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Seems that Sarah Palin isn't the only right-winger out there trying to convince the world that the "death panels" actually exist. Indeed, as Media Matters notes, there's a whole bandwidth of wingnuts out there trying to revive the notion.

One of these is the Troll Who Lives Under the Bridge And Sucks Your Toes, aka Dick Morris, who was on The O'Reilly Factor earlier this week with fill-in host Monica Crowley:

Morris: Look, Monica, it's one thing to load a big bill with pork. That's what the stimulus package was. But to load a health-care bill, where Americans are seriously worried that this is gonna destroy the health care their parents get, that this is gonna lead to government-imposed euthanasia, where they'll say, 'No, you can't have this annual mammogram, because I know it might save your life, but it costs too much.' 'No, you can't have this drug for colon cancer, because the drug we're going to let you take isn't as good as this one, but we can't afford it.' When we come to those kind of euthanasia-like decisions, to learn that the reason the Senate approved this was some little bitty payoff that went on to some insurance company that gave you a campaign contribution -- that kind of tawdry stuff for this kind of magnitude of deformity on the system is enough to drive people crazy -- me included.

I've always said that anyone who takes Dick Morris's advice deserves everything they get, because the man is such a font of misinformation. That includes a lot of intentional disinformation, promoting provably false "facts" that unhinge the people who absorb this crap. As we can see.

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David Axelrod discusses the healthcare bill on This Week with George Stephanopoulos:

STEPHANOPOULOS: And, David, the public seems to have questions as well. We did a poll this week, ABC News/Washington Post poll, that showed that 53 percent of the public think their own health care will cost more if this passes, 55 percent think the health care system overall will cost more, and only 37 percent think their own quality of care will be better.

In the face of this kind of skepticism, is it wise to ram through legislation like this, such a huge piece of legislation on a party-line vote?

AXELROD: Well, I would say a few things, George. First of all, you say this is what people think, I think when people see what actually happens after these reforms are passed, those concerns are going to be allayed, and they're going to realize that if they have insurance, they're more secure in their relationship with their insurance company, their costs are going to go down.

If they don't have insurance, they can get it at a price they can afford. It's going to reduce our deficit. It's going to extend the life of Medicare. Medicare recipients are going to get a better deal on prescription drugs and better care. So the reality I think will trump polls numbers in the dead of winter as this debate is going on.

In terms of ramming it through, we've been talking about this, we've been debating it and considering it for eight months. The Republican Party has spent a month engaged in parliamentary maneuvers and dilatory tactics to try and prevent and vote.

Understand, the big question here isn't whether or not we're going to get a vote, whether this will pass or not, the big question is whether the Republican Party will allow a vote. A majority of senators support this reform, and the Republican Party wants to prevent it from coming up for a vote. I think the American people are entitled to a vote.

If you are a person with pre-existing conditions, if you're a small business person who can't afford health care, if you are a person who became seriously ill and was thrown off your insurance -- their insurance because of that, if you're going bankrupt because of out-of-pocket expenses, you need the United States Senate to act.

STEPHANOPOULOS: But most of the changes, even if the bill passes won't be instituted until after the next presidential election, so you're asking people to take an awful lot on faith.

AXELROD: George, that's not really true, almost all of these insurance protections, the things that will protect people in terms of out-of-pocket costs, the pre -- children...

(CROSSTALK)

STEPHANOPOULOS: (INAUDIBLE).

AXELROD: The day the president signs the bill, children with pre-existing conditions will now be -- an insurance company can't keep them from joining their parents' insurance policy. People with pre-existing conditions will have a catastrophic plan they can join.

And then, of course, when the thing goes fully into effect, everyone will be on insurance, insurance companies can't ban anyone with pre-existing conditions. But there are number of insurance protections that go into effect as soon as the president signs the bill. And not to mention, will begin reducing that gap in Medicare prescription coverage. So there...

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Just got off another blogger conference call, this time with Howard Dean, former CIGNA exec Wendell Potter, and Mike Lux.

Dean announced the results of a DFA poll that is "really quite stunning," he said. (You can read the results here.) The Senate cloture vote is scheduled for 7:30 p.m. on Christmas Eve, he said.

Democracy for America's "No Option, No Mandate" campaign to contact Harry Reid clocked 7000 calls in four hours, too, he said.

Dr. Dean opened the call by saying "this bill has always been a giveaway to the insurance industry, but we were willing to compromise" to get the public option.

He recapped all the compromises we made: "We wanted single payer, but that was taken off the table early on. That was a mistake. We had to get to the place where we had health insurance for all Americans." But now, he said, there's no public option, and no Medicare option.

"You're forced to pay money to an insurance company or get fined $750 by your government, while 27% of your money goes to CEOs who are flying around in these private jets," he said.

He talked about the compromises made for pre-existing conditions, the most disturbing one the ability to charge you 300% more, merely for being older. "It's guaranteed issue, but if you’re making $65,000 a year for a family of four and you’re paying $20,000 for insurance, how is that reform?"

He said the real bad stuff in the Senate bill was
"hidden in the weeds, so you can’t find it."

Dr. Dean brushed aside the "Get a bill, any bill" mentality in Washington. "Any legislation passed will have a huge impact on American healthcare. If they can’t fix it, it shouldn’t pass."

Wendell Potter, former CIGNA executive and reform activist, said the insurance industry got "every single thing they wanted" in the Senate bill.

"There's no individual mandate, no public option. There's also three words, 'benefit design flexibility' in Senate bill – that means the freedom to design plans that will pass more and more of us into ranks of the underinsured - and charge up to 22% of income if someone gets sick," he said.

In Massachusetts, they have a 2 to 1 premium ratio, "and they're already having trouble finding affordable, adequate insurance. The industry wants to shift even more costs to individuals and families, having the government pay them half a trillion dollars. The Senate bill meets every one of their requirements," Potter said.

"They will continue to shift the cost burden to consumers and get around not using preexisting conditions by charging for certain factors like high cholesterol."

Dr. Dean pointed out the House bill "is the compromise, we didn’t think it was right to take the option of an employer-based system away if people liked it."

In Vermont, he said, you can't be charged more than double the lowest premium.

Dean listed some more of the insurance company wish list the Senate was so eager to fill. "Getting rid of the anti-trust provision. This contributes to the predatory effect of the insurance companies – they're essentially unregulated. We need to get the provision in, get them regulated.

Wendell Potter talked about something you often hear pushed from the Republican side: "Just let us sell across state lines and let the market decide." As he points out, insurers would go to the states with least regulation.

Paul Hogarth from Daily Kos asked them to address criticism that if the bill is killed, "there's no reform and we’re worse off, the momentum is gone."

"I don’t know that we’ll be worse off," Dr. Dean said. "We ought to strip down this bill and get rid of the mandate. It should have been done by reconciliation."

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(h/t Heather.)

First of all, I'd like to reiterate that yes, a bill without a public option can serve the same purpose as the public option: namely, to force efficiency and competition. So yeah, I do see this as a win - and so does Nate Silver. And I don't buy the insurance company "we won" mantra just yet, because the Medicare buy-in proposal is a real threat to them. After all, the 55+ group is very profitable for them.

It seems clear the most important component of a plan lacking a public option is a mandated medical-loss ratio. But here's the most important detail of a requirement that companies spend 90 percent of each premium dollar on care: Who will be responsible for enforcement? In order to work, it's got to be the feds.

This is the most important part of the argument, because insurance companies (and their PACs) have enormous influence in state markets - and in state legislatures. State insurance commissioners are usually (not always) hired from the ranks of the industry, and are famous not only for rubber-stamping rate increases, but for far too often turning a blind eye to insurance company abuses.

What we want to watch in the Medicare buy-in is, are they going to take premiums (subsidies, whatever form it finally takes) into the Medicare trust fund? Believe it or not, it would be a very good thing if they did. A younger, healthier population would actually lessen the strain on the Medicare system. But I'm betting Republicans will shamelessly present it as "an assault on Medicare."

We also have to look at who gets to buy in - and why. Under the current proposal, people 55+ get to pick Medicare through the new exchanges in 2014. But what do we do until then? Well, they plan to allow them in starting in 2011.

Is this only for high-risk patients? Because it would really be a drain on the Medicare system (if the premiums went into the same system) if it was. It would be a bad idea anyway, because it would be too difficult to sustain if it was all people with pre-existing conditions.

Will the new Medicare members be charged the full cost? At 65, you're heavily subsidized for most of the cost, paying about $100 a month. The real cost is closer to $500. So will there be subsidies to purchase Medicare? Definitely, in 2014.

In the meantime? Not clear. This is one of the areas on which you want to lobby Congress.

You probably already know the problems with triggers - namely, that they're usually written in such a way as to make it highly unlikely they ever kick in. (That's why Queen Olympia loves them.)

As you might expect, we'll be watching closely.

Former CIGNA executive Wendell Potter says one of the most important things we can do to reform health care is to control the medical loss ratio - something Al Franken, Jay Rockefeller and other senators are attempting to do:

Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.

Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.

Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.

The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.

Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American
patients and their doctors, according to the industry's trade group.

And they do this by finding every excuse in the book not to pay a claim, even if it means
canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging."

In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main
consideration.

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.

The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.

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From This Week with George Stephanopoulos, Republican Rep. Marsha Blackburn and Democratic Rep. Debbie Wasserman Schultz get into one of those discussions over this week's breast screening recommendations in which the Republican simply constructs an alternate reality:

BLACKBURN: ... Debbie is right when she says they forgot about people. Indeed, they did. But we have to realize, this group that made this recommendation, this isn't some outside group. This is a part of HHS. And when you look at the...

WASSERMAN SCHULTZ: It's an independent group. That is not accurate.

BLACKBURN: ... 118 -- when you look at the...

WASSERMAN SCHULTZ: It is not a part of HHS.

BLACKBURN: No, it is a part of HHS.

WASSERMAN SCHULTZ: No, it is not.

BLACKBURN: And when you look at what is going to happen with these 118 new bureaucracies with 62 directives that are given by the health choices commissioner on what insurance can be offered in this country after 2013 and what is going to be paid, you know that this is the bureaucrat in the exam room. This is how it's going to happen.

WASSERMAN SCHULTZ: Marsha...

BLACKBURN: And this is the first step.

WASSERMAN SCHULTZ: Marsha, there's an insurance company bureaucrat in the -- in between the patient and her doctor right now.

BLACKBURN: This is breast cancer. Well, and people don't like that, and we need to get rid of...

(CROSSTALK)

WASSERMAN SCHULTZ: And your bill -- your -- your alternative...

(CROSSTALK)

BLACKBURN: We need to get rid of all of those insurance bureaucrats.

WASSERMAN SCHULTZ: ... does nothing to...

(CROSSTALK)

STEPHANOPOULOS: I'm going to have to -- I'm going to have to stop this right now.

Yes, George. Because your job is to provide a showcase. You're not supposed to confront the guests when they make things up.

If they're already admitting to causing deaths, why should they care about a little girl's hearing?

What more do we have to do to fight back against these horror stories? What will it take to get these insurance companies to see the inherent immorality of focusing on the bottom line to the exclusion of all else? Think Progress:

One of the worst abuses of the private health insurance industry is its practice of denying claims to pay for necessary care for patients. This practice has become so rampant in the industry that a recent study by the California Nurses Association found that a whopping 21 percent of all insurance claims filed in the first half of 2009 in the state of California were denied by insurers.

As the story of six-year-old Madison Leuchtmann of Franklin County, MO, demonstrates, even children are victims of this insurance company abuse. Madison was born with bilateral atresia, which means she lacks ear canals in both ears. In order to hear, she wears a special device on a headband that allows her to make out sounds. Despite her disability, Madison is at the top of her kindergarten class and is slowly learning to read.

Yet Madison, due to her growth, will soon require a new hearing implant to be able to recognize sounds. Her hearing and speech therapist warns that “if she doesn’t get her implants by age seven, she’s not going to be able to blend her words. … She won’t be able to hear herself [talk].” Madison’s pediatrician, Dr. Randall Clary, also insists that without the implant, the girl may never be able to hear again. Unfortunately, the Leuchtmann’s family insurer, Cigna, has issued "one denial after another,” flatly refusing to cover the $20,000 bill for the implant. In a written statement to the local news station Fox 2, Cigna explained, “It is not unusual for commercial benefit plans to exclude hearing assisted devices,” prompting Dr. Clary to angrily respond, “This is obviously medically necessary. You have a child that has no ear canals!” Dr. Clary also told Fox 2 that he sees these sort of denials “on a weekly basis.”

Apparently the Catholic Church, just like the other Beltway lobbyists, now writes our legislation.

The drama had built for months, pitting a group of Democrats against the Catholic Church. Priests and bishops were calling members to lobby for stricter language to limit abortion coverage, members and aides said last week.

But the final decision played out over a few furious hours Friday night as the fate of the broader bill still hung in the balance and stirred up long-dormant tensions within the Democratic Party over reproductive rights.

The beneficiary of this impasse was Stupak, an outspoken abortion-rights opponent whom the leadership had tried to circumvent, in order to pick up the votes he claimed to represent. After months of stalemate, the speaker was forced to accept language Stupak first drafted over the summer that would bar any insurance company that participates in the exchange — including the government option — from offering insurance plans that would cover abortions.

“Normally, at the end of the day, you’re arguing over fine-tuning,” said an aide whose boss was involved in the negotiations. “But this is a sizable change to current policy. So everyone was kind of stunned.”

For more than a decade, the Hyde amendment has prohibited the federal government from paying for abortions through any existing government program. The law needs to be reauthorized each year as part of the appropriations process, but the two sides had come to something of a détente.

The health care fight, however, disrupted that balance, and a big bloc of anti-abortion Democrats were threatening to derail the entire bill unless party leaders agreed to stronger restrictions the church could accept. Since mid-September, House Majority Leader Steny Hoyer had been working closely with Rep. Brad Ellsworth (D-Ind.) to craft language that would thread what proved to be an impossible needle.

Ellsworth, in consultation with the U.S. Conference of Catholic Bishops, was trying to amend legislation passed out of the Energy and Commerce Committee to make sure insurance companies that receive federal funds under the programs created by the bill don’t use any of that money to pay for abortions.

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One of the things that you can never anticipate fully before becoming a parent is the absolute ferocity of the instinct to protect your child. It's innate, feral, and so deep that it can actually scare you. I am profoundly grateful every day that my children were born healthy, but I know that should my luck run out and one of my kids develop some sort of life-threatening illness, there is no stone I would leave unturned in my quest to save my child. There is no length I wouldn't go for my babies.

And if all those efforts were in vain, I don't know how I'd survive the loss of my child. I had a miscarriage some years back, and I carried that loss like a huge, gaping wound inside me for so long. And that was for a child with whom I never got a chance to know or develop a real bond.

Now imagine how Hilda Sarkisyan feels. The daughter she bore, raised and nurtured for seventeen years dies just hours before the insurance company she battled finally relented to give her daughter the liver transplant she needed. Can you imagine that grief, that anger at how unnecessary Nataline's death was? All the obstacles placed in their way by a for-profit insurance company in addition to just missing Nataline had to be paralyzing in its pain.

Which makes how CIGNA employees treated Hilda Sarkisyan so much more contemptible:

Surrounded by supporters, Hilda Sarkisyan marched into Cigna Corp.’s Philadelphia headquarters on a chilly fall day, 10 months after the company refused to pay for a liver transplant for her daughter.

"You guys killed my daughter," the diminutive San Fernando Valley real estate agent declared at the lobby security desk. "I want an apology."

What she got was something quite different.

Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her "the finger."

Sarkisyan walked out, stunned and hurt.

"They showed me their true colors," she said. "Shame on them."

This woman has just gone through a pain I wouldn't wish on anyone--watching her child die needlessly--because CIGNA decided there wasn't enough of a cost-benefit to them to authorize a liver transplant. A for-profit insurance agency acted as a de facto death panel, opting to let this child die. Got that, GOP? There's the death panel you fear-monger. But they're not some hypothetical used to scare Grandma and Grandpa, they're REAL and some day, they may decide that you--or worse, your child--are not worth the cost of saving.

And don't be surprised if they show their heartlessness by heckling you and flipping you off when you walk in their doors to ask why.

And as if on cue, here comes Fox News, defending CIGNA:

Dear God, where's the humanity?

I found this in the comments over at Corrente and wanted to share it:

Insurance companies reserve the right to make changes to their formularies at any time, but are supposed to notify you and allow you one month's supply of your current drug in order to give your medical provider the opportunity to "pre-authorize" your access to said drug. Your doctor cannot simply write a letter saying "I'm the doctor by god, and I want the patient to have this drug". No, he must provide evidence that he has "stepped" you. Stepped means that he/she has tried you on "approved" A, B and C drugs to little or bad results first.

Now, A and C may no longer be on the formulary, so they don't count, so he/she has to find out what approved drugs are on the formulary so that he/she can say that they have been tried and if that is true, or he/she will say it is true, then it will go to the Pre-Authorization department.

If the PA department can't sort it, say because your diagnosis does not fit neatly into what the insurance company says the drug can be used for, albeit that it works for what ails you, the application goes to the in-house pharmacist. The in-house pharmacist (average salary $90,000 per annum) will make the final decision based on following company guidelines and keeping his/her job. If the decision is that you get the drug, then said drug will be approved for you as "off formulary", moved to class 3 and if your co-pay was $25.00, it will now be $60.00 or more.

If the drug is not approved, then you will be properly stepped with the ineffective, approved drugs before your pre-authorization can be reconsidered. After you have been stepped, the drug will still be off formulary and the co-pay will still be increased. It sucks and I am so sorry.

Signed Anguished in the PA Department - United Health Insurance Inc

Lovely. This is why we can't stop fighting:

(CN) - An insurance company's "reprehensible" decision to rescind a South Carolina man's coverage after he tested positive for HIV warrants a $10 million punitive damage award, the state Supreme Court ruled.

Jerome Mitchell applied for health insurance with Fortis Insurance Co. in 2001 at the age of 17. Fortis issued him a policy after he stated that he had never been treated for an immune deficiency.

One year later, Mitchell tried to donate blood to the Red Cross, which informed Mitchell that he was HIV-positive. Mitchell's doctor confirmed this finding.

Fortis investigated Mitchell's medical history and rescinded his policy, stating that Mitchell had misrepresented his HIV-positive status.

Mitchell sued for breach of contract and bad faith and presented evidence that he would die of AIDS within four years without medical treatment.

The trial court ruled in Mitchell's favor, awarding him $186,000 in actual damages and $15 million in punitive damages.

The state high court upheld the awards, but reduced the punitive damage award to $10 million based on the ratio of the projected $1 million cost of Mitchell's treatment.

"We find ample support in the record that Fortis' conduct was reprehensible ... Fortis demonstrated an indifference to Mitchell's life and a reckless disregard to his health and safety," Justice Toal wrote.

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You know just how crazy Ann Coulter's worldview is getting when Bill O'Reilly serves as an honest-to-God voice of sanity in dealing with her proposals for how to reform health care, as she laid them out on The O'Reilly Factor on Thursday.

Coulter, who's evidently just wrapped up another genuflecting session before the altar of Ayn Rand, thinks the whole problem could be solved just by doing away with state regulations and "opening up competition," at which point "every problem would go away":

O'Reilly: But every problem wouldn't go away. The one thing that I would like to see the federal government do is strict oversight on the insurance companies when they hose people. I mean, I don't think they should be throwing you, Ann Coulter, off the rolls if, God forbid, you get MS or something.

Coulter: That will not happen. But Bill, that will not happen under competition. Look -- [Crosstalk] -- no, no, let me make this point. No it will not. The government was regulating, the SEC was closely watching Bernie Madoff. Government regulation doesn't stop that sort of thing. What stops it is, people knowing you're investing with this guy at your own risk, and then all these private organization develop. Competition is what enforces that.

O'Reilly: Yeah, well, I don't believe that. I think competition can drive the prices down, but it cannot make an insurance company honest. Only a federal oversight committee that says if you don't do it, we fine you.

Coulter: Yes it can. Yes it can. Otherwise, what about the SEC with Bernie Madoff?

O'Reilly: No, Bernie Madoff got away with it because the SEC, under a Republican, Christopher Cox, simply wouldn't investigate him. That's why he got away with it.

Coulter: That's the government regulation! Why do you keep thinking a different regulator will be better? Government regulation does not solve these problems, competition does.

Because if I belonged to a health-insurance company that threw me off when I got sick, people would hear about it. There would be magazine articles. And I don't mean to be me, I mean people --

She's really been drinking the Randian capitalist kool-aid, hasn't she? Hell, people get thrown off their insurance when they get sick all the freaking time and there sure as hell aren't magazine articles about it.

But the Madoff analogy really takes the cake. O'Reilly, as we noted, is sensible about this: The SEC failed in its regulatory capacity precisely because it was under the guidance of a Republican who didn't believe in regulatory oversight!

Coulter subscribes to a philosophy which argues that less government regulation makes for better competition which in turn enforces honesty and ethical behavior. But when in fact it's demonstrated that such governance produces outrageously (not to mention criminally) dishonest behavior, she blames not the practitioners who gutted that oversight for its then-predictable failures, but rather the entire concept of oversight itself.

It's a classic tautology: Let's gut government oversight so that when it fails, we can blame it, thereby creating an excuse to do away with it altogether.

It's also, of course, the kind of completely insane thinking that has dominated movement conservatism in recent years. And a large part of the reason we have Bernie Madoffs and AIGs in the first damned place.

Angela Braly, the CEO of Wellpoint, called for health care reform at a meeting in Indianapolis.

One of them most powerful women in the nation is calling for health care reform. Wellpoint CEO Angela Braly says she supports guaranteed coverage for everyone - as long as everyone gets and stays covered [...]

"The high and rising cost of health care in America is just not sustainable," Braly said. She said the current system, including Medicare, which is administered by the federal government, was inefficient and promotes quantity over quality. She also said it posed "a real threat to the social and fiscal obligations of the government and to the health and prosperity of the American people."

"We believe insurance companies have a role to play. We can and are making a difference," Braly said. She said Wellpoint's strategy was moving beyond processing claims and managing risk, noting employee incentives when customers get healthy.

Braly says the what worries her most about the plan currently under consideration is the "public option."

This is, essentially, the insurance company-approved argument for health care reform. They see it as forcing everyone to buy their coverage, making refusal to buy their insurance a crime, and offering no competition to their monopoly over it. I'm sure they don't want to see that anti-trust exemption of theirs lifted either, the one that has led to 94% of the individual insurance market becoming "highly concentrated" in the hands of one or two companies.

Braly kept talking about how the current system is inefficient and leads to skyrocketing costs, as if she has no agency over that whatsoever. There are issues with how the fee-for-service system promotes quantity of medical care and not quality, but that's due to the profit incentive, which is exactly the same in the insurance market. Braly's argument seems to be that it's doctors and hospitals at fault for chasing profit in health care, but insurance industry CEOs like her are good samaritans and innocent bystanders who just so happen to do the same thing. If a profit-driven health care system is wrong, then it's pretty much wrong across the board. And she actually advocated for an outcome where insurers would be "free to offer a range of choices," while worrying about a public option... which would just be another choice, one that could deliver quality coverage at a lower cost.

Braly tried to argue that health insurance profits aren't all that big:

According to Braly, the difference between the Medicaid or Medicare payouts and actual costs are shifted to the private plans, costing you $1,500 a year. Add that to the $1,000 a year shifted to the private plans to cover the uninsured and it costs you a total $2,500 a year.

"Sounds a lot like the Fannie Mae for health care and I think we all know how that experiment is going," Braly said [...]

"If you completely eliminated insurance company industry profits which is clearly the aim of some, you would pay for two days of health care in America and in the process you would eliminate the market mechanism to control costs and improve quality of health care being delivered," Braly argued.

I don't know what any of this means. The market mechanism in health care has not controlled costs in America whatsoever, yet throughout the industrialized world we see public programs that control costs and provide better health outcomes. Private industry has begged off completely from limiting health care costs through any means other than denying coverage to their customers and rationing. Health care spending in Medicare and Medicaid is lower than spending through the insurance market. And insurers have used the employer market effectively to confuse employers and employees alike about the true cost of their service. Braly throws out "Fannie Mae" for health care, but the current system is clearly "Goldman Sachs" for health care - where the relentless drive for profit at the expense of people creates a spending bubble that nobody ever bothers to burst until it's too late.

In the end, Braly calls Wellpoint a "supporter" of health care reform. That's funny, I would think that a company committed to health care reform wouldn't illegally force their employees to lobby against it.

Consumer Watchdog in Santa Monica has asked California Atty. Gen. Jerry Brown to investigate its claim that UnitedHealth Group and WellPoint Inc. pushed workers to write their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches their interests [...]

WellPoint, whose Anthem Blue Cross unit is the largest for-profit insurer in California and employs 8,000, took a more overtly negative tack.

"Regrettably, the congressional legislation, as currently passed by four of the five key committees in Congress, does not meet our definition of responsible and sustainable reform," Anthem said in a company e-mail last week. The proposals would hurt the company by "causing tens of millions of Americans to lose their private coverage and end up in a government-run plan."

The appeals amount to illegal coercion under California law, Consumer Watchdog research director Judy Dugan said. "While coercive communications with employees may be legal, if abhorrent, in most states, California's labor code appears to directly prohibit them," said Dugan, citing sections forbidding employers from "tending to control or direct" or "coercing or influencing" employees' political activities or affiliations.

Insurance companies like WellPoint support health care reform, all right - completely on their terms, and guaranteed to provide them a financial windfall. Anything else would be unacceptable, and they will take any tactic - no matter legal or illegal - to stop it.

Today I had an appointment with the surgeon who I expected to do the surgery on my ankle. I presented him with the second opinion from one of his colleagues, and he agreed with it.

"Yes, you really do need this surgery," he said. "But you need someone who can do an arthroscopic exam for bone fragments and a ligament reconstruction at the same time, and I can't do that. There's only a handful of people
who do."

Is there any reason why I couldn’t have those surgeries separately? I asked.

Well, no, he said. But it really didn’t make sense to separate them and the insurance company would probably dispute it. The thing is, he knows the other orthopedic group with whom I have the appointment - one of the best in the city, he hastened to add - and he knows they have a lot of restrictions about what insurance they’ll take. He said they probably wouldn’t accept the open car insurance claim in payment.

At this point, I was almost in tears. “What are my options?” I said.

There’s this one guy over at Jefferson who does both, and he might take the insurance, he said. “And there’s another guy up in Princeton, but that’s it as far as I know.” (And by way of passing, told me he had a patient that week from 100 miles away who drove to his office with a badly broken arm because he couldn't get anyone closer to accept his Medicaid.)

So I came home and called the doctor at Jefferson. The office assistant informed me they’re no longing accepting New Jersey car insurance cases. “No, no, my health insurance is Jersey. My car insurance is Pennsylvania,” I said, desperate to get a break.

Finally, I got one. The office assistant took all my information and said she had to verify my coverage and the open claim. I told her I was on COBRA, running out of money and really needed to get this surgery done ASAP.

Continue reading »

I am thoroughly disgusted by Obama's lack of effective leadership on this - and Congress's willingness to lard the bill for their contributors at our expense. It's very important that we keep the pressure on, because if we don't, we're going to be saddled with a very expensive dog of a health care "reform" bill.

I suggest you send this story to your congress creature and ask what they intend to do to protect our interests:

Reporting from Washington - Lashed by liberals and threatened with more government regulation, the insurance industry nevertheless rallied its lobbying and grass-roots resources so successfully in the early stages of the healthcare overhaul deliberations that it is poised to reap a financial windfall.

The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers -- many of whom would get government subsidies to help pay the companies' premiums.

"It's a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama's massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski said the industry's reaction to early negotiations boiled down to a single word: "Hallelujah!"

The insurers' success so far can be explained in part by their lobbying efforts in the nation's capital and the districts of key lawmakers.

The bills vary in the degree to which they would empower government to be a competitor and a regulator of private insurance. But analysts said that based on the way things stand now, insurers would come out ahead.

"The insurers are going to do quite well," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. "They are going to have this very stable pool, they're going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide -- plus their administrative costs."

One of the Democratic proposals that most concerns insurers is the creation of a "public option" insurance plan. The industry launched a campaign on Capitol Hill against it, grounded in a study published by the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group. The lobbyists contended that a government-run plan, which would have favorable tax and regulatory treatment, would undermine private insurers.

More Kabuki. After reading Taibbi's article, It's clear the public option is already gutted and not worth fighting for in its present form.

[...] Undermining support for the public option wasn't the only gain scored by insurance lobbyists.

In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders' medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients' healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.

Most group health plans cover 80% to 90% or more of a policyholder's medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans.

[...] Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families.

"These are a bad deal for consumers," said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America.

Meanwhile, companies would probably see a benefit by providing less insurance "per premium dollar," Hunter said.

"It would be quite a windfall," said Wendell Potter, a former executive at Cigna insurance company who has become an industry whistle-blower.