to make up for differences in benefits between member plans when national contracts made it necessary. The Blue Cross Association was created as a holding company for HSI stock, which was actually owned by the plans themselves. Blue Shield set up a similar structure, establishing Medical Indemnity of America (MIA) as its counterpart to HSI. Read more at link.

So the Insurance Companies have a law in place to help them take advantage of us. All of us!

And you learned how a non profit Insurance turned into a for profit.

So now you know a bit more to form a good decision about Health Care Reform.

The question is: Why don't we have Single Payer?

If Insurance Companies can do this, why are we allowing them to exist? Not to mention the billions of dollars they make from us.

From the Washington Post:

HHS: Insurance Companies Encourage Employees to "Revoke Sick People's Health Coverage"

By David S. Hilzenrath

You might have known that insurers can deny health coverage based on preexisting medical conditions, but here’s something else to worry about: They can take away the coverage you thought you had when actually need it, the government says.

The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.

“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”

“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.

The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.

At least one insurer included such savings in an employee performance evaluation.

“Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said. more at the link

It's time to educate yourselves instead of believing what you hear or read. Research!

Denied Health Care by Insurance Companies?

Watch this and tell me if there is any morality left in the United States of America:



How do they sleep at night? It's easy when you are filled with greed and have no soul!

But answer me this, why do people keep voting against their best interest and how can they believe that these corporations, be it health care or financials or telecoms, will treat them fairly?

Please people, open your eyes, get answers, seek information so that you are not fooled by those who want to scam you. You are easy prey to them.

Health Insurance Lobby Spins Data

Like we didn't know they would try this. The Health Insurance Industry are rubbing their hands together waiting for mandated health care.

From the Washington Post:

The industry that helped scuttle health reform 15 years ago with its "Harry and Louise" ads is back, voicing support for a central element of the Obama administration's plans: making sure everyone is covered.

That does not mean the industry is backing the administration. Indeed, the leader of the insurance lobby has sent lawmakers a message: Be careful what you change, because "77 percent of Americans are satisfied with their existing health insurance coverage."

Karen Ignagni, president of America's Health Insurance Plans (AHIP), invoked the statistic to argue against the creation of a government-run insurance option. But the polls are not that simple, and her assertion reveals how the industry's effort to defend its turf has led it to cherry-pick the facts.

The poll Ignagni was citing actually undercuts her position: By 72 to 20 percent, Americans favor the creation of a public plan, the June survey by the New York Times and CBS News found. People also said that they thought government would do a better job than private insurers of holding down health-care costs and providing coverage.

In addition, data from a Kaiser Family Foundation poll last year, compiled at the request of The Washington Post, suggest that the people who like their health plans the most are the people who use them the least.

Those who described their health as "excellent" -- people who presumably had relatively little experience pursuing medical care or submitting claims -- were almost twice as likely as those in good, fair or poor health to rate their private health insurance as excellent.

The level of satisfaction expressed with private insurance was essentially the same as that with Medicare, the government program for the elderly and disabled.

snip

"A government-run plan would turn back the clock on efforts to improve the quality and safety of patient care," AHIP has argued. Such a plan "will ultimately limit choices and access," the big insurer WellPoint contends.

But systemic problems have persisted for 15 years, and it is not clear how much private insurers have done, or can do, to solve them.

"Insurers promise choice, they promise innovation, they promise a lot of things, but I think they've delivered very little," said Alan Sager, professor of health policy and management at Boston University. "I think net they give us very bad value for the 10 to 20 percent share of the health dollar they skim off the top."

Instead of choice, they offer "the illusion of choice," he said.

Illusion. That is how any big business sells it's product. Just watch the TV ads.

Health-care costs have continued to rise faster than personal incomes and economic growth. Even the industry agrees that much of the spending is wasted, exposing patients to unnecessary risk.

Insurers argue that a government plan could dominate the market, reducing consumers' options. But in the private market, options are limited by employers who restrict employees' choice of insurers and by insurers who restrict their choice of doctors.

Cigna, one of the nation's largest insurers, took away its own employees' alternatives in 2006 and left them with only high-deductible coverage.

"There were a lot of unhappy people," said Wendell Potter, who until last year was Cigna's head of corporate communications. For many people enrolled in such plans, "the deductibles are so high that they forgo care," he said.

Here is another Illusion. People are canceling appointments with their doctors because they can't afford it. But you don't hear about that. The argument you hear is that doctors liability insurance is too high. You don't hear about the people who can't afford quality care even with insurance. And why is their liability insurance too high? Because insurance companies make lots of money selling liability. How much of that insurance is really used? How often do doctors get sued? I'd like to see those numbers! And if a doctor makes a mistake, they should pay!

AHIP has produced a stack of glossy reports describing health insurers' efforts to improve care. In recent testimony, Ignagni said private health plans serving the elderly have been highly successful in reducing hospital admissions and readmissions for patients with diabetes and heart disease.

Yet one of the AHIP reports says that in an Aetna Pathways to Excellence hospital incentive program, "readmission rates did not improve significantly."

Opponents of a public option argue that it could put government bureaucrats between patients and doctors. Today, for people with commercial or employer-sponsored coverage, care is overseen by private bureaucracies. Where government bureaucracies answer to the body politic, the corporate versions answer to Wall Street.

The issue of whether a public plan would be more successful at bringing costs under control is harder to evaluate. As a prototype for government-run health care, Medicare has failed to control costs and makes little effort to restrict care.

Economists generally agree that if costs are to be brought under control, someone must say no to care that doctors propose and patients demand. So far, that role has fallen primarily to insurers.

"Private insurers have effectively engaged in rationing, so they're doing the dirty work for everybody else," said Jeff D. Emerson, a former health plan chief executive. "It's a thankless job . . . but somebody has to do it or health care will be even more expensive than it is now."

This writer started out so good but had to throw this little gem in. And it's the last paragraph of the article.

Private insurers might be better situated than the government to do the unpopular work of saying no, said Paul B. Ginsburg, president of the Center for Studying Health System Change, because they are less susceptible to political pressure.