Health insurance isn’t health Care
By Bill Knight | 1st January 2008
A medical test was recommended. Insurance cards and forms were completed, and competent health professionals conducted the procedure. A follow-up exam was urged and completed. Good news. Time passed. (More than six months.)
The first notice that hundreds of dollars was past due came as an initial statement from the medical center 26 weeks later. A kind woman answered a phone call, looked up the account, and noted that a Preferred Provider plan applied the first charge to a deductible, then denied the second charge. The secondary insurer, an HMO, never responded to the medical provider.
Contacted, the HMO said they’d not received an Explanation of Benefits from the PPO. Called again, the PPO - which sent no previous notice about anything - said they’ll send one.
The balance remains unpaid.
Health insurers that drag their feet like turtles on sedatives are familiar - for people fortunate enough to even have health insurance.
In fact, according to the state Office of Legislative Research in Connecticut (where several insurance corporations are based), such practices aren’t uncommon, with some actions “arbitrary, reckless, intentional, malicious [and] fraudulent.” States supposedly regulate insurers through laws like the Unfair Claims Settlement Practices Acts, which mandate that insurers process claims promptly and prohibit requiring unnecessary or repetitive reports or forms. Still, some health insurers don’t handle claims promptly, delay settling claims, deny claims without reasonable justification, require duplicate information, cancel policies or increase premiums - all to avoid paying and to boost profits.
The problem with health care is less about health providers than insurance providers.
Nevertheless, timid reformers in Springfield and Washington are confusing proposals to provide health insurance with providing health care. Only Democrats John Edwards and Dennis Kucinich advocate plans addressing the need to efficiently provide health care to all Americans: a single-payer system.
Illinois Gov. Rod Blagojevich has pushed an expansion of health-care coverage despite misgivings by public advocates, his own party, and an increasingly divided labor movement. The California Nurses Association strongly supports single payer, as do more than 350 union locals, as well as 80-some members of the House of Representatives on record as backing such as bill (HR 676), plus millions of regular Americans.
“Single-payer” describes a way to run a program in which one entity administers it - a government, in the case of Canada’s health-care system. The single payer collects all fees for the goal, like health care, and disburses all payments. Incidentally, “universal health care” isn’t the same thing. It may be single-payer, but it needn’t be. Universal health care refers to programs intended to guarantee that everyone in a certain place - state or nation - has access to most types of health care, and in theory that could be arranged through existing health insurers.
But they are part of the problem - financially more wasteful than skyrocketing hospital costs, redundant (and expensive) medical equipment, malpractice insurance and the lawsuits (and malpractice itself) that cause it, and exorbitant salaries for a few medical professionals.
Amazingly, AFL-CIO leader John Sweeney and leaders of the breakaway Change to Win labor coalition in November spoke out in favor of Blagojevich’s employer-based state health insurance reform plan, similar to one introduced by Governors Arnold Schwarzenegger (R-Calif.), Mitt Romney (R-Mass.) and Ed Rendell (D-Pa.).
Such employer-based “reforms” are criticized by the California Nurses Association (CNA), Physicians for a National Health Program (PNHP) and other progressive groups as undermining a better solution - a single-payer system.
“Blagojevich [first] proposed to raise taxes, which Illinoisans would then pay to insurance companies - but private insurers are the problem, not the solution,” said Dr. Quentin Young, an Illinoisan who co-founded and leads PNHP. “The only effective solution is a single-payer public insurance program.
“We pay the world’s highest health-care taxes already,” he continued. “While Canadians live longer and healthier, they spend just over $3,000 per capita, compared to our $7,000. Because we rely on private insurers, we pay more for less.”
Blagojevich says his plan is the best that can be done - echoing Hillary Clinton when she spearheaded the doomed “managed care” reform in the early 1990s.
“So much of what you do in government is done through political realities,” said Blagojevich, quoted in the publication Corporate Crime Reporter. “The art of politics in government is the recognition of what is possible. The choice is between whether you take an existing structure - an employer-based health care system - and build on that, shore that up, or whether you scrap the whole thing and create a whole new system that historically has not taken root in the United States.
“In a perfect world and in theory, the single-payer system is one that I could certainly support,” he added. “As a practical matter, I don’t think it is something we are going to achieve in the near future.”
Sweeney recognized single-payer’s popularity, but he seemed to surrender, too.
“I recognize that there is tremendous support for single payer,” he said. “But as the Governor has said, it is important that we move on health care coverage now with what we have the political will to achieve. That doesn’t mean we aren’t going to continue to strive for a single-payer health care system.”
However, other interests threaten to derail single-payer before it ever gets on track.
Behind the retreat-as-reform press conference with Sweeney were two (labored-backed) insurance companies, Union Labor Life Insurance Co. and American Income Life, plus PhRMA (the Pharmaceutical Research and Manufacturers of America lobby), a Blue Cross Blue Shield consultant, and former Democratic Congressman Richard Gephardt, now with the world’s largest law firm, DLA Piper (which represents more than half of the top 250 companies in the Fortune 500). The appearance was put on by “America’s Agenda: Health Care for All,” whose board includes a few union leaders, attorney Joseph Bock (a campaign contributor to Republican and Democratic candidates alike) and PhRMA vice president Jan Faiks.
Young, the PNHP doctor, said other proposals for reform are inferior, “patch-quilt failed systems that won’t work.”
Only Edwards’ proposal even comes close, he continued, and Clinton in particular “is ultimately duplicitous. People are being ripped off and these liberal Democrats are doing nothing to ease their pain.”
Independent-minded progressives and conservatives see the problem with relying on insurers.
Daniel Gallington in the conservative Washington Times newspaper last month wrote, “Private insurance companies are licking their chops over national insurance ideas that would have billions of dollars paid to them - no matter who pays.”
Young summarizes the real choice - one ignored by all Republican and most Democratic Presidential candidates and a troubling number of labor leaders.
“Replacing private insurers with a single public coverage program - a kind of Medicare for all - would recover enough funds currently lost to administration to cover all Illinoisans without additional cost to the state, businesses or consumers,” Young said.
For details on single-payer health-care, go online to -http://www.pnhp.org/facts/what_is_single_payer.php.
Also, Physicians for a National Health Program (PNHP) has a valuable Frequently Asked Questions page - http://www.pnhp.org/facts/singlepayer_faq.php
Bill Knight is an award-winning journalist who teaches at Western Illinois University.Contact him at bill.knight@hotmail.com.