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Health Net Arizona -Insurance co. bails on cancer patient — in the middle of chemo

Health Net is back in the news, this time here in Arizona.
From Laurie Roberts comes this
Here are some of the juicy bits:

Not only did Health Net of Arizona cancel Iorio’s insurance, court records indicate it took back every cent it had already paid her doctors.

And suing Health Net “What they’re doing,” said her attorney, John Doyle, “is using the rescission process as a profit making center.”

Rieger says it’s not about profit but about exposing fraud to save their nearly 200,000 Arizona policy holders money. “Our job,” she said, “is to root out health care fraud so we can continue to keep our heath care affordable.”

No doubt it keeps their execs comfortable as well. According to the Securities and Exchange Commission, Health Net’s president and CEO, Jay Gellert, scooped up $5.23 million in salary and stock options the year Iorio was kicked to the curb. Last year, the company made $200 million in profits and this year, executives will see double their normal bonuses if they hit revenue projections, according to SEC records.

Source: azcentral.com blogs | LaurieRoberts

Fraud? If there is any talk about fraud, it should be toward the health insurance companies.
The concept starts simple: Pay premiums, get sick and the insurance company pays the bills, spreading the risk among all the insured.
The reality is Pay Premiums, Get sick, Get Fucked!

Health Care can be made Universal. It can also be made painless. But not in the hands of for profit companies.

Google Health makes its pitch

Dana Blankenhorn posts about Google’s entry into the Personal Health Record Sweepstakes.
Google Health makes its pitch | ZDNet Healthcare | ZDNet.com

Nice try, but no sale here. Personal Health Records cannot be built on anybody’s proprietary system. This is why health care is so fucked up now.
Don’t get me started on the million reasons against Microsoft managing Personal Health Records.
When the shelf space for claim forms exceeds the shelf space of patient records in your doctors office, do ya think there might be a problem?

This is IndivoHealth This is an Open Source project for Personal Health Records, that is not proprietary.
Hat Tip to Adriana Lukas for the Link

RIAA’s ‘making available’ theory falls – The INQUIRER

In a fit of reason over rhetoric Judge Janet Bond Arterton tossed the ”making available” theory out the window. She correctly notes that unless there is actual transfer, the infringement through distribution is nonsense.
RIAA’s ‘making available’ theory falls – The INQUIRER

A .pdf of the decision is here.

Rescission, Health Insurance and Universal Health Care

From Legal Explanations.com comes a definition of Rescission

Rescission(n) Rescission is the mutual agreement between the partied to an agreement or contract, deciding to nullify, cancel or otherwise terminate the agreement entered among them and restore the position prior to that agreement
Source Legal Explanations.com

Most folks have never heard rescission in their daily lives, but it impacts them more than they know. Consider the three day grace period on a lot of major purchases. Consider 30 day money back guarantees. Both of these are examples of rescission, which protect you against high pressure sales, bad faith, crappy products, and not having to pay for something that just is not going to work for you. This is the right of rescission, which was made into the law of the land in the Consumer Credit Protection Act of 1968. The Health Insurance Industry however looks at it as a 2 YEAR get out of coverage/payment card.

More Bad Faith

The LA Times reports that Health Net, one of the largest Health insurers in California has been found to have breached their contract and displayed bad faith to the tune of $9 Million bucks.
Health Net ordered to pay $9 million after canceling cancer patient’s policy
The Money Shot

“At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.”
“It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the judge wrote.

Link to .pdf of the Bates Arbitration Decision

That Health Care Insurance is considered an Industry like making ground beef or cars should cause danger music to play in your ears.

The Politics of Health Care
The current Democratic Presidential Candidates both agree we need health care. Both of them however are blinded by the belief that the Insurance Industry is the One True Way.
Hillary Clinton says that Health Insurance needs to be Mandatory. This is an ass backwards idea of universal health care. The idea is that with everybody covered, the cost of care and insurance will go down, and we will all live happily ever after, or at least through the next re-election cycle.

Barack Obama is offering National Insurance which sounds good, but is still predicated on the Health Care Insurance Industry managing it.

The funniest or most tragic point of both plans is that they are modeling their plans on the coverage that members of Congress get. Which are outstanding plans, that we are paying for already.

Both of these candidates are living under the delusion that the Health Care Industry is actually concerned about health care, and that economies of scale will bring us to the promised land of a country of Shiny Happy Healthy People.

Why Neither of these Plans will Work
Let me set the stage for you with a couple of little know facts.
The Insurance Industry is Exempt from Antitrust. Antitrust is where companies in the same industry compare notes, pricing, and other information. In every other business in the US this is Illegal. But the insurance industry has massive databases of information, including pricing, coverage and information on anybody who has ever paid a single premium for insurance of any type.
They own MIB which warehouses this information.
In reality this is the first stop in denying coverage and or canceling your coverage.

Pricing Information. The Health Care Industry has another database used to determine payments to not only plan providers, but also everybody who may provide health care.

Yet Health Care Insurance neither insures very well, create cost savings, or is affordable.

More Americans Are Giving Up Golf – New York Times

Good News for George Carlin! If this trend continues, we can as a nation, fill in those 18 holes and turn all that real estate into homeless shelters

More Americans Are Giving Up Golf – New York Times

Weekly Lunacy

Been a bumper crop of lunacy across the interweb this week.

About the web, we have Zeldman who was one of the leading lights in working to have browser makers support current and emerging code and display standards. At the time circa 1999, Microsoft’s Internet Explorer had serious problems requiring designers to use more code in their web sites just to get around non standard markup.

This week Zeldman has written that coddling Microsoft is okay for doing the same thing they did then.
sigh….GET a fucking clue!!! Microsoft will never build a standards compliant browser.

In other MS News, another EU deadline, another press release saying that Microsoft will embrace Open Standards. What is this #4?
see get a clue above

In politics we have Obama running the ChangeTrain, putting a serious kink into the bullshit from Hillary in supposing that we will only vote for a professional politician. See 7+years of the Shrub, for why this isn’t gonna happen.

Also being dragged to the platform and pushed onto the ChangeTrain is Larry Lessig. I admire and respect Larry. Hell I was one of the first geeks to send him money to fight Eldred in front of the Supreme Court. I use the Creative Commons Licensing for my ravings out here. Despite the defects in it. But Larry is really in the wrong weight class here.

Politicians either have or develop ethical ‘flexibility’ which is not a hallmark of the academic.

There is more weird shit going on, but the tech pundits are having a meltdown over Facebook loosing its Happy Shine That sucks cause it means that they will be looking for their friends elsewhere.

More Health Insurance Company Problems

Yet another insurer gets to explain why they are canceling policies.

L.A. says Health Net illegally halts insurance
Advances in technology used as weapons by Insurance Companies
Fear of insurance trouble leads many to shun or hide DNA tests

DomainKeys Identified Mail DKIM

Being able to assert your identity online is problematical on good days and impossible on most. Having the ability to create and confirm your online identity is a subject close to what little heart I have. Getting your computer hacked and having someone using your identity from your email server to cause pain to you and others is not a thing you want to have happen. Believe me, it is next to impossible to track these folks down. Just check your spam folder.

There are a lot of really bright folks working on online ID projects to create a framework that will allow you to create, confirm, and manage your online identity. There is a new player on the horizon that may provide a method for a secure verifiable online identity system.
DomainKeys Identified Mail DKIM
While this is an email project, when you think about it, email is probably the most significant communication used. Having folks I communicate with able to confirm that it is me, and conversely being able to confirm your identity, is a very good thing. This is something to keep your eyes on.

Yet another reason for change in health care

Doctors balk at request for data – Los Angeles Times

Health Care Closed Source or Open Source

Dave Winer has written a couple of posts about health care
Debating health care in 2008
Debating health care in 2008, day 2
On day 2 is this nugget:

The basic Republican argument goes like this. Why should I pay for the health needs of people who are so irresponsible as to not have
health insurance.

If I got it wrong, please set me straight.

Now I’d like to answer this, very carefully.

The Democrats aren’t proposing that you should pay for the uninsured. Key point. They either agree with you, or know that they’re not going to get their proposal passed unless they take this into account. The Obama plan says you don’t get care unless you have insurance. His proposal aims to get a lot more people insured. Clinton goes one step further, by requiring everyone to have health insurance. LINK

No Dave, you have summed up the current positions pretty well. There is a but……
Here is my 2 cents.
Health Care Closed Source
Geeze Dave!
You are sucked into the same quagmire as everybody else with the position is that Insurance is the only way to pay for health care. Currently Health Care is the worst Closed Source game around.

Consider that Insurance is a numbers game developed to share the risk of cost. Sounds pretty good, a bunch of folks pool money to pay for illness or injury repair.
Let’s look at what the game really is.
The Insurance Company provides you with a policy to cover health care expenses. With the limitations, exclusions, co-pays, deductibles, networks, and caps, a cell phone contract is a better deal.

Health care premiums are predicated on costs , which are billed by providers, who predicate these on cost plus profit like any other business.(that we are even considering Health Care as a For Profit Business rather than a Service Industry is another rant)You would think that economy of scale and free market forces would bring lower health care costs. You would be wrong.

The Insurance company that is providing you ”coverage”, is the same company providing malpractice and liability insurance to docs, clinics and hospitals, which causes them to raise their rates, which jacks up your premiums, which adds to the administrative burden, which requires more overhead, adding to the cost of care, which at this point we have not addressed actually providing any fucking health care!!

So the Insurance Industry is getting largest amount of money from you, for the least possible level of service, getting the most money from the actual health care providers for liability and malpractice, which they then use as a cost basis to justify either jacking up your premiums, or decreasing your benefits for the same money. And it a lot of cases BOTH!
Notice I still haven’t actually mentioned actual Health Care?
But Wait! There’s More!
There is an entire industry called claims payers, who are between you, your health care provider and your insurance company.
The Medical Information Bureau is another of those semi secret organizations that allow the HCII to deny you coverage.
Don’t forget the Medical Liens Industry

I am really tired of the argument Think of the Poor Health Care Insurance Industry(HCII)!! The dems are just as guilty as repubs, in continuing this lunacy.
What exactly has the HCII really done to control costs which is their selling proposition?

  • Have care costs actually come down?
  • Are more companies providing Health Care for their workers?
  • Are more families able to afford Health Insurance?
  • Are doctors and hospitals able to treat patients at a reasonable price?

No they are not. Like the poor woman whose insurance company approved treatment 6 days after she was dead.

Why aren’t insurance companies paying for experimental procedures? One of the best arguments I can put forth against the HCII is their refusal to participate and pay for new and experimental treatments. Yes they are risky. But if the patient, doctor, and hospital are willing to put forth the effort in order to actually try a course of treatment, they should be in the lead in doing this. Currently the rich are being soaked for this, in those cases where there is a confluence of disease and money. Which is not fair to them. The rich are citizens too. All lot of groundbreaking work and procedures are developed as a result of the higher incidence of poorer folks having medical problems. This IS a numbers game. No I am not advocating a gigantic Tuskegee experiment on poor people.

Health Care Open Source
I am going to start with a couple of observations.
Healthy people are more productive. Healthy people are happier. Healthy people are less likely to shoot up malls, classrooms, city councils, steal your car, or kill you for walking down the wrong street. Most people who get into health care, are about helping other people, not about making money. Besides if you want riches beyond avarice, you go into business.

My argument is for Universal Health Care. If you breathe and are a citizen you get health care.
Here me out before you go all private enterprise on me.
There are a few things that need to be done to make Universal Health Care a reality.

1. Standards of Care
Fix the problem. What ever it takes. Record problem, treatment course, and outcome. From a stitch from a bar fight to a liver transplant. Make this information Universally available. This implies a central database to make this information accessible to health care professionals everywhere. This has to be an OPEN SOURCE effort. Microsoft and Google are the last folks on the planet to trust in designing, managing of guarding medical information.

2. Medical Record keeping.

We need a single record keeping system used by everybody. This contains all of the pertinent patient statistics, problem, diagnoses, treatment and outcome information, with treating facility, physician, nursing and ancillary staff including to links to test results. But is not linked to individual patients by name or other identifying information. This can form a useful function in giving doctors access to information to courses of treatments that failed or worked. It also can form a synergystic function if treatments used are parts of either drug trials, (eliminating proprietary or secret drug trials,) or experimental treatment scenarios. In the case of failures, this needs to be used to fix problems and not blame. No the malpractice attorneys will need to find other careers.

Personal patient information, must not be accessible on the public facing side of this. Gaining access to this information needs to be strictly controlled and granted only in limited circumstances, such a Public Health Issues, Epidemics or disease outbreaks. Or by the patient. We can dismantle a bunch of the HIPPA bullshit here.

Since we are talking about Universal Health Care, the Health Care Insurance Industry can be dismantled and those folks can buy a casino and set up a sports book. They probably not make as much money but that is too bad, as my sympathy for the Health Care Insurance Industry is too small to measure by any current technology.

3. Payment

Everybody Pays.
Individuals, a national sales tax which will catch everybody. Welfare to Wealth, everybody buys stuff.
Employers, a premium scheme setup along the same lines as Workmans Compensation is set up now, understanding some industries are more dangerous than others, and do pay higher premiums, with a deduction in premiums for businesses that have better safety records.
Usage Taxes, auto licenses get a surtax as autos are one of the primary populators of health care facilities. Probably consider taxes on other toys like boats and planes.

4. Administration
The only role I see for the Government either federal, state or local is collection. This needs an NGO setup for administration, payment and oversight.
Having this information available is the best way to get the best care at the best price.
Having this information available will also eliminate discriminatory and predatory insurance schemes.
The cost savings in eliminating Private Health Care Insurance, redundant paperwork, claims payer networks, and other third party remoras between the doctor and patient will drive down the cost of health care.

That’s my 2 cents.