Insurance is a numbers game and that hasn't changed....

[vi5]

I can't tell you in my 3 years of having to deal with my son's medical issues and insurance claims and all that as almost the equivalence of a second full time job how many times I've talked to people who have insurance who, when they find out that we got something paid for, more or less under the same type of insurance same type of plan, etc. are shocked. They didn't know about a particular clause, or a particular law, or a particular aspect of their policy that was being violated in denying their child a particular procedure or benefit or what have you. They didn't know that they could call and fight it and dispute it. Or because of the nature of their job they did not have the time or the ability or in many cases the command of English to be able to call and dispute or fight or appeal. I have good insurance, I have a very flexible and accomodating job that allows me the ability to make calls at work, or to take time off or to "fight the good fight" and just be the general all around type of pest that insurance companies hate and will give in to just to shut them up. I have unfettered access in terms of both free time and connectivity to the internet and all the information that comes with that. And it's still a constant uphill battle for me. I've talked to and dealt with and know and seen the pain of literally hundreds of people just in my small circle of experience who have none of those benefits and who struggle because of it.

And this is what the insurance companies count on. They have risk analysis, and cost/benefit analysis. They calculate that if they deny coverage to 10 people that if only 5-7 of those people call to fight or appeal or complain, they still win and make a profit with the 3-5 who did not, or who could not or who didn't work office jobs that gave them the opportunity during the day to call and sit on hold while they waited to talk to someone or who didn't have lawyer friends who could give them advice, or who had to fight and focus just to understand the medical terminology they were dealing with, let alone the legal insurance company minutiae.

So for a minute let's forget the public option. Let's forget medicare expansion. Let's forget abortion coverage. We shouldn't, but for the sake of this post, let's just do that. Let's only talk about the things that advocates of the bill, or the glass half full crowd are saying are good about it. No denial for pre-existing conditions. No annual caps or lifetime limits. No dropping people who get sick. Let's only talk about those.

The risk analysis will still exist with these new laws. The cost/benefit analysis will still exist for these laws. They will be able to determine to the penny if it's cheaper for them to pay the fines than it is to offer the coverage. They will be able to determine just how many people will have the time, or the energy, or the understanding and awareness of the laws to file claims in whatever board of appeals exists in whatever form is set up under the bill. They'll determine whether it's cheaper to just have only a handful of poorly rated oncologists in network than it is to actually cover a cancer patient. I hope I'm just not fully aware of how these bills in play now will prevent this from being the case. I hope that this stuff is being considered. But I haven't yet seen anyone in numerous posts and numerous threads and in numerous interviews and speeches address this aspect of it.

The fact is that insurance is a gambler's game. And in it, like with gambling, the odds are always in favor of the house. If there's aspects of this bill that makes that not the case then I support it and am in favor of it. But if all this bill does is move us to the craps table instead of the nickel slots, then I'm afraid as a veteran of our current horrid system, then that's why I'm dissapointed. Not because there's no public option (although I wanted that), not because there's no medicare expansion (although I wanted that), not because I wanted single-payer or any of that. I know how important the things that all the advocates of the bill point to are. I would never dismiss the pre-existing conditions aspect, or the lifetime caps aspect or the banning dropping coverage aspect. But I know that any reform that comes without safeguards, without enforcement or adequate penalties or without strong advocacy and retribution will not do the trick.

[spanone]

1. the purest form of 'protection money'