Tag Archives: health insurance

Leadership, Carville & Truth

Leave it to James Carville to get people thinking. His advice this week to President Obama was to panic, fire a bunch of people and indict some of the people responsible for the financial crisis. I, respectfully, differ.

This President has done his darndest to play the traditional role of cheerleader President. No matter the reality, reassure the masses and do the “right thing.” Find compromise. Reassure his base through incrementalism. Reassure his opponents by putting everything on the table. I don’t think that I am the first to say that this ain’t working.

These are not normal times. The opposition party sold out their patriotism a long time ago for corporate favor and corporate-sponsored ideology. President Obama is being played. Over and over and over again.

I have a suggestion. Tell the American people the truth. Sounds un-American, doesn’t it?

Sure, the stock market up 30% since Obama took over and the Bush economy that was going down the toilet is growing again slowly up the side of the bowl. Sure, some of the bleeding has stopped, but there is a limit to what a President can do without Congress. Even less with a Congress that is doing everything they can to undermined America. I say, cut the crap and tell us the truth.

Tell us that the banks have been lying and most are insolvent – as bad as as what’s going on in Europe. That we face a multi-trillion dollar under-capitalization of banks. Tell us that we, the treasury, has colluded with the financial industry to allow them to classify assets as preforming that are junk. Tell us that the only thing that has kept them in business is the abuse of the Fed window allowing them to bet on a totally rigged Wall Street – and, of course, the continued rape of consumers – aka: Americans. Tell us truth, while reminding us that bank CEOs are paying themselves billions in bonuses – while we are wondering whether this is the week that a bank will repossess our house with fraudulent documents. Then remind us that our homes can’t be sold for what we owe and that millions of repossessed houses aren’t even on the market, yet.

Tell us that we are in real trouble. That most of our pension funds are also insolvent. That they have invested in worthless real estate and our treasury has colluded with them to pretend it isn’t true. That those empty office buildings around the country are being counted as if they were worth something. That commercial real estate is a scam and it is the other shoe that will drop, unless we can just pretend our way out it this mess. Tell us the truth: there is a limit to how many offices Homeland Security and the NSA can lease.

Tell us that we are in unwinnable wars around the world. That Iraq and Afghanistan are as big a mess as when we arrived. That we continue to fight them because we are terrified at the thought of bringing 300,000-400,000 fully armed private mercenary soldiers, along with a 200,000 of our real troops, back home where there is no work. Tell us, that we have had a wartime economy since Reagan. That if we were to have peace, this depression would be number one. Tell us the truth.

Tell us that most of the the 13 million official unemployed will never work again for real wages unless we do something to change it now. Tell us that 10-20 million more who are doing everything they can to keep their families together by working fast food and driving cabs, shouldn’t expect find real work again, either. Tell us that the reason we haven’t done re-training of these Americans so they could find jobs, is that there aren’t jobs to be found. Tell us the truth. That stimulus was misnamed. A third of of it was typical pickle barrel stuff to get votes. A third of it went straight to the states to keep them from firing people. And the final third, was, well, a mix of shovel ready jobs and liberal aspirations that was oversold.

Tell us, that, we the people, have screwed up big time. That corporate bribery of our Congress is so rampant that we have totally f’cked our tax system and need a new one. That we have an economy where the American dream, aka: Bernie, is really dead. Tell us 90% of us are slaves to the other 10%. Tell us the real plot of Ayn Rand capitalists is to get the wages of the poor down to the pennies a day they pay in third world countries. Tell us the truth.

Tell us the truth that organized labor working with organized business is what created the middle class and made our economy the envy of the world. Tell us the truth about the bill the Republicans passed last week to weaken the NLRB. That it is an attack on the middle class at a time when we need Labor more than ever.

Tell us the truth that tens of thousands of bridges and roads are crumbling and that investments in our infrastructure to rebuild them will create good jobs and lasting value for all of us.

Tell us that our nation’s school systems are failing and that the most important investment we can make is in our next generation. Tell us how we can fix it.

Tell us the truth that our farm subsidies have ruined family farmers around the world and caused deadly food inflation in the places most vulnerable. That our subsidies for corn is a huge part of the obesity problem. Tell us the truth that by subsidizing corn and corn ethanol, which will always be inefficient and penalizing sugar cane and sugar-ethanol imports, which are very efficient, we are preventing our own southern hemisphere from a rich and sustainable future.

Remind us that gasoline costs over $10 to get to the pump, but that the Federal Government subsidies allowing you to buy it for $3.50 – something that has to stop. Tell us the truth that free trade is not fair trade. That low prices are good for Walmart customers, but not people wanting a job anywhere but Walmart. Admit that you caved on ozone rules because you were afraid it would cost you reelection and that the new rules need to be implemented. Apologize to all those you could have appointed during recess, admit you were afraid of Senate Republicans and promise not to do it again.

Tell us that the reason Medicare and Medicaid are in trouble is the greedy bastards in the pharmaceutical, medical equiptment and health insurance industry who have rigged the system. Tell us to look at every other country in the world and we’ll see that we are a nation of chumps. Tell us that “Obamacare” is a bullshit compromised bill. That it should be repealed and replaced with a new bill with a single payor that would give us all better care for way less money. Tell us the truth: that privatization is just a more expensive way of doing the same thing, but will make some individuals rich, but not you. Tell us the budget deficit is meaningless to most of us, but the rich do want the government to pay them interest. Tell us the truth: that if the rich won’t pay taxes and the poor can’t, just who the f’ck is left pay? We, the whoever is still working, are. Tell us that we are acting like lemmings marching behind the t-party idiots off the cliff.

Tell us that unless we get rid of the bastards in the House and push back the lowlife lobbyists on K-Street, the whole friggin’ thing, our American way of life, is going to topple down. That we the people will starve in the streets of the richest country in the world while the top 1/10 of 1% are laughing their asses off behind their gated communities. Tell us the truth.

Remind us that the President is part of the executive branch of government. That the executive powers are limited to carrying out the wishes of Congress. And when Congress, or their lobbyist masters, wishes the country to go in the ditch, the President is powerless to stop them. Tell us the truth.

Tell that creationism and intelligent design are silly and that evolution is fact. Tell us that global climate change is real, will kill us all and may already be too late to reverse. Tell us that tax cuts do not and never have created jobs. Tell us that water boarding is torture. Remind us that Santa and the Tooth Fairy are not real. Tell us the truth about Roswell, Kennedy and Elvis.

Tell us that the games are over. That he, President Obama, is going to tell the truth. That when these crazy pink Republicans say blatant lies, he’s going to call them on it. That we are going to hell and take the world with us unless they stop this idiotic fantasy.

On the other hand, maybe he should just fire a bunch of people and indict some of the people responsible for the financial crisis.

Joining the 50 million

Our health insurance was canceled last month. We have joined the ranks of the uninsured. Collateral damage in health care reform and the race to parse the regulations, drive trucks of cash through the loopholes and squeeze every dollar out of every soul still breathing.

Payments were current. We had not made a claim that exceeded our deductible in a couple of years. Nothing had changed. And we weren’t even told until three weeks after it had happened. There’s no appeal. No reason required. No COBRA. It is just gone. And it was done on purpose.

Our business had used  Business Advantage, a PEO (Professional Employer Organization), to act as our “virtual employer” to provide Blue Cross group health care insurance. Technically, we worked for an LLC owned by Business Advantage for this purpose. According to Wayne Surman, National Sales Manager of Business Advantage*, “We decided to close that company because rates had gone up.” Business Advantage voluntarily shut down Near Northside, LLC because they didn’t think they were making enough money, which immediately canceled our policy and whomever else was in the plan. While failing to apologize for not telling us that we were going to be totally screwed, he did say we were welcome to “apply” for new coverage – coverage, subject to acceptance, with a new LLC and at new rates.

Responsible: Left to Right: Stanley R. Joseph, Wayne Surman and Jason C. Joseph of Business Advantage.

Were we just chumps? Hard to know so far. It seems pretty straight up for a business to fold a company and ruin the lives of anonymous customers when, in the owners’ judgment, it makes good business sense. The people behind Business Advantage, Stan and Jason Joseph, are well connected, and as far as I can tell, well thought of. Perhaps, they didn’t realize they were making a life and death decision in the lives of others? Perhaps, they needed the money more than we need health insurance? Perhaps, it had gotten to be too much trouble. All understandable these days. And it makes me hope there is a hell.

The CBO expects this to happen to 3 million others while waiting for health care reform to be fully implemented in 2014. Robert Woods Johnson research puts that number much higher. People who are employed. People who want coverage. People who won’t have it. People, like me.

While we will apply, no company is expected to take us on an individual policy because of preexisting conditions. Blue Cross has offered us a take or leave it conversion policy – take it and our rates will go up by $2,586.26 a month, plus, of course, a required payment for the month we had just lost and will never be able to use, a higher deductible and the expectation that rates will rise even higher.

A certificate of insurance was included with our cancellation notice. A certificate of insurance offers some federally required exceptions to preexisting condition exclusions if a policyholder is not without insurance for 62 days and is able to get back in an employee sponsored plan. It does not, however, give you squat protection for individual coverage. The 62-day clock on insurability had already ticked down to 42 days when we found out we needed it. We will apply, but acceptance and affordability is a serious concern. As is trust that it won’t happen again in a few months. Or next year. Or the year after.

By now, you must be asking yourself, “what about the health care reform bill, I remember reading on LikeTheDew.com that within 90-days of its passage, uninsured individuals who have a preexisting condition will have access to a state or federal high risk insurance pool?

There will be no Georgia pool. Georgia goobernatorial candidate and Insurance Commissioner John Oxendine has written US Health and Human Services Secretary Kathleen Sebellus saying of the fully funded federal program, “I cannot commit the state of Georgia to … a scheme which I believe the Supreme Court will hold to be unconstitutional, leads to the further expansion of the federal government, undermines the financial security of our nation, and potentially commits the state of Georgia to future financial obligations.” (Source: AJC) Georgia joined 17 other states refusing to participate (including almost all Southern states).

The federal high risk pool will be funded beginning July 1st. Details of the process and eligibility are still being developed, but the law requires that individuals be uninsured for six months – perhaps, this will save us next fall. The cost benefit is extraordinary: it is capped at $11,900 a year including all out of pocket costs. Easily $25,000 less than a private plan.

We could take the chance and bet we’d be healthy for six months to wait for the federal program, but what if we were wrong? Or, we could bet that we could pay the huge price increase even if we had nothing left to use it — which is what they want: pay as much as you can possibly afford and be too broke to ever use it.

In complete candor, the medical history questions on the forms make me apoplectic – the fear of the costs rob my sleep –  the fear of an insurance need limited by a preexisting condition is cruel, but in America, hardly unusual.

________________

* Feel free to contact Wayne Surman, Business Advantage Program Employee Leasing, 11175 Cicero Drive, Suite 100, Alpharetta, GA 30022, Office: 678.242.5277,  Fax: 678.242.5241, Cell: 678.480.5200, email: [email protected] or [email protected] – Linkedin: http://www.linkedin.com/pub/wayne-surman/13/478/a14 or Stanley R. Joseph, President & CEO of Business Advantage, Inc. – Linkedin: http://www.linkedin.com/pub/stan-joseph/5/73b/954, Jason C. Joseph – Linkedin: http://www.linkedin.com/pub/jason-joseph/0/915/100, Co-Founder and Executive Vice President. The Josephs are also involved in  X1 Capital Partners, LLC, Hibernian Pacific Holdings, LLC and Fog City Blue Entertainment, LLC who do business at the same address as Business Advantage, Inc., but, of course, those businesses could close at any time without warning.

Last Minute Gifting

On behalf of 46 million Americans without health insurance, 56 million Americans pre-existing conditions, and all of us who are terrified we’ll join the others, I’d just like to say, “thank you.” I know you shopped hard, had to make difficult choices on size and features, and probably spent way too much, but I just love you for thinking of me. I got a little something for you, too – my vote.

Health Care Bill Passes

Listing those who will die

Something extraordinary happened Wednesday night in the House of the Representatives. Rep. Alan Grayson (D-FL), gave a speech on health care. He continued speaking about the 44,000 Americans who die each year because of lack of health insurance. This time, he broke out the number who will die next year by the Congressional district of those who oppose the reform bill. Republicans went to great lengths to shut him up, but they didn’t (they start trying in Part Three). Watch it.

Part One

Part Two

Part Three

Part Four

Part Five

Part Six

Part Seven

Part Eight

Reading the fine print

Health Care OverhaulThe Baucus Bill (aka: what’s left of Obamacare-Hillarycare-Nixoncare-Roseveltcare (aka: Insurance-Lobby-Care-Less)) doesn’t go into effect until after (yes, AFTER) the next presidential election. November 2013? Right. Over 3 years from now. That’s the one, sorta. The non-health insurance “subsidies” in the bill (the health insurance companies will receive most of their subsidies earlier) Democrat-designed to make the mandate requiring we all have health insurance “affordable” (if you consider 20% of your income affordable) for those who are near or below the poverty line are tax credits. Hmmm. The benefit of Baucus health reform tax credits will arrive sometime around or after April 15th, 2015 – if you make enough. Long enough. This is what’s in the fine print.

The healthcare system is killing us

ilanakohn_sketchForbes, yes, Forbes, reports today on a new study finding that “medical problems and expenses contributed to nearly  two-thirds of all bankruptcies in the United States.”

In fairness, the American Journal of Medicine, Harvard Law School, Harvard Medical School and Ohio University study used data from 2007 and, according to the researchers, was “collected prior to the current economic downturn. It’s likely that the current rate of medical-related bankruptcies is even higher.”

Those of you who haven’t experienced how this can happen to “solidly middle class” people with jobs, insurance and college degrees, get ready. You will.

Generally, what happens first, is that you go to a doctor. Your financial advisor and the health insurance industry strongly discourages this step. After co-pays, deductibles, tests, more co-pays, referrals, uncovered expenses, out-of-network anonymous radiologists and labs, and more co-pays, you find out that you are sick and need treatment for something. Researchers estimate that the likelihood you will at some time see a doctor and find you are sick is 99.95%.

After a generation or so of cruelly strategic lobbying by the extremely profitable health insurance industry, your health care system is set up as a war of attrition. By severely limiting physician reimbursements for a patient visit, you are lucky to see a doctor for more than a few minutes. You are, however, likely to wait a month or more for the appointment and an hour or more in various waiting rooms.

With expenses for the office, practice insurance, professional staff and paperwork specialists, your doctor simply cannot afford to see you, test you and treat you in a single visit for $53.50. Your insurance company prefers a system requiring the scheduling expensive tests for diagnosis and subsequent treatment appointments on the theory that you will either get better on your own, run out of money for the deductibles, co-pays and non-covered expenses, or just die.

The only exception to the rule, is gun shot wounds. Our system works really well if you are bleeding in the waiting room.

Once you get in the system, it can easily take years to find out what is wrong and treat you. During that time, you’ll miss a lot of work. Even while at work, you’ll feel like miserable, your mind will be elsewhere and you will wish you were. Eventually, your employer will announce a “strategic restructuring” and you will be out of job. You will be able to keep that lousy great insurance at a much higher cost for a few months before you lose it. Then you’ll have a preexisting condition. Just try and find another job while you are sick and have a public record of a pre-existing condition – no company will ever hire you with benefits again. Next, your credit goes to hell. The credit card companies raise your rates to 30% or so, plus whatever fees they wish especially if they have been spying on your purchases and notice you no longer buy luxury, only meds. Your spouse will lose work time taking care of you and will risk your fate. You will lose your home and declare bankruptcy. This is what happens in America.

“Our findings are frightening. Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy,” lead author Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School, said in a news release from the Physicians for a National Health Program.

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when a prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain,” Himmelstein said.

When your Congressperson speaks on CNN or Fox about your right to choose private health insurance coverage, keep in mind that what they are really saying is: Keep those campaign contributions coming and I’ll sell the chumps I represent on the idea that they already have truly great coverage as long as they are healthy. Who cares what happens went they eventually get sick? They’ll be broke, powerless and dead soon enough.

Related:

The illustration is a sketch by Ilana Kohn from IlanaKohn.blogspot.com

Turning an Opportunity into a Problem

mccarthy_complexshitThe storm must have seemed perfect. An issue that had matured since Nixon first introduced it in 1974. An overwhelming Democratic majority in the house. An almost filibuster-proof Democratic majority in the Senate. A Democrat in the White House with 60%+ approval ratings. And polls showing an overwhelming majority of the American people, Republicans and Democrat alike, in favor. Decades of horrific cost increases. A terrible economy. New pressures on business to be globally competitive. A new “transparency” sure to limit the influence of lobbyists. The health insurance industry must have been preparing for the worst. Not a chance.

The health insurance industry wants to turn their problem into an opportunity by turning our opportunity into a problem. The recipe is all too simple.

▪ Provide a dash of spin to the party of no that re-defines “universal healthcare” into a requirement for all Americans to buy private health insurance.
▪ Add equal amounts of cost-fear to business and decreased-benefits-fear to the wealthy, pensioners and the unions.
▪ Mix in gracious amounts of campaign money to incumbents.
▪ Chop up some populist talking heads on cable news and discard.
▪ Mix finely grated experts with talk radio.
▪ Let the mixture sit in a dark, smoke-filled room until the odor rises and forces opponents to run for cover holding their noses.
▪ Season to taste with government subsidies to states to provide their legislature’s version of coverage for their uninsured and the uninsurable.
▪ Heat and serve.
▪ Creates servings for some (the biggest portions to shareholders of the health insurance industry), but far from all. Does, however, ensure that the health insurance industry will live a long, happy and profitable life, safe from single payer universal healthcare for Americans, unlike like the short, miserable, and destitute lives of those who will never be able to afford it.

More reading on the issues involved from Wikipedia (where you can also view supporting links and citations):

The following is a listing of universal health care pros and cons as argued by supporters and opponents.

Common arguments forwarded by supporters of universal health care systems include:

▪ Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.

▪ Health care is a basic human right or entitlement.

▪ Ensuring the health of all citizens benefits a nation economically.

▪ About 59% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies – a universal health care system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.

▪ A single payer system could save $286 billion a year in overhead and paperwork. Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending.

▪ Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal health care system over the current U.S. system.

▪ Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.

▪ Wastefulness and inefficiency in the delivery of health care would be reduced.

▪ America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times, according to the Commonwealth Fund.

▪ A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.

▪ Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)

▪ The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.

▪ A 2008 opinion poll of 2,000 US doctors found support for a universal health care plan at 59%-32%, which is up from the 49%-40% opinion of physicians in 2002. These numbers include 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons. The reasons given are an inability of doctors to decide patient care and patients who are unable to afford care.

▪ According to an estimate by Dr. Marcia Angell roughly 50% of health care dollars are spent on health care, the rest go to various middlepersons and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on health care.

▪ In countries in Western Europe with public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also two-tier health care.

▪ Universal health care and public doctors would protect the right to privacy between insurance companies and patients.

▪ Public health care system can be used as independent third party in disputes between employer and employee.

▪ Libertarians and conservatives can favor universal health care, because in countries with universal health care, the government spends less tax money per person on health care than the U.S. For example, in France, the government spends $569 less per person on health care than in the United States. This would allow the U.S. to adopt universal health care, while simultaneously cutting government spending and cutting taxes.

Common arguments forwarded by opponents of universal health care systems include:

▪ Health care is not a right. As such, it is not the responsibility of government to provide health care.

▪ Universal health care would result in increased wait times, which could result in unnecessary deaths.

▪ Unequal access and health disparities still exist in universal health care systems.

▪ The performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.

▪ Many problems that universal health insurance is meant to solve are presumed caused by limitations on the free market. As such, free market solutions have greater potential to improve care and coverage.

▪ The widely quoted health care system ranking by the World Health Organization, in which the US system ranked below other countries’ universal health care systems, used biased criteria, giving a false sense of those systems’ superiority.

▪ Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates. As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare’s spending. Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage than Medicare while still controlling costs as well.