Sunday, August 30, 2009

Health Care reform and the politics of fear

I spent more than 8 years working in the Health Insurance industry. Ask me anything, I'll tell you the truth. 1997, the year when privatized Medicaid came into vogue. States were hemmoraghing red ink from their budgets. HMO's seemed like a reasonable alternative. It worked for the general public, after all. When I started working for Company X, I was young, broke, stupid and the head of a household that was barely holding on. We'd just barely managed to keep the house after my grandmother died. $7.50 an hour, plus commission seemed like a good deal. It was, actually. I doubled the value of my annual wages inside of 10 months. I also felt like I was serving a purpose. I was helping people. In the beginning, the benefits were actually far better than what Medicaid offered. A win-win scenario: Save the state money and help people.
Over the course of the next 8 years, it became more about maximizing profits and less about serving either of our clients. Irony of ironies, my health insurance was worse than the plan's members. Eventually, Company X had contracts in 3 states, about 500k members and was making 20 million dollars a quarter as a privately held company.
I was making 36k a year, and I was miserable.
Here's why:
1. If you're on Medicaid, chances are you're either desperately poor or you have a debilitating health condition. (There are a lot of nuns on Medicaid, btw. Seems that priests get taken care of by the diocese and nuns are left to fend for themselves.) We're talking about people who are mostly in vulnerable economic strata and often don't know how to advocate for themselves. Add profound illness on top of that and you've got a member pool already hanging by a thread.
2. Doctors. Yes we've all got to wait too long and finding the right doctor is a pain, but if a doctor provides services, they deserve to be paid in a timely fashion, without dispute. This does not happen with HMO's.
3. Red tape. Covered physicians, referrals, out of network authorizations, authorizations for procedures, drug formularies, brand-name authorizations, non-formulary letters of medical necessity...(I could go on, but it's endless.) Providers spend more time dealing with beauracracy than patients. Tell me that's not compromising patient care. Ha.
4. Routine denial of care. Everything that's not a covered service or routine diagnostic test is denied pro forma. So are non-formulary drugs. Period. In the hopes that either your provider will do something that is covered or that you'll be too sick, too helpless or too stupid to fight.
5. HMO's make money based on the number of members they have. Each member = x number of dollars per month whether you get services or not. The fewer services you have, the more of that money goes towards bulking up the profit margin.
All of the things the right-wing chorus of, "No," is saying will happen with a Govt-run plan are exactly what's happening every day in this country. Only, we're paying for it and we can't even afford to use it. Health care is a basic human right and it contributes to the public good. It's also economically smart. A national health care system would force commercial plans to become more competitive and actually provide what their members pay for. It would relieve the pressure small business owners are bearing the brunt of and we'd have a healthier populace.
Does anyone have any questions?

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