The Doctor Is In: How health insurers hinder health care reform
Filed under: Columns, Healthcare
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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Reader Comments (Page 1 of 4)
10-07-2009 @ 4:48PM
Pagie said...
And how much did the insurance companies pay YOU last year Doc Turk ?? Or are you one of those broke CT Dr's ??
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10-07-2009 @ 11:15PM
mickey said...
The doctors should employee illegal aliens to sift through the insurance paperwork. They can pay dirt cheap wages and thus keep health care costs down by having cheap labor do the red tape work. Come on doctors, get with the program. Help us Americans save on health care by giving an illegal alien a job.
10-08-2009 @ 7:05AM
L R said...
Here it is **CEOs of the country's 10-largest health insurance companies earned on average $11.9 million each*** Dr. Turk, M.D is upset about wages.
10-07-2009 @ 6:29PM
AntonioSosa said...
Informed Americans want REAL reform, not the Obamacare scam!
Fortunately, thinking Americans understand that Obamacare (as “public option,” “co-op,” “Baucus bill” or whatever names they use to manipulate us) has NOTHING to do with improving our health care system.
Obamacare is just another scam, another power grab that would further destroy our health care, destroy our economy, steal money from our children and grandchildren, multiply our deficit, and enslave us through lies, manipulation, intimidation and coercion.
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10-08-2009 @ 10:32AM
Randy said...
Yet, you have offered no alternative. Just like a Republican! Complain, complain, and complain some more but offer not solutions while more Americans lose health insurance every day and premiums skyrocket.
10-08-2009 @ 12:27PM
flamingrose40 said...
Ahhh but Randy, they HAVE offered many, many idea, but the Dems wont let them be heard. All you have to do is go to GOP.gov and there are MANY ideas that make sense to those with common sense, which the Dems just dont seem to have on this or any other issue right now. Their answer is spend, spend, spend......bankrupting the middle class americans and taking away our children's futures. Anyway, I digress, some of the proposals the Republicans and Independents are trying hard to get SOMEONE in congress to listen to is TORT reform, and being able to shop across state lines...the govt keeps talking about competition...well there it is yet no one on the left will even discuss it. Contrary to what the dem nutjobs are telling you...the repubs are in agreement with you that we should demand coverage for everyone regardless of previous conditions, we agree with you about portability, we agree with you about so many things...but its better press if there is constant discourse between the parties...makes for more propoganda opportunities. The republicans have put forth these issues just in the last month and ALL of them the DEMS have shot down....why? Simple question...WHY?? And the list of the issues is: #1 Verify citizenship so that the American people dont continue to pay for those that pay nothing in to this country. DEMS VOTED NO!! #2 Repubs want the bill posted online for 3 days before they vote so the American people can read it , if our elected officials wont. DEMS VOTED NO!!! #3 That every elected official must accept going on the same plan they expect the American people to use. DEMS VOTED NO!!! #4 The republicans put forth a bill that says that NO taxpayer money will be used for abortions...DEMS VOTED NO!! The republicans want to meet in the middle but the libs are keeping the fire of dissent smoldering so they can pitch their "Well all they want to do is say no to healthcare" smear....again...these are people we are supposed to trust, when so far, we've LOST 3 million jobs since Obama promised a creation of 4 million jobs, LIE#1, We were told unemployment wouldnt go over 8% if we hurried up and passed the stimulus, LIE #2, We were told during the campaign "We will do whatever is necessary to win this war" LIE#3, We were told "No taxes on anyone making (insert current amount here) LIE#4, We were told this was going to be the most transparent administration ever LIE#5....this is just the ones I remember in the limited space here...could go on...but the gist of it is...THEY HAVE LIED FROM DAY ONE....AND YOU WANT ME TO TRUST THEM WITH MY HEALTHCARE....I THINK NOT!!!!!!
10-08-2009 @ 8:03PM
Nita said...
AMEN!!!!!!!!!!! You got it right on! Glad to see some others thinking like we do. I will never understand how so many smart people are getting fooled so badly!
10-07-2009 @ 7:34PM
Chuck said...
All those profits in the millions? So that's where all that money goes from denying patients that are critically ill payment for their care even though they have duly paid their health insurance premiums.
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10-07-2009 @ 7:46PM
Checkers said...
The insurance companies will pay dearly to prevent change to their gold mine. At a rate of $700,000.00 per day, which senators can't be bought?.
I've been unemployed for almost a year, and can't afford health care insurance. Should I ever need to be in a hospital, the goverment can pay the bill, or take my home that I now owe more on than what it's worth. Either way they all play hell getting money out of me, cause I got none!!
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10-07-2009 @ 8:40PM
bwhit said...
I WONDER HOW MUCH THE OBAMA ADMIN. HAS SPENT TRYING TO PROMOTE A SINGLE PAYER PLAN WHICH IS WHAT THEY WANT ANYWAY. WHY DO THEY WANT TO CHANGE EVERYBODY'S HEALTH INS. TO COVER A FEW MILLION PEOPLE WHO REALLY WANT AND NEED HEALTH INS. ? IT'S BECAUSE THEY WANT TO CONTROL THE WHOLE BALL OF WAX .THEY CANT EVEN RUN A BROTHEL RIGHT AND NOW THEY WANT TO MANAGE 1/6TH OF OUR WHOLE ECONOMY. I THINK NOT. THIS WHOLE THING IS STRICTLY A POWER GRAB AND I AM AGAINST IT.
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10-08-2009 @ 3:59AM
Tom said...
Just keep paying $300-$1800 a month with $5000, deductable
to that insurance company that will find a reason to drop you
if you start to cost them money.
Profit making Health Insurance Companies operate about the
same as Auto Insurance Companies.
10-13-2009 @ 10:44AM
bettty said...
First of all, we do need a health care over haul. Insurance companies have profited in the millions on the backs of people an and some businesses, however my husband works for a company that is actually owned by an health insurance company. You would think with that being said they employees would have good coverage, right?. Think again. This insurance companies want thier employees to pay premiums bi-weekly in the amount of $125.00 to start and the possibility that they may be raised and they also must pick up and pay 40% of the health care cost and prescriptions out of thier own pocket.
so my thoughts are that we not only need a overhaul in health care, we also need to crack down on insurance company who profit and denie care and treatment. If it take a public health care option to do this, I am for it. I also believe that every body should be entiltle to health insurance and would make it less expensive for all in the long run.
10-07-2009 @ 8:54PM
Tom said...
Laid off yet, keep voting republican and you will. Then you will loose your health insurance. You republicans do not care what is good for America, you want to get those fat cats of yours elected.
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10-07-2009 @ 9:17PM
thnkugal said...
These health 'for profit' insurers care not one wit about the customer they profess to 'insure'. What's worse, this article seems only to address only the dumping of enrollees. It barely touches on the huge mortgage sized premiums they charge just for basic option/catasrophic plans. Or Big Pharma- where's this article addressing THAT elephant in the room. You know, the greedy self serving Merck's and Pfizer's who waste billions of health care dollars advertising (and confusing the lay public) script ONLY pharmacueticals across our television screens daily.
And to think- Obama just wants 'em all to have a seat at the 'reform' table of love fest.....
What a damn waste.
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10-07-2009 @ 9:41PM
underinsured said...
you guys are crazy i pay 700 a month for insurance -- after copays and whatever the insurance company refuses to pay i lose a third of my monthly income because my wife is sick. i'll take a raise in taxes if it is less than my monthly premium so i can afford life instead of giving it all to the health care indusrty
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10-08-2009 @ 2:45PM
Sonja said...
Your comment proves how many of you are only thinking of saving yourself monies, not really about good health care. What goes around, comes around. If any health care reform goes through with any form of "public option" you & your family most likely will end up on it, with everyone being put on a waiting list, possibly being denied treatment due to cost to the government, etc. If you have a sick wife, she will not get better or receive good quality health care in the end, as any form of "public option" will be putting people to an earlier death, & all of you will end up wishing you had a private insurance instead of a "public option". The private insurance needs reformed, putting people on any form of a "public option" is not reforming private insurance, the bills are nothing but a scam for the government to have complete control over the American people by taking away their freedom.
10-07-2009 @ 10:40PM
larry grumet said...
In Pennsylvania, our insurance carrier Highmark raised my wife's monthly premium over 10% and mine over 25%. They make annual multimillion dollar profits and have a multibillion dollar surplus. Another carrier, UPMC just applied for a 48% rate hike on one of its groups. The PA Department of Insurance never met a rate hike it did not like.
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10-07-2009 @ 10:40PM
cdr1174 said...
What I find so funny about this entire debate, there is not one word on how much they are really going to save us. All we get is insurance premiums have gone up 113% since 1999, and they are poised to double again over the next ten years. So lets look at the Canadian system. In 1999 the province of Ontario spent 20.6 billion to pay for healthcare. The 2009-10 budget has healthcare expenditures totalling 42.8 billion. This has happened everywhere in Canada. So even in a system which covers everyone their expenses have gone up 104%. And if you look at England, France, and Germany their cost have doubled too. The price of health care is not driven by greedy insurance companies as some would have you believe. So what is driving prices higher and higher. Could it simply be technology? We are saving people who 10 years ago would have died from their illness, which means they will consume even more services in the future. This the beauty of todays medicene. Of course, our system is not perfect, and it can use some overhauling, so why not simply identify areas that need improvement and start there, instead of trying to ram down the throat comphresive reform which does nothing and can not do anything to control cost. What really at stake is a single political party's domination of government. It does not give one rat's ass about cost(evident of massive deficits) it just wants its power, and that is why this is dangerous issue.
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10-08-2009 @ 8:01AM
billdaviau said...
I read your comment about health care costs also doubling in Canada and the UK.
The statement is true but their costs have doubled against a smaller begining base cost. The UK and Canada spend about 60% as much as the U.S. on a per person basis, have longer life expectancy, lower infant mortality.
10-07-2009 @ 11:14PM
Ralph said...
No matter what the bloated windbags say on
Talk Hate Radio There simply is no excuse why
in 21st century America, The richest society that has EVER
existed in the history of civilization, WE DON'T PROVIDE
HEALTH CARE TO ALL CITIZENS.
The insurance companies spend 127,000,000 to influence
the senate and house SHOULD YOU BE SURPRISED???
How on earth can a health care exec make 11,000,000.00
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These bloodsuckers should be drawn and quartered
I get a kick out of the hate radio blowhards who make
100,000.00 a day talk about how a family of four with a yearly income of 75,000.00 should be able to pay for health insurance. C--KS--ker Blood Suckers
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