More than a healthcare crisis—this nation has a widespread health insurance crisis. Just today, the LA Times reports that professional associations are increasingly shut out of the health insurance market because group purchasing doesn’t let insurers cherry pick the healthiest customers. This comes on the heels of last week’s news that Blue Cross is being fined $1 million for illegally dumping patients off the rolls, a new look at how elderly patients are being fleeced by their mercenary insurers, and complaints from doctors that they spend more time fighting corporate denials of care than tending to their patients. Given this health insurance crisis that demands a solution, it’s no wonder the Sacramento Bee comes close to endorsing the SinglePayer system, and doing away with these bad actors.
The latest canary in the insurance coal mines are the professional associations that offer their members health insurnace. As Lisa Girion of the LA Times, who has been on a tear lately, writes:
Health plans offered by professional associations were once havens for millions of people who couldn't get coverage anywhere else. But as medical costs have soared, groups representing professions as varied as law and golf have been forced to stop offering the benefit or been dropped by insurers.
More than 8,000 people with coverage through the California Assn. of Realtors could be next if Blue Shield of California succeeds with its plan to cancel the group's health coverage.
"It's a real stab in the heart," said Marcy Garber, 62, an Encino real estate agent whose history of breast cancer makes her an almost-certain reject if she seeks similar coverage on her own.
Why are the insurance companies leaving this market? Because they can’t cherrypick customers:
Insurance carriers began pulling out of association markets about 10 years ago amid mandates requiring the groups — like employers — to offer coverage to all members who wanted to buy it, regardless of preexisting conditions. Unlike employers, however, who typically pick up the much of the premiums for employees, most associations do not share in the costs. Instead, they arrange for their members to purchase coverage at group, rather than individual, rates.
Another real estate agent, Hector Aguirre, 39, of Rancho Cucamonga, also thought the group's coverage was safe. He pays nearly $1,000 a month for coverage for himself and his family. His wife has lupus and a daughter needs daily shots of an expensive growth hormone.
"I always thought it had more control and more pull because it's such a huge umbrella under the whole California Assn. of Realtors," Aguirre said.
Realtor Terry Lucoff, 60, of Malibu, who pays a monthly premium of more than $600, fears that if he loses his coverage he will be unable to obtain new coverage that will allow him to continue seeing his regular doctors because he has been diagnosed with a kidney condition.
"If they can do this to the California Realtors association, they can do it to anybody," he said.
It is truly, grotesquely surreal that the American medical system is organized around and by huge corporations that only want to serve healthy customers, and that make money by denying the healthcare they are chartered to insure.
Is it any wonder everyone hates them? But look, there’s more from the car-wreck that is our insurance market.
Blue Cross of California "routinely" violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide….
As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion. </blockquote>
Regulators examined 90 randomly selected cases of policy cancellations — out of about 1,000 a year in California— and found violations in each one.
Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state.
So, I ask all the politicians who are supporting insurance mandates: do we really want to force the entire nation to sign up with their heartless corporations? Do want to increase their influence over the delivery of care in our health system?
Blue Cross denies wrongdoing. That's fine. There is a larger lesson here: This health insurance market, the one for individuals or families who don't automatically get covered through their jobs, is sick. Insurers try to avoid covering people who need care. And many Californians avoid getting insurance until it is in their financial interest to do so. It's a game, and the game must end somehow. That can only happen by blowing up the individual health insurance market that exists today and replacing it with something that makes more sense. And that can only happen with the California Legislature and Gov. Arnold Schwarzenegger.
There are two basic choices here when it comes to health insurance. One is to get rid of private health insurance altogether and replace it with a program in which the government directly pays doctors and hospitals to provide care. That's known as single-payer. It is championed by some Democrats, but opposed by the governor. Single-payer isn't a likely short-term compromise, but the more we look at this mess, single-payer seems to be an increasingly likely long-term solution because of the many ills of the private insurance market.