The Doctor Is In: How health insurers hinder health care reform

If you haven't seen the new video produced by the political advocacy group, MoveOn.org featuring Will Ferrell, it's worth watching -- and not only because it's hilarious. While the video is a spoof intended to muster support for the ailing "public option," the hyperbole contains a grain of truth.

A group of actors make the case that "As the health care debate heats up, we need to remember who the real victims are: health insurance executives." Asks Ferrell: "Why is Obama trying to reform health care when insurance companies are doing just fine making billions of dollars in profits?"

In fact, the CEOs of the country's 10-largest health insurance companies earned on average $11.9 million each -- a combined total compensation of $118.6 million, according to Health Care for America Now (HCAN), a pro-reform grassroots-lobbying group. Profits at these companies increased 428 percent from 2000 to 2007.

As you might expect, America's Health Insurance Plans (AHIP), the lobbying group for insurance companies, posted a pat response to accusations of corporate greed on their spin-off "educational" website, the Campaign for an American Solution: "Rising health care costs are the result of increased spending on medical care, not health plan profits. For every dollar our nation spends on health care, less than one penny goes towards health plan profits. A sincere cost-containment discussion would focus on the other 99 cents."

While CEO pay and company profit margins can be dismissed as a drop in the bucket of total health-care costs, they still exist along with numerous other unconscionable practices that some of these companies' have been called out on. We've all heard the horror stories about insurers refusing coverage to people with pre-existing conditions, dropping coverage altogether and denying care based on technicalities.

Unreasonable denials for reimbursement and care still frequently occur, but more commonly both patients and physicians offices waste significant amounts of time and effort on minor problems that are usually resolved -- eventually.

For instance, there are five ways for doctors to identify a patient on an insurance claim. But if a single error is made, the insurance carrier denies the claim, often by marking the denial with an indecipherable computer-generated code. That means the patient or the doctor has to get on the phone to figure out and fix the problem. Then, a corrected claim must be sent. This happens so frequently that doctors' offices routinely run monthly billing reports with lists of which companies aren't reimbursing them.

My staff and I have spent hundreds of hours fighting these companies for payments -- and for my patients' rights to get necessary medical care covered. I doubt there are many doctors who haven't done the same. This is not only a hassle but it drives up health care costs.

Is it any wonder that in a recent poll of more than 2,000 physicians published in The New England Journal of Medicine, nearly three-fourths supported some form of a public option in addition to existing private plans? Most doctors support the public option because it would force insurers to adopt fair practices, offer better services and lower their prices. And we're tired of being bullied by insurance companies.

Of course, the point of these controversial practices is to contain costs and maximize profits -- and they seem to work just fine. Why is there such a deference to these companies that have long been part of the problem facing the U.S. health system? Health insurance remains a for-profit industry, and its members have reached into their deep pockets to try to influence lawmakers. The Public Campaign Action Fund, a campaign finance watchdog group, found that insurance and HMO political contributions and lobbying expenses totaled $126 million over the first half of 2009 to influence public policy and elected officials -- spending money at the rate of almost $700,000 a day. The lawmaker who received more of this money than any other? According to The Washington Post, it's Democratic Senator Max Baucus, the architect of the Senate health plan introduced in September.

On the positive side, the health insurance industry has vowed to make changes to some of its more controversial policies -- a huge change from its stance in 1993 when insurers helped derail health care reform. But as far as I'm concerned, it's too little, too late. I'm just waiting to see what new tricks these companies will try to contain costs, especially if 45 million uninsureds get added to their rolls.

Russell Turk, M.D. is an obstetrician and gynecologist in Fairfield County, Conn.


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