Today, a stirring report on how health insurers rescind coverage when you get sick, routinely deny coverage recommended by your doctor and compromise your health….evidence why NM’s Health Security Act needs to be passed and signed in 2019.Today’s post describes what happens when corporate for-profit health insurers operate as a gateway to your healthcare. Spoiler alert: it is tragic and provides yet another illustration of why capitalism and its sole priority being profit is ill suited to be involved in anything that involves human need.
Today’s post also points to the critical need for all of us to support and lobby for the NM Health Security Act (HSA) in January. The Health Security for New Mexicans Campaign has been advocating for this law for over a decade. Kudos to them for their tenacity, but it is time to get this done. Democratic Socialists of America has made the HSA their number one priority and as this post will illustrate, for very good reason. If you want to get involved in advocating for the bill, click here to reach the Health Security for New Mexicans Campaign. The site has information about the bill, how you can donate or how you can get involved. And now….a post that will motivate you to get involved.
Health Insurers Cost Lives. Lots of Them & You Could Be One of Them
We start with a report from CNN. Before examining how common denials of claims can be, a case study from a CNN report. Kate Weissman, a 33-year old who was diagnosed with 2B ovarian cancer, underwent 55 rounds of radiation, 17 rounds of chemotherapy and surgery to remove cancerous lymph nodes. But the cancer spread to her paraaortic lymph nodes, tucked behind the bowels and lying in front of the lumbar vertebrae and doctors felt that the the only treatment that could save her was proton beam therapy. Her medical team five of whom teach at Harvard Medical School and one who is the world’s foremost expert in proton beam therapy, felt that the standard treatment would likely kill her and recommended proton beam therapy.
Kate’s Situation is Rare. Irresponsible Insurance Denials Are Not
From a report from CBS news: “A recent survey entitled “Not What the Doctor Ordered” from the Doctor-Patient Rights Project (DPRP). Health insurers denied coverage for nearly a quarter of the Americans with chronic conditions or persistent illnesses. In a third of the cases, these patients, all of whom had insurance coverage, said their conditions worsened after being rejected.” Furthermore, survey respondents who were successful in making appeals, indicated that in 30% of the time the delay in getting approved was three months or longer. If you are Kate, you do not have three months.
Also from the CBS report: “As denials and interminable delays rose, about four in 10 health insurance policyholders said their opinion of their insurer had declined, according to the DPRP. Only one percent said they trusted their insurer’s judgment. The DPRP study said that insurers have, in effect, usurped the role of doctors, and so can make their own determination as to whether a treatment is medically necessary. Insurers now tell a patient what and how much treatment he or she can have, with what drugs, and for how long.” Click here to read the CBS report. One percent!!! Even Donald Trump is more trusted than that.
How do they get away with this? The graphic at left depicts precisely how. Insurers would rather spend billions to lobby Congress and support candidates who will protect them than to pay for care that can minimize the impact of chronic conditions or, as with Kate, to save a 30 year old woman.
From an NBC News Report. A surprising number of patients have been in the middle of costly treatment for a serious disease only to have their policies canceled, sometimes even retroactively, and found themselves responsible for astronomical bills. It’s called rescission.
In a conversation with William Shernoff, the senior partner of Shernoff Bidart Darras, a Claremont, Calif.-based law firm that represents insurance policyholders, NBC found: “It’s a secret program that if you have a serious illness … or are on costly medications, when they get the bills, they go through [your file] and look at your application … and get medical records from the last several years. And if they find an inconsistency in your application, even if it’s an honest mistake, your policy is rescinded,” says Shernoff. “It’s a very harsh punishment visited upon a lot of people.”
Shernoff mounted a class action suit against Blue Cross in California and Blue Cross was fined $1 million for rescinding 6000 policies retroactively without even reviewing the policies for justification. I might add, that $1 million is chump change for Blue Cross.
This is the ethos of capitalism: make a profit at all costs to your customer. Lie, deceive, delay, dissemble, but no matter what–make a profit. How much of a profit? Enough profit to pay CEOs obscene salaries.
It is time to begin dismantling the capitalist economic model piece by piece and one place to start is by removing health insurers from the healthcare equation. Share this post with friends, reach out to The Health Security for New Mexicans Campaign, send a check, agree to host a house party, get trained to door-knock, but we are all dependent upon our health and while we care, insurers don’t.
Another takeaway from this post relates to something reported n Tuesday’s post when I made the case for supporting MLG for governor despite her ties to gas and oil. I stated that your vote is not an affirmation of full agreement with her positions, but rather a vote to create the political environment in which you want to operate for four years. While likely requiring HEAVY pressure, MLG is far more likely to sign the Health Security Act than Steve Pearce.
Paul & Roxanne