Covering the Super-Healthy Only
If Bill Clinton, Dick Cheney or Chief Justice John Roberts applied for private health insurance, they wouldn’t get it.
Neither would Michael Moore for his obesity or Arnold Schwarzenegger, who went to the hospital in 2005 for rapid heartbeats.
An organization called the Medical Information Bureau would take a quick look at their histories and tell 470 companies they are hopelessly bad risks. Their work helps health insurers cherry-pick prospects to cover only those who are unlikely to get sick.
So much for universal coverage and the faith that Republicans, including President Bush, have in the marketplace. After the removal of his five polyps last month, he would have trouble getting health insurance himself.
CBS reported recently that a survey by the Commonwealth Fund last year found that 89 percent, or 52 million, of those looking for individual health insurance didn’t get it because it was too expensive or they were turned down.
“Insurers are getting double the profit that they make in the group market. Why is it so lucrative? Because they exclude anybody and everybody who has even a remote sense of risk associated with their health care,” said Dr. Bryan Liang, who has studied the insurance industry for more than a decade.
Someone should break the news to Rudy Giuliani, who loves the current system. His 2001 treatment for prostate cancer would rule him out for coverage in a New York minute.
Cross-posted from my blog
13 Responses to “Covering the Super-Healthy Only”
I imagine that this post will be criticized by the true believers in the omnipotence of the free market. Me, I’m not surprised at all. The same thing happens in the group plans for small businesses. Every year the rates my employers are told they must pay rise far more than overall inflation. One year in the not too distant past they were given a 43% increase estimate by the company they had at the time. Every single year hours upon hours of time are wasted in a search for the least objectionable plan.
Yes, I am one of those who cannot get health insurance.
Simply Put…The Health Care System is totally Bankrupt, because Bush is wasting $10 Million per Hour in his Iraq Misadventure.
NPWJ apparently understands neither peace nor justice and doesn’t know that the insurance industry and health-care system were all messed up before we went into Iraq.
Robert: Adhering to rule 5, I have to hold back from writing that you’re someone who has obviously read all the liberal talking points but has no clue. Are health insurance companies not supposed to make a profit? As a customer of theirs, I sure hope they make a profit, as I would hate to try to get a claim paid by a company that loses money. Or are you b****ing that insurance companies are less likely to offer coverage or low rates to those deemed higher risks than they offer to lower risk customers? What insurance company – anywhere – does that? Smokers pay more for life insurance – if they can get it. Teenage boys pay more for car insurance. Insurance companies charge a premium based on their expectation of making payments. Someone with high risk – whether because of previous health issues or lifestyle – is expected to consume more health services than someone deemed ‘healthier’. Your swipe aside, Guiliani, Bush, et al, could have individual coverage, they would just have to pay an awful lot for it… as they should have to do given their histories, and as should be the case for many of those you refer who couldn’t ‘afford’ health insurance. It ought to be expensive for someone with a history of heart disease or cancer of something similar to get health insurance. If you’re objecting to this, then why don’t you come out and say you want all the good risks to pay more, not for their coverage, but to subsidize low rates for those in bad shape (whether or not it is self-inflicted)? Or, to put your money where your mouth is, why don’t you offer to provide affordable insurance for someone who can’t get it? Call up Cheney and offer to underwrite his health care for $100 a month. What, you don’t want to do that, you’d go broke paying his bills? Well, as a typical liberal, you simply want others to pay for what you’re not willing to pay for yourself.
Jim: the reason your company gets zapped with higher than inflation increases is because (1) health care costs have been rising faster than inflation as a whole, and (I presume) (2) your company is submitting claims at a rate higher than expected, which leads to the insurance provider ‘recovering’ some of those costs from increases (and yes, from experience, although rare, when you have a ‘good’ year, your rates don’t go up so much) . Again, that is simply the way insurance programs work.
And Holly, you do understand there is a big difference between the state of health insurance and health care?
stevesturm, I usually try to keep away from wishing people the worst, but I would really like to see you make first hand experience with chronical illness, so you’ll see the results of uncontrolled capitalism from another perspective.
Insurance companies making a profit is absolutely necessary, so they stay in business. But this isn’t the point, the question is wether the market should be twisted in their favor by abstaining from regulating their policies and their conduct. And this means especially that they shouldn’t be allowed to eliminate all customers who might be a bad risk or who start to become a burden. After all, that’s not the definition of ainsurance, the idea is that the risk is shared by putting it on as many shoulders as possible, not to simply cash in without standing up to the obligation s if push comes to shove.
In other nations, independent insurers offer standardized contracts with optional benefits, and the customer can be sure regulators will look how those companies stand up to their obligations. Those companies still make a profit, and actually, it’s the most successful ones that are profiting most, not the most deceiving and evasive one. A much fairer competition than in the US, where an unregulated market results in a race to the bottom, with cynical methods being rewarded. That’s always the case when there’s no incentive in the game for companies to do ‘the right thing’. Only an economy where there are rules, prohibiting players from seeking unfair profits at the cost of their costumers, will result in advancing the common good. Even Adam Smith acknoledged this.
Regarding this, nothing in your rant really constitutes a valid point why legal oversight should be bad for business, so imho it’s totally besides the topic. Try harder.
I had to take many deep breahs after reading strevestrum’s comment:
“typical liberal, you simply want others to pay for what you’re not willing to pay for yourself.”
What rubbish!
This is a common song and dance number in some political circles.
Well, then, don;t you dare drive on roads you haven;t paid for, or fly on airplanes for whose safety you haven;t paid, or more importantly, participate in a governement for whose creation you didn’t pay.
It’s obvious people like this commenter are all too eager to reap the benefits of a society that enables them to make money, without feeling responsibility for maintaing the kind of society that can enable them to do so.
The collapsing bridge story is a perfect metaphor for our health care system, and our crumbling social fabruc, in general. Everybody used the bridge in order to make money one way or another, those representing businesses and workers, alike.
But mention taxes as revenue for maintenance, and screams about liberal/socialist/ communist schemes are immediately heard.
Those who don;t recognize their obligations in maintaining our social infradctrure, just like the physical inrastructure, are the real free-loaders, who want others to pay for their benefits
Sometimes I wish a computer model could be built showing exactly what would happen if we stopped providing anything at all to those who can;t pay, No more nanny state!
Then, I would make everyone complaining about those who can;t pay sign a statement accepting responsibility for the results. I wonder how they would arrange to pay for new cemetary construction, for one thing.
How can I try harder when you mistake – intentionally, ignorantly or otherwise – the premise on which you base so much, the idea that insurance markets are defined by putting on as many shoulders as possible the burden of paying claims?
And I can I try harder when you, again for whatever reason, totally miss the point of what insurance is when you seek to impose on insurance companies an obligation to offer insurance (and presumably, at a ‘fair’ price) to every one who comes asking?
And, as far as your advocating a system of ‘rules’, I would have thought a system where people get what they pay for – nothing more, nothing less – constituted such a system. People in the US pay a premium and in return they get a contracted amount of coverage. The gripes come from people, perhaps out of ignorance, carelessness or some other reason, accept such a contract, only to complain when they are denied coverage or payment for services rendered outside the contract (such as what happened in the Gulf when those who had flood exclusions – and therefore weren’t paying premiums for such coverage – decided that, regardless of the wording of the contract, they should be reimbursed for their losses. that playing by the rules for you?).
Yeah, it’s sad that some people can’t get all the health care they want for as little as they want to pay for it. But the system works for far more people than it doesn’t, and regardless of the issue, you screw things up when you try to give everybody everything they want. There are finite resources, and as I pointed out in my first rant, every dollar of health care you provide to someone outside the coverage they’ve paid the premiums for has to come out of someone’s pocket. And, unsurprisingly, it’s never your pocket, is it?
Stevestrum=
I don;t know what your;re talking about whane you go on about advocating for this or for that. If any of your rant was directed at my comment, please refer to somehing specific I said.
My point is this:
1. The nation has a serious problem with provding health insurance and health care.
2. If the health insurance industry can;t handle it, then issuing reasons why ttey can.t is neither here nor there They need to move over to make room for problem solvers.
3. To some extent, insureres actually impede the solutions process because they skew the demographics of shared risk, by culling the low risk group and leaving the high cost for someone else (the government).
4. The question you are not addressing is: “Why should insurers expect gvoernment policies to safeguard their profits, if they can;t contribute to solving our problems?
It’s ironic (and illogical) that you should be stressing what the Insurers can;t do and whining about their need for profits at the same time.
Protfits , like a wage, are paid in return for somenting that IS DONE, not what can;t be done.
So, whose pcket will provide the cost of taking care of all the things that insurers can;t do? Surprinsingly, it’s always someone else’s pocket. Insureres = profit, cost=someone else.
Nice!
Anyone who rants that we have a serious problem providing health care to people is, well, there is no other way of putting it, ignorant. We may not provide as much of it as cheaply as people want (which amounts to ‘make me all right and don’t charge me’), but I don’t see too many people running off to Canada to get in line for surgery. And the same holds for health insurance, where the vast majority of people seeking insurance coverage are able to do so. Nobody is forced to buy health insurance, they do so because they think it a good deal. If it were so bad, there would be far more people opting out of coverage. impose new regulations, however, perhaps those mandating coverage for the 4 pack a day smokers, and you’ll make it even harder for Joe sixpack to afford the coverage.
Of course, the fact that it works for the vast majority of people is no obstacle to whiners who want to screw up everything – and make it more expensive for lots and lots of people – all because they can’t bear to say NO to someone who isn’t getting everything they want.
I haven’t seen very many posts showing a complete lack of understanding of the relations between health care, health insurance, the psychology of health insurance and all of the other things that go into our system as what stevesturm has posted here.
Frankly, most of it doesn’t deserve a rational response because it’s not rational. He doesn’t see lots of people running to Canada for surgery? Well, Canada isn’t that inexpensive. But there is a growing body of “health” tourism where people who need some procedures will travel to India and other countries that have developed hospitals the equal of any in the United States and often staffed by doctors trained here. According to multiple news reports the care is as good as here and the surgery and hospital expenses are so low that even with travel expenses it’s cheaper than the equivalent procedures here. That doesn’t mean it’s cheap but that for those fortunate enough to have the money it’s less expensive.
The usual comment about how of course insurance companies deserve to make a profit pops up. Nowhere does he address the fact that they spend so much money on staff to research how to deny claims that their administrative overhead is far higher than Medicaid or Medicare. I fully expect stevesturm to attempt to spin that fact to a level of distortion beyond recognition but it is true. And it should also be recognized that there is a difference between making a profit and making a big enough profit to make Wall Street analysts happy with a publicly held company. And since that is what determines executive compensation the customers will always be placed second if not even lower in the scheme of things for insurance companies. I also sincerely doubt that he fully appreciates how much having people who can’t afford preventative care or visits to the doctor before something becomes serious enough for the ER really hurts the overall system and drives up costs for everyone. And I definitely don’t think he really cares about those who truly cannot afford medical care or insurance on top of the expenses of daily life. Or perhaps it’s just that his ideology somehow denies that they exist except for those who are poor by choice.
Jim, jim, jim: pray tell, where did I say insurance companies ‘deserve’ to make a profit? Granted, in your rush to condemn my comments, you may have let your built-in bias see what wasn’t there, but if you’re going to make such a mistake, why should the rest of your criticisms be taken seriously?
Saying it slower, for those of you who are willing to pay attention, my argument is that insurance companies, like any company wishing to last past tomorrow, seek to make a profit. And it is fine, even desirable, that they do so, especially when my ability to get my medical bills paid depends on my insurance carrier not going broke. It isn’t that they deserve to make a profit, it is that they, like any other company, ought not be forced to take customers they don’t want or forced to offer services for less than they can charge in revenue. Along the same lines, they, like any other business, ought not be able to change the rules mid-stream by denying their customers services covered by the terms of the contract. No more than contracted, no less than contracted.
You may not like that certain people can’t get ‘affordable’ coverage (defined as having other people pick up the difference between their premiums and their claims) and you may not like that some people choose to spend their paychecks on things other than preventative medicine, but neither of those bleeding heart emotions justifies screwing around with a system that works pretty well for an awful lot of people.
Maybe you’re fine with paying more than you would otherwise have to pay, if not for the need to offer triple heart attack victims ‘affordable’ coverage. Then again, you may simply be someone with high medical expenses who wants someone else to pay your bills. If the former, you’re more generous than I. If the latter, you’re greedier.
stevesturm
Your swipe aside, Guiliani, Bush, et al, could have individual coverage, they would just have to pay an awful lot for it… as they should have to do given their histories, and as should be the case for many of those you refer who couldn’t ‘afford’ health insurance.
This is factually incorrect. I, like Dick Cheney, have a pacemaker. (Just a pacer instead of a pacer/defibulator.) I call up individual insurance company and ask for insurance. They say ‘We cannot insure you’. There’s no ‘We won’t insure you for anything less than X’, they simply flatly state they won’t insure me, at all, whatsoever, under any circumstances.
So I don’t know about the others, but, no, Dick Cheney could not purchase individual coverage health insurance. And I’m in a hell of a lot better shape than Cheney. Replacing my damn pacemaker and the occassional antibiotics for a sore throat every few years are all my medical expenses, I don’t wander around having heart attacks. If I can’t get any insurance, he certainly can’t.
If you don’t believe me, feel free to pick any health insurance company, call them up, make up a fake name, and, when they start asking for more information, tell them right off the bat that you have a pacemaker and are concerned they won’t cover you.
Go ahead, do it. If you have time, pick a few other problems like diabetes or throat cancer and try those. (I honestly don’t know what the results will be.)
Of course, this varies by state, and possibly there’s some state-run high-risk pool plan that Cheney could join, in whatever state he chooses to live in, but many states do not have that and that’s not the same as ‘purchasing individual coverage’, that’s something provided by the states. And it exists because fools like you continued to stall the Federal government from fixing health insurance.
The fact you’re so amazingly uninformed as to think that everyone can get health insurance, and they’re just whining about cost, really exposes how poorly-qualified you are to talk about this subject all.