Health Insurer Paid Out $20k In Bonuses For Dropping Sick Policyholders

The Los Angeles Times reports that Health Net Inc., one of California’s largest insurers, “avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006.” Its senior analyst in charge of cancellations, Barbara Fowler, made $20,000 in bonuses during that period for meeting cancellation goals. We hope for her family’s health that she uses that extra money to buy insurance from a better company than Health Net.

The article says the practice of canceling policies after expensive medical claims is “industry-wide but long-hidden,” and we’re glad they were able to produce some hard evidence that it does indeed happen.

The documents that showed Health Net’s bonus program were made public during a lawsuit brought about by a woman whose Health Net policy was canceled while she was in the middle of chemotherapy treatments. Health Net sought to keep the documents private, “arguing that they contained proprietary information and could embarrass the company.”

Although “state law forbids insurance companies from tying any compensation for claims reviewers to their claims decisions,” Health Net has argued that Ms. Fowler is an underwriter, and therefore not covered under the law.

“Health insurer tied bonuses to dropping sick policyholders” [Los Angeles Times]
(Photo: Getty)

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  1. DrGirlfriend says:

    I’m not surprised. I work at a hospital and deal with health insurance, and I’ve seen HealthNet weasel out of coverage for patients. It seems the more life-saving it is, the more they try to weasel out.

    Looking back, that there are cancellation goals makes a whole lot of sense.

  2. supra606 says:

    That’s pretty disgusting but unfortunately not that surprising. These people are scum.

  3. vaxman says:

    insurance companies are sick twisted groups, my mom used to work for one… she’s pretty twisted as far as consumer rights go…

  4. warf0x0r says:

    Hello insurance industry, I’m government regulation. I’ll see you soon.

  5. Nelsormensch says:

    This is why medical insurance as a business is such a wonderful idea- it incentivizes finding ways to drop expensive coverage for really sick people. Not only will it be impossible for them to find another insurer (let alone one that will cover a preexisting condition) but they’re too sick and broke from their expensive treatments to sue. The insurer saves money and the underwriter get a $20K bonus. Everyone wines! Except for the sick person, of course. They die.

  6. Parting says:

    @Nelsormensch: ”Not only will it be impossible for them to find another insurer (let alone one that will cover a preexisting condition) but they’re too sick and broke from their expensive treatments to sue.”

    Or even better in company’s eyes : they are dead from whatever they had.

    Cases like this are the reason I strongly believe in universal public coverage and optional private health services on the side.

  7. StormyBkln says:

    The fact that this is Hell Net doesn’t surprise me. A company that I used to work for had Health Net. I filled a prescription every month, and every month it was $20. One month, I go to have my prescription filled, and the cashier rings up the bill and it’s $30. What?? I know, it’s only $10 more, but I thought something was odd. I called Health Net, and was bounced around for over an hour between different reps. Finally, they gave me a number to call regarding prescriptions. I called the number, and it was after business hours, so of course no one was there. Well, I kind of need this prescription to survive, so I paid the $30 and went home.
    The next day I call back, during business hours, and I am told that I elected to change my plan to a tierred prescription plan. I did? Yes, they said. I was on a 10/30/50 plan. Preferred generic drugs, $10 (meanwhile the cost of that type of medication can be $10 without insurance). $30 non generic preferred, and $50 non generic, non preferred. Well, since there is no generic form of my medication (Novolog insulin), this wouldn’t make much sense, would it? Besides, I NEVER CHANGED MY PRESCRIPTION PLAN!!! So after arguing with the rep that I spoke to for an hour or so, defending my claim that I didn’t change my plan, I was told that they would look into it.
    Fast forward a week, I get a call from Health Net. No, I didn’t change my plan, and it was a “clerical error”. My plan was changed back to my base co-pay of $20 across the board.
    Here is where the surprise comes in. Fast forward another month, and I get a check in the mail, for $10! That I did not expect. I had written off the $10, but there it was.
    Anyway, I digress. If I hadn’t called to complain and threaten going to my company’s HR department, as well as the AG, American’s with Disabilites, etc…, I’m sure that they would have happily continued to bill me for my gold level PPO but give me a much lower plan’s co-pay.
    Sorry for the rant.

  8. Applekid ┬──┬ ノ( ゜-゜ノ) says:

    And to think I never expected there would ever be a name I could put on my “Wouldn’t it be awesome if the people on this list would get some kind of excruciatingly painful and incurable disease requiring medical care but they can’t get medical insurance anymore because their policy is canceled?” list.

  9. JiminyChristmas says:

    The percentage of premiums paid out in claims in known as the utilization rate. The lower the utilization rate, the more profit the health insurer makes. So, the incentive is to charge the highest premium the market will bear and deliver as few services as the law (and human decency, if that applies here) allows.

    If your utilization rate is still too high to keep the execs and shareholders happy there’s still another way to squeeze out a little profit: delay or deny payment on valid claims. After all, the insurer doesn’t make money by paying your bills; they make money by keeping your premium in their own investment vehicles for as long as possible.

  10. iamme99 says:

    Health insurance companies are new used-car sales people. Scumbags you should never trust. They are all out to maximize their incomes and pay their executives ever more.

  11. goodkitty says:

    @Nelsormensch: Actually, the hospitals lose out too, since those who are uninsured will end up declaring bankruptcy or simply not paying an impossibly large sum. To match that, the hospital (and other providers) have to increase their rates, which makes the insurance companies cut costs and cancel people more, which leads to more financial misery at the hospital, and then… you get the idea.

    I hate big government, but health care is truly out of control for the kind of ‘evolved’ society we think we have. Of course, ALL these issues (including most every other story on Consumerist) stem from one problem that does not have a cure–unchecked greed.

  12. JiminyChristmas says:

    BTW, if you aren’t disgusted enough by Consumerist’s synopsis of the article, you should click on the link and read the whole thing.

    While I wouldn’t wish a debilitating illness on these people, like say flesh-eating bacteria, I think jail and bankruptcy sounds about right.

  13. StevieD says:

    @StormyBkln:

    You complained about a clerical error that the company corrected and subsequently refunded the overcharge?

  14. tempname says:

    Ahh HealthNet. About 2 years ago, HealthNet came into Arizona. They offered some amazing insurance. Low co-pays, very low premiums, and excellent coverage across the board.

    Needless to say, my employer switched to them post haste. Fast forward exactly 1 year to the day our coverage was issued. The premiums sky rocket, the prescription coverage went to the dogs, and the co-pays oh god the co-pays. At the time I was taking 2 daily doses of Alegra-D 24 Hour. Which at the time cost me $20 dollars a month. This medication was make or break for me. It is the only allergy medication that worked for my sever allergies. After the 1 year mark, Alegra-D 24. Was dropped from the prescription formula. I tried everything, getting my allergist to contact them, begged and pleaded with them, everything I could think of. In the end, my employer decided to drop HealthNet and go back to UnitedHealth.

  15. bohemian says:

    The woman doing chemo that lost her insurance still has the drug catheter in her chest and nobody will remove it because she has no insurance. Uh, leaving something like that in too long runs the risk of a nasty infection, in her chest cavity. This was the first thing I heard this morning when I flipped on CNN getting ready this morning. Maybe that explains my sour outlook today.

    There is no freaking excuse for this.

    Insurance companies are NOT your friend.

  16. azntg says:

    @warf0x0r: Indeed, I think government regulation is being given more of a reason to come out. I don’t know what’s worse, an inept government regulation or corporate corruption and greed, but hopefully the government will feel that it’s in its best interests to not kill off everyone with health problems.

  17. mgyqmb says:

    individual coverage is issued to only the healthiest applicants, who must disclose preexisting conditions.

    Does this not seem backward to any of you? To the United States? Aren’t the least healthy people with the highest medical bills the ones who need help with it the most?

    Yes, I understand and appreciate the capitalist system, but you will never make me admit that profit has any place in the health care a person receives.

  18. CumaeanSibyl says:

    Bah. I’d very much like to have a small, streamlined government that didn’t poke its big stupid nose into every industry, but clearly we’re not ready to handle that kind of responsibility without acting like total jackasses. THIS IS WHY WE CAN’T HAVE NICE THINGS.

  19. esqdork says:

    There is a special place in hell reserved for people like her and those who run her company.

  20. cabedrgn says:

    Semi-similar situation with Great West medical. I’ve seen documents from my previous company on how they sell their services, spinning up the fact they auto-deny XX% of first run, X% of second run and a small percentage of third run claims as a savings benefit for the company purchasing the plan.

    From the sounds of it, the idea is to get the patient to ‘give up’ on smaller claims and just pay it (thinking by the time its approved, it would have cost less to just pay) out of pocket instead of appealing the denials.

    I’m sure this is illegal, but the documents didn’t spin it this way, sounds like they used various methods to avoid payment such as minor clerical errors, smudges on claims and the like. Probably filed under the ‘shouldn’t be but is barely legal’ pile.

    luckily I’m back with UHC, while they haven’t been the best, they certainly are a few tiers higher than great west. That, and I don’t have them denying nurses, food and other things that are ‘accidentally’ classified as out of network while the hospital itself is in-network.

  21. Ailu says:

    OMG. I have HealthNet.

    *shivers*

  22. Dr_awesome says:

    viva kucinich

  23. sonichghog says:

    Looks like they broke the law, a good fine wold be 71 million. 2 times what they saved.

  24. XTC46 says:

    For everyone who said “insurance people are scum” do you have insurance? if so why? with a few exceptions insurance is not required. As far as I know, health insurance is never required. So if you hate them so much, why do you pay them?

  25. Dr_awesome says:

    @XTC

    Yes, health insurance people are scum, and yes, people still pay for it. They do so because it’s one of those things that you shouldn’t live without, and insurance companies seem to be all too happy to take advantage of that fact.

  26. Dr_awesome says:

    Also @ XTC

    Health insurance is required by law in the state of Massachusetts. And as an added little “F-You” to the residents of MA, the people who passed this legislation decided to make the penalties for not having health insurance FAR greater than the penalties a business would recieve for not offering their employees a coverage plan.

  27. DrGirlfriend says:

    @xtc46: Why? Because think of the alternatives to not having insurance, and then having something awful and costly happen to you.

    @mgyqmb: It is indeed backward. And no, ideally, money shouldn’t come into play when it comes to someone’s healthcare. But here is the reality: medical practices cost money to run; hospitals cost money to run; insurance companies cost money to run. It’s all a business, because everything costs money. It’s not just a capitalist thing — if things cost money, then money will always be an issue, in one way or another. For example, under Federal law a patient cannot be turned away from an emergency room if he is uninsured or cannot pay. But he will still be billed anyway. But an uninsured patient with not a lot of money may think twice before going to an ER, or may decide to not take an ambulance, which might get him there faster, because he can’t afford it. The money issue leaks into everything.

    One could say that socialized health care is the answer, but someone is footing the bill for all these services. Someone is going to have to decide that certain things won’t be covered, because there just isn’t enough funding. It’s a never-ending cycle. Unfortunately, we’re not dealing with that cycle even remotely appropriately. And Cumaeansybil has a point: entire industries can’t be left alone because, left to their own devices, they will ruin everything for everyone.

  28. Leohat says:

    I love the smell of lawsuits in the evening. It smells like … like victory!

  29. Buran says:

    @StevieD: I think it’s a valid complaint when your health insurance costs go up for a totally BS reason. I’m sure they would have been happy to keep the $10.

  30. Buran says:

    @Dr_awesome: So don’t live there. I don’t agree with every law in the state I live in, either, but your end of the social contract you make with your ELECTED government is to follow the laws your elected reps enact.

  31. Buran says:

    “claims reviewer” = “one who reviews claims”

    This woman reviewed claims, clearly, to see if the company should weasel out of its responsibility.

    Thus, they’re breaking the law.

  32. parnote says:

    Isn’t it amazing … for far less than we will spend on the “war” in Afghanistan and Iraq, every man, woman and child could be covered with Universal Health Care access. PLEASE … pray for a candidate who will fight for Universal Health Care access to get into office. As a health care worker, I am consistently exposed to the waste, excesses, and inequities of the current health care system. This is the BIGGEST issue facing the American public. We are the ONLY industrialized country in the world without universal health care access, and we must have it to compete and prosper in a world economy. And the added benefit … the scum-bag, greedy, immoral, insensitive insurance companies will effectively be put OUT OF BUSINESS of deciding YOUR BUSINESS when it comes to healthcare.

  33. unclescrooge says:

    I’m just wondering why aren’t people targeting the woman who made these decisions for profit? I’m not saying to do anything other than call her out for the pariah that she is.

    What she did was disgusting and everyone in her church, her community, and her alma maters should be let in on Barbara Fowler’s source of income. I’m sure they would not be proud of her.

  34. Parting says:

    @parnote: What I don’t understand is how USA spends more $$$ per person for healthcare than Canada and still unable to offer universal care access.

    Where this money goes?

  35. Parting says:

    @xtc46: Decisions, decisions …
    Where do you live? (I mean country)

    Most peoples have a choice : pay for insurance or lose everything they possess if they get sick, an accident, etc. (Few people are affected : Bill Gates, Paris Hilton…)

    Bankruptcy due to medical expenses is very common.

    And if you are paying for a service (aka health insurance), the contract should be respected by the insurer. Dropping customers, while they get sick (hoping they won’t be able to fight back false pretenses) is very ”lowlife”.

    Similar to buying a airplane ticket and being pushed off the plane over Atlantic ocean.

  36. XTC46 says:

    So all of the responses to my question were along the lines of “they suck…but its better than nothing”

    I live in the US (Hawaii to be exact) and I have had no trouble with my insurance companies (health or auto) I have no trouble with the company who handles my Flex Spending account for medical either. What this leads me to believe, is that either I am incredibly lucky (I’ve had no major injuries, but have been to the emergency room a few times, torn a tendons in my hand, pulled several muscles got, stitches several times, a concision of 2 etc.) or there are both good and bad companies (like every other industry). So why do people give money to the bad ones.

    I have 2 jobs, both offer medical (one even offers 3 separate plans to chose from). In addition to that, I can pick a number of private medical insurance plans. If I had no job, I could get state provided medical. So with all these options, why use a crappy one? If you can only afford a crappy one, then work towards affording a better one. otherwise it’s like people saying “because I can’t afford a BMW, Kia should make their cars just as good” it doesn’t work that way, you get what you pay for. For those who say its “required by law” then pay the stupid minimum fee, and pretend you don’t have it. Car insurance is required here, I think the minimum just covers if you hit somone, it doesn’t cover your injuries, or any damage to your car. That will cost all of 30-40 bucks a month on a cheap car. You want better coverage, you pay more. I pay 110/mo because I drive a SUV and have been in a few accidents. But I also have full coverage, and in every one of those accidents my car came back as good as new. You get what you pay for.

    Now I understand that what this company did sucked. But that is there business. They look and see if the payout is bigger than the risk, in this persons case is wasn’t so they dumped the person. If you decided that the premium you were paying your insurance company was more than the risk of you needing it, you would stop paying them, and no one would blame you. It’s business.

  37. XTC46 says:

    @parnote: Universal Health Care only helps those who are irresponsible enough to not get their own insurance. So unless my jobs decide to dump our insurance, and give me a significant raise to cover the tax increase, I wont support it. Why should I have to pay for insurance for those who dont want to help them selves?

    The only exception to this is for kids. If you are <18, then sure give them health care, its not their fault they have irresponsible parents.

    And please don’t give me this crap about not everyone being able to afford insurance. I have held a full time job since I was 15, every one of them offered health care. And for the last 4 years I have held 2 full time jobs because life is expensive, so we need to work to deal with it. If you can’t afford health insurance for a kid, don’t have a kid, its that simple. Any adult (with the exception of those who are disabled) can easily hold 2 full time jobs. And I cant think of a single place where 2 full time jobs even at minimum wage, is too expensive to live on your own. Those who are disabled already have the benefit of welfare and medical. Everyone else is just lazy or irresponsible.

  38. acasto says:

    If these people burned in their houses while they slept, I would mark it on my calendar and be sure to celebrate it annually for years to come. For as much as I hate government bureaucracy, I hate health insurance companies even more.

    BCBS of NC dropped my mom when she had a claim saying she didn’t specifically report that she’s had migraines before, and not constant or chronic migraines, but has just had a migraine before. Who hasn’t? Anyways, after she complained they reinstated her, but raised her premiums and since it was after that claim they dropped her for, added it to the pre-existing condition list. So moral of the story is, unless you list every head ache, stomach ache, flu bug, cold bug, itch, gas, or cough you’ve ever had, they will drop you for any little arbitrary thing if they can save themselves a buck or extract an extra ten out of you.

  39. acasto says:

    @XTC46, if you think having to work two full-time jobs in order to afford the basics is a sustainable an acceptable way for everyone to live, then I’d hope everybody takes your opinions on the health care industry with a grain of salt. Also, it is quite clear you have never been self-employed or worked with small mostly family owned businesses.

  40. uricmu says:

    @xtc46: That’s complete BS. Many people are not insured not because they are “irresponsible” but because nobody will insure them. For example, if you have a chronic disease (E.g., cancer survivor, rheumatoid arthritis, etc.), you can’t get insurance.

    The problem with private health insurance is that they’re out to make money (legitimate), and therefore won’t be able to insure people with those disaeses.

    And what about the person who got dropped? Can they get insurance?

  41. KJones says:

    Tell me something, people: Would you object if telephone companies said, “You can only get a phone in your home if your employer pays premiums and sponsors you”? And the employer’s choice of phone company means you are stuck with a lousy company with excessive fees and rates? Or the phone company demands you pay for long distance calls *before* you make them yet won’t connect you (or disconnects you) when you try to make long distance calls?

    Of course you would. It would be idiotic to expect people to live without a phone while they are between jobs (or without a usuable phone, period) while paying for it, and yet that is the exact same situation the US has with health care.

    The universal health care in countries like Canada, England and other places may be flawed systems, but flawed is better than (apologies to the siteowner) completely fucked up systems. At least the other countries have medical systems that work instead of constantly breaking down.

  42. TechnoDestructo says:

    Well, at least their stock went down a little. Might have been more, but I suspect there were some people who thought “hmm, that’s pretty shrewd! BUYBUYBUY!”

  43. mconfoy says:

    @supra606: Disagree, its the fucked up system we have in this country. What do you expect them to do? Embrace less profit?

  44. mconfoy says:

    @xtc46: Its already been called out that you are full of it. Two minimum wage jobs will pay to live in NYC? Right. The fact is we pay almost twice as much for health care as the #2 country (France) for far lesser results. That is the fact. Our GDP, our taxes, our salaries, is being pissed away to feed an administration nightmare so that we have the privilege of less health. Address some facts instead your nonsense opinions about who is what. The greatest country in the world requires you to have two full time jobs to barely live? That is so messed up. Is this what we want government for? And yes, doesn’t it piss you off that Iraq’ costs could pay for the whole thing and leave money left over with to invest in education? oh well.

  45. ogman says:

    Wanna fix health care? Get insurance companies and their sky-high profit margins out of the picture.

  46. BigNutty says:

    Healthcare 1
    Consumers 0

  47. veterandem says:

    @xtc46:
    You’re funny. All those deadbeat douchebags out there wanting a free ride for basic medical care! The nerve of some people! The government shouldn’t do anything to help anyone (fire, police, etc) because that would be “giving” away services for free. Meh, the “pull yourself up by the bootstraps” people really annoy me. We pay an insurance company for many things, as you mentioned, but the payment for that insurance constitutes a contract, which is supposed to be legally binding (and the defintion of “legal” has undergone a sea change over the last 6+ years). As health insurance companies continue to operate in this manner, it is just a matter of time until you “become” one of the unfortunate rabble who is either denied service (even Medicaid will deny coverage on certain types of treatments) or outright dropped (regardless of the “cafeteria” of health plans you have to choose from). At the rate were going, life insurance claims will be denied because the insured DIED. At that point you can’t fight the insurance company….or pull yourself by the bootstraps…as it were.

  48. heddybee says:

    I suggest a compromise between government-managed healthcare and the current for-profit system: a system of independent, non-profit health care organizations that are funded through taxes on businesses, but are independently managed. NC has Blue Cross/Blue Shield; it’s a nonprofit and the state has been able to keep it that way, despite BCBS’s desire to switch to a for-profit company. With no profit incentive, there’s no incentive to be draconian with benefits, and there is much more money available for providing services.

  49. Tyr_Anasazi says:

    @xtc46:

    This isn’t the 50s son. Not all people are irresponsible and lazy. And if you are happy with working two jobs, that’s great that it works for you, but not for everyone. Open your eyes to what’s really going on…

  50. doormat says:

    The goal of insurance companies is as follows: take in premiums, pay out as little as possible.

    If you dont see whats wrong about that from a consumer’s perspective….

  51. MsClear says:

    Universal health care is coming to the US. I’d say it will take another 15 years (worst case) but it will be there. The average person faces so much risk if they happen to acquire a serious disease.

    Oh and the USA pays more and gets less than any other industrialized country. All the other advanced economies of the world seem to be able to pass universal coverage, why not US?

    I live in MA. While the new system has its flaws, it did allow my hubby to buy a policy to cover him while he gets his MBA. This is good, because I couldn’t afford my employer’s “family plan” as it was ridiculously expensive. The MA plans are state regulated and have no allowance for random and arbitrary exclusions. Anyone is eligible. And no, we aren’t on a subsidized plan, we’re paying the cost ourselves. There’s a large deductible in the unlikely event he gets sick, but we have savings. It’s the “catastrophic coverage” that is most needed.

  52. Hambriq says:

    Okay, so XTC46 may be going a little bit overboard with the whole anti-Universal Health Care thing. But the problem with the system is that health care is TOO EXPENSIVE. If it weren’t too expensive, everyone would have it. So enacting Universal Health Care is the truest definition of treating the symptom, not the disease.

    The libertarian in me believes in the competitive ideal, privatizing health care, and all that jazz. But we’re half-assing it here. Insurance companies can cancel people if they don’t think they will earn them profits. But hospitals can’t. So what does that mean? That person still receives health care, and the cost is still absorbed by the system. Until we are willing to turn people away en masse and let people die so that businesses can make their own decisions, we will never achieve that level of efficiency we are looking for.

    And therein lies the problem. The entire argument for privatizing health care lies in the fact that it would inevitably be far more efficient than a government-run system. But we’ve crippled the private system with various governmental interventions, and now it can never reach that peak of efficiency that we’re looking for.

    Is that a bad thing? No! If the private health care system DID reach its peak efficiency, health care prices would be low, low, low, and the quality of health care would be poor, poor, poor. How is this any different or better than if we enacted Universal Health Care? Low prices, low quality.

  53. Hambriq says:

    The point of my previous post is this: We aren’t going to get anywhere by trying to operate on the spectrum of “Privatized Health Care vs. Socialized Health Care.” The end result of both extremes is low prices and low quality health care.

    The end goal should not be to universalize health care. The goal should be to make health care more affordable, more accessible, and of higher quality. Don’t think socializing the system is the answer. The answer is in changing the system, separating the proverbial wheat from the chaff, and excising all the unnecessary factors that drive up the cost of health care.

    Where to start? I’ll be the first one to say it: Retail Pharmacy.

  54. MsClear says:

    France has the #1 healthcare system in the world. Please explain how this is “low quality”?

  55. frankblevins says:

    That’s the problem – health insurance is a business not a human right. BTW I think it’s neat the aticle exposes the name of the person in charge of the cancellation program. I wonder how much blood is on her hands?

  56. DrGirlfriend says:

    @Hambriq: I absolutely agree. Fixing the system is the real solution. Universal health care will still be just as expensive and restrictive if we don’t deal with the costs.

  57. Hambriq says:

    @MsClear:

    How can you even make a statement like that? First of all, you don’t provide any proof or evidence for your claim. Second of all, even if you did, “ranking” countries’ health care systems is silly, because it’s totally subjective. Sure, France has one of the highest accessibility rates for health care in the world. But the United States performs far more life saving surgeries per capita and has a much higher number of doctors and health care centers per capita than France. Does this mean one is clearly better than the other? No. And even if it did, that wouldn’t be very helpful to us because we have a different culture, different society, and a different set of health care concerns than France.

    See, what really burns me up about these kinds of comparisons is that it’s exactly this kind of black-and-white, “you’re either with us or against us”, ignorant refusal to accept a progressive point of view that’s preventing us from enacting any real change to the system. Why does everything have to fall under the umbrella of privatization vs. socialization? It doesn’t. We as a society don’t benefit from that battle. Politicians and money changers do.

  58. MsClear says:

    I do consider the World Health Organization as a credible source. France’s #1 ranking is hardly a secret.

    [www.photius.com]

    You can find mentions of this ranking in innumerable publications with a simple Google search, just as I pulled one up for you in seconds.

    You stated that socialized medicine lead to poor quality care, without backing it up with any more facts than I initially posted.

  59. pshah says:

    Summary :

    HealthNet = Evil Bloodsuckers who needs to be put out of misery

    XTC46 = intellectually challenged (Yes I can’t expect Kia to be as good as a BMW but I do expect it to not be a death trap).

  60. the_wiggle says:

    @CumaeanSibyl: best way i’ve ever heard it put.

  61. redkamel says:

    please dont forget to add that the US has the highest rate of obesity (linked to many long term, chronic diseases) as well as diabetes (I think). We also give CTs and MRIs out like candy, and have no problem giving rotator cuff replacements to someone who is 70 years old, and consult multiple specialists and docs for one problem. We also blow most of that money on admin costs. Thats why we spend the most amount of money.

    If you want to save money, dont cover everyone. Thats just asking the governemt to ruin everything by lowering costs. If you think Healthcare will get the same kind of funding the military does…or want George Bush and the DMV in charge of your healthcare… you are crazy. I’d rather have a google or apple, or even MS any day.

    Heres how to fix the system:
    1. Universal Health care bill form: this will save doctor and hospitals much time and money.

    2. Regulate insurance companies.

    3. National Care Guidelines decided by doctors and some way for consumers to have independent recourse against an insurance company for unfair practice

    4. Cap insurance company profit.If they behave, they can increase their profit.

    5. Insurance companies are taxed depending on how many people are not insured. Or maybe the more satisfied customers they have the more profit they are allowed. Now they have an interest in insuring people, just like people have an interest in getting insured.

    6. let docs make more decisions without fear of being sued all the time so time and money is not wasted on lost causes and CYA tests. Also increase preventative medicine education with the public, since this saves a lot of money

    To everyone who wants universal coverage: ask YOUR doctor if they are for or against, and why. Most are against because it will put them in the poorhouse while increasing the workload and tying their hands. Also, ask why they dont run a medicare only practice since you think government healthcare is so great.

    Other countries may have better systems in general, but we have the best, hands down for the rich. Bring costs down, efficiency up, and corruption out, and most other people will have the same access.

  62. jeffjohnvol says:

    It ought to be federal law that if they cancel someone due to them providing bad info, they have to refund all the money they paid in, plus the interest. Its sick that they keep taking the money until they realize they are sick, then they try to remove the service.

  63. jeffjohnvol says:

    href=”#c2937767″>redkamel: FYI. State Farm insurance is a mutual company. Any profits they have gets sent back to the policy holders.

    Some complain about the 47 million uninsured, but 10 million of those are illegal immigrants and shouldn’t be here anyway, and the other 2/3rds are able to afford it (barely) but have made a decision not to have it. According to John Stossell anyway.

  64. Bunklung says:

    Don’t quote me on this, but I recall a co-worker of mine telling me his father’s health coverage was canceled. They quickly found a new provider since his company offers (has to provide health insurance by company policy) many health insurance providers. He said they all [providers] have limits in their policies, but many people don’t know about them or read the fine print. He said his father’s was canceled after his total medical bills hit 10 million dollars. This was in Massachusetts.

    I know everyone is knocking on insurance companies here, but is anyone out there have any info on real limits?

  65. Hambriq says:

    @MsClear:

    Thank you for at least providing some proof. Now, kindly refer to statements #2, #3, and #4 from my previous post.

    #2. Ranking countries’ health care systems is pointless because there are far too many subjective factors in doing so. To wit, I have to call into question the relevance of any study that ranks Malta, Singapore and Andorra significantly higher than Canada, England and the United States.

    #3. Even if we were to objectively state that France has the best health care system in the world, that does very little to help model how we should do things. We have a completely different set of health care needs. For one, we spend exponentially more than France does on health care. That’s what’s causing this crisis in the first place. You can blame it on fat Americans all you like, but until we’re willing to let fat people die in order to prove a point, it’s a reality we are going to have to deal with. If we were spending as much on health care as France was, there wouldn’t be headlines like this on Consumerist. So the analogy really serves no purpose.

    #4. Again. Why does it have to be a constant battle between socialization vs. privatization? We as a society don’t benefit from that whatsoever. We have to think a little bit beyond our narrow political lines to get things done here.

  66. Hambriq says:

    @jeffjohnvol:
    This is true. But at the same time, it’s kind of irrelevant. If we just look at the facts of the situation, we are providing these people with health care regardless of whether or not they have coverage. So when it comes down to it, someone is footing the bill. Most of the time, it’s absorbed by the system, and we all end up paying for it. Kind of like socialized health care.

    Because we aren’t willing to not provide health care to people who don’t have health insurance, we’ve basically forced socialized medicine on ourselves via our own consciences. This isn’t a good thing or a bad things, it’s just the way things are. To me, most of it comes down to dollars and cents because that’s what is causing this whole crisis in the first place. In almost every case, it would cost less to provide these people with health care coverage before the fact than for the costs to be absorbed by the system after the fact, especially when you factor in the savings associated with preventative medicine.

  67. jeffjohnvol says:

    @Hambriq: I accept your first argument, but the last one is way too idealist and unrealistic for me to accept. If you have socialist healthcare then companies will stop providing it and we’ll depend on the government for everything, and your taxes will double.

    The best solution in my opinion is to do like Massechussets (sp?) did. Make it a requirement to have it, and provide assistance to those at the very bottom who can’t afford it. Too many 30 somethings go without it even though they could afford it. Every state should make it a requirement to work, just like most states make it a requirement to have car insurance if you are going to drive.

  68. Parting says:

    @jeffjohnvol: Please ”taxes will double”. Right now USA spends MORE per person on healthcare then Canada. And Canada has universal health care paid by taxes. If USA gouvernment stops waisting money, they will be able to afford social health care with what they spend alredy.

  69. Hambriq says:

    @jeffjohnvol: If you have socialist healthcare then companies will stop providing it and we’ll depend on the government for everything, and your taxes will double.

    Well, firstly, I don’t think that we should have socialized health care for the exact reasons you mentioned. The point I was making is that we are still spending the money regardless of where it comes from. It could come from the government, it could come in the form of higher premiums, it could come in the form of a lot of things. But we’re still footing the bill.

    Rather than just spread the costs around (which would happen if we completely socialized our health care system), we should enact reforms in order to decrease our costs on the whole. Some of those steps would inevitably require an amount of socialization. But I don’t think socializing the entire process will help the matter. In the end, I think you and I are really on the same page here.

  70. jeffjohnvol says:

    @Hambriq: ok, point taken. I think we are on the same page as well. IMO, part of the problem is that everyone that wants socialized medicine wants it for free. And honestly, when you figure most Americans would buy a chinese shirt that costs 13 cents less than an American one, will they really tolerate the tax increases, because someone is going to have to pay for it. I don’t think its fair that I have to pay 7K a year for my family’s insurance and then pay more taxes for those that don’t even shop for for insurance.

    I think requiring insurance of everyone would do as you say, to decrease the cost on the whole. Normally, I think of socialization implying the gov’t take care of things, I’d rather use the gov’t to force people to be responsible and help those that are below the poverty line.

  71. asherchang2 says:

    It sucks that the person can’t be prosecuted because she was an underwriter, whatever that means.

    Why the hell does an insurance company have a quota for cancellations of policies? Who can possibly bear the guilt that must come from taking away people’s healthcare coverage and therefore their security, money and their lives just because it saves your company some money?

  72. RvLeshrac says:

    @jeffjohnvol:

    Yes, excellent idea.

    That way, the insurance companies can charge ridiculous amounts of money for health insurance, like they do car insurance, in the states that require everyone to have it.

    More importantly, we can then lock people up for not having it, even though they can’t afford it and the government fails to provide appropriate amounts of cash for relief.

    My parents have to keep extremely close watch on their health insurance premiums, because my mother has Hep-C, from a bad blood transfusion ages ago, even though she’s been negative for several years, and despite the fact that the insurance company didn’t have to cover any of her drug costs because she obtained her medicine through some program or another.

    Insurance was costing them ~$200/month for her to be on his insurance at work. Then it jumped up to ~$300, and they had to look elsewhere – private insurance isn’t much cheaper.

    Her new carrier just decided out of nowhere that they weren’t going to cover an eye infection (several doctor’s visits, etc), and they’ve (parents) been discussing it with the insurance commissioner’s office. They can’t actually afford to pay for a lawsuit, if it comes to that.

    There are millions of people just like them. Is the government going to cover the $500+ premiums for a family of four that is barely making ends meet with both parents working, due to one of the kids having a serious illness? Is the government going to pay for the lawsuit necessary when the insurance company decides they no longer want to pay?

    State governments can barely afford to pay assistance for *just* children. What makes you, or anyone else, think they can afford to pay even part of the ridiculous costs of health insurance for families?

    The problem in this country is that health care providers charge far too much for services, and insurance companies charge far too much for coverage. Just look at England – health costs are very low, and that’s with the government paying. Prescription drug costs are very low, and that’s with the government paying most of the cost. All this despite the fact that it costs *more* to live in most parts of England than it does in the US. Yet physicians in England seem to have no complaints – they get less than half what our physicians charge, have a higher cost of living, and *can’t complain*? They get less than our physicians and yet make *fewer medical mistakes*?

    Something is wrong. Socialized health care isn’t necessarily the solution – the high cost regulation of socialized medicine is. The health care system will rail against it, of course, with sob stories about how a cardiologist will no longer be able to afford the insurance on his Enzo, but they’re not going to control costs themselves – that much is obvious.

  73. RvLeshrac says:

    @Hambriq:

    Oh, and we don’t have a “different set of health care concerns” than any other first-world nation. If anything, we have a smaller subset of health care concerns compared to Europe, as the EU has more porous borders and more third-world immigrants and travelers who carry with them worse health problems than “too fat” or “smoked twelve packs a day.”

  74. jeffjohnvol says:

    @RvLeshrac: 300/month for insurance is a steal these days. My tab is $750/month with dental.

    Insurance isn’t healthcare. Insurance is a gamble that if you suffer a horrible disease, the insurance will help defer the costs. Insurance is NOT an inexpensive source of healthcare. Ironically, part of the reason healthcare is so high is becuase of insurance that pays $3k a night for a hospital bed. If the free market were at work, it would be much less.

    Lock people up, no. But why should I have to pay for YOUR health insurance or vice versa. Hell, add a big tax to everyone that earns a paycheck and defer it with a credit if they have proof of insurance. Free markets would keep costs down if all have it. Its not an Owellian conspiracy that all (ins co’s) would charge tons of money because of a captured market. And your argument about car insurance companies raising their prices because they have a captured market is false on its face.

    Why do people in this country think they are ENTITLED to inexpensive healthcare. Its not a right, but a service you have to pay for. Maybe bring in hospitals from India for some competition. England takes 75% of your income and there’s a 2 month waiting list for any doctor. Do you really want that? Then move to the UK or Canada.

  75. jeffjohnvol says:

    @RvLeshrac: I basically agree with your point is that there should be methods employed to reduce the costs.

    One good way I can think of is to put in clinics in all of the WalMarts to let them do the simple visits to get an antibiotic. It amazes me how good that company is at reducing costs. Because I think a large part of healthcare costs are a simple Dr visit to get an antibiotic, especially mothers that drag their kids in for any sniffle.

    Another is to limit pain and suffering payments from medical lawsuits to 100,000. And put retired judges on juries instead of the brainless collection they always seem to find (e.g. McD’s coffee verdict). Yeah, if a guy screws up and kills someone they deserve some money, but a 45 million payout gets passed on to US, not the Dr or the insurance company.

    Also, either eliminate the illegal immigrant problem by having them go home or having their employers pay for their medical expenses.

  76. Hambriq says:

    @jeffjohnvol: Why do people in this country think they are ENTITLED to inexpensive healthcare. Its not a right, but a service you have to pay for.

    I think we have tacitly decided as a country that people ARE entitled to health care. As an example; hospitals can’t turn away people based on their insurance coverage. We can never have a free market in this country until we remove all the barriers to its operation. Which, ultimately, means giving businesses the power to let people die in order to make a profit.

    Sound dramatic? Wait until the politicians get ahold of it. While completely privatizing and decentralizing health care may be sound in theory, but doesn’t really have a place in the discussion about how to fix our problem, simply because it’s just not a realistic option. I’m not saying I would be against it, but it’s just one of those things that could never actually happen.

    Even if it did, I question the ramifications it would have on our health care, but I addressed that in an earlier post, so no need to be redundant. But I think you’ve got the right ideas. Streamlining the process (like your Wal Mart idea) is integral. As is massive tort reform.

    Ultimately, the end goal of dealing with the problem should be reducing the costs of health care without sacrificing its quality. The first step to that is cutting out the wasteful spending and unnecessary burdens to the system.

  77. jeffjohnvol says:

    @Hambriq: All good points. One way I could see saving money would be to have a contracted nurse that has an examination room at local pharmacies. With the insurance company employed GP, the nurse would do tests that the doc asks, while over a video conference terminal. Any scopes (ear thingy) could be piped through the camera and the stethoscope can be transmitted as audio. 90% of the time the doc would prescribe an antibiotic, or refer them to a local GP and/or specialist.

    The contracted nurse would be an agent of whichever insurance carrier you use.

    I think this would save the company a lot of money since there wouldn’t need to be a $400 cost to the GP everytime you get a sinus infection. The pharmacy would benefit because they would get a fee from the insurance carrier and could sell the prescription right there.