Healthcare Reform: Sliding down into nothing good…

September 16, 2009 at 12:55 PM (Uncategorized)

I’ve called and emailed the President and Congress and given them my bona fides on healthcare  When I could work, I did Claims Customer Service for a health insurer, recovery of duplicate payments for a health insurer, process improvement team leader for a health insurer, claims processor for a health insurer…I’m the kind of front line person Wendel Potter used to not notice as he got in the elevator at work…. But he is so right! We’re headed for potential disaster and a Private Insurers Protection act…and my gut hasn’t felt this twisted up since just before that dumb*** Iraq war, in Nov 2002, when it was very clear to me that Bush was going and everything else was window dressing, vamping until the shock and awe began.

I do disagree with the president on one point….he says the insurer’s aren’t bad people.  You cannot generalize of course, and I worked for and with a lot of great folks, and they treated our customer’s ethically, worked hard to resolve problems in our members favor, and treated me well as a co worker; I am not a ‘disgruntled former employee.’

But, company policy has/had evil results and there are individual bad actors…

One actually had his co-workers offices bugged (until he was found out and fired with a huge severance package)  another took paper claims, deciphered the diagnoses and laughed and scorned the patient while they processed the claim.  (A clear HIPPA violation, and they were dismissed.)

Health Insurance should never have been made a ‘financial instrument.’  It made the CEO’s certain that their pay/benefit package should parallel a bank CEO’s.

The minute you turn over an entity to not just underwriters, but accountants as well, with the blanket directive of ‘make more money,’ hey presto you get murder by spreadsheet.   The crowd who creates the ‘cost benefit analyses’ are isolated from the reality of what this number crunching does to people waiting (and dying) for care.  They’re they guys on AMC’s ‘Mad Men,’ just not as creative.

in 1996 I had a paperback copy of John Grisham’s “The Rainmaker,” a novel where he had clearly done his homework on the insurance industry,  on my desk at work in an insurance company.  I was reading it at lunch.  I got an unusually dirty look from my boss’s boss’s boss, whilst reading it when he saw the cover.  I just stared back.

I had filing drawers full of claims that I had to pay, since they had been initially denied per company policy, the requested information (minor stuff) had come in from the insured, and we then reprocessed the claims to pay them.  For thirty days or so, we got to hold on to our money….cost containment, translating into needless delay.  Other departments also had their own too cute by half ways of keeping legitimate payment out of the hands of members and medical providers for a time, or forever, depending on the individual claim.

They are experts at squeezing blood from a turnip.  If the measures of pre-existing conditions and rescission are not available to them, if they cannot overcharge for gender anymore they will think of something else. (As is proven by the excellent Baucus Diary today by mcjoan.)

Whatever they tell you Mr. President, members of Congress, it will end up being a lie.  If the industry hasn’t voluntarily reformed up til now, they will act just as the banks have done…they will figure out more ways to cut coverage (even if they can’t drop the entire policy,) they will provide sick people a bare bones policy and give more benefits to the healthy ones…Five years after a private insurance only ‘reform’ is in place, their profits will be the same or greater than before, and premium costs for individuals and employers will continue to increase.

They Aren’t Going To Make Nice, Mr. President. They will lie to you.  They will lie to legislators, shareholders, anyone they are forced to discuss this with.  They. Will. Lie. To. Preserve. Their. Profits.

They will promise what needs to be promised to get toothless reform passed, and then go right back to their old ways, in a shiny new set of guidelines that will conform technically to the new legislation and continue the same game. and the sooner you are clear on that, the clearer the nature of the fight becomes.

I feel unheard, I feel as though clear information from inside the walls is not having any effect and I’m actually getting physically sick while writing about it.

And if individual legislators are clearly in the health insurance industry’s pocket, proven by the shape of the legislation itself or proven by their vote on it….

Then while we continue to go broke, sicken and die out here in the real world we won’t forget to vote


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