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Make the insurance companies do the right thing on health care reform

By Julian Sereno

A friend and fellow small-business owner has just hired a lawyer to sue her health insurance company. She said they invented a pre-existing condition so they could avoid paying for doctor bills that resulted from a recent auto accident. They want to refund the premiums and leave her holding the bill.

I expect she will prevail in making the insurance company pay up, and if she is lucky she will get the insurance company to cover her legal bills, too. Which means that, at best, she will have broken even financially.

For the insurance company, the worst thing that could happen is they will have to do what they promised to do in the first place. They may pay a little extra, but they will face no fine. If health insurance companies choose not to, there is no way to make them do the right thing other than by suing them. The company will stretch out the in-house appeals process, string you along and then hang you out to dry.

What it means is that small businesses are in the most difficult position in today’s health care system. Health insurance is expensive, hard to get and companies will drop you in a heartbeat. Nobody has your back.

Health insurance companies’ primary mission is not to help heal the sick but to make money for shareholders and pay huge salaries and bonuses to executives. They accomplish this by trying to maximize revenue inflow and minimize outflow. Take in as many premiums and pay out as few claims as you can.

They make more money by letting the sick die.

The right-wing defenders of the status quo and their Republican acolytes have resorted to lying and dissembling to thwart health care reform, the same technique they used to sell the war in Iraq. Then it was Saddam’s imaginary weapons of mass destruction and make-believe meetings between Saddam’s intelligence agents and 9/11 planners. Now it is lies about death panels persuading senior citizens to have themselves euthanized, from former vice presidential candidate Sarah Palin and Iowa Sen. Charles Grassley, no less.

Angry protesters at town hall meetings demand that the government keep its hands off Medicare, oblivious to the fact that not only is Medicare a government program, but the Republicans fought tooth and nail 45 years ago to try to stop its passage.

Medicare passed, of course, because then-President Lyndon Johnson was a master politician and rammed it down the Republican’s throats. Obama and the Democrats will probably need to do that, too. In order to be successful, they are going to have to simplify health care reform from a thousand pages down to one or two: All consideration of preconditions is outlawed, coverage can’t be cut and rates can’t be raised due to illness, there can be no caps on lifetime benefits and mental illness needs to be covered the same way as any other illness.

That simple.

They also are going to have to get it right. When the Democratic Congress did nothing about health reform in the early Clinton years, in 1994 they were swept from power for the next 12 years. If they pass health care reform and it doesn’t work, they will be swept from power as the Republicans were in 2006 over the bungling of the Iraq War and in 2008 over the Great Recession.
Ironically, opponents of the Obama plan have some excellent points to make about health care reform, though they are hard to hear above all the lies and shouting. One is that malpractice tort reform also is needed. Doctors need to stop having to order batteries of expensive tests to protect themselves against lawsuits and patients who have suffered because of incompetent care need to be compensated with money pooled for this purpose rather than the lottery of a malpractice suit.

The other is that businesses should no longer be responsible for health insurance coverage of their employees. This would contribute greatly to business profitability and liberate employees who may stay at a hated job for the health insurance benefits.

Without these two things, medical costs will continue to skyrocket, health insurance reform notwithstanding.
But the key to it all is making the health insurance companies do the right thing. And when they don’t, they need to be kicked to the curb. That is a good starting point.

Julian Sereno is editor and publisher of Chatham County Line.

2 Responses

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  1. E. Evans

    Wow! Thank you. This is the most down to earth, sensible Op-ed I’ve read on the subject!
    The only point to which I take exception is your perception (which is common) of the benefits of Tort Reform. The Medical malpractice issue has masked the interests liable for faulty and defective product settlements. They’ve profited most from Tort Reform. Thirty seven states have adopted tort reforms; but the practice of medicine, the rate of cost increases and, in most cases, malpractice premiums were unaffected.
    Some localities report better outcomes by providing doctors with access to a data base of scientific information on the efficacy of different treatments. Apparently there’s an estimate that it takes 17 years between the time an innovation is discovered and its commonly medical usage. This data base would provide the most recent scientific data but medical decisions will still be made between doctor and patient. Republicans and reform opponents distort the concept by claiming that ‘government’ panels will be dictating treatments.
    I’m disgusted. During the Presidential campaign, the idea of shifting the responsibility for providing health care coverage away from employers made sense. Without benefit costs as part of the overhead, American made products could be priced more competitively and help grow the economy.
    A majority of eligible voters canvassed and/or phoned banked and/or made donations and voted for President Obama’s platform. They sent him to Washington with majorities in both houses. Now the prevailing paradigm is that most Americans like and want to keep their existing coverage. This makes no sense considering all the complaints and horror stories about increasing premiums, the declining quality of coverage, refusals to cover necessary treatments and medications, arbitrary policy cancellations, etc.
    Meanwhile, significant numbers of Democratic members of both Houses appear to have forgotten or decided to ignore the platform for which we voted. During the August break, most Democrats were poorly prepared at Town Halls and, when able to speak, augmented misrepresentations. Poor Senator Grassley is the poster boy for Republicans who only memorized talking points and ignored the content of the bills.
    Some of the people I helped elect are concerned with placating Tea Baggers who’d never vote for them under any circumstances. Come Election time, I’d never vote for anyone who supported the Tea Baggers. I’ve seen people deprived of chances to make informed decisions by their use of disruptive tactics and with a grandiosity often only displayed by the mentally ill. I wonder if it’s occurred to the Blue Dogs that new-found civic activists won’t be helping them get re-elected.

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