obama: we are held hostage by insurance companies that deny coverage

Does the Government do anything that is cost effective???? Um, no. If they would like to have money to cover the Health Care costs of US Citizensthey could start with pay cuts to the do nothing congress. They are the absolute biggest source of waste there is. Oh, and congressional pay raises? I don’t think they should get the vote on that. They can add it to the ballots every couple of years so we can vote on it: Do you think Congress deserves a raise, yes or no? Some years they should even give us the option of a pay cut. While we’re at it, we can stop some of their unnecessary Health Care coverage. I mean seriously! Have we paid for Pelosi’s botox and Biden’s hair plugs?

denying a claim and dropping coverage are distinct. if your insurer drops you (which btw Medicare cannot do for qualifying individuals, by law) then you lack all coverage for anything whatsoever; you can’t even make claims in the first place, if you have no coverage. so you’re comparing apples and oranges here.

granted, there are significant problems with how Medicare is administered (chronic overpayment primary among them). you done a nice job, and clearly a lot of hard work, showing a lot of that here.

denying a claim and dropping coverage are distinct. if your insurer drops you (which Medicare cannot do for qualifying individuals, by law) then you lack all coverage for anything whatsoever; you can’t even make claims in the first place. so you’re comparing apples and oranges here.

granted, there are significant problems with how Medicare is administered (chronic overpayment primary among them). you done a nice job, and clearly a lot of hard work, showing a lot of that here.

Outstanding work AGI. This reveals the real truth about Gov’t Payors. There is only one thing, not all reimbursement for providers is over U & C, in many cases, the Medicare reimbursement rates are below cost, leaving providers underwater and not willing to accept Medicare patients. This limits access to care (aka rationing)for patients. I feel certain, you would find similar results with the Medicaids, but it would take an enormous amount of work to gather the data.

Agreed, there is a distinction between denying claims and dropping coverage. However, how do you gather data on dropped coverage? I’m going to go out on a limb though and say the stats on Insurance Co’s just “dropping” coverage for no reason and winning any appeals on that are pretty small relative to the number who remain insured. There are many avenues for a member to pursue should an insurance company “drop” you without cause. They include the State Insurance Commissioner. There are also several Patient Advocate Groups that provide legal and financial assistance to litigate your case, if you don’t have an employer group to support you. In addition, insurance companies are answerable to their clients (employer groups), they can take their business elsewhere if the insurance company is not paying employee claims, you may not even need to go the Insurance Commissioner.

I can’t speak to the existence of any general database, but there are a lot of isolated data points that indicate a pretty clear (and pretty big) pattern. One example from House hearings this summer:

WellPoint’s Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

http://articles.latimes.com/2009/jun/17/business/fi-rescind17

The problem with health care in America resides in one place: Insurance companies. We don’t need them. They SHOULD be put out of business.

We need doctors, hospitals, treatment, and pharma. We do not need insurance.

You guys are decidedly right wing when it comes to the healthcare debate.

Medicare is NOT worse than private crooked insurance companies. Stop that nonsense.

Rather than measuring percentage of denied claims, the better measure is the cost of the denied claims. And you know it.

Who pays the doctors? Direct fee-for-service doesn’t really work; I don’t know if you have $200,000 laying around for cancer treatment, but I sure don’t, and most people don’t either. I have to assume you’re advocating single payer, then, in which case I say: yep, me too.

sorry about the double-post; spam thing caught it, i guess, so i re-posted. please feel free to knock one off.

The data demonstrates that Medicare denies a higher percentage of claims, so you could extrapolate from that a higher dollar amount of claims are denied from Medicare than the largest private payors put together.

Decidedly right wing, huh? Don’t resort to name calling.

Does it really matter in the end what the cost of a per average of what was denied??

T, at the recieving of 475,566 claims was a person.

If one is for a “public option” then why are you not upset at the mere fact a person was denied?
Especially if the doctor thought it best???

Who gets to decide? The doctor and Patient or the dollar amount of all the claims denied?

The amount runs into the trillions. Who cares if it’s one or two? The human at the bottom of the food chain was served his plate of healthcare ala cart.
What on earth is right or left about a persons well being?
You want the IRS auditing your colon? Not me.

Numbers are not right wing or left wing.

Flying blind is. I am still waiting to hear more details behind a bill that will be voted on and how those details compare to the options currently available.

And, BTW “You guys” is not an inviting way to open an address to folks you do not know. There are some dolls here, too and we all know that the nonsense is that you don’t know what we don’t know and we know it because we don’t know Jack Squat about you, T.

Please have a good evening of pre-existing wellness.

All those pieces of information being thrown about may all be true, no matter who is saying it which is why I say:

WHY THE RUSH? WHY NO PUBLIC HEARING? WHY NO FRAUD INVESTIGATIONS so that it can be accurately determined how much savings can be gained from the elimination of fraud and waste which can be used to fund reform?

Then when it is obvious that the only way to go is a public option, then go for it courageously. Have faith in the American people’s ability to decide to support a good thing.

It’s all the behind the scenes negotiations; secret deals with pharmaceutical companies; AND refusal to publish bills online.

DEAL WITH THE PEOPLE HONESTLY!!! ALL OF YOU IN CONGRESS AND THE EXECUTIVE BRANCH. The whole process is sickening. It is the kind of sickness for which there is no insurance coverage or immediate cure.

A need for a big rush to bailout insurance companies but the troops in Afghanistan can sit and wait.

Thanks, AHS.

You don’t need to be denied or dropped by the Health Insurance Companies to lose coverage. My son home from college suddenly had a seizure – something no one in the family had a history of or experience with.

He was taken to emergency who assigned him to a neurologist who guessed on medication. That wasn’t it and our son was in emergency again with a second seizure. (Luckily UCLA knew the right medication).

Aetna doubled his monthly insurance premium. The next month they doubled the double, going up exponentially each month so we had no choice but to leave.
Did they deny coverage or throw us out? No. But the effect was the same. And that doesn’t show up on statistics anywhere.

Medicare couldn’t have done that.

I read a very convincing article which made the case that Medicare underpayments are a non-insignificant reason for the increase in prices for non-Medicare prices. Basically, if it costs $5 to perform a procedure and Medicare only reimburses $2.50, they will charge other insurers at least $7.50 to break even overall. What happens if Medicare / Government health care covers in increasingly large percentage of people?

Unfortunately, I didn’t bookmark the article. One of these days I will find it again…

Medicare doesn’t cover checkups or routine preventative visits. Why? Beats me.
Ask Congress because they are also the ones responsible for Medicare also not being able to get competitive bids or negotiate with the drug companies.
And BTW – the Medicare paperwork is contracted out to a private company.

I think there are many, many people who have similar stories, Ellen. My son was a sophmore in college when he suffered a severe head injury [TBI]. We had/have what some refer to as a “cadillac” insurance policy [paying through the nose, I might add].

I can’t tell you how many telephone calls and appeals I had to make to get the insurance company to pay for the coverage that we had paid premiums on for years and years. And if the critical patient doesn’t have an advocate to fight for his/her rights and coverage?

You’re up shit’s creek.

So, I have no sympathy for the insurance companies that have realized something in the neighborhood of a 350% increase in profits over the last 10 years.

Unfortunately, I have little confidence in the present Administration to make it any better.

Both of your stories are all too common.

One thing to consider in those numbers is that Medicare does not drop patients. Medicare’s percentage of denied claims may be higher, but then, they haven’t cherry-picked the healthiest patients.

If your patient load is generally well, and you deny 3% of claims, that is not comparable to a plan that takes all comers and denies 6%. Given the patient base that medicare covers, their denial rate is actually less onerous than the private insurers. Medicare has really, really sick patients, and most of them are getting what they need.

I am a doc and can say that I have much more trouble getting services for private insurance patients covered in general than I do for state insurance.

Maybe numbers make that clearer.

Say medicare has 100 patients and 80 of them are really sick. 6 get denied some services or payments, but 74 of the really sick folks get what they need. 74 out of 80 means 92 percent of the sick got cared for.

A private insurance company drops as many of their sick patients as they can, and won’t take people with pre-existing conditions. Of their 100 patients, only 10 are really sick. Of those, 3 are denied services, meaning that only 7, or 70% of their sick patients got cared for.

Do you have any data on charges denied by Medicare that were resubmitted and subsequently paid?

My mother (and late father) almost never had anything denied by medicare. On the occasions it did happen it was usually a coding error, a resubmission was made and the claim paid.

My mother got a letter in the mail from Medicare telling her of the preventative things she was eligible for and had not used. I think they were like breast exam, Pap smear and a couple of other things, so I guess they are covered somehow.

Oh! Here ya go:

http://www.medicare.gov/Health/Overview.asp

Wow. This is a great post!

While media like CNN go out of their way to fact check a comedy skit on SNL, they don’t bother fact checking the Liar-In Chief Obama.

In that speech he gave to both Congress Obama outright fabricated two stories about people being denied health coverage.

Every speech he gives on healthcare is packed with lies and deception.

Never ever forget that most insurance companies are ran by people from the medical field. My questions to both Medicare, and Insurance companies. What have you done that has worked? Why did it work? Do you continue to do those processes that do work? If not, why, not?
I believe both sides of the fence have gotten away with much simply because they know the “average” person is caught up in the difficulty of the medical malady happening to their family, knowing full well in advance they have no intention of upholding the care the hands-on physician and staff are providing. Further in order to accommodate those who abuse the medical system; which is common place and commonly planned on and accepted; people who have plans, government or otherwise are dropped, policy amounts are raised, or coverage is removed, yet the abusers are often “grandfathered” in-this makes no sense at all at first blush. What I think there is in place but not spoken of out loud is a quota system at work in both private and government funded healthcare, rationed by specifics set by either a board or a government entity. Where the meme of health care is based on the moral responsibility of the population to care for the least of us, but we actually do try; it is the systems in place that fail, as each system in being ran in a renegade faction, loosely following the rules on high, but much like ACORN interpreting at a local level, which no doubt has more political input and influence than we may already know. Therefore, the local bottom line becomes the focus, not patient care, and the moral responsibility has been mandated at that level, thus deciding who deserves what care and when is based on what will look good on paper. It is done in college awards, it is done in employment statistics, it is done everywhere. We need a centralized means in an independent fashion to examine who abuses the system, where the real costs are going; what had worked what hasn’t without trying to serve categorized specifics to plug in numbers to promote further policy based on the political arm of any lobbyist, whether AARP, Big Pharm, or even the NAACP as an example. You cannot base coverage on cherry picked self promoting entities, it has to be considered for the group as a whole, first.

In fact, the biggest denier of claims is the current US Government plan aka Medicare.

Lost post, e-mail sent.

Exactly Hokma, Check this out:

http://www.gazettetimes.com/news/local/article_f6b1c316-b20e-11de-84e9-001cc4c03286.html

President Barack Obama assembled more than 100 doctors outside the White House on Monday morning to enlist the medical profession’s backing for his proposed health care reforms.
Dr. Paul Hochfeld crashed the Rose Garden party in hopes of bending the president’s ear. The Corvallis emergency room physician has spent most of the past month on a national tour with an Oregon group called the Mad As Hell Doctors to promote single-payer medical coverage.
“It wasn’t really a meeting,” Hochfeld said in a phone interview afterward. “It was a photo op for the president to show he had the support of all those physicians.”

stop with the *you guys are right wing* crap. I have written many articles on health care, and actually like a universal system. What I don’t like is when politicians don’t tell you the truth, and lie about things. The Democrats are fighting to post the bills for 72 hours, and the Right is pushing to get them posted. Why are the Dems FIGHTING to post the bills, when Obama PROMISED FIVE DAYS of transparency.

If the Administration keeps knocking private insurance companies for denying claims, but we find out that Medicare denies MORE claims – people should know that. Especially when they denying there will be rationing…

I am with you! They want public option – go for it. The Dems don’t have any guts. They are lily lizzard liars. And they are actually fighting to post the bills for 72 hours!

that’s why people are fighting this so bad – they know things just don’t add up.

I also think ignoring things like tort reform and opening up states borders are big mistakes. Tort reform would lower malpractice insurance, which would allow docs to have walk in clinics. doctors can’t afford to practice because of malpractice insurance.

uh…did you read my post? the whole thing is about that link.

UGH! How awful Peggy Sue!
I hope all is better.

I agree that we need reform, and like you, I don’t trust the current Dems to take care of it. One of the reasons I supported Hillary was because of her background with health care. I trusted her to reform it. But now, I know what a bunch of lying corrupt crooks the dems are, I don’t trust anything they want to do. The pharma deal, the lies, the non-transparency, the hemming and hawing, the indecision, the lies about the taxes/costs….

I think, personally, that the $200,000 cost of treating cancer is that high because of insurance.

Everything is inflated because they charge insurance companies. Drug costs are outrageous. Machines and technology are all SO expensive. My husband (dentist) can’t believe how much things cost in the states, compared to what he charges here. He is fee for service.

John – Insurance companies make up 17% of the US economy. And employee millions of people. What do we do if we get rid of them?

I like universal coverage here, but there are a lot of things to consider to get there. but I agree that dropping people who have been paying for insurance is wrong wrong wrong.

i am making lunch so this is rushed, but i was just thinking more about this. The thing that ticks me off, so many believed Obama’s hype, health care was such a HUGE part of the campaign, and I was so mad that people voted for him, when I knew he didn’t give a rats ass about health care. (not like Hillary).

And now you can tell. He passes the buck, do you think people really voted for Pelosi to write health care? Now there is a perfect storm of Dems in control, and they are too chicken sh*t to just go for it. They make secret deals with drug companies, waffle on public option, etc. They are in the perfect place to risk it all, put their re-elections on the line, and go for what they have *always wanted*. But they don’t. You would think if they truly wanted great reform, they would go universal coverage, and risk re-election.

Shouldn’t that be worth it? After all you hear from them how much they *care* blah blah…it should be bigger then another term. Instead they lie about all this crap like coverage for illegals, abortion, etc. They won’t touch tort reform WHY? They won’t open up the state borders, why?

Why don’t they just go for it, massive reform, admit there will be raised taxes, instead of lying and denying it, and who cares what the Repubs say. They control it all now, they can friggin do it.

They don’t, IMHO, because Obama doesn’t care, and is inexperienced, and the rest of them are running around kowtowing to their donors.

They could pass single payer, or universal coverage, whatever you want to call it tomorrow, if they wanted to. They could lay all their cards on the table, admit to the costs, and get it done. The thing about what they are proposing is people will still be paying for private insurance, plus they will end up paying trillions in taxes for coverage for ~30M… It just doesn’t make sense. Taxes and health care for all, or just open up the insurance borders and tort reform, and perhaps catastrophic insurance mandates. But this wishy washy half ass attempt is just not cutting it.

Lunch is ready – more later.

Obama is playing politics with our young men and women. He says that because sick people are dying, we must pass a health care bill NOW. But the young men and women of our military are dying NOW, and he says he must wait before making a decision to send more troops into Afghanistan. He does not want to make a decision because if he were to send more troops his popularity would fall even further.

yeah how insane is that?!

they’re so insulted that SNL would dare to parody him they are literally beside themselves. whatever happened to it all being good fun? are we not allowed to joke about the president anymore?

here’s a link to the CNN clip:

http://www.youtube.com/watch?v=O7x-dzXVcOw&feature=player_embedded

OK, more of my rant…

Both systems have their problems – horror and success stories in both. The difference is that if we are going to have a trillion dollar system, that is paid for in taxes, then we should have a system for everyone, that everyone pays into. Not a system that covers a small % of the population that other people pay for. And they need to quit fibbing about what is in the bill, and what it covers.

Also, the system in Italy, which is universal coverage, but we still have private doctors that you can visit, and pay as you go. I visited a private doctor for 150 euro, and was sent to the hospital for tests (that costs like 20 euro). So, people with money can still get private appointments and be seen timely. But, yes, there can be long waits for non-emergency operations. But my BIL had a massive tumor and was operated on within a week. (I’ve written about all this before…I am just in the mood to rant. haha)

I think a lot of people want reform, but don’t trust the administration to execute it, and that is because people don’t have trust in Obama and Pelosi et al. It’s hard to trust them with this massive overhaul when they can’t even decide what the hell they want, and go for it. I feel like they are all too worried playing politics, and worried about their donors, not their constituents so much, and don’t have the courage to just go for it. And it all comes from the top – Obama is ill equipped to stand firm, and put forth a plan that he wants, and get the Dems support. He instead is passing the buck, flip flopping, lying, covering up, not being transparent, and flying off to go on dates and push for the Olympics.

And on top of all that, we are in massive debt. So, they are trying to put us in further debt, with a plan that sucks, and one that even won’t cover ALL people.

I think they should either get some guts, and go for full on reform – universal coverage, and be honest about the tax increases, explain to people what that means annually/monthly, and full disclosure on how it will work, and also set up the private doctors option like Italy.

OR they need to back off, do the small things now – like tort reform/malpractice insurance, opening up the insurance borders, mandate catastrophic insurance, and perhaps create a law that insurance companies can’t drop people. They could also extend Medicare to include 60-64 year olds, increase the income line for medicaid…. And figure out what to do with illegal immigrants coverage.

All during the primary I knew that Obama wasn’t the right choice to get this done.

I don’t think two wrongs make a right. Anyone who does not believe insurance companies are trading in death for profit simply has not looked at all the data. There will be some problems with any program, of course. In the U. S. a problem with all government programs is that the federal government whether Republican or Democrat is generally corrupt and unconcerned with the well being of the people who are supposed to be the government.

right now, we have the productive responsible people in this country working hard to support a lot of lazy, even criminal people–not forgetting that some people really do need help due to injuries or tragedies–and this needs to change. In other first world countries national healthcare exists along with other public programs that use tax dollars to provide benefits and important amenities to the general populations. I believe these programs work in places like Norway and France, etc. because they are closely monitored. There is accountability. It’s a shame that Americans are so afraid of the “government” providing necessity of life programs when we all are the government.

In the United States the only time politicians look at improving the quality of life for the general population is when they think they’ll get votes out of it.

This country is run by a corporate oligarchy. Until that changes, it doesn’t matter what system we have for anything else. It’s going to be tainted and corrupt. Insurance companies are part of that corporate elite. They are in business to make money and they do very evil things to guarantee each years’ profits will be greater than the year before.

If Americans don’t take on these evil powers, we will continue to live in a country that is a fake democracy run by facist corporate interests.

That’s the pity of Obama being in the WH. He’s really more loyal to corporate interests than to the people of this country.

Peggy Sue: couldn’t agree with you more. Obama lost the trust of the American people in the campaigns when he purposely divided people and did so many blatantly corrupt strategies to get in the WH. Now, he can’t get anything passed because people don’t trust him.

I read an article this morning that the HH Sec is insisting all Americans get the swine flu shot and swore that it’s safe. My first thought was: I don’t believe her. She’s one of Obama’s minions.

Well, at least now you can change Insurance providers.
If there’s only one provider (Government), and they refuse coverage for a given condition, then what?

sara: Also, Obama went into office determined to appease the Republicans and that’s a problem too. I never thought he sounded like a Democrat. The other problem with him is he’s just too inexperienced and ignorant of all the major issues. yes, some people are not going to like a more efficient healthcare system. There are ways to get around the cost and give quality service, but Obama is afraid his U of Chicago buddies won’t like him.

felizart: hear, hear.

I wonder if universal healthcare and other public programs work well in Europe because those countries are smaller and more homogenous and there’s more oversight? Of course, Canada seems to work efficiently as well. They probably don’t have the huge population we have and millions coming in illegally.

tf: I could not believe a headline yesterday was a dissection of SNL’s claims that Obama has done nothing. The propaganda is already rolled out!

Then I saw a headline that a poll showed Obama is gaining popularity. Axelrod doesn’t waste any time getting Pravda in gear.

Now today we see a headline that the public is really on board with Obie’s healthcare reforms. More propaganda.

I cannot stand this administration.

from what i have read, the problem is he said he wanted to work on a bipartisan solution, but he shut out all the republicans. i wrote a post a bit ago about a bunch of repubs who have sent letters to obama, accepting his * invitation* to come to the WH and go over the bills line by line. He has ignored their letters. Also, he keeps saying they don’t have any plans, but there are over 35 proposals put forward by the Repubs. He is just full of bull on everything he says…

If the government is so keen to manage health care, why haven’t they perfected their skills over the decades?
Medicare seniors are contracted out to insurance companies. That is a fact! Some supplementals cost $0 to the patient. That’s right, insurance companies are paid by the government to administer the coverage of these people. Why doesn’t the government handle it?
Gov. Bredesen of my state, a former HMO owner, is estimating the reform costs to range from $571 million to $1.2 billion for our state alone.
We are passing from deficits to insanity, so we had better hope for good mental institutions!

Paddy: in universal healthcare systems run by governments they CANNOT refuse treatment. Why would they? They don’t have to worry that a certain procedure will be so costly it will prevent annual profits from rising.

And you are just flat out wrong. Usually, if people have been denied coverage by one insurer, they can no longer get private coverage from any insurance company–pre-existing conditions. And someone should do research on these new insurance companies advertising on tv and other media promising the moon for little money. Most of them are out and out scams.

Two good videos:

http://tinyurl.com/yb5ku3a

http://tinyurl.com/yeoxacj

Not true – treatments for expensive illnesses are denied in universal programs.

http://news.bbc.co.uk/2/hi/uk_news/england/derbyshire/7118607.stm

http://www.blrag.com/blog/2009/9/2/terminally-ill-patients-denied-treatment-in-england.html

http://www.medicalnewstoday.com/articles/162013.php

http://www.timesonline.co.uk/tol/news/uk/health/article4499847.ece

http://www.mirror.co.uk/life-style/real-life/2009/09/09/baby-denied-medical-treatment-and-handed-back-to-his-mother-to-die-115875-21658263/

http://www.dailymail.co.uk/health/article-1016568/Thousands-arthritis-patients-denied-drug-treatment-ruled-expensive.html

I just did a quick google… i could go on and on.

Govt. run programs are paid for with taxes. They have a pool of taxes in which to pay for care. They either have to deny treatments, or raise taxes, or go into deeper debt…

Hi Sassy,

My state too!

T: Find the data to support your argument and post it. Otherwise it’s just one opinion among millions.

But Peggy Sue — since you know from first-hand experience what an ongoing rolling tragedy our present health care system consists of, how can you so blithely dismiss Obama and the progessive Democrats in Congress who are trying to institute major reforms geared at protecting American citizens? A public option would have meant that a strong, reliable insurance plan would have been available to your son the instant he needed it. And to all Americans. And since a public option is universally considered likely to lower overall costs, it would be good, not bad, for America’s longterm budget.

We all need to be supporting Obama and the Congressional progressive leaders. They are now all that stands between America and bankruptcy.

I agree completely. We could do the little things and help many people. It will be impossible to take on real reform with an invertibrate president. So many of us (pre Obama nomination) had real hope for change if the Dems could take control of the government. When the captain of the ship is not a leader it leaves the boat to founder.

Correct. We need a single-payer government-run, non-profit insurance system. Unfortunately, there is no chance we’ll get this, at least not this year. The progressive Democratic public option proposal is the best we can hope for. We can only hope that in the days to come, Obama will choose to give a finger to the Republicans and support it.

Wrong wrong wrong. We’re going to do major reform, and we’re going to do it now, and Obama is going to lead that charge. AGI below is deeply wrong as well — there is no serious Republican proposal on the table that does anything but tinker at the edges. The Republicans are completely, lock-stock-and-barrel in the pocket of the insurance industry, and to believe or say anything different is to be carrying water for among the most evil and dangerous lobbyists in Washington DC. They will destroy this country if given the chance.

We desperately need major reform, immediately. And the Republicans have made quite clear that they will not play any role whatsoever in getting it. I will be shocked if any health care reform proposal coming out of Congress receives more than a tiny handful of Republican votes, no matter what is in it. Their only goal is to damage Obama.

AGI, I’ve read your stuff, you seem intelligent and knowledgeable. Surely you cannot believe in your heart that the Republicans have ever had any interest in working on policy issues in good faith with Barack Obama. I don’t believe for a second you could pass a lie detector test on that question. They want to destroy his presidency, period. You read about politics, so you must know this to be true. Why do you say otherwise?

among all this hype about single payor health care..no one has asked how much it will cost each person (not just the overall cost.) many people are under the assumption it will be free. its NOT. it will cost as much if not more than private insurance. and if you dont sign up you will be fined $1350. if you dont pay the fine it will cost you $25,000 and possibly jail time. are they kidding us???!!! with so many people out of work who cant afford to buy in, how the hell do they think they can pay fines like this? and if you dont then the irs will come after you. if this isnt as scary as shit, then i dont know what is.

Thanks for the note, AGI. My son had a remarkable recovery, due to a wonderful medical team and rehab specialists. He went from a very grim prognosis to regaining a good 90% functionality. That’s about as good as it gets for these injuries.

But it was the worst year of my life and fighting with a bunch of insurance people is the last thing anyone should be doing when faced with catastrophic injury or illness.

And trust me, I don’t take this health care reform battle lightly. But you’re right: when the President turned the bill over to Congress and Pelosi, then made a backroom deal with Big Pharma and the Baucus committee invites K Street to sit in on the writing of that proposal and we know how many of our representatives are in the pockets of the insurance companies, how in the hell is anyone suppose to have confidence that this whole thing wasn’t tainted from get-go?

All this on the backs of the sick, injured, elderly and/or desperate.

It’s disgusting. Btw, had my husband and I had HMO coverage [cheaper by far] at the time of our son’s injury, he would have been approved for 60 hours of therapies, which for a head injury patient is barely getting started. It’s a cruel joke and only underscores the fact that the foremost reason for personal bankruptcy in this country is due to gargantuan medical bills.

I don’t blame the medical community for this. Despite all their whining, the insurance companies get the lion’s share of blame. And rightly so.

they don’t need to pay attention to the republicans. they can create the best and most drastic bill they want, and pass it. But they AREN’T. they are back tracking and coming up with a crap bill that doesn’t even cover ALL americans.

“The Republicans are completely, lock-stock-and-barrel in the pocket of the insurance industry”

Really? Just republicans?

http://www.wahpetondailynews.com/articles/2009/09/16/breaking_news/doc4ab0e220c7c7c114102640.txt

http://www.opensecrets.org/news/2009/10/senate-finance-committee-membe.html

Sara, it is possible that you will be proved right. I certainly hope not. There is evidence on both sides of this equation, which itself constitutes evidence either of Obama’s political genius (if they wind up getting a good bill passed) or his weakness and cowardice (if they don’). I’m a big Obama fan, but if the latter happens I will be on here admitting that I put too much faith into him.

Many NQers, however, reject even the positive progressive bill being discussed as some kind of Communist takeover. That is utter foolishness.

Like you one of the reasons I supported Hillary in the begining WAS healthcare reform, actually I always thought it SHOULD be called insurance reform, We have great hospitals and doctors in this country if you have serious, lifelong illnesses or conditions, they problem IS making sure you can keep your insurance or better yet even be able to get AFFORDABLE insurance IF you do have pre existing conditions. I TRUSTED Hillary to come up with solutions to the problem and not totaly overhaul the entire medical system like Obama and his corrupt friends want to do.
I worked for years with my Dem Congressman, trying to get a bill passed for congenital heart defects and one of the issues we discussed alot was the problems with insurance.
The min I saw those damn Harry and Loiuse ads, that Obama sent out during the primaries, I KNEW whatever he did IF he became POTUS was NOT to benefit the people and he didn’t give a damn about healthcare, just needed it to fool more people into voting for him.

Scout wrote earlier:

One thing to consider in those numbers is that Medicare does not drop patients. Medicare’s percentage of denied claims may be higher, but then, they haven’t cherry-picked the healthiest patients.

I am a doc and can say that I have much more trouble getting services for private insurance patients covered in general than I do for state insurance

Points taken, Scout. But consider this:

Private insurers can’t deduct significant, non-negotiable fees from every wage earner’s paycheck, like the government does for Medicare and Medicaid, even though Medicare doesn’t cover those wage earners until they’re at least 62 years of age, and Medicaid only covers the poor. What will government deduct if it subsidizes tens of millions more people, and how will subsidizing more people effect the reimbursement you enjoy today? If insurers weren’t able to attach riders to new policies for pre-existing medical conditions, there’d be no incentive to even purchase insurance until illness presented.

Private insurance incentivizes (to borrow a term the POTUS likes to use) healthy habits. Abstainers of unhealthful behavior pay less for health insurance. Those who enjoy some unhealthy behavior pay more. As it is now with Medicare and Medicaid, government only discriminates based on age or income and I’m unaware of any incentives in current proposed legislation that will be expanding government subsidy.

My husband and I have HSAs with very high deductibles. Nevertheless, our provider still helps to pay for various test, services, medications, etc. Yet HSAs may become a thing of the past according to some proposed legislation. Why?

There’s a chain of private clinics cropping up (Qliance) that charges reasonable monthly membership fees for primary care. Qliance accepts no private or government insurance, thus passing along substantial cost-saving to the benefit of their patients’ care. We need more innovation of this sort — where’s the incentive for it in current proposed legislation?

State mandates have driven up healthcare costs and spending by requiring increasingly comprehensive insurance coverage. The result is many consumers (often via employers) have to pay for services they really don’t need or want. Why aren’t legislators addressing this problem? Is it fear of bucking their unionized political patrons?

Drugs prices are a big factor when it comes to rising healthcare spending. So, why are WE paying high prices for American prescription drugs in order to subsidize foreign consumers of them? Why isn’t our government proposing something to correct this?

My belief is there’s very little creativity and honest, fair brokering in current proposed healthcare “reform”. A goal of equitably containing spiraling costs and spending seems to be non-existent. Anyone, please, feel free to tell me about aspects of proposed legislation that refute my belief. I’m truly hoping the situation’s not as bad as I think it is.

Maybe the reason that for-profit insurance corporations deny claims is to make their profit. But maybe the reason medicare denies claims is because so many of those claims are fraudulent on their face; and they should be denied.

I think your blog post is brilliant, AGI, so first off, thank you for all your hard work. Your information challenges readers to think, and that is so crucial.

But, there is a difference between Medicare and For-Profit Insurance Corporations, so comparing the “denials” for them is akin to comparing apples and oranges. Medicare does not operate at a profit; and their administrative costs are at or near 3%, compared with 15% or more for For-Profit Insurance Corporations [which still have to make a huge profit over the administrative costs].

But some of the Medicare claims–as I said–are fraudulent on their face. And, those fraudulent medicare claims are increasing at a steady pace, now that the MAFIA has infiltrated the Medicare Scam biz.

http://www.dispatchpolitics.com/live/content/index.html
Bogus billing
Medicare fraud growing violent
Easy money, low risk appeal to career criminals

Wednesday, October 7, 2009 3:10 AM
By Kelli Kennedy

Associated Press

MIAMI — Lured by easier money and shorter prison sentences, Mafia figures and other violent criminals are increasingly moving into Medicare fraud and spilling blood over what was once a white-collar crime.

Across the nation, federal investigators have been threatened, an informant’s body was found riddled with bullets, and a woman was discovered dead in a pharmacy that was under investigation, her throat slit with a piece of broken toilet seat.

For criminals, Medicare schemes offer a greater payoff and carry much shorter prison sentences than offenses such as drug trafficking or robbery.

“We’ve seen more people that used to be involved in (dealing) drugs are switching over to health-care fraud because it’s not as dangerous,” Miami FBI spokeswoman Judy Orihuela said.

Medicare scammers typically make their money by billing Medicare for medical equipment and drugs that patients never receive — and never needed. Some pay homeless people on Los Angeles’ Skid Row for Medicare or Social Security numbers to use on fake billing invoices. Others intimidate elderly victims to use their Medicare numbers, federal authorities say.

His message isn’t about what’s good for America. If he really was all about America, he would have figured out a better way to get out of the hole were in instead of borrowing money from China to fund the bailouts and stim packages.
Then, he wouldn’t have us further beholden to them or enslaved, apparently. Since he has refused to meet w/ the Dalai Lama, one can only presume that is his reasoning.
We are so indebted for more than just money, we cannot afford a re-haul of the health care system at this time.

Did you see this comment I did right below you on preventative stuff from Medicare?

O-M-G. Thanks for telling us about this, mountainaires.

And AGII, I meant to thank you too for yet another awesome article!

The CBO just released:
Congressional budget experts said Wednesday that the sweeping health care overhaul bill awaiting a vote in the Senate Finance Committee will cost $829 billion over the next 10 years.

The preliminary report said the committee’s health care reform package will not add to the national deficit — and will save $81 billion over the next 10 years compared to current federal health care spending.

The CBO predicts that the bill will increase spending by $829 billion — but that figure will be more than offset by the tax increases, fees, penalties and spending cuts also proposed in the legislation.

But the CBO also said the bill would not fully solve the problem of the uninsured.

“The number of nonelderly people who are uninsured would be reduced by about 29 million, leaving about 25 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants)

Does that sound like a good bill? ALL that money and time to cover 29M people, but still leave 25 M uninsured – uncared for, and a drain on the system?

We aren’t going to get good reform, and tough decisions made if these tools are still in the pockets of the health care industry. And as the links show above, they are, especially obama.

A few points.

1. This is a measurement of the current draft of the Baucus bill, which is already notorious for suckage. We won’t know what bill will actually be voted on coming out of the Senate until next week, probably, let alone what bill will emerge from the coming epic bargaining session between representatives of the House, Senate and White House. So don’t make the mistake of assuming that Baucus is anything approaching the final word.

2. Please note also that even this lobbyist-written legislative atrocity is, according to the CBO, DEFICIT NEUTRAL. Stop talking about all the extra money we’re spending. To the contrary: all these different versions of legislation are, in varying degrees, designed to slow the growth of health care spending. The path of bankruptcy is to do nothing, or tinker around the edges, as many NQers advocate.

3. If you’re going to argue from the position of caring most about the uninsured and the federal deficit, you should be advocating as strongly as possible for a robust, national “public option” insurance plan. This is the only proposal that has any prayer of lowering the trajectory of overall health care spending while also covering virtually all the uninsured.

If you agree with these statements, then you are in parallel with the progressive Democrats who who are fighting for just this sort of bill in both the House (where it will be easy to obtain) and the Senate (where it is the epic political battle of a lifetime). Whether a public option succeeds, I believe, will in large part depend on whether Obama is willing to do the right thing. Just don’t like as though this question has already been decided. And please do have the intellectual honesty to acknowledge a) that a public option is essential, and b) if we get one, it will be because Obama was smart and strong and political shrewd and progressive enough to fight for it and make it happen.

Finally, Sara, thank you for writing me an actual response (as opposed to a cavalcade of reflexive insults). I do heartily enjoy getting into a mature dialogue on this fascinating site; it’s the reason I keep coming back, and keep ignoring the meaningless “stupid bot” spew.

Bipartisanship is not just getting one side to do everything you want. From what the Repubs keep saying, he is doing all these things behind closed doors, not reaching across the aisle, and not addressing issues like tort reform and open state borders, etc.

When Repubs were expressing their concerns about the stimulus package, and the massive rice tag, Obama told them “I won”. Is that reaching across the aisle?

http://www.noquarterusa.net/blog/2009/09/19/yepwords-just-words/

As I said above, he doesn’t need them. He is blaming them because he can’t get the support from his own party. He doesn’t need them, but he doesn’t have the votes from the Dems, so it is quite easy to blame the right for his failures.

The Iraq war, which Dems love to blame the Repubs for the financial mess, was supported by 75% of the Senate. Bush had all their support. Obama can’t even get Dems to support true health care reform…

Just for fun:

http://www.youtube.com/watch?v=_y0-_-0EHyE&feature=player_embedded

CHRIS MATTHEWS: “Can you give me a case where Barack Obama has reached across the aisle and cut a deal and gotten something done for the country? One example.”

GOVERNOR PATERSON: “Well, Senator Obama has been there two years and I can’t cite an example right now…”

Good one, that is fun!

Excellent. So you favor a single payer system but believe that Obama is too sold out to corporate interests to support even a public option. It’s possible you will turn out to be right. But can you confirm here that you think that all the other NQ posters who believe Obama is a Communist/Socialist who wants to turn health care over to the government are flat-out wrong, and certainly antithetical to your own thinking?

I agree with you completely, of course, except that I continue to hold out hope (considerable hope) that Obama will wind up pushing through a plan that includes a real public option.

Sigh. You want to assert that in fact the Republicans are reasonable and want to work with Obama on a bipartisan basis? That is so out of the realm of reality I don’t even know where to begin.

Well, actually, yeah, I do. Name one Republican who has agreed to support even one of the six different health care bills that have come out of committee since the summer, all from fully bipartisan committees in which, by law, Republicans had equal representation.

the realm of reality… Kool-aid only goes so far.

Castaneda often referred to this unknown realm as nonordinary reality, which indicated that this realm was indeed a reality, but radically different from the ordinary reality experienced by human beings.

.
sigh

You know the story about forcing people from medicare advantage?{was called a lie} ………well I called them the other day and was informed that after dec. I will NOT have this option anymore . no choice …just that the FEDERAL GOV’T decided they didn’t want it anymore, so here I am. ..Remember how Obama and Gibbs and all those people said that we wouldn’t be dropped, that we could choose. what other lies are turning out to be true, HuH ? they said those were republican lies. So in reality the new health care plan won’t deny us medicare advantage, because it has already been eliminated.

http://www.dailymail.co.uk/news/article-1218927/Plumber-shattered-arm-left-horrifically-bent-shape-operation-cancelled-times.html

hilarious…