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Woman Loses Health Insurance Due to Facebook | e-Patients.net

Woman Loses Health Insurance Due to Facebook | e-Patients.net.

Insurance and Health Care seem to be in conflict.  You can bet that your insurance company is not the only one that uses Facebook to make your life miserable.

Health Care Rationing and Death Derivatives

We need a Public Health Care Plan. Available to all, Covers everything. Full Stop.
The folks who want to scream Socialism only need to read this sentence, “Public Schooling gave you the ability to read this.” Available to all, covers everybody.
That private for profit Insurance Companies are offering to take anyone regardless of condition is bullshit. Let me count the ways they will slide. Claim Denials, Rescission, Cost. There has never been an insurance scheme that has resulted in lower costs. No Fault Insurance states are the poster child of this. Every time private insurance companies get to sell policies under mandates, the price goes up.

Health Care Rationing
According to the California Nurses Association/National Nurses Organizing Committee
California’s Real Death Panels: Insurers Deny 21% of Claims PacifiCare’s Denials 40%, Cigna’s 33% in First Half of 2009

Death Derivatives
The NYT has a story on the latest wrinkle on investing.

Wall Street Pursues Profit in Bundles of Life Insurance
“After the mortgage business imploded last year, Wall Street investment banks began searching for another big idea to make money. They think they may have found one.”

“The bankers plan to buy “life settlements,” life insurance policies that ill and elderly people sell for cash — $400,000 for a $1 million policy, say, depending on the life expectancy of the insured person. Then they plan to “securitize” these policies, in Wall Street jargon, by packaging hundreds or thousands together into bonds. They will then resell those bonds to investors, like big pension funds, who will receive the payouts when people with the insurance die.”

“The earlier the policyholder dies, the bigger the return — though if people live longer than expected, investors could get poor returns or even lose money.”

This is the next credit-default swap, and or collateralized debt obligation, backed by your illness. You know how well those worked out.

Health Care killed his father

Here is an interesting look at health care.
How American Health Care Killed My Father Some of the villains are surprising.

Rescission Math

Rescission is the retroactive cancellation of individual health insurance policies.  This is used by the health insurance industry to keep their medical loss ratio low and avoid paying for expensive or chronic health problems. Which is what you bought insurance for, but who knew.

Unconscionable Math is a posting at Taunter Media that shows your chances of being cancelled if you get sick or need expensive care is a whole lot higher than the health insurance industry is telling you. Highly Recommended.

Medical Loss Ratio

Health Insurance has always been presented as a method of sharing risk across large groups so that when catastrophe strikes you are covered. The theory is that premiums create a large pool of money that is used to cover you in the case of need. Conversely your premium is used to help someone else. This of course breaks down as soon as somebody can find a way to get folks who might actually need to use their policy denied benefits. The insurance industry uses rescission, purging, and the latest game, the Medical Loss Ratio.

Medical Loss Ratio is a term that has nothing to do with providing health care, but everything to do with profitability of for profit insurance companies.

Here is a quote from Wendell Potter, who until recently was the Chief PR guy at Cigna, during an interview with Bill Moyer.

WENDELL POTTER: Well, there’s a measure of profitability that investors look to, and it’s called a medical loss ratio. And it’s unique to the health insurance industry. And by medical loss ratio, I mean that it’s a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry’s been dominated by, or become dominated by for-profit insurance companies. Back in the early ’90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

Here is the Interview Video.
Here is the transcript.

After watching this, you may have a different view on health insurance.

Medical Bills and Bankruptcy

Headlines around the web[1] are reporting that a recent study(Feb. 2005) by Harvard University[2] noted that medical bills accounted for 62% of bankruptcies.

This curious tidbit is not new, nor other problems with Insurance based Health care. From The National Coalition on Health Care [3] comes these nuggets:

Health care spending is 4.3 times the amount spent on national defense.

The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,700 in 2008. Workers contributed nearly $3,400, or 12 percent more than they did in 2007.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).

According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care.

Politicians are staging themselves around Health Care. This is political posturing. Everyone of these folks that is saying Health Care, really mean Health Coverage because they all have a large insurance company stick rammed up their ass. The only efficencies that are currently in the insurace industry is how fast they can deny your claim, exclude treatment and therefore payment, or use recission on your ass to just not pay at all.

The insurance industry should be the absolute the last group invited into any discussion about health care. When 62% of bankruptcies are related to medical bills, and 78% of them had health insurance, maybe you might want to think about why universal health care is a better idea.

[1] Google Search ‘Harvard University bankruptcies medical expenses’
[2] Harvard University Bankruptcy Paper – Final Manuscript (PDF)
[3] National Coalition on Health Care Health Insurance Costs

Health Records and the folks who bill

Online health records are getting a lot of publicity, but very little significant traction. In one of the more public tests e-patient Dave recounts his experience in uploading to Google Health. And here is the spin behind that experience.

A couple of issues stand out for me. One is the insurance billing code nonsense. Every Insurance company has Not Invented Here Syndrome. So every time you are exposed to a hospital experience, a small army of billers has to drag down the particular manual to be able to submit a claim in hopes of getting paid. That this adminitrivia is such a large part of overhead is part of what is driving health care costs through the roof.

Part of the current adminstration’s plan should be to create codes for all procedures and require insurance companies to use them or not have a hope in hell of getting a dime. The VA has such a system that seems to work.

Hospitals need to change. They are currently being run like hotels. You get charged for everything in the place, regardless of use. They look at occupancy rates, and add extras, to make their ‘nut’. The design is lunatic. If you have ever needed blood work, x-rays, and MRI’s you find yourself riding elevators and stacking up mileage as they move your around like grocery stores putting the milk bread and eggs at the back of the store. This helps them keep you there longer to get an extra day of occupancy out of your insurance company. Fixing the problems is not the preferred outcome, as the longer they can keep you, the more they can charge.

Out Patient Aftercare is heresy of the blackest sort, because of the billing scenario above. Insurance companies are not working to reduce hospital stays either as this article in the NYT shows.

They are not paying for health, they are paying for procedures. Seriously fucked up.

Vendor Relationship Management and Personal Health Records

VRM is a theory that we own our data and should be in control of our relationships with folks who want to sell us stuff.

Dave over at e-patients has posted “Meaningful Use”: a pivotal definition for new-wave medical records systems which looks at coming medical records that are headed to the same place.

Dave outlined these principles on medical records.

My principles

* Patient is a first-person word. Your time will come: someday it will be you, your child, your mother, your spouse on that hospital bed or at that roadside being tended by an EMT. The way to think about this is in the first person: “my data,” not “patients’ data.”
* It’s my data. It’s my life that’s at stake. I have a right to seek the best care in the world, and if that means exporting a copy of my data from your system and taking it somewhere else, I have a right to do that..
* Corollary: No more proprietary data. Whose data is it, anyway? We must put an end to the era where a system provider thinks the data they collect is their property. Lives are at stake. Vendors must adapt to a world where they earn their margins by creating on-going value, not by holding data captive. This includes images (CT scans, MRIs, etc) as well as lab results and everything else.
* Let each constituency say what works for them. Patients shouldn’t say what doctors need, and doctors shouldn’t mandate how patients should and shouldn’t describe things. (Warning: experts on both sides should be able to comment on / warn the other about apparent errors. Docs must be able to say “Whoops, you overlooked this,” and patients must be able to say “Whoops, you overlooked this.”) [[link to medpedia post]]
* Enable participatory medicine – doctor-patient collaboration. Make it possible for each party to view the same data. (Ideally, I’d like to enable collaboration tools such as online discussion of my medical records – but that’s beyond the scope of this post.)Source e-patient.net

Replace Patient with Customer and you see what I mean.

Bonus Link: Health Care Relationship Management

Electronic Health Records and Health Care

Electronic Health Records are being looked at and tested as one of the Holy Grails of medical care and cost containment. The theory is that EHR’s will increase care and reduce cost. This is part of a yet unformed strategy of Universal Health Care which is the democratic ideal, that every special interest is fighting tooth and nail. From Insurance Companies to Drug Companies and Hospital chains, blocking any attempt to derail the current system is at the top of their to do lists.

Two items that demonstrate this disconnect are an article at the Nation by Kate Michelman, “A System From Hell”, where she describes her journey through the health care system, and e-Patient Dave whose website e-Patients.net is reporting on moving his health records to Google Health. It is not a pretty picture.

Health Insurance Fee Data Victory, Sort of…

The State of NY has ordered United Health Group to update its fee database as part of an underpayment “scheme to defraud consumers”, settlement.
At issue is the United Health Group’s wholly owned Ingenix business unit, which operates databases that insurance companies use for making payments, under the rubric of “reasonable and customary”. However this ‘victory’ is limited to reimbursement when using an out of network doctor. These payments are calculated by what is known as the ‘prevailing local fees’. These fee schedules become part of the databases used for calculating payments that end up with your bill for services.

Here is the rub with this ‘victory’. It lets stands the concept of networks, where insurance companies and doctors agree on payments for services, under the assumption that the doctor will ‘win’ with a patient group requiring a single paperwork submission process, lowering his overhead and providing him with profit. The insurance company will ‘win’ by being able to negotiate cheaper fees in return for volume discounts, (those being the implicit promise of patients. Implicit rather than explicit as explicit is known as steering and is for the most part illegal.)

Prevailing Local Fees
PLF’s are calculations made by pooling billing data by geographical regions. The PLF fees which form the basis of this database, are skewed by ‘network’ arrangements, which have already been driven downward by pressure by the insurance industry. This database is shared among insurance companies, in what would seem in any other industry a violation of anti trust, but for federal McCarran-Ferguson Act of 1945 exempted the insurance industry from anti-trust regulation, so that this game can continue.
The insurance industry does not make money writing checks, they make money collecting premiums
You would think that on a common sense basis a provider like your hospital, clinic or doctor, who is doing a large volume of business, would have lower costs by ‘buying in bulk’, having less paperwork for payment processing, and so on. You would think that a big hospital which buys in bulk and has all of the diagnostic and surgical toys on site would provide medical care cheaper. Dream fucking on. So why is an aspirin costing you a dollar? Hospitals use every cost associated with their physical plants and add a piece of it for your bill. You come in for 6 stitches, you pay for an mri machine,staff, carts, advertising, and everything else the hospital can think of. Part of this is valid, most is not.

So when you get medical services, and receive bills that are far outside of what the contract between you and an insurance company, this is why. So the ‘victory’ is a bullshit move.
Even this is bullshit:

Under the agreement, UnitedHealth will pay $50 million to finance the creation of the new database, which will be intended to determine the prevailing costs of medical care in specific regions. Although the university to operate that database has not yet been selected, Mr. Cuomo said he would prefer it to be based in New York. Meanwhile, UnitedHealth’s Ingenix unit is allowed to continue running the operations.
Source NYT Online

Also note that we have not discussed health care yet.