Blue Cross Wants Your Doctor To Help Them Cancel Your Health Insurance

The LA Times says that doctors are objecting to a letter sent by Blue Cross of California requesting that the docs help “indentify members who have failed to disclose medical conditions on their application that may be considered pre-existing.”

From the LA Times:

“We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality,” said Dr. Richard Frankenstein, president of the California Medical Assn.

Patients “will stop telling their doctors anything they think might be a problem for their insurance and they don’t think matters for their current health situation,” he said. “But they didn’t go to medical school, and there are all kinds of obscure things that could be very helpful to a doctor.”

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said Monday that it was sending out the letters in an effort to hold down costs.

“Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members,” WellPoint spokeswoman Shannon Troughton said in an e-mail.

“Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers,” she said. “We send these letters to identify members early on in the process who may not have been honest in their application.”

Shannon sounds like a real sweetheart, doesn’t she? The article goes on to discuss recent lawsuits in California over insurance providers who approve people without checking their applications for errors, then cancel their policies later. Blue Cross is currently fighting a $1 million fine that the California Department of Managed Health Care assessed for “alleged systemic problems the agency identified in the way the company rescinds coverage.”

Doctors balk at request for data [LA Times] (Thanks, Everyone!)


Edit Your Comment

  1. redhelix says:

    Blue Cross pulls this shit all the time, usually when someone is about to undergo an expensive series of surgeries or therapies. The only difference is they usually have an internal investigator taking care of it, so this is pretty bold. I can’t even believe this is still legal.

  2. BP2012 says:

    Hence, the police state…

  3. durkzilla says:

    These are the things that make me hate insurance companies. Not just health insurance, but all of them.

    I’m a conservative at heart, but if Hillary or Barak will put Wellpoint out of business once and for all with socialized medicine then I’m all for it.

  4. johnva says:

    Disgusting. While fraud by patients is one thing, I think it pales in comparison to the fraud being perpetrated by health insurance companies. This is just going to get worse and worse until and unless government drops the hammer on them and nationalizes the healthcare industry. I’m now convinced that insurers are so corrupt that their industry is beyond redemption and should be outlawed and taken over by government. I don’t condone lying on your insurance application, but what these guys are doing is fishing for some sort of technicality they can use to weasel out of paying claims they legitimately owe.

    It’s not the doctors’ jobs to be acting as lawyers for the insurers. In fact, this tries to place them in direct opposition to the interests of their patients. Is it even legal for doctors to disclose private medical information to the insurers beyond what the insurers need to know to process claims? I would think it wouldn’t be. Moreover, I can’t see how it could possibly in the doctors’ interest to cooperate. Cooperating would just increase the chances of insurers finding a reason to cancel coverage and stick doctors with unpaid medical bills. If I were a doc I wouldn’t cooperate even if it was legal and even if I felt that application fraud was wrong.

  5. johnva says:

    @durkzilla: Unfortunately, neither of them want to do this. They instead want to create a sort of hybrid public/private system that works with the existing insurers. This may be the best chance to get at least some reform (I’m fully aware of the incredible lobbying power of the insurers). But I highly doubt it will solve the problems we’re seeing with abusive insurers. The only thing that will work to do that is to get rid of the insurers’ role in the healthcare system through nationalization of the industry. And I’m not holding my breath for that to happen.

    The simple fact is that insurance does not do a good job of providing healthcare. Insurance works better for situations where you want to spread the risk of high-cost, low probability one-time events occurring. That’s not what healthcare is.

  6. JustAGuy2 says:


    Usually, if a patient wants an insurance company to pay a doctor, there’s a waiver that the patient has to sign authorizing the doctor to share information with the insurance company, and I don’t think it’s very narrow. It’s usually in that stack of papers that you sign when you first see a new Doctor.

  7. forever_knight says:

    uh, fuck you Blue Cross.

  8. Stan LS says:

    @BP2012: Police state? How so?

  9. johnva says:

    @JustAGuy2: OK. I can believe that. I still can’t believe it’s legal for them to just chat about your whole medical history with the insurance company. Fortunately I don’t believe most doctors would ever want to disclose more information than necessary.

  10. kcrusher says:

    “WellPoint, which operates Blue Cross and Blue Shield plans, posted fourth-quarter net income of $859.1 million”

    That’s net income. Yah, they’re reeeeaaallly hurting and need to hold down costs – gotta keep those shareholders happy (screw the patients!).

  11. puckhead80 says:

    Not insinuating that gals can’t be heartless but “Shannon” could be a dude, dude.

  12. Coder4Life says:

    I hope the worst for these executives. Seriously, they just screw up people’s live. They make so much cash and who cares if they have pre existing condition, where else are they going to go.

    The insurnace company should think of themselves as god considering they can provide these people insurnace and that means they are able get care and live. They are saving lives.

    When did it become so ethical that these companies see a live they can save but just say NO THANKS.

    What if one day their wife or children are in an accident and you were walking by and could help them, would you say no? NO, you would probably help.

  13. bohemian says:

    At this point I think more doctors would welcome national single payer coverage so they can quit wasting time and money playing games with insurance companies just to get paid.

  14. RandoX says:

    Isn’t this some sort of HIPPA violation?

  15. DrGirlfriend says:

    A single-payor system would come with just as many hoops to jump through. Medicare, for example is pretty hard to keep up with.

    I think the way to eliminate the abuse that insurance companies are currently engaged in is to re-vamp the laws that pertain to them. We need insurance, whetehr it’s provided by the government or by private companies. But they have remained largely unregulated for too long.

  16. darkened says:

    @RandoX: For all insurance you ever get you sign a HIPPA disclosure authorization form which gives them full access to your medical records. This would clearly be allowed under your authorization. I have never seen a HIPPA disclosure with an expiration date which would mean it is available for use the entire time you have an active contract with the insurance company. When you leave or are canceled for insurance that would make the HIPPA disclosure void.

    However since at that point everything they garnered from your medical records has already been added to the MIB (kid you not) insurance medical database it doesn’t matter anyway as they have your records forever.

  17. ThinkerTDM says:

    Actually, I think the HIPAA rules specify that communications with the insurance company (for billing purposes or something like that) are not covered by HIPAA. And with a net income of $895 million, they could successfully argue that this is for billing purposes.
    cha-ching! Everything is coming up bluecross!

  18. matto says:

    is his name seriously Dr. Frankestein?

  19. Mr_Burmie says:

    There is no way that any doctor is going to do something that puts his getting paid in jeopardy. Did Well-point even consider this major snag in its plan?

  20. kcrusher says:

    “At this point I think more doctors would welcome national single payer coverage so they can quit wasting time and money playing games with insurance companies just to get paid.”

    That’s exactly what single payer healthcare is meant to do, plus give coverage to those with ‘pre-existing conditions’, who, currently, have no options for insurance (we’re not considering $2k/month premiums an ‘option’).


  21. Gev says:

    @RandoX: It’s HIPAA and no it’s not a violation.

    You basically sign a document when you go in to a doctor’s office to be seen that essentially says that they can discuss your condition(s) with your insurance company.

  22. Mr_Human says:

    What’s really sad is that otherwise honest people are forced to lie on insurance applications so they can get health care. That’s an awful predicament.

  23. Boberto says:

    Cooperating with this request is in direct conflict with the Hippocratic oath.

  24. balthisar says:

    We’ve all come to hate insurance companies so much, that we’re pissed off that they’re trying to prevent insurance fraud? Are you the same people that bitch to State Farm that your brand new, original Rembrant was in the trunk of your car when it was stolen, too? What a bunch of bad, bad, bad consumers.

  25. timmus says:

    And thus WellPoint spokeswoman Shannon Troughton spoke the word “utilization” in a public statement, her shining hour, sinking back into the corporate soup and dooming herself to a career of mediocrity.

  26. marsneedsrabbits says:

    This is just the kind of thing that will usher in government managed care.

  27. dorkins says:

    But not the HIPPAcratic oath.

  28. dorkins says:

    “government managed care” … talk about an oxymoron.

  29. Jaysyn was banned for: says:

    Dr. Frankenstien.

    Can you imagine that coming over a hopital PA?

    “Dr. Frankenstien to the morgue, please. Dr. Frankenstien to the morgue.”

  30. redkamel says:

    thank you Dr.Girlfriend, I wish more were of your wisdom.

    Also: Dr. Frankenstein. That is awesome. Please tell me he does transplant surgery. Please.

  31. Angryrider says:

    Oh man, thankfully I saw SiCKO a little while ago! I bet that if one has a yeast infection, he/she will be denied insurance just because he/she had it!

  32. UX4themasses says:

    Would you like to be the doctor that starts sending information out? Fastest way to end up on this site!

    Are insurance companies expected to be responsible for KNOWN preexisting conditions? I am not talking about what is _right_ or _wrong_, just trying to find TRUE accountability.

  33. Stan LS says:

    “Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members,”

    Actually that sounds very reasonable. You are required to disclose your medical history. This is akin the car insurance companies requiring you to disclose who else in your household has a driver license. This is how the insurance companies work. What’s the big deal?

  34. bohemian says:

    Well at least they haven’t adopted the policy our former group health plan had. Everything for the first six months is considered pre-existing until you prove it otherwise. I made a part time job out of dealing with these clowns just to get medical bills paid.

    The icing was when they called me demanding to know who hit me so they could go after their insurance to recover for my MRI. It took me a half hour on the phone to get them to go back and look that it was a diagnostic MRI for arthritis ordered by a rheumatologist. Morons.

  35. “Fronk-uhn-STEEN!” Had to go for that one. I can just see someone trying to turn in a madical report or note from him, who the hell’s gonna believe your doctor’s name is Frankenstein? [Also, is he taking new patients? I don’t really care if he’s any good, I just really want to have a doctor named Frankenstein.

  36. pastabatman says:

    It’s only insurance fraud if the state says so. NY state does not allow refusal of health insurance OR change in rate due to pre-existing conditions. there is only a 6month waiting period before the pre-existing condition can be treated through the insurance.

    My point is, it’s fraud because some states LET it be fraud. everyone NEEDS health insurance.

  37. Anonymous says:

    The woman from Wellpoint is right. The more people use their insurance to pay for medical care, the more expensive it is for everyone else. The dollars you or your employer pay each month are what go out to pay the doctor.

    Insurers are in a no-win situation. Patients say they charge too much. Doctors say they pay too little. Both sides try to game the system by buying coverage only when they’re sick or favoring procedures based on profitability rather than effectiveness. In the end, it all boils down to medical inflation rising at nearly twice the rate of general inflation.

    I don’t envy those tasked with having to fix this mess. It’s going to be extremely difficult to do. Until then, it would be best to avoid getting sick.

  38. DrGirlfriend says:

    @Mr_Burmie: That’s a really good point. Sure, let’s rat on a patient, get them kicked off health insurance, and then kiss any reimbursement still due to the doctor goodbye! Oh, wait, even better, lose the patient because now they can’t afford to come back and see a doctor!

  39. DrGirlfriend says:

    @mexmexmex2000: That’s the other thing about clamoring for universal health care. Not that I am against the idea of it at all – as I said above, we need health insurance. The problem is that no one is mentioning that there is so much more to this catastrophe than just insurance companies acting like greedy jerks. Medical costs in and of themselves are constantly going up. Drugs cost a fortune. Hospitals *charge* a fortune. It’s one big vicious cycle and all elements affect each other.

  40. bearymore says:

    @Stan LS: This would be reasonable if the system weren’t so skewed in favor of the insurance companies. Consider a person who received coverage through his or her employment for 20 years and was laid off when his job was shipped to India. After about six months, that person would lose his employment based health insurance and be required to find individual coverage. If he developed health problems while on the job, that will be impossible due to the pre-existing condition clause on virtually all individual insurance. This is a person who would have paid into the system for 20 years and then, in a time of need, be refused the coverage that his former payments have underwritten (in the insurance industry sense of the term).

    Then there are those who are denied coverage after the fact due to pre-existing conditions that are both minor and not-related to the claim at issue — such as the woman whose policy was rescinded after a claim for cancer therapy due to non-disclosure of hay-fever as a preexisting condition. Blue Cross was fined over $1mm (peanuts) by the State of California for this little peccadillo.

    If we are to have private insurance it needs heavy regulation. On the one hand, basic insurance must be mandatory so that even the healthy buy coverage. This will lower the current costs for all insured and lower the overall life-time costs for the currently healthy. On the other hand, insurance companies must be forced to offer a basic coverage package to all comers at a community (not experience) based rate. Beyond that, they could do what they want. That way everyone would have basic coverage at a lower cost than in our current system.

    Even better – remove the middle man and offer single payer national health insurance. I daresay the extra taxes to finance that would be A LOT less than private health insurance premiums for identical coverage.

  41. I know this is the wrong site for this, but does anyone else have a better plan for a company to minimize it’s shot at moral hazard risk, which is an inherent (and ugly) part of the insurance game?

    For those not familiar: I am shopping for insurance. I possess an information advantage over any company that would like to insure me. I know that I have conditions X, Y, & Z. In fact, my knowledge affects which plan options I’m interested in. The insurer only has my word that I’m healthy and free of XY&Z. They sign me up, and they wind up boned, as I get tons of drugs and treatment for XY&Z due to my information asymmetry.

    Perhaps it would be draconian of them to require a physical, that they will pay for, before they quote you. That would solve it, but would probably have consumerists up in arms.

    This is not ideal practice. It’s anti-consumer. But since Insurance is a risk based business, don’t they have to have some option to at least accurately judge that risk?

    Last thought: A good socialized health model will create the equivalent of company group plans on a national scale, thereby eliminating insurance drops and the moral hazard problems inherent in insurance.

  42. @DrGirlfriend: Is it possible that the skyrocketing cost of all things health, that outpaces general inflation by more than even college tuition has some root in the current, privatized system and might be fixed with a socialized model?

    Fer instance: let’s say as a doctor, you can charge whatever you like. You charge up to the max that the insurance company will reimburse, even if it has no relation to your actual cost. There’s your incentive. Maximize profits. Given a single payer system, wouldn’t the balance of power between suppliers and customers be shifted to the monosonist [] ? Me thinks so, since that’s what economic theory would tell us.

  43. mattpr says:

    Two things from an MDs perspective:

    (1) Not disclosing your medical information to the insurance company IS insurance fraud, and withholding this information the same information from your doctor severely compromises your care. There is really no way around this. The fact that the insurance companies have a hefty net profit doesn’t change this.

    (2) That being said, I find Blue Cross using the physician in this instance to be VERY troubling and highly unethical on their part even if it’s not in violation of HIPAA. It severely compromises the doctor-patient relationship and strong-arms the physician into disrupting it. A doctor should be an advocate for their patient regardless of the status with an insurance company.

  44. MissTic says:

    I fail to see how the govt can do any better at health coverage. I also find it ironic that people are willing to turn over such a private/important matter to the govt. Anyone that’s dealt with govt healthcare (Medicare, Indian Health Services, VA) will tell you what a nightmare it is. In fact, it will make this little stunt by Blue Cross look quaint in comparison. I’d like to see health insurance revamped. Clearly it is not working for a lot of people as the OP proves. But turning it over to the people who brought us the DMV?? Hell no. I say change the health insurance market and allow consumers the ability to purchase privately much like car insurance. On a related note, I’ve always thought it odd that most of us at the mercy of our employer’s HR person – they pick the policies offered unless you get one on your own. Lovely.

  45. Anonymous says:

    @bearymore: In my state, and I believe in most states, as long as you don’t have a break in coverage, you would be able to sign on for individual insurance or new group insurance and not be subject to a waiting period or pre-existing condition exclusions. You’re typically eligible for COBRA coverage to bridge until you can find a new policy (assuming you don’t like the COBRA.)

    The idea of a waiting period and a pre-existing condition exclusion is to prevent people from only buying in when they need care. The waiting period is usually nine months because of pregnancy.

    Insurance companies seem heavy handed with these rules, but in many cases the way business is conducted is helpful to the majority of paying members in that it keeps costs down. Otherwise, people would only buy insurance after they got sick and that’s not how insurance works.

    Agree with you that states should require all to have insurance to keep costs down.

    Don’t agree that tax payer funded, government run single payer would be any cheaper. The drive for profit creates a demand for efficiency. This doesn’t generally exist in the public sector.

  46. bukz68 says:

    No system of health care coverage will ever be 100% efficient. But the truth of the matter is that the per capita costs in this country exceed most every other developed nation in the world yet our health care outcomes (infant mortality, deaths from preventable illness, etc.) are far worse.

    Option A: A public, universal, single payer system in which the sole goal is to control costs and spread risk amongst EVERYONE.

    Option B: A private, non-universal, multiple payer system in which the main goal of the payer is to control costs and make a profit, and perhaps do a little risk spreading on the side.

    The larger question is whether we see health care as a public good or a privelege. If it’s a privelege most would agree that a free market, privatized system would be most efficient. If it’s a public good then it should be socialized.

  47. Poshua says:

    @bukz68: You’re misusing the term “public good.” With the exception of certain matters of public health (like preventing overuse of antibiotics) health care is by definition a private good, because it is excludable and rivalrous. I think you’re asking whether it’s a “right”.

  48. youbastid says:

    I got denied insurance from Blue Cross (California) because I once had a prescription for Lunesta with my previous provider. The plan I was buying from Blue Cross doesn’t even cover brand name prescriptions, so it wouldn’t have even cost them any money. In any case, I switched providers, and signed back up with Blue Cross 6 months later, without mentioning the Lunesta. Approved. When I get into a car accident in 10 years and break both my legs, they’ll probably cancel my insurance retroactively because I failed to mention that on my application. I love America!

  49. bearymore says:

    @mexmexmex2000: Continuation of coverage depends on the state. In at least 20 states, after expiration of COBRA, those with pre-existing conditions are placed into state “high risk pools” with rates 50% to 200% higher than standard rate policies. This keeps them out of the individual market and creates an institutional subsidy for insurance company cherry picking.

    Furthermore, once you have an individual policy you lose all protections. According to the L.A. Times, insurers are increasingly playing games with individual coverage. They cancel long existing plans which, because of the length of time they have been in existence, tend to have a contingent of older, higher risk long-term policy holders. They then start a new plan, substantially similar to the old one. Since the old plan no longer exists, all its policy holders lose coverage and need to apply to the new plan. Since the plan is new and the applicants no longer have policies with the company, the company is able to deny coverage to those with preexisting conditions. Not all do this, but it is becoming increasingly popular among the less ethical companies in the business.

    As per the efficiency of a government plan. The Medicare loss ratio (% of premiums paid in claims) is 95%. No private health insurer comes close. Blue Cross of California, for example, keeps more than 20% for administrative expenses and profit. Where efficiency comes in is in the actual practice of medicine. Under both single-payer and private insurance this is provided by the same privately owned providers. The difference between private and public plans is that private insurance has a built in incentive to keep medical prices soaring. Since profits are a fixed percentage of claims, the higher the costs, the higher the claims, and the higher the dollar profit. The only caveat is that the insurance company needs to raise its rates before the providers raise theirs. This is assured by the UCR (usual, customary and reasonable) fee structure that is used to set reimbursement rates. Since it has its own built-in price inflator, everybody is happy except the patient. This utterly perverse incentive doesn’t exist with publicly administered insurance. The greater administrative inefficiency (and administration is all that any insurer does) is more than offset by savings in marketing, medical underwriting, recission staffs, etc. that a public plan doesn’t need. Furthermore, these savings pale next to the reduced cost of care that will (and have in country after country) accrue to a change to public funding of basic medical care.

  50. StevieD says:

    My Doctor down at Best Buy says that if I sign the binding arbitration agreement then he can refuse to release the data to AT&T, but if I refuse than he is required to release the data to Starbucks.

  51. DrGirlfriend says:

    @PotKettleBlack: But the thing is, every insurance (including Medicare, which is what would approximate a single-payor model for universal healthcare in the US, if run by the government) already has what’s called a “maximum allowable charge”. A hospital can charge a million dollars for an aspirin, but if the insurance company only pays $50 per $50 per aspirin, the hospital only collects $50.

    The difference does not usually get passed on to the patient, because most insurance companies stipulate that if a provider accepts reimbursement from them, they are agreeing to collect *only* that allowable amount, and not go after the patient for the rest.

    What we need to look at is this: is $50 for an aspirin (and that is only SLIGHTLY exaggerated) an appropriate amount? In many cases, costs are very exaggerated, and the maximum allowable amounts only scale down that exaggeration by a small amount. This is what I mean that the *entire* system, from all conceivable angles, is very, very broken.

  52. Hambriq says:

    @bearymore: The Medicare loss ratio (% of premiums paid in claims) is 95%.

    This is just patently false. I would like to see where you got this information from.

    [The study’s] estimate that local community pharmacies received an average Part D dispensing fee of $2.27 per prescription reinforces our position that community pharmacies are not adequately reimbursed for the costs of dispensing drugs. When you also consider the slow rate of reimbursement, as evidenced by the recent University of Texas study, pharmacists may be forced to close their doors, or stop participating in these government programs, rather than operate at a loss, and patient access to the medicines they need will be seriously threatened.

    With the $2.27 dispensing fee, the compensation to pharmacies then averages $11.40 per prescription. The recent study by the accounting firm Grant Thornton found that the average cost to dispense a prescription drug is $10.50, leaving a net profit of 90 cents, on average, per Medicare prescription. With an average prescription price of $68.26, this yields a mere 1.3% net profit margin.

    As per: “Review of the Relationship Between Medicare Part D Payments to Local, Community Pharmacies and the Pharmacies’ Drug Acquisition Costs.”

    Medicare’s rate of reimbursement, and the obscenely slow pace at which they issue returns is one of the major problems in the pharmacy industry. Approximately 50% of Medicare accounts are 60 days past due! The notion that the inefficiency will somehow be offset is ludicrous. The inefficiencies of Medicare are causing smaller pharmacies to go out of business and forcing big-box chain pharmacies to ramp up the number of prescriptions they are filling in order to break even.

    Don’t get me wrong, I don’t think a privatized system is the answer. But you are sorely, sorely mistaken if you think the inefficiencies of Medicare are a minor problem.

  53. Hambriq says:

    P.S. Here is the full reference:

    Office of the Inspector General of the Department of Health and Human Services: A “Review of the Relationship Between Medicare Part D Payments to Local, Community Pharmacies and the Pharmacies’ Drug Acquisition Costs.”

  54. johnva says:

    @balthisar: I’m not condoning fraud, but I think you’re misunderstanding what the true goal of these fishing expeditions is. They aren’t really trying to stamp out the “fraud” of people lying about pre-existing conditions. Normally, they are okay with that as long as the patient isn’t costing them a lot of money. It’s only when someone starts to cost them lots of money that they start to care and try to find a reason to justify retroactively cancelling coverage. This is just another tactic to cut their costs by selecting only the healthiest patients as customers. And they are doing it with “omissions” that are not only totally unrelated to the condition that is costing them lots of money but also minor and unintentional in many/most cases. It’s like if you forget to mention that you have a food allergy and they use that as a pretext to retroactively cancel you when you get cancer. THAT is what this is about.

    Moreover, this problem is going to get even more messy just a few years down the road once genomics start to becoming a bigger and bigger part of medical practice. Then the insurers will potentially be able to claim that almost anything is a “preexisting condition” since they will be able to show a potential genetic basis for all kinds of diseases. Genetics has an immense potential to revolutionize the practice of preventative medicine, but people will be afraid to use it if the insurers can use any genetic risk as a way to deny coverage or retroactively cancel policies. More and more people will be shut out of the healthcare system as insurers can do a better and better job of selecting only the healthiest people as their customers (and they will define “healthiest” in terms of things that we have NO control over, like genetics).

    Nationalized healthcare is the only solution I can see that will ensure some level of equitable access to care for all. The profit motive simply does not work at providing healthcare because it guarantees that care will not be provided to everyone. It is immoral, inequitable, and soon may become a form of capitalist eugenics once the genetic testing stuff gets involved. We have to kill the insurance monster before the genetic stuff becomes a concern.

  55. ekeyser says:

    Yeah this happened to me about 5 years ago. Got health insurance through BC. Was hospitalized some months later. Retroactively canceled my coverage. Thanks Blue Cross.

  56. Randy says:

    I didn’t see anything about the letter being revoked, so here’s the URL: []

    BC came to its senses and canceled the entire thing.

  57. brent_w says:

    Someone needs to send another letter to all of the doctors Reminding them of Dr / Patient confidentiality.

  58. JustaConsumer says:

    Blue Cross is organized crime. They let people die to make a few extra bucks.

  59. ELC says:

    Nationalizing health care will not get rid of this problem – it will only reduce the health care quality available to us. What WILL reduce these types of problems is implementing capitalistic market forces into the system. If people were really able to pick a company based on the costs of services and they were able to shop around whenever they wanted (instead of the few choices offered through companies, usually once a year), then people would quickly dump the insurance companies that do this. It isn’t like the cable/satellite markets where you MIGHT have 2 or 3 choices in an area which really creates an oligopoly. for insurance, you’d have MANY choices and you could truly shop around – just like clothes buying from multiple retailers in your local area.

  60. Elviswasntmyhero says:
  61. johnva says:

    @ericole: That is nothing like how our current system works. I realize you aren’t saying it is, but many people that favor the status quo seem to think that we currently have a market-based system. We don’t.

    Here’s the main problem I have with your proposal to “fix it with capitalism”: it does not address the inequality inherent in a system where insurance companies want to make a profit, and it doesn’t recognize the fact that insurance isn’t a good solution to the problem of providing healthcare. Insurance is meant to hedge against the risk of infrequent events that you hope don’t happen to you (like a car wreck). If you are a bad driver, your auto insurance premiums go up, providing you an incentive not to be a bad driver.

    Health insurance doesn’t really work like that. While some health events are under your control, many others aren’t. Genetic predispositions are not under your control, for example. Everyone gets sick at least sometime in the life. And health takes constant investment in maintenance…do we use insurance to pay for car repairs (beyond the warranty period where expected losses are low)?

    So this brings us to the question of fairness. Everyone needs to take care of their health, but it’s more expensive than the average for many people through no fault of their own. I think it’s wrong for society to allow those people to be put at the mercy of for-profit insurers, who will want only customers who don’t cost them much money. It’s a different moral question than car insurance, since after all you don’t need a car to live. An analogous situation would be if a statistical study showed that blacks were more likely to get a certain disease than whites (many such studies exist, for all races). Should insurers then be allowed to charge blacks higher premiums based on this risk, even though they have no control over their skin color? There is really no difference between this and other genetic discrimination except for that skin color is an externally visible genetic characteristic. I don’t think society should tolerate this, and I don’t see how we can prevent it in a for-profit insurance model.

  62. Rusted says:

    Well, health insurance is for healthy people. AT least in this country.

  63. bearymore says:

    @Hambriq:Medical loss ratio refers to the percent of premiums paid out in claims. It is totally unrelated to the reimbursement procedure or amounts reimbursed. The most recent data I have can be found in the Statistical Abstract of the United States, 2006 for calendar year 2005 (Table 136). Total income from premiums and general government funds were $356.8 billion, while total benefit disbursements were $330.3 billion for a 93% loss ratio. Relevant to your point, the last year before Part D, 2003, the loss ratio was 97%. Look what Part D has accomplished. It is a poorly designed and poorly administered program — just what you’d expect from a Republican congress more interested in subsidies to big Pharma than designing a reasonable and efficient program. It is no accident that Billy Tauzin (R-LA), the Congressman who pushed the bill through the House in an unprecedented all night session, was hired by Phrma, the industry association, at a reported salary of $2.5 million when he left Congress two months later.

  64. Hambriq says:

    @bearymore: Gotcha.

    The main reason for my confusion, of course, was the context in which you were using the medical loss ratio. That particular statistic has no real meaning without a very specific context surrounding it.

    It is by no means an indicator of quality, because the number does not take into account the number of beneficiaries. It is also by no means an indicator of efficiency, because there’s no universally agreed-upon scale of efficiency for medical programs. Indeed, traditional measures of ‘efficiency’ would indicate that a lower loss ratio is better; after all, the program would be spending far less than it is bringing in. We can obviously see why this is not a good thing for participants in the program.

    It is only what is is: the measure of how much is paid out versus what is brought in. We cannot unilaterally say that “higher is better”; a loss ratio of 10,000% would indicate a severely bankrupt system. On the other hand, a loss ratio of 0% would be woefully underserving its participants.

    What it comes down to is, we have to look to more concrete examples of quality and efficiency to judge public (and private, for that matter) health care systems. Working in a pharmacy, I can say from personal experience that, by far, the lowest quality of care tends to come from publicly funded programs: Tricare, VA, Medicare, Medicaid. Of course, this is just the anecdotal evidence of one person, and it holds no real weight in the overall course of discussion. But it does make me regard each side of the issue with a hefty grain of salt.

    I think, in the end, we would be all be better served if everyone did this.

  65. Hambriq says:

    Also, to clarify, I’m not anti-Universalized Health Care. I believe that, to some end, every person should have health care in this country. And I think that most people would agree with the thought behind that statement; it’s just the logistics of making it happen that we all argue about.