By NYCeve (Eve Gittelson)

Despite being in the national spotlight as healthcare reform makes its cumbersome trek through committees of Congress, insurers continue their wantonly deceptive and consumer unfriendly business practices. It boggles the mind, but insurance executives appear oblivious to the reality that it is the most despised industry in the country.

It’s inconceivable that health reform could involve mandating that recession battered Americans be required to pay private insurers for dubious coverage, with no public option, and little or no guarantee that these denial machines will be responsible corporate citizens.

These fears are justified. Under the proposal circulating in the Max Baucus controlled Senate Finance Committee, crucial rule-making authority could reside in the hands of The National Association of Insurance Commissioners, a private association of state insurance commissioners that consumer advocates fear is too closely tied to the industry.

“The NAIC is clearly an organization that is dominated by the insurance industry,” said California Lt. Gov. John Garamendi, a former state insurance commissioner.

“I think the NAIC has an important role to play. They have a lot of knowledge, but I would be concerned about giving them authority to set the r ules.”

The group’s 56 members are public officials — the elected or appointed chief insurance regulators of the states, the District of Columbia and five U.S. territories — responsible for enforcing laws that vary widely in rigor depending on jurisdiction.

But the association itself is a private organization not subject to open meetings and public records law, noted J. Robert Hunter, insurance director of the Consumer Federation of America and a former Texas insurance commissioner.

“They have no transparency,” he said.

At every bend in the road, and by any means necessary, insurers refuse to live up to even the most minimal standards of corporate decency.

Here’s just the latest example of egregious abuse. This time courtesy of Anthem Blue Cross of California.

According to a Times analysis published Feb. 18, Anthem sold thousands of policies that were intended to be safety nets for the sick, jobless and uninsurable at premiums that exceeded state-issued rates.

At the time, Anthem said it had erred and pledged to make amends. And Anthem did mail out refund checks.

But Greenberg, an investment lawyer, said the $12 check he got fell far short of what he believed he was owed.

It all began in February when Greenberg’s wife, Paulette, a paralegal, noticed the Times story. She said, " ‘Hey, this is applicable to us,’ " Greenberg said. " ‘Get on it.’ So I did."

Greenberg began by filing a public records request to obtain the rate caps for the safety-net coverage that are calculated each year by the state Managed Risk Medical Insurance Board. Then he compared those rates with the premiums Anthem had been charging him and concluded he had overpaid by $5,750.24 over several years.

Greenberg complained to Anthem as well as the state Department of Managed Health Care. But that didn’t seem to go anywhere, he said.

So, he went to Small Claims Court. At a brief hearing Thursday, Greenberg showed Judge Rex Minter the law, the state-issued rate sheets and his calculations. Minter awarded him everything he said he was owed, plus $1,475.73 in interest and $85 in court costs.

And the human tragedies inflicted on middle class Americans because all they can afford is bare bones junk insurance, continues to blight our national landscape.

Meet Jim and Martha Martin.

All they can afford is Swiss-cheese insurance, and they are part of the army of dangerously underinsured Americans. And despite being “insured”, people like Jim and Martha are one illness or injury away from financial ruin.

As hard as they both work to make their modest income — about $45,000 a year — the medical bills pile up. Jim and Martha struggle all the time to figure out how to keep up.

Between medical bills and premiums, a whopping 45 percent of their income goes to healthcare!

But Martha doesn’t have much choice. More medical bills are coming. She needs to have a hysterectomy next month, and she says her insurance will pay only $1,000 of the hospital bill.

For the Martins, 2009 is starting to look a lot like 2008. Last year they paid $6,210 in health insurance premiums for themselves and daughter Sara, plus another $13,955 in uncovered hospital bills after Rebekah’s surgery.

It added up to almost 45 percent of their total income of $44,815.

“Forty-five percent! That’s just crazy! I don’t pay that much in taxes,” Martin exclaims. “So you know, I just think there should be a health insurance plan out there that everyone can sign up for.”

She’d be happy to pay the premiums, she says, if only she could get decent coverage.

So you truly don’t know whether to laugh or cry when you read that Kent Conrad plans to vote against the Rockefeller and Schumer public option amendment currently being debated in the Senate Finance Committee.

Salvation from the damnation of the U.S. healthcare system for millions and millions of Americans runs right through the public option. Period.

By NYCeve (Eve Gittelson)

Max Baucus, the chairman of the Senate Finance Committee, asked his fellow heavily insured Senate colleagues, to summon courage from deep within, as they slow walk the mark up of the healthcare bill. Providing healthcare to the American people is a scary undertaking for these folks, and they need “courage”.

But I’ll wager that it takes a lot more much courage to be an uninsured or underinsured American citizen. And if Max Baucus needs a courage pep talk, he has fifty million Americans who would be glad to explain survival strategies with him.

Baucus at one point had called for members to do what Harry Truman admonished others to do in the past, which is to show some courageous, skillful leadership, and seize the opportunity to change things for the better. So far though we’ve seen little of that great statesmanship, and instead a lot of old-fashioned partisan politics.

It seems clear that righting the deep moral wrong strong healthcare legislation with a public option, would remedy is sadly lacking from the debate.

But truly, for Mr. Baucus to invoke the concept of courage (just to do his job), is one of those moments when you don’t know whether to laugh or cry.

The cloistered bubble of Washington DC, has rendered those we send there to do our business, fully incapable of understanding the day-in and day-out realities Americans at every socioeconomic level contend with. Survival on many different levels, for so many of us, has become a full time job in the United States of America.

Today, in a searing report in the New York Times, we learn of the likely closing of the dialysis unit at Grady Memorial Hospital. It’s out of funds. Imagine this, Mr. Baucus, in the richest country on the planet. Imagine the fear of the dialysis patients, about where they will go for the treatment they require three or more days a week, just to stay alive. If you don’t get it, you die. This is courage, Mr. Baucus.

Uninsured and dangerously underinsured Americans have more courage in their little fingers, than members of the United States Senate could ever imagine or withstand. And their pathetic and lame stalling, and refusal to do the business of the people is a fitting tribute to small-minded little men and women—I’m speaking to you, Kent Conrad, Blanche Lincoln, Max Baucus and others.

It gets even better, or worse, depending on your point of view.

At one point in the proceedings yesterday, Jim Bunning, offered a nonsensical amendment demanding final CBO estimates befo re the committee could vote, an amendment that might put off a final vote for two more weeks. and then promptly fell asleep.

Yesterday during the Senate Finance Committee’s mark-up of chairman Max Baucus’ (D-MT) health care bill, Sen. Jim Bunning (R-KY) chastised the whole operation. “I do not support a government takeover of the health-care system,” Bunning complained, saying the bill “confiscates more money from the taxpayers” and “tramples on American freedom and liberties.” Soon after, Bunning decided to take a little nap:

During opening remarks at the Senate Finance Committee session, the Kentucky Republican appeared fast asleep for several minutes, with his head cocked to the side and his eyes closed, before a staffer roused him. Bunning’s head was propped in his hand and his mouth was slightly open while he slept, several witnesses told HOH.

How pathetic. How tragic. But thanks to CSPAN, at least it’s on view for the world to witness.

By NYCeve (Eve Gittelson)

As members of the United States Senate and the House of Representatives stand on the floors of each chamber debating the relative merits, and the extent and cost of healthcare the American people may or may not be entitled to, keep in mind, these people have healthcare and other benefits, the rest of us can only dream about.

Though we have fifty million Americans without any access to healthcare, and many additional millions dangerously underinsured, those we elect to do our business, have the finest and most affordable healthcare available in the United States. Why this fact is not part of the debate is beyond me.

Benefit consultant Watson Wyatt is forecasting a bitter 2010 open enrollment period for Americans not blessed to have the FEHBP.

In a word, higher costs, higher out-of-pocket costs, higher deductibles, more and greater costs shifted onto the shoulders of recession battered Americans.

This is what we have, and the healthcare reality for most Americans going forward.

What=2 0can U.S. workers expect when they receive their fall open enrollment benefit packages for 2010? In short, higher costs. But through research, global consulting firm Watson Wyatt has identified a few financial rewards trends in health benefits plans for next year.

Employees might find their 2010 employee benefit packages include financial rewards for promoting healthy lifestyles, full coverage for preventive services, closer scrutiny of dependent and spousal coverage, and greater use of consumer-directed health plans (CDHPs), according to benefit experts at Watson Wyatt.

“Faced with an uncertain economy and rising health care costs that show few signs of slowing, many employers have made changes to their health benefit plans for 2010,” said Tom Billet, a senior consultant with Watson Wyatt. “While next year’s benefits will reflect these higher costs, workers can also expect employers to continue their commitment to encourage employees to lead healthy lifestyles.”

Without a public option to act simply as a cost stabilizer and competitor to for-profit insurers, middle class families will continue to see huge chunks of their wealth fly out the window as healthcare costs continue the inexorable upward spiral.

On the other hand, our elected officials have what is known as the Federal Employee Health Benefits Plan. It is heavily taxpayer subsidized, with the taxpayers picking up approximately 72% of the costs of th e premium.

For many years, the Cadillac benefits our elected officials avail themselves of, has been a huge issue for me and many Americans—but as I said, the national debate is strangely silent on this point.

When you receive a huge volume of emails from Americans in desperate need of healthcare as I do, you’ve got to wonder why the citizen taxpayers of our country agree to such an outlandish and unfair arrangement?

Kaiser Health News peels back the curtain on these deluxe benefits which as federal employees, members of the House and the Senate receive.

Children and dependents are covered.

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

FEHBP insures 8 million federal employees, retirees and dependents. This means that long after we have voted an elected official out of office, they=2 0hang onto these cherished benefits.

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the President, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Choice, choice and more choice.

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Nationwide, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up207 percent. The year before, the annual premium increase was just 2.1 percent.

And what do the diabetic friends of Toni do?

Those kids who are either uninsured or dangerously underinsured. Toni learned this summer at a camp for diabetic children. They re-use their insulin needles—and dull needles really hurt.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

The French think the debate we’re having in the United States is “surreal”, they spend a fraction of what we do, and have a longer life expectancy.

France spent about $300 billion for the health needs of its 64 million people in 2007, the last year for which reliable statistics are available, the OECD reported. That amounted to about 11 percent of gross domestic product for a system covering an estimated 99 percent of the population, well below what Americans pay for a system that leaves out tens of millions of people.

On a per capita basis, France also ranked well below the United States in health expenditures. It was eighth on the OECD list, while the United States ranked at the top.

Spending less apparently has not lowered the quality of health care. Despite their reputation for guzzling red wine and eating fatty cheese, French people have for years enjoyed a longer life expectancy than their counterparts in the United States, currently at 80.98 years compared with 78.11.

The situation in America is no longer a crisis, it’s a catastrophe. How do the politicians sleep at night?

By NYCeve (Eve Gittelson)

Several months ago there was an important (and tragic) article in the Boston Globe about American with insurance being priced out of medical care. This reality takes on new meaning as we’re learning from another new report that perhaps up to 45,000 Americans die prematurely every year simply because they don’t have health insurance coverage at all!

People without health insurance are 40 percent more likely to die than those with private insurance, according to a new study whose authors say the finding underscores the need to expand coverage to the 46 million who lack it.

According to the report, published today in the Journal of Public Health, lack of health insurance was a factor in the death of as many as 45,000 people in 2 005.

These ghastly new numbers are indisputable. Even those Americans like some of us, with very expensive junk insurance are unable to seek medical care in a timely fashion due to spiraling out of pocket costs. Escalating co-pays, deductibles and declining reimbursement make a routine trip to the doctor, a luxury purchase even many with insurance can no longer consider.

This is the phenomenon known as “think you’re insured, think again”. Let’s take a look at the financial plight insured families faces, this might shed some additional light on the realities faced by the even worse off uninsured.

Costs are keeping patients from care: Copayments rise as families struggle

People with robust health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

Not that long ago, such dilemmas were typically faced by lower-income families, often on publicly subsidized insurance. But with many consumers struggling to pay rising healthcare costs amid today’s shrinking family budgets, these tough choices are becoming commonplace – even among families with employer-provided health insurance, consumer advocates say.

So here we are, good, tax-paying, heavily insured middle class Americans. We pay so much for this worth less insurance, that we make all manner of sacrifice just to pony up that exorbitant premium every damn month.

But despite doing this—working hard and playing by the rules, (and in Massachusetts facing a fine, if you refuse to play along), we still cannot afford routine medical care. And keep in mind, Max Baucus is also proposing to fine people who don’t purchase private, for-profit insurance.

Fines or no fines, the larger issue remains, will the Senate Finance proposal, make purchasing real health insurance coverage affordable? Well not if the stock prices of health insurer stocks is any indication.

Mandates. Fines. No public option, little or no cost control. The dream of Wall Street and the insurance industry. Fifty million new victims customers.

Baucus also dropped a plan to set up a government insurance program — the so-called public option — to compete with private insurers. Instead, he proposed giving $6 billion in seed money to nonprofit cooperatives that would compete with companies such as Hartford, Connecticut-based Aetna Inc.

Insurer stocks rose on the news, with the Standard & Poor’s 13-member index of managed-care companies up 3.9 percent.</blockquote&g t;
But Even the insurance industry is wondering about affordability.

Scott P. Serota, president and CEO of the Blue Cross Blue Shield Association, said while the group’s 39 affiliated companies nationwide support the goal of making coverage affordable, they are not in favor of taxes on the industry.

“We are greatly concerned that burdensome new taxes and fees aimed at insurers and other healthcare industry stakeholders would severely undermine the reforms that the chairman’s mark aims to achieve,” Serota said in a statement. “These unprecedented new taxes would make coverage much less affordable for individuals, their families, and employers.”

The proposed taxes also met with opposition from America’s Health Insurance Plans, which represents nearly 1,3000 insurers nationwide.

“New taxes on health care coverage will have the opposite effect by making coverage less affordable for families and employers across the country,” AHIP president and CEO Karen Ignagni said.

Consumer Watchdog is far from sold on the Baucus insurance industry bail out.

The new health reform plan released today by U.S. Senate Finance Committee Chairman Max Baucus (D-MT) will charge middle-class families nearly 20% of their an nual income for health coverage, while letting insurance companies charge what they please for policies, said Consumer Watchdog. The consumer group, which pioneered the most successful insurance premium regulation law in the nation, today said only the extension of such regulation to health insurance can even begin to make insurance affordable—which it must be, if Americans will be forced to buy it.

The final word on the urgency of the Public Option belongs to the CIGNA whistle blower Wendell Potter:

Speaking before the House Democratic Steering and Policy Committee Tuesday, former health insurance industry executive-turned-whistle blower Wendell Potter warned that if Congress “fails to create a public insurance option to compete with private insurers, the bill it sends to the president might as well be called the Insurance Industry Profit Protection and Enhancement Act.”

Potter also struck back against one of the key arguments made against the public option: that it would have an unfair competitive advantage over private insurers.

’Contrary to the misinformation being disseminated by the health insurance industry and its allies, the public insurance option would not have a competitive advantage over private plans," Potter told the committee. "It would have to meet the same benefit requirements and comply with the same insurance market reforms as private plans. "

By NYCeve (Eve Gittelson)

First, a huge shout out to Howard Dean for telling the truth about the Baucus Insurance industry Protection Bill.

Howard Dean, former Democratic National Committee chairman, minced no words about Sen. Max Baucus‘s healthcare proposal, unveiled to the public this morning. "The Baucus bill is the worst piece of healthcare legislation I’ve seen in 30 years," Dean said last night at a healthcare town hall and book signing in Washington. “In fact, it’s a $60 billion giveaway to the health insurance industry every year,” he said. “It was written by healthcare lobbyists, so that’s not a surprise. It’s an outrage.”

So what exactly are we going to do about the garbage legislation from the Senate Finance Committee?

First we have to deal with the “just pass anything” crowd.

Jay Rockefeller is emerging as an uncompromising healthcare warrior. He’s worried and so am I. Will Democrats redefine down the meaning of reform, snatch an easy victory and present the American people with unacceptable legislation?

Are Democrats dialling down expectations on what can be acheived under the banner of healthcare reform this year? Sen. Jay Rockefeller (D-W.Va.) seems to be concerned they are.

Rockefeller emerged from the Senate Democrats’ weekly luncheon Tuesday afternoon, which featured an appearance by President Barack Obama’s communications guru David Axelrod, wondering aloud (perhaps rhetorically) whether the White House’s get-it-done message to Congress wasn’t bold enough.

“David’s in there — Axelrod — saying we’ve got to try to get ‘something.’ So, the new benchmark is, ‘Well, if we can do something, if we can do anything, then we can say we did healthcare reform,’” Rockefeller said.

If this is the plan then, as Dr. Dean has advised, we’ll have our fifty (with Biden), or fifty-one good Democrats, use reconciliation and deliver the American people from this healthcare evil.

The Baucus bill leaves out some of the president’s goals for healthca re reform, such as the controversial public option. While more palatable to Senate moderates, the Baucus proposal also drew criticism from Sen. Jay Rockefeller, a Democrat from West Virginia, who said yesterday he would not vote for it in its current form. “I’m glad Senator Rockefeller is not going to vote for it. I wouldn’t vote for it at all under any circumstances,” Dean added. Instead, Dean said Senate Democrats should and would end up using the reconciliation process to pass a plan with the public option. “It can be done, and that’s how it will be done,” Dean said, pointing out that a majority of Senate Democrats still support a more robust bill.

Americans are dying because for-profit insurers are out-of-control, and getting in what may be their last licks. The refusal to honor contractual obligations has reached epidemic proportions. In California claims denials are running as high as 40%

Just ask the family of 17 year-old Emily Gomez, if we need a public option.

Emily Gomez is fighting for her life, as her parents are fighting with their insurance company to pay for her treatment.

It’s estimated that eleven million Americans suffer from eating disorders, a condition that initially plagues, then kills. Emily Gomez is one of these young Americans dealing with this deadly illness.

Emily started passing out in school and several times she wound up in the hospital. Her doctor said something had to be done — and fast. “Her doctor would look at me and say, ‘You have got to do something and quick. … This child is extremely sick, and if you don’t do something immediately, you’re going to find her dead on the floor,’” Leigh Gomez said.

A team of pediatricians said outpatient care wasn’t enough. They said Emily needed long-term residential treatment.

But that treatment is expensive, ranging from $750 to $1,000 a day. Because Emily was so sick, her parents assumed the treatment would be covered by their insurer, but they were wrong.

“Each time I called, they just said I’m sorry, there’s nothing we can do for you,’” Leigh Gomez said.

Like millions of us, survival for the Gomez family comes in the form of a public option. Nothing else matters, nothing else will do.