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Universal Health Coverage needed

Posted by Captin Cannuck on January 30, 2008 at 12:13:03:

I wrote a piece last month on the other forum. I want to share it with you on this forum. It relates to the issue of private health insurance, and its effect on people with Obstructive Sleep Apnea who are currently living in the United States. In my own view, private insurance is a big problem, which is doing a disservice to people with OSA who are living in the United States. There are two campls of people who are done a disservice. First, the people who do not have insurance, but cannot get insured. Secondly, the people who duly paid their premiums, but who are cheated or abused by the companies in many ways, as outlined below.

Just today, a poster on this forum(the person who posted below) is in a dilemma. He/she does not have health insurance, and cannot get it because of a "pre-existing condition". This individual is falling between the cracks of the private system. Lots of people are in the same situation. One poster on the other side mentioned that he wanted to change his job, but could not do so because his having OSA necessitated his keeping the insurance, and so he had to stay in the job that he wasn't happy doing.

A lot of people on this site are battling private insurance companies to get surgeries covered or medical equipment such as CPAP, dental devices or oxygen covered. I just saw Michael Moore's newest movie titled "Sicko". It was a real eye-opener for me to see what is really going on.

The documentary film shows how these companies are getting rich by trickery/deceit and are abusing the customer's legitimate expectations for medical care. In the movie, Moore showed the beginning of private insurance, and traced how it developed. Here are some of the points that were made:

1. Beginning and Evolution of Private Health Industry in USA:
In the beginning, the companies were set up to make a profit. The concept was to provide LESS and charge people MORE. The beginning was in the Nixon years. Nixon kept tapes of all his conversations. His comments regarding private health insurance in negotiation with Mr. Kaissar Permenente are on record: The voice of his aid says, "All the incentives are for LESS medical care"..."The less incentives you give'em, the more they pay". Nixon replies: "that appeals to me".

2. The Political Corruption - Pay-offs, etc.
The Health care industry spent 100 million dollars to defeat Hillary Clinton's proposal for universal health care under Bill Clinton's administration. Many congressmen/women are being bought off by these wealthy companies.

3. Inner Workings of the Companies
The inner workings of these companies was revealed in the movie. Former employees of the health care companies hated their jobs, and spoke to Moore candidly about what they did. They revealed that they were obliged to keep weekly reports with a rejection quota. The employees who maintained the highest rejection quotas were rewarded with promotions and payment bonuses. Inside the company, a payment for a claim is called "a medical loss". The bosses in the company had pep-talks with the medical reviewers. They told them to look at it like this, "you are not denying people care, you are only denying them payment".

4. Trickery to avoid payments / Abuse of clients
Some employees (in the film, the employee Lee Iner, for example) are charged with the responsibility of finding ways to get the company's money back by finding technicalities (e.g. minor slip-ups in the application). One lady, for example, had failed to mention that she had had a yeast infection, so when the time came when she had a major illness and needed to claim, the company poured tremendous energy into going through her paperwork looking for a technicality and found this fact and used it to disqualify her. The employees likened this examination to a forensic examination.

5. Disqualifying People to Maximize profits.
Other employees revealed that they had to reject people with pre-existing conditions. Thus, if a person had sleep apnea, he/she would likely be rejected.

5. Wearing People Down To Avoid Payment, Maximizing Profits
These companies wear people down. In the movie, there were many examples of people fighting the same fight that we see here on this site, where these companies reject claims for neccessary medical needs. In the movie, the character Maria (Blue Cross customer) had a brain tumor and requested a MRI which was rejected. Other companies were shown to make similar rejections. The chief medical officer's do not actually see the cases. For example Dr. Glen Hollinger revealed in a hearing before congress that his name was "rubber stamped" on the rejection letters by underling adjusters. This is the usual practice.

In the movie characters from Horizon Blue cross, BCS and Cigna company rejected tests for patients who had cancer. Some of those characters who spoke to Michael Moore are now dead because of delays/mismanagement due to battling these companies.

Need for Reform
I don't know what the answer is, but I have to say that I hope that the next administration will bring in reform of some sort. I think that there is an urgent need for reform. The current emphasis on profits is resulting in the abuse of the patients. It is likely that there will be big changes coming to America. As Bob Dylan says, "the times, they are a changin'". I really hope that the new change will be a good change, and it will put people before money. That is the biggest thing. People with progressive minds are badly needed.

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