Guaranteed Healthcare

This essay will help you understand how and why your health insurance claims are denied and why they must be denied for our for-profit system to thrive.

The insurance industry in the United States has a single purpose, to provide a stream of profits to shareholders who own the stock of healthcare companies. Guaranteeing the healthcare needs of the American people is not even an afterthought.  Our private, for-profit insurance industry is a huge, sophisticated and dangerous denial machine.

We pay huge premiums year-after-year, then when we become ill, our claims are routinely denied.

I'm going to take you inside one company which functions exclusively to deny as many claims as possible.  Remember a denied claim goes right to the bottom line.

The first concept you need to understand is the Medical loss ratio.  You and I are losses in insurance industry lingo.

The medical loss ratio refers to the percentage of dollars actually spent on medical care versus administrative costs or profit. The higher the ratio, the more money is being spent on actual delivery of care. Components of the medical loss ratio include payments to physicians, hospitals, pharmacists and other providers of health care.

It looks like 2008 is going to be a tough year for the for-profit insurance industry.

The crooks bean counters at UnitedHealth are circling the wagon.  Their bottom line is under assault.  This is not good news for you and me.

Let me take you on a quick stroll through the world of insurance denials and what happens when things take a turn for the worse. Worse means that profits are declining and medical costs are on an upswing.  

The for-profit insurance industry serves investors--not you and not me. That's why it's called for-profit. Investors pay money to buy their stock. Investors invest to make money. Last time I checked, the way a company makes investors happy, is to increase earnings and control costs.

Think of our monthly premiums as earnings or revenue. Our bodies are costs. When our bodies get sick they become big costs.

Costs are bad. Costs must be crushed and defeated.

Here's the ugly story. The financial success of the for-profit insurance industry is due to their business model that must limit their medical losses. We, that means you and I, are medical losses.

Dear friends, this is called the medical loss ratio. You and I (and our health needs), are known in insurance lingo as "losses".

Every dollar they spend our our healthcare needs goes against the bottom line.

Access to health care is a complex matter, ranging from availability of health professionals in one’s community to many barriers to care, such as racial/ethnic, geographic, and literacy factors. But as the costs of health care surge ever higher, the financial barrier to care has clearly become the biggest impediment of all. Having insurance used to offer some protection against this barrier, but does so less all the time as the numbers of uninsured and underinsured grow.

Nurses have long argued that the real problem in our health care system is the out-of-control insurance corporations.  Seems the politicians are starting to notice.  The LA Times reports this morning that insurer PacificCare is facing millions...or maybe billions...in fines for the way it treats its patients, and the State Assembly is mvoing to bar the practice of tying employee bonuses to terminating care.

I hate to be melodramatic, but that’s pretty much what it comes down to.

At least according to today’s report finding that America is last among industrialized democracies in terms of infant mortality.  Because our healthcare system is set up to guarantee billions of dollars of profit to unnecessary insurance corporations, kids born here are more likely to die than they are in countries with guaranteed healthcare through the single-payer model.

The Los Angeles Times reports this morning that one of the nation's largest health insurers paid bonuses to its employees for kicking sick people off the health insurance rolls, including approving chemo therapy for a 51 year-old woman, then cancelling her policy immediately afterward.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

And these are the people that Mitt Romney, Arnold Schwarzenegger, and Clinton/Edwards/Obama see as the answer to our healthcare crisis?