Guaranteed Healthcare

I have some comments on my story on the NRP radio program, the Story with Dick Gordon, that aired Tuesday (Nov. 18)...

"One pill makes you larger, and one pill makes you small," so begins the verse from Jefferson Starship's classic song, White Rabbit.  "And the one that AHIP's selling, won't do anything at all."

O.K., so that's not the way the verse really goes, but my subject, healthcare reform and the placebo politics that surround it is enough to make me mad as a hatter. Actually, it's made a lot of us angry, and we're getting organized for the fight of our lives. Our success and our ability to achieve true healthcare reform has everything to do with perception, placebos, and a good dose of myth-busting reality. 

When it comes to health care reform, any politician that welcomes insurers to the table as invited guests and expects them to behave like polite company, will be sadly, even tragically disappointed. Like the oysters in Lewis Caroll's classic, The Walrus and the Carpenter, we must be especially wary when the insurance industry repackages and markets itself as a solution to the health care crisis. "Now if you're ready, oysters dear, we can begin to feed."    

America's Health Insurance Plans (AHIP), are doing just that; they're gluttonously greedy and they're pandering for an invitation to 'fix' the crisis they created. Skyrocketing costs; marginal, reduced, detrimental-to-our-health 'benefits'; recissions, denials, exclusions, and huge profiteering by insurers has eroded and eaten away at our collective health like a cancer.  There can be no doubt about it. In medicine we have a term for that, pathognomic: distinctively characteristic of a particular disease or condition.  For example, lesions in the brain which are pathognomic of a cancerous glioma.

"So, what is that tumor or neoplasm thing in my head, nurse?" Senator Edward Kennedy might have asked that question of his trusted nurse, after his venerable doctors left the room. The short answer might have included a definition and an analogy to aid in the patient's understanding. "A neoplasm is best described as a new, uncontrolled growth of tissue that's serving no useful physiologic function.  It's crowding out healthy tissue and it's very greedy.  It doesn't share or play fair with the oxygen, nutrients, and the blood vessels that supply them.  That's why you're sick."  Like for-profit health insurers who serve no useful function in health care, they're shortening our lives and we're dying because of them.

The two major party candidates for President of the United States have extended that "invitation" anyway. It's party-convention time, and we the people are seated at the table. It's time to shed our naivete.  AHIP is not unlike the fabled Walrus and Carpenter; they're waltzing in with their buckets of campaign cash, profits they took at our expense. They're hoping we won't recognize them for who they are and they're hoping to control the party's platform. They're hoping to keep control of a system that works for them, and they're hoping that Harry, Louise, and the rest of us believe their  love affair with our premium dollars will be enough to sustain a long term relationship that's been in their best interest, not ours.  "It seems a shame, the walrus said, to play them such a trick." In reality, AHIP has no shame.  A bandaid for your cancer, Senator? Salmonella on your salad, anyone?

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.