Oh, those greedy, grasping insurance companies…
…with their junk policies before Obamacare came along and fixed it for you.
From an article in the WSJ by Edie Sundby, who suffers from gallbladder cancer and yet has outlived her original dire prognosis by years:
Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.
But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.
You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan””a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).
So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive””but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
Edie’s dilemma is not just about premiums being lower or higher pre- and post-Obama; it is about physician and hospital availability, which will affect people who buy on the exchanges, because (at least as far as I can determine) the vast majority of the exchange policies limit choice to doctors and hospitals in approved networks. And in many places the networks are far more restrictive than people’s policies were before.
As yet, most people have no idea about this consequence of Obamacare; it is the Obamacare boot (in more ways than one) that has yet to drop. So far I can’t recall seeing a piece from a pro-Obamacare pundit that factors it in or deals with it at all. However, I’m almost certain that if and when they do get around to acknowledging the phenomenon, they—and President Obama—will blame it (once again) on the insurance companies doing the limiting, and claim they’re doing it just to greedily maximize their take above and beyond what’s needed (although why this behavior should suddenly have taken such a jump post-Obamacare, and why many companies wouldn’t want to offer more choices than their competitors, and thus attract more customers, I don’t know).
But Obama and his progressive supporters will almost undoubtedly use their stock response that any and all negative post-Obamacare changes are not the result of Obamacare itself but are instead opportunistic grabs by the insurance companies wishing to screw customers still further. For Obama to ignore the math of how the insurance business actually works—that you can’t add coverage to a policy without increasing costs to the consumer, or limiting coverage in another area of that policy—is okay with many of his supporters, who don’t seem to understand the way insurance works, as well.
And if everything bad about Obamacare can be blamed on greedy insurers, the next step, of course, is to eliminate those insurers from the equation by going to public option or single payer. Public option drives out private insurers somewhat more slowly than single payer, but it tends to get there all the same.
I’ll close by reproducing here a response to Sundby’s piece from a commenter named Michael Kaiser (can’t figure out how to give a direct link to the comment, but it’s one of the earliest, on page 1 of the comments to the article):
No offense guy, but you have gotten much more than you have deserved. Over a million dollars spent on care at multiple world-class providers. And now you actually are complaining that you can not keep it all forever? Situations like yours are at the core of what is wrong with our healthcare system and our planet as well. We can not afford to keep everyone alive and well fed, etc. forever no matter what. Furthermore, end-stage care makes up a disproportionate amount of medical dollars spent. How much more do you think society–and ultimately it is society–should spend to try to keep you in the 2%?
Aside from its intense mean-spiritedness, it shows a complete lack of understanding about how insurance actually works. Health care insurance has come so far from its basic roots that I suspect he may even genuinely not understand the simplest principles of insurance; hard to tell. But look for attitudes like his to become more and more prevalent and more frequently voiced: if you get something, you are by definition taking it away from me and you don’t deserve more than I get.
In this, as in so many many other things, we can hardly do better than to turn to the words of Winston Churchill. For “socialism” you can substitute “progressivism” if you wish:
Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.
[ADDENDUM: Excellent posts here and here by Ace.]
[ADDENDUM II: And Think Progress jumps in with the inevitable “She didn’t lose her insurance because of Obamacare, she lost it because of the insurance company” defense, thus missing one of the most important points of Sundby’s article (not that I think they really missed it; I think they purposely distorted it). Her problem is that the exchanges limit the doctors and hospitals that people can go to much more than most older policies do, and this is true whether you had a policy that was canceled (as Sundby did) or are coming to the exchanges for other reasons. She is warning people that money isn’t the only thing that will change about coverage, it’s access and choice.
The White House’s Dan Pfeiffer approvingly cites the Think Progress article. No surprise there, either.]
Socialism has been a great success in Zimbabwe. After 30 years of socialist rule, everybody is now a millionaire. Of course, 1,000,000 ZWD is only worth about 10 USD, last time I checked.
Reproducing the Volkish laws that ended the lives of the unprotected classes last century via Aktion T4…
our people cant “get” equivalence
they expect “equal” not equivalence
so they do not see the reproduction of the equivalents of the neuremburg laws that restricted jobs, education, medical treatment to the Volk, and rationed and impinged upon the non volk…
the “Nationalizers (Nazis)” are back…
cause they never left…
Wish neo would make a tiny attempt to list out the parallels in equivalence and homages, and imitations
and so we copied all this almost exactly
from the perversions of homosexuality in liberal behavior and theater of weimar, to the health care laws, to the nuremburg law copies, to gun control, and on wards.
multiculturalism is basically – Blood and Soil
as is protected classes = Volk.
meaning white males = Jews
(and jewish males are what?)
oh well..
Those who are not “approved”, will not be allowed outside to pasture. They will be sent to the slaughter house, led by the Judas goat.
To leftists, a simplified response:
If insurance companies are greedy now, weren’t they greedy before? And if they were greedy before, why couldn’t they pull this sort of crap? If they couldn’t pull this before, why can they pull it now?
It seems Obamacare has enabled their greed. Good job, Obama!
(Of course, all of this is specious…I just wanted to make an argument their tiny brains could understand)
neo: “But Obama and his progressive supporters will almost undoubtedly use their stock response that any and all negative post-Obamacare changes are not the result of Obamacare itself but are instead opportunistic grabs by the insurance companies wishing to screw customers still further.”
Never realizing, of course, that their logic is twisted. Should not the geniuses that wrote the O’care law and regs not have written them in such a way as to steer around the greedy insurance companies? If not, why not? The mental gymnastics required to place blame on anyone or anything but the dems and the administration are truly Olympian in their execution. Their hope is that, if they keep calling this wretched dog a cute little pony, eventually the majority will believe it’s a pony.
J.J.
That was also my point.
Everyone knows the left hates insurance companies. If Obamacare didn’t take their greed into account, it is another example of incompetence.
Some of the disingenuous left will know that it’s OK, because Obamacare was designed to eventually destroy the insurance industry. The well-meaning but naive left will be dispirited…you see, they weren’t invited to the conspiracy meetings.
This reminds me of the very great damage done to the left’s psyche when the Hitler-Stalin pact was revealed.
“We can not afford to keep everyone alive and well fed, etc. forever no matter what.” – Michael Kaiser
This type of response galls me, not so much because of the callousness – we’ve seen this on other topics before – but because of the built-in assumption that “we” are paying for care, and therefore “we” will just have to make those tough decisions for you.
Edie isn’t looking for a handout, a bailout, or for someone to keep her alive an well-fed, thank you very much! All she wants is to continue purchasing her plan that becomes illegal to offer in 2014 thanks to Obamacare.
And I would imagine Mr. Kaiser would also be just as unsympathetic to say, a 60 year old who would prefer to pay less money for a plan that isn’t larded up with unnecessary coverage like maternity care. Because we can be forced to buy something we do not want or may not need, yet “we” can choose to let someone else die.
The ultimate irony is that the nasty little commenter to the WSJ article probably threw pebbles at Sarah Palin when she predicted death panels.
As I toddle toward my 80th year, I am sensitive to the subject. I could probably accept that maybe society has the right to pull the plug for the common good if that is the way we want to go. But, if we are going to go that route, we need to be up front about it. There should be an open declaration that our government and other involved institutions will fund no treatment, other than possibly easing pain (or maybe not), for anyone over the age of xx; no exceptions for politicians, celebrities, or those whose contributions are now considered worthy of merit (geriatric Supreme Court Justices?).
Politicians should run on that premise. Prior to the cut-off, no restrictions. Of course there would be some inequalities in the crap shoot of life; because some could survive without treatment longer than others. So, maybe the next step would be mandatory euthanasia at a certain age so that old folks don’t continue to take up space and resources. How about it?
If 2014 doesn’t turn out well, I’m afraid the response will be widespread tax-dodging ala Greece.
“So, maybe the next step would be mandatory euthanasia at a certain age so that old folks don’t continue to take up space and resources. How about it?”
UK’s NHS already has that: Liverpool Care Pathway. The doctors don’t even have to consult or inform you or your family. Apparently NHS even set up an incentive program (cash rewards) in order to get hospitals to meet or exceed LCP quotas.
There is a tiny glitch ( a now PC-approved word!) in Neo’s article. The Patient had Stage IV GALLBLADDER cancer, not BLADDER cancer. Both are extremely bad, extremely advanced in their respective Stage 4s, and statistically quite lethal, with a great deal of suffering, like being on the rack.
Of the two, Gallbladder cancer is far more rare, directly invades things that make us work (liver, upper small bowel) and is harder to treat, even palliatively.
Be careful Michael Kaiser, you, too, could get cancer and if you do, you will beg that someone with more humanity than yourself makes the decision of what your mean, small life is worth in dollars and cents. If we judge by kindness, you are already a dead man.
Edie bought her policy and paid her premiums. She deserves good care. My heart goes out to her.
Let obama, his “wife” and their offspring be forced to sign up for these exchanges. He exemped himself because he knows it is a lousy trap meant to ensnare us in a totalitarian scheme.
We are the little people that he despises. I have learned from this forum that communists come in two flavors, those who want power over us and all our hard earned money and those who live in la la land and think that communism is for the common good. Obama is definitely the kind that wants power over us, our money and endless luxuries.
The great and damning sin in Edie’s story is often glossed over.
One of the problems with the current (or should I say former) health insurance industry is the govt meddling which prohibited inter-state sales of policies. Now, not only has Obamacare not solved that problem, but it has exacerbated it by making health insurance a county-by-county fiefdom. I read a story about a Philadelphia-area couple who can no longer use the doctors with whom they have a decades-long relationship because their physicians are in Delaware (a double Obamacare sin, out of county AND out of state).
“In theory there’s no difference between theory and practice. In practice . . . .”
Don Carlos:
Thanks, I will fix. Careless error of mine.
I actually knew someone who had gallbladder cancer and died of it in the 1990s (although he survived for many more years than expected). I remember at the time hearing how rare his case was.
Socialized medicine — European style — always cuts off such expensive — and ultimately futile — medical interventions.
This is buried in the back pages of regulations and budgets.
Dr. Ezekiel Emanuel has pushed this forward as THE way to square up the national medical budget — going back years and years.
It’s a difficult calculus, for such massive expenditures DO task the medical community.
When a patient is limited to their own resources, it’s impossible to shift the economic burden to the larger society.
We no longer abide by that restriction. Via the intermediation of insurance companies, it’s not uncommon for cancer patients to run up staggering bills even as the prospect of cure drives to zero.
This tendency is enabled to the limit with complete socialization of medical provision.
And in every nation, in one guise or another, death panels are empowered to play God — and jerk the plug.
While, at first, the process is pitched as being required for the financial viability, nay stability, of the system — without a doubt it progresses down from the extremes to the banal.
In too short a time, just being bedridden is cause enough to pull your plug. This has already been exposed in Britain. The administrators were being given kickbacks for terminating grandma! They did so by the tens of thousands per month!
We’re talking about elderly patients that were merely bedridden. The challenges of drinking fluids and bed pans were too much for the State.
I can’t imagine how America could not fail to fall into the same moral rut once the corrosive effects of 0-care cut deep.
Lest we forget, socialized medicine does not allow torts. The State shall not be sued.
0-care is a travesty of privacy, of coercive power, of crony capitalism, of cynical politics.
It can’t be made to run on time — i.e. by years end.
It’s chasing away the physicians. It’s a moral insult to their profession.
And, no one can explain to me where all of the additional premia are going to. It would seem that we are expected to sign up for policies that actually can’t pay out; that our destiny is to queue up forever. — The latter THE common trait across all socialized medical schemes.
I don’t think even the insurance industry can correctly price these new policies. Just too many variables are in extreme flux.
The President constantly pitches subsidies — but where exactly is THAT money coming from?
Am I to believe that the insurance industry is now a branch of the IRS — collecting funds that get shunted over so that some taxpayers get subsidies?
It all smacks of un-Constitutionality.
Is the IRS being used to collect insurance premia?
It’s a hairball.
I’ve not seen anyone address this bizarro mechanism.
Is it the case that the subsidies are merely a round about mechanism for rigged prices based upon how the PREVIOUS years income tax return was filed?
What happens when incomes rise and fall, when people lose their jobs?
It’s a hairball.
SWAT teams have been used to collect student debt.
It won’t be long now before the death squads are unleashed on uncooperative citizens that aren’t “paying their fair share”.
Great. You can ALWAYS find a one of to prove a point. As Republicans are fond of doing, they swing out a heart warming story or heart wrenching one in a lame attempt to counter the very intuitive idea of universal coverage.
And no, you were not truly a Democrat. People don’t change that much. A registered one maybe, but one in spirit, never.
SWAT teams have been used to collect student debt.
It won’t be long now before the death squads are unleashed on uncooperative citizens that aren’t “paying their fair share”.
*************
You’d like to believe that wouldn’t you? But it’s not true. It was to arrest an individual committing student loan fraud. Why do folks willfully misrepresent facts?