Equal Treatment for the Uninsured? Don't Count on It.

[MountainLaurel]

Good thing we don't have any of that socialized medicine over here in 'Murikka.

. . . When we examined the young woman we found a chronic infection of her pelvis so painful that she resisted our slightest touch.

How long had she been living like this, I wanted to know. Through tears, my patient hesitantly began an explanation that told me as much about our diseased medical system as about her illness: She'd had diabetes since she was a child, she said. On her 18th birthday, she lost her insurance and had been able to afford insulin only occasionally. She worked two jobs, she said, but neither offered insurance. Uncontrolled, her diabetes had let the infection develop and fester.

As I left her room, I realized I'd already grown accustomed to the rank odor. That, I think, is what happens when we learn that 47 million people in the United States are uninsured. At first, we find it shocking. But over time, most of us learn to ignore it.

snip

That experience sparked a conversation with a friend, a primary care physician who told me that about 20 percent of the patients he treats at the hospital are uninsured, and he is not compensated for treating them. (As physicians sometimes say, "No other professionals -- lawyers, plumbers, accountants -- provide uncompensated service to one-fifth of their clients.")

Although the uninsured look like any other patients, it's easy to spot them: Their charts have places for their address, emergency contact and insurance information; an empty insurance box is a telltale sign. Some doctors examine this sheet before examining the patient -- a practice we refer to as a wallet biopsy.

http://www.washingtonpost.com/wp-dyn/content/article/2008/10/10/AR2008101002679.html

[antigop]

1. And some people don't want universal coverage because health care would be "rationed"

It's rationed now -- on the ability to pay and the ability to get insurance.

[MountainLaurel]

3. Absolutely

And don't forget rationing based on where you live: If you're in a small Mississippi town, there's not going to be a child oncology specialist doing cutting-edge research to save your child's life, and you can't afford to take your sick kid to the medical centers where that research is happening.

[antigop]

4. K&R. Thanks for posting the article.n/t

[nichomachus]

7. It's rationed

By some flunky in a windowless cubicle, a person who gets a bonus based on how many claims he/she denies each month.

[Citizen Number 9]

13. Not really, it isn't rationed now.

Rationing means a lot more attention to cost/usage/utility issues, and external decisions being made for you.

84 years old?

I'm sorry, honey; that's too old for a new hip. You'll just have to wind down at the care center, now.

That's rationing.

[MountainLaurel]

16. Horseshit

Insurance companies make those kind of decisions every day.

[Citizen Number 9]

17. I don't think they do...

Unless the situation was already outside of the existing Plan Contract. They can't make arbitrary decisions like that at the risk of being sued.

[primavera]

20. Oh please

Claims officers get paid bonuses based upon how many claims they deny. As for the threat of suit, they know that most clients don't have the resources to file suit against them and, even when they do, the contracts are filled with hundreds of pages of microscopic fine print in which their attorneys have concealed clever loop-holes to allow them to escape liability for refusing claims. Contract suits generally don't allow for punitive damages, so the worst that can happen to the insurance company is having to pay out the claim they should have paid out in the first case. The insurance companies lose a few suits, but the cost of a few lost suits is negligible next to the savings of not having to pay out on major claims.

[Citizen Number 9]

21. Excellent theory; I wonder if it is correct.

A pattern of unjustified denial and it's all over for them. There are any number of competent attorneys who would be happy to take them to task on the greater charges. There is no doubt that insurance companies would rather not pay, particularly in cases that are not clearly defined, but there are legitimate points of contention that arise every day. If it was intimated that any particular carrier had a pattern of not paying on proper claims, it would be all over for them. Your sense of being inconsequential and powerless is noted, however.

[primavera]

22. I think your premise is flawed

A pattern of unjustified denials of claims can be documented for the majority, if not all, of the major insurance companies, yet, far from it being "all over for them," they're doing quite well. Again, I think a part of the reason is that simple contract claims do not offer punitive damages, so, if you're an attorney looking to represent an injured subscriber, there's not going to be some huge pot of gold at the other end to cover the considerable resources that you'll have to expend to take on the insurance company and its battalion of lawyers. Now, if you can kick it up to a tort claim, then you can get into punitive damages and the payoff on the other side may justify gambling on an extremely expensive litigation action. But for a tort claim, you would have to establish a degree of egregiousness of conduct on the part of the insurance company that would be challenging, to say the least, to prove in the face of determined resistance from the insurance company's lawyers who, you may rest assured, will be doing their practiced and expert damndest to thwart you in making that case. Not a proposition for the faint of heart. Of course, it does happen every now and then, and the insurance company will take a bath on that particular case, but, in the meantime, they successfully denied coverage on another 100,000 or so claims, which more than makes up for any losses on that one case. You can be certain that this is the subject of beancounters performing actuarial analyses, carefully weighing risks versus benefits, and arriving at the financially rational choice to adopt this practice. In the end, money talks and if a company makes more of it behaving negligently than behaving responsibly, you can bet whatever's left of your retirement account that that is precisely what they will do every day of the week and twice on Sunday.

[Citizen Number 9]

24. Generally represents an inexperienced view of how things really work...

"But for a tort claim, you would have to establish a degree of egregiousness of conduct on the part of the insurance company..."

Yet, this appears to be exactly what you are claiming the insurance companies are up to. An unjustified denial of claim can be as simple as not recognizing a claimant as a subscriber due to some clerical error. These are usually later corrected.

It sure would be nice for some young lawyer to get his hands on the internal documents banging back and forth between the beancounters and the actuaries that detail their little plan to unjustly deny claims for profit, wouldn't it?

[primavera]

26. How I wish that were true!

Alas, young and inexperienced is no longer something I can claim to be. Nice try at a dismissal though.

As for your innuendo of creating conspiracy theories, that too is a nice, although unoriginal, try at dismissal. This is a favorite strawman ploy of conservatives, to allege that corporate malfeasance has to take the form of secret internal memos and microdots and James Bond gadgetry, at which point it can be tidily ridiculed as "conspiracy theory." But, of course, the real world doesn't work that way, as I'm sure you very well know. No CEO is going to be stupid enough to publish a general memo instructing claims adjustors to deny claims and they have no need to. Claims adjustors find at the end of each year that, when they've denied lots of claims, they receive nice big fat Christmas bonuses, or even get promoted. And, no, equally obviously, those bonus checks will not bear any absurd, convenient notation stating that they've received them for having successfully denied 100 claims this year; rather the employee will simply be patted on the back for having done a good job and for having helped contribute to the excellent year the company enjoyed this year. Innocent enough, but how long do you think it will take for the message to make the rounds of employees that those who routinely deny claims get rewarded while those who pay out too many claims find themselves having to endure "little chats" with their department heads? Likewise, actuarial analyses need not be published, nor need they bear nicely inflammatory report titles like "How We Plan To Rip Off Our Customers In The Upcoming Fiscal Year." But that doesn't mean that the reports aren't run and the data contained therein doesn't influence the behavior of corporate executives. People who share a common goal can behave in certain ways without the necessity of meeting in dark alleys to discuss their nefarious purposes. That doesn't mean that a corporate culture doesn't exist which favors certain types of behavior. So, sorry to disappoint you, but the absence of some preposterous conspiracy in no way diminishes my point that the customary practice of insurance companies is to do that which maximizes their profits, namely, pay out as few claims as humanly possible.

For similar reasons, proving to a court's satisfaction the level of egregious behavior required for punitive damages is likewise slippery, because corporate executives inconsiderately don't publish conveniently incriminating memos. Yet again, though, that doesn't mean that there isn't a customary business practice which works very much to the disadvantage of the patient - only that it's hard to document to the level of rigor required by a court of law.

But again, a valiant try! You get a low C for reality, but an A+ for effort. Keep at it, though, I'm sure if you try hard enough, you'll find a way to convince yourself that insurance companies are really philanthropists motivated by nothing besides the tender love and care of their customers. Not an easy delusion to reach, but I have every confidence in your ability to attain it.

[Citizen Number 9]

27. Philanthropists? That's a bit over the top, isn't it?

You see all sorts of dark things within the corporate walls where there are rarely any but the individuals that serve in them, subject to individual weaknesses and flaws. Corporations run on paperwork and the bigger they are, the more there has to be in order to move anything forward. That's why I still maintain that you are inexperienced, at least as regards the inner workings and motivations of corporations. I have run corporations at the highest levels. I think a number of corporations have gotten their just deserves, but not because there was a sinister corporate plan. Most often it's because they don't adequately police their greedy (and lazy) little employees.

[primavera]

29. Guess we'll just have to agree to disagree then

To me, the vast sums that the insurance companies spend on campaign contributions and lobbyists for the purposes of influencing the policy making process to their advantage, the vast sums they spend on attorneys to protect them from potential lawsuits and defend them when they do get sued, the ever increasing number of denied claims and persons denied coverage, the ever dwindling number of conditions covered, the skyrocketing premiums and the staggering profits generated within the insurance industry suggest a pattern which cannot be explained away as mere coincidence or the acts of a few greedy, lazy workers. But I think you hit upon the very reason courts have difficulty acting in cases of corporate malfeasance: the courts' power is limited to ruling on a very specific and carefully controlled set of facts. Proving in a courtroom that a nebulous entity like a corporation bears liability for improper conduct is apt to run into the same objections that you raise, that it's not any systematic plan, there are no secret memos written in code anywhere, ergo, it's really all just the fault of a couple of bad apples, an innocent mistake. To look at the big picture and observe that there seem to be an awful lot of bad apples committing an awful lot of supposedly innocent mistakes exceeds the authority of the courts, for that, the legislature needs to act. And since just about every official in Congress - on either side of the aisle - received about half of their campaign warchest from the insurance industry, well, we don't really need to worry too much about them pursuing too zealously anything that might compromise the interests of the insurance industry, now do we?

[Citizen Number 9]

31. The greedy and lazy number greater than a "few"...

"we don't really need to worry too much about them pursuing too zealously anything that might compromise the interests of the insurance industry, now do we?"

Well, you got that right. :)


I am wondering, however, how the insurance company contributions compare to the trial lawyers' lobbying efforts.

At the risk of ruining all this agreement, I have to point out that conditions covered, skyrocketing premiums and staggering profits are valid business choices and can all be addressed through either increased competition or decreased patronage.

[primavera]

33. Right, because competition and patronage has worked so well...

... giving us the disgraceful conditions we now enjoy. And, if one needed any additional evidence of the efficacy of market mechanisms, one need look no further than the financial market. Such a pity the shrub wasn't successful in privatizing Social Security, just think where we'd be if we all relied upon the market for our well being! Well, when we're old and grey and living in cardboard boxes beneath bridges, we can drink from a muddy puddle together and celebrate the munificence of the free market!

[Lydia Leftcoast]

28. My brother's a doctor, and his main complaints about insurance companies

is that people with no medical training are making decisions about what is justifiable care for his patients.

A few years ago, there was an article in the Science section of the New York Times (don't have time to look for it) in which a former insurance company employee claimed that they were expected to deny all but the most obvious claims in the hope that the doctor or patient wouldn't press the matter.

I think health insurance companies as currently administered are among the lowest and most hypocritical forms of corporate life. They put out glossy brochures telling how much they care, write articles in newspapers about how everyone should get checkups and screenings, and then they won't pay for checkups and screenings on most plans. They tell you that a Health Savings Account will solve your problems, when it does is make you prepay your deductible--and it costs more than a conventional plan with the same deductible.

Pond scum, that's what they are.

[Citizen Number 9]

30. So, do you do business with pond scum?

"people with no medical training are making decisions about what is justifiable care for his patients"

Yep, that's correct. They are armed with some statistics and generalities and believe that they have all the answers.

Docs need to stand firm however. They need to tell the payers that they can no longer see their members if it is going to mean ludicrous arguments with their employees who authorize service.

[Lydia Leftcoast]

32. Oh, he's already dropped one company

but he's a solo practitioner, so it's not doing much good.

[xchrom]

2. recommend

[primavera]

5. K&R

:kick:

[silverweb]

6. USA -- #1 in shame.

One medical center I transcribe for has a standard space for the patient's living situation. The number of "unhoused" has been growing rapidly.

Also increasing rapidly is the number of people who are "noncompliant" with doctor's orders because they lack insurance and cannot afford their meds or treatment. These patients then return to the emergency room when they can no longer tolerate their severe symptoms.

The situation is utterly shameful.

[Citizen Number 9]

14. What's the shameful part?

The fact that they haven't gotten insurance?

That they are "uhhoused"?

Because, if they are getting attended to in the ER despite being able to pay or having insurance, I hardly see that as shameful.

[MountainLaurel]

15. Prevention is the key to health

Why should a kid with asthma have to go through life-threatening attacks on a regular basis if they could be easily prevented with the proper medication that her parents can't afford? You find that perfectly acceptable?

[Citizen Number 9]

18. If they are so easily prevented......

Not at all, but let's be perfectly clear here. The first shameful thing is that the parents can't provide medicine for their daughter for her "easily prevented" attacks. The second shameful thing is that some states do a poor job of providing for children like that. In my state they are generally covered by Dept Social and Health Services. Maybe the states should do a better job of covering their responsibilities.

[Crunchy Frog]

19. Shameful that we have so many homeless and so many uninsured people.

Difficult to comprehend, I know.

[4_TN_TITANS]

8. "No other professionals-- provide uncompensated service..."

Any teachers want to comment on that? I know my wife puts in more than 8 hrs. a day w/ no overtime, sometimes just because someone forgot to pick their kid up.

[FM Arouet666]

9. Socialize medicine in America.

Yep, see this all the time, chronic illness devastating those who cannot afford insurance or the treatments. One doc I went out to dinner with was bragging that he stacks all the referrals into a pile and orders them based on insurance payments. No insurance or crap insurance and you get put at the bottom and may never get into see him. An acute illness will be treated from the ER which replaces the PCP for those without insurance. Sadly so many acute illnesses are the end result of no routine medical care. The girl in the example above will cost more to take care of with all the complications of her uncontrolled diabetes than it would have cost to provide insulin and access to a PCP.

Saw a special on PBS a while back about health care in other countries and what works and what doesn't. The U.S. can do much better. Big pharma and big insurance control our current system and health care is now a luxury of the wealthy. I agree with Obama, it absolutely should be a right of every American to have coverage.

Wish the conservatives would stop with the socialism = communism = atheism = USSR and evil bit.

[area51]

10. "Wish the conservatives would stop with the socialism..."

Yes, but they sure don't seem to mind our socialized police force and socialized fire department. When was the last time they had to buy insurance to get a police officer to respond to a burglary call, or buy insurance to get the fire department to come put out a fire for them? :think:

[FM Arouet666]

11. And now our socialized

banking industry and automobile industry.

[Citizen Number 9]

25. Conducted by a Republican Administration, no less!

I can't deny the Right the pleasure of calling it Socialism. Out of everything they say, its one of the more accurate. I think this whole financial crisis highlights a flaw of unbridled Capitalism. The problem would appear to be personal greed. Just try working that out of the system. It looks like we would be well advised to conduct our financial affairs in a slightly more "Socialized" manner in the years to come.

There must be some similar individual flaw that weakens the Health Care system... I just can't put my finger on it right now....

[Delphinus]

12. K & R!

[MountainLaurel]

23. Another relevant article

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x4279619