Monday, November 29, 2010

How Many Times Do We Need to Learn This Lesson?

This is, or was, Alisa Wilson. She could have been saved. She wasn't.

Here's the thing about health insurance companies: they're in the business of making money. Full stop. Finis. Done. That's it.

Health insurance companies are not in the business of keeping people healthy or saving lives or anything else other than making money. They take your money in the form of premiums and in order to keep that money, they have to pay as few claims as possible. By "claims", I mean "procedures or medicines that keep people healthy or alive."

That is the goal of a health insurance company, to pay for as few medicines or procedures that keep people healthy and/or alive as possible. From the perspective of profit, an organ transplant is a cost, a waste of money, less profits. Therefore, an organ transplant is, like all other "claims", something to be avoided at all costs. Including human life.

That's why tragedies like this happen:

It was this practice of frivolous denials that ended up costing Jacksonville, Florida woman Alisa Wilson her life. For months, Wilson, her family, and the surrounding community had been pleading with her HMO to approve coverage for a liver transplant. Although Wilson was enrolled in the state’s Medicaid program, she was not guaranteed care because she was “forced to join a private plan as part of a Gov. Jeb Bush-era experimental overhaul of the program,” meaning she had to deal with a private, for-profit insurance company to get her care, not a government agency accountable to the public.

Alisa Wilson died because allowing her to die maximized profits. She died for money. Morally, I really can't see the difference between what happened to Alisa Wilson and a person who kills their spouse for the insurance money. Either way, a person died so somebody else could have more money.

Death panels, indeed.

12 comments:

  1. I'm pretty sure health insurers only pay for cancer screenings in order to find out whose coverage they should drop.

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  2. Y'know, I think it would be wonderful if the right people actually learned the lesson at all...

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  3. I've said this before, but... I'd far rather get my death panels from the government than private industry.

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  4. "I've said this before, but... I'd far rather get my death panels from the government than private industry. "

    I'd rather exactly the opposite. At least you have some recourse when dealing with health industry bureaucrats. You can switch to a different set of private bureaucrats. With government bureaucrats you have no choice at all. My wife is fully disabled and has had to deal with both private and government insurance people on a regular basis (she's now on Medicare.) They're both bad, but the government is worse: less choice, less flexibility, and more arbitrary rulings.

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  5. "At least you have some recourse when dealing with health industry bureaucrats. You can switch to a different set of private bureaucrats."

    Yes, but the 'healthy competition' logic presumes that the other private corporations profiting from withholding health-care have a reason to be better than their competitors.

    With smaller, more transparent business ventures, competition works well as a driving force. Up your quality or lower your prices, or customers will go to those who do: in a healthy, vibrant, ever-changing industry this philosophy works well.

    Not so when you're dealing with a small number of mega-corporations (as in the insurance industry) or when the "product" being sold is nebulous and vague (as in the insurance industry) or when demand for the product is a solid, consistant base that never changes or fluctuates (as in... you get the idea).

    Corporations of that size are heavy and slow to adapt or change, and they reach a point of stagnation: each company accepts their slice of the pie. They are large enough to afford to piss off a percentage of their customer base: the influx of pissed off customers coming from their competitors doing the same thing balances it for them (there's where the consistant demand-base comes in). They don't have to worry about their large competitors, because they're doing the same thing, and they're capable of crushing smaller, better competitors via advertising and buying them out.

    Add to this the fact that "insurance" is not a product: it's barely even a service. It's a bet: they bet that you won't get sick (by their definition of sick) or hurt (by their definition of hurt), and they'll have to pay up if you do. Thus, "quality of service" is practically impossible to gauge unless you're in serious trouble, which isn't true for the majority of their customers. Which means, in turn, that there is no incentive for the corporation to provide any. The only thing you can go by is the price of the premiums.

    So if the choise is between a number of monolithic beaurocratic faceless messes all designed to take my money away from me, with providing health care as a potential side effect, or a single monolithic beaurocratic faceless mess designed to provide health care when I need it, which is paid for by my taxes, I'll take the latter.

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  6. The scamming started with the very first life insurance policy ever written. It was a bet that William Gybbons would live one more year. He didn't quite make it, and the insurers claimed that “a year” meant according to the lunar calendar, which is a week or so shorter, so they didn't have to pay. The court called bullshit, but they've gotten lots more creative since then .

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  7. "Yes, but the 'healthy competition' logic presumes that the other private corporations profiting from withholding health-care have a reason to be better than their competitors."

    I don't disagree with you about the state of the health care insurance industry. But I would argue that it is that way precisely because of excessive government involvement. -- but that's a whole other issue.

    "So if the choise is between a number of monolithic beaurocratic faceless messes all designed to take my money away from me, with providing health care as a potential side effect, or a single monolithic beaurocratic faceless mess designed to provide health care when I need it, which is paid for by my taxes, I'll take the latter. "

    Government healthcare bureaucrats are doing exactly the same thing as private ones. They are looking to minimize costs and manage risk. From my experience the choices offered by government healthcare are worse than those from private industry. And for those with actual good plans, private industry insurance is far superior. I know this doesn't apply to everyone, but a significant portion of the population does have the ability to switch jobs and seek out better coverage and service. With the government you have to take what you get period. And chances are that government management is going to be less efficient and more costly -- because that's just the nature of government.

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  8. I don't even understand how this could happen.

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  9. This is what happens in fascist/socialist countries.

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  10. " And chances are that government management is going to be less efficient and more costly -- because that's just the nature of government."

    Really? Because in my experience, private enterprise is frequently less efficient and more costly - and that's even in individual businesses, so I'm ignoring the aggregate inefficiency of forcing medical professionals to navigate multiple byzantine, draconian systems in order to eventually receive some sort of payment for their services. On top of that, while the government on whe whole is certainly interested in keeping costs down, individual government employees generally have far less incentive to screw me: they get paid the same either way. Unlike the fellow at the bank, whose paycheck depends on him making a real effort not to cancel my credit card when I tell him to.

    Granted, I don't have any solid data to back up those impressions - but I've worked in both private industry and municipal government, and I'm really not impressed with the supposed "greater efficiency" of private enterprise.

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  11. i gotta side with Michael on this one - i've had both gov't insurance {Champus, military insurance that is, until i was 19; Medicaid now...] and MANY different "private" insurances.


    PRIVATE insurance is what denied me MUCH needed surgeries, TWICE - then paid out the ass for emergency surgery, instead. it was also private insurance that refused to cover labs after surgery, so when i got MRSA, *no one* could prove it for WEEKS - because the labs were "expensive and unnecessary" when the patient is "young and healthy" - nevermind that I'M NOT HEALTHY...
    it was ALSO private insurance that had CAPS on every-fucking-thing - and considering the pool i was in [college students...] they were ASSININE caps - my meds were paid 4 months of the year. the other 8? several thousand dollars [which is BEYOND stupid, because the insurance pays a LOT less for the meds than i do!]


    gov't insurance? hasn't done any of that to me. not even when i spent most of my 3rd grade year in the hospital...

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