
(Photo of an actual sign in the UK, via hugovk.)
In the insurance industry and in insurance litigation of claims, there is no phrase that is used with more stigma (and, frankly, misused at times by folks on both sides of the cases) than "bad faith." It is also the phrase that scares the bejeebers out of insurance boards of directors and investors, and can make millionaires out of lawyers on both sides of a case.
I don't often use the phrase as a result of all of this — because I think it ought to be reserved for the sort of truly egregious behavior that needs to be called into question in the strongest of terms. And today, I open the NYTimes business section, and find this:
After more than four years, Mrs. Derks, now 81, has yet to receive a penny from Conseco, while her family has paid about $70,000. Her daughter has sent Conseco dozens of bulky envelopes and spent hours on the phone. Each time the answer is the same: Denied.
Tens of thousands of elderly Americans have received life-prolonging care as a result of their long-term-care policies. With more than eight million customers, such insurance is one of the many products that companies are pitching to older Americans reaching retirement.
Yet thousands of policyholders say they have received only excuses about why insurers will not pay. Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state.
"The bottom line is that insurance companies make money when they don’t pay claims," said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. "They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die."… (emphasis mine)
Now, I have no idea what the insurance contracts say in these cases with these particular insurees. But I do know this: taking advantage of the elderly, whose terror of watching their fixed income dissipate under the sheer weight of increasing energy costs, and the rapidly rising costs of prescription medications and health care is unconscionable. And when you add in the "hard sell" practices that many of these companies do ("do you want to be a burden to your children, ma'am?"), the word "scam" just leaps to mind for some reason.
For every person out there who has ever bitched about the scourge that is a "trial lawyer," let me ask you this: If your elderly parents had paid for long-term care insurance, planning ahead — or so they thought — to deal with increased costs and care needs as they aged, and then had the insurance company give them the run-around about paying a valid, sincere claim after all those years of premiums being paid to the company, how angry would you be? Would you say words such as "fraud," or "bad faith," or even "scam?" I think I might.
And if you think for one minute that each and every one of these companies are going to hold themselves independently accountable out of the goodness of their hearts, I've got some oceanfront property in Arizona to sell you. Not all insurance companies operate in a smarmy way — a number of individual agents that i know are caring, decent people who work hard for their clients. But the few rotten apples out there — especially those who would take advantage of the nation's elderly to make a quick buck, hoping to hold off on paying a claim until after their insureds kick the bucket? That is just scummy at the highest possible level. Accountability on this one, please. Now.



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Fitz!
So much bad faith, so little time….
WAXMAN!
This company, as it states elsewhere in the piece, has already gone bankrupt once because it could not pay its claims.
This problem should be viewed alongside the subprime mortgage industry.
People are making money off the poor. They make the money, then go out of business. And the poor are left with no coverage for the healthcare they paid for. And no house when the mortgage payment goes up beyond their means (and the housing prices go down beyond the mortgage they’re in hock for).
Always look at the larger picture. These things occur because there is no oversight. In a climate of no oversight, the thieves go after the poor and the naive. The poor and the naive get poorer. And the rich simply take the money and run.
And all of this is supported and endorsed by the political cronies at every level of our corrupt system.
The whole system is rotten. Good people are leaving government. And unless things change radically, the good people will stay away from government.
I wonder if a couple of charges of conspiracy to commit murder by neglect charges could be sucsesfully filed against them.
That might make their asses pucker.
EPU – O’Reilly at LeonPanetta.Org LINK
This site is on fire today…
Must get some work done…
Oh well. Another day of intellectual stimulation among equals. Thanks
Jim Clausen @ 6
Good idea, get some work done today, spend Wednesday watching the Waxmen hearing.
They’ll tell the insurance commissioners what the commissioners want to hear. And if the commissioners are elected, guess who donates most to them? (Look at the other insurance companies. They want it required for driving, and for housing purchases, but they don’t want it to be used by the purchasers. That’s extortion, not insurance.)
We need oversight, and we need honest regulators. (And regulators who will yank the papers of corporations who persist in things like this.)
Neil @ 7
I tell my students that we at firedoglake can analyze several problems at once.
I call it the University of Hamsher etal
My mother is in medicine, and she curses the insurance companies, every single day, especially when doctors prescribe treatment for a patient, it’s what the MD believes is best, but the insurance company seems to know better. Nope, you don’t need that surgery. Here, have a mint.
What I resent more than anything is paying more and more and MORE for health insurance and getting less and less and LESS back from it. Who here doesn’t have deductibles through the roof, and only going higher every year, along with the premiums?
And no, I don’t believe it’s to cover the cost of the uninsured. Worried about having to pay claims? Cut some of those CEO salaries. Some of these guys make enough to pay for the operations of THOUSANDS of uninsured people.
the insurance industry is pretty much despicable.
this much i learned when my house burned down: having a policy only gives you the right to sue the insurance company.
Here’s a thought: re-regulate the insurance industry and require companies to operate as non-profits.
Or just create a freaking single-payer universal system like virtually every other industrialized country has done.
Dealing with Blue Cross is sometimes frustrating. On my shoulder surgery, the result of a fall while hiking, I get sent questionaire after questionaire – do you have other coverage, are you SURE this isn’t work-related (!!!), why didn’t you go through the VA, etc. Meanwhile my physical therapist isn’t getting paid. Put that on top of hospital fees much higher than normal (Alaska), I’m at wit’s end. And I’m only 60. I can’t imagine having to deal with this crap if I was 75 or 85 or 95.
I would so so so love single payer. Cut out all that bureaucratic crap.
Anyone ever work for an insurance company? I have. Cheap motherfuckers. Low pay, awful benefits. You’d think you could get insurance through them cheap. HA!
I’m working in the litigation dept as a temp for a Gigantic Insurance Corporation. It’s appalling what I’ve seen here. People pay the premiums for as long as they’re supposed to – but when they file a claim they ALWAYS get denied. Always. Then the claimant, who by that time is probably going broke, has to find an attorney to get what the policy claimed it would pay.
The first time I saw an old lady “settle” with the insurance company for 25K (less attorneys fees!) when her deceased husbands policy was supposed to pay 250K I was sickened. Please don’t let your readers think that life, accidental death and dismemberment, LTD or STD policies are worth any more than the paper they are printed on. The policies are worthless
Our insurance industry skews the social justice. spending 2/3 on administration on how to avoid paying for risks they are commissioned to take.
Thay are gaming the system and screwing America.
I explain it to my six year old through “Mr. Incredible” who is trying to help others in SPITE of the Bureaucracy.
Comey, Fitz, Leahy, Waxman, FDL…the truth please!
At last post Knut Wicksell said at 109
“Since Waxman is featuring prominently in this thread, is there any news as to the status of Condi’s response to his demand that she respond to his questions about what and when she knew about the Niger forgeries? The deadline was March 23. Would you like that tea with a subpoena, Ms Rice?”
Who came up with those Niger Documents? Micheal Ledeen, Rhode, Doulglas Feith. When will we see Phase II of the Senate Select Committee on Intelligence be completed? ( Senator Pat Roberts did his very best to delay and divert the completion of Phase II) Senator Rockerfeller we are watching and waiting!
When will we witness those responsible for the WMD INTELLIGENCE SNOWJOB accountable? This is the very least that congress can do for those who have needlessly lost their lives in a ‘war of choice”
Hopefully the Democrats do not need lies about BLOW JOBS to get them to do their jobs
DE-ESCALATE
INVESTIGATE
OR LOSE IN 2008!
FDL is a virtual think tank, according to looseheadprop. I agree completely. Everything here, every idea, is constantly in process, being analyzed and transformed.
Is this issue ever off topic at the lake?
Jim Clausen @ 16
I’d hate to have to explain this to a six-year-old, with or without Mr. Incredible. Kids that young have a way of seeing right through the BS.
EvilDrPuma @ 12
Evil Dr. Puma,
Keep in mind that NONPROFITS are part of the criminal conspiracy(oligarchy) that has raped Amerika.Think Grover Norquist and the ATR
Wait a minute, wasn’t this a movie starring Matt Damon? Based on a book by John Grisham? Rudy Baylor!
Sicko insurance companies. Sicko government. I don’t know which is worse.
Ed*ard Teller @ 13
My insurance company didn’t pay one of my surgeons for nearly three years. I saw one questionnaire–one. I didn’t like the questions on it. So I called them and told them, look, jerks, I paid my premiums for years and years, never filed on any of it. I needed surgery, I got it done. I even used one of your PPO doctors for it. Now pay the woman for her hard work and leave BOTH of us alone. And don’t you send me another damned questionnaire. It’s insulting to me and to the doctor.
OK, I’m going to put down the rice cakes and the FDL and get some work done. BBL.
OT, but there’s a release from Waxman’s Oversight and Government Reform Committee on requiring the RNC and the “Bush-Cheney 2004″ campaign remnants to preserve e-mails and meet with the committee staff.
Thought folks would like to know…
Biodun @ 18
fdl –
virtual think tank, uh, how about actual think tank?No offense meant, just that the term “virtual” can mean “imaginary.”
o/t
per the prior thread and mention of the long bankrupt and mishandled Native American trust funds -
seems there was a BIA(Bureau of Indian Affairs) trustee named Slonaker, who proved to be such a pain in Norton’s side that she demanded his resignation . . .
well lookee who was involved in his firing -
Wampum
This is why the Insurance Industry MUST be short circuited out of ANY discussion of universal health care. CONFLICT OF INTEREST.
Jim Clausen @ 21
Fair enough. I’m more of a fan of the second choice anyway.
Oh, and not OT in this case, it seems that Hillary is jumping back on the universal health care bandwagon. Without actually committing herself to any specific plan, of course; she wants to have another “conversation” first. I think I’ll put my vote behind Edwards on this one.
Oh damn, you’re making me very nervous. I just bought a long term care insurance policy. It’s part of the NYS Partners program. I hope it’s there if & when I need it.
How about this one from last Saturday’s NYTimes:
My bold.
Bugboy @ 28
Ah! The fox is guarding the henhouse?
This is why self-regulation is a euphemism for exploitation like voter fraud is Repug-speak for denial of voting rights.
Virtual, as distinct from brick-and-mortar. FDL, as distinct from Brookings Institution, or even worse, The American Heritage Foundation.
FishGuyDave @ 25
Leahy’s made a similar request. More and more, their staffs have come to realize the importance of reading comments at TPMMuck, Kos and our
virtualrockin’ think tank. If the Rethugs had known what a shitstorm was headed their way a year ago, they would have forced through Uncle Ted’s netneutralitycensorship legislation, no matter what.OT – Elizabeth Edwards on CNN, Tony Snow’s temp replacement on CSPAN.
From ThinkProgress:
Waxman Warns RNC, Bush-Cheney ‘04 Campaign: Don’t Delete Your Emails
Biodun @ 33
The American Heritage Foundation is neither American, nor a heritage, nor a foundation. Discuss.
Until we have a national health care system or at least a single payer system like that of some European countries (France is the one I am familiar with) we are going to have this type of abuse. As long as there is competition and profit involved it will almost invariably devolve too this. You cannot pay enough people to oversee the industry as it exists now. Trash it and do it right.
FishGuyDave @
25
Awesome. Leave them no place to hide.
As a provider I would love a one-payer system.
I would prefer Medicare for all. With parity for patients so that mental health is reimbursed at the same percentage as physical health.
Yes, this would mean providers would often get paid less. But there would be more care for more people. And people who go into healthcare should not be doing it primarily to get rich.
Only when it becomes clear that corporations are hindered in the international market-place because they have to pay so much for healthcare will they fight the insurance industry so that the healthcare is paid for by our taxes.
Caring for citizens should be a “right to life” issue. A right to a “healthy life.” A right to be treated as a human person from birth to death. Not an expectation of every latest treatment – we will have to be reasonable and ethical together about that – but compassionate, caring, ethical treatment FOR ALL.
OT, Evil Dr. Puma,
Are you in Iowa City? I’m in NE Iowa.
Did you read the Mc Clatchy article bringing up Matt Dummermuth, a member of the Class of replacement USA’s who worked in THE CIVIL RIGHTS division(also known now as decimated by resignations and the Voter Fraud division) Sorry no link but maybe a fellow firepup will provide.August 23 mcClatchy Washington paper
Anyone wonder why Mr. Bush made limiting punitive damages and restricting the class action law suit such priorities? Christy’s article about insurance company “Bad Faith” hits the nail on the head.
When an executive acts wrongly but in good faith, a company has insurance on itself that covers losses that result from that conduct. When an executive acts in bad faith, he isn’t negligent or reckless, he intends his wrong. That can sometimes void a company’s insurance on itself, making the company and the executive pay damages out of their own pockets.
Just as scary, intentional conduct can lead to punitive damages, which can dramatically increase costs. (Since they are meant to deter similar future conduct rather than directly compensate the victim.)
Intentionally wrongful conduct is often part of a business plan directed at groups, not individuals. Similarly situated groups wronged by the same behavior can pool their resources and sue together. That makes them infinitely more potent adversaries for large companies than the proverbial little old lady from Pasadena or her estate.
This administration’s policies are not one-off, nice to have items thought up in response to pressure from individual constituents. They are intensely brainstormed tools that form part of an integrated plan to acquire and hold power, in part by protecting supporters from liability for their harmful conduct. Do you mind if I smoke?
The Global Insurance Motto
“We’re there for you when you don’t need us”
Therapy at post #3;
“These things occur because there is no oversight.”
The laws are on the books to protect the public from this kind of sham, but the oversight is intermittent, at best, and industry-managed, at worst.
There’s one group of victims who represent the worst of these possibilities, our wounded veterans, whose lives are totally shattered, they are being cast out onto the streets and into homelessness, and no lawyer on Earth can plead their case for them because they signed all their rights away when the recruiter failed to read them the fine print.
Jim Clausen @ 41
I am in Iowa City…but congratulations on being in the northeast. There’s some great scenery up there close to the Mississippi. No, I haven’t caught the McClatchy piece, I’ll have to beg for a link.
great article which also references the NYT article cited by Christy at the linky:
http://www.tompaine.com/articl…..ht_mix.php
Fallenmonk @ 38
Yep. The reason “the market” can’t do healthcare efficiently is that it is more profitable to deny care than to provide it.
Contrary to the faith of market-worshippers on the Right, free-market efficiency is only oriented toward making money, not toward “doing everything better.” It provides a social good only if that social good is aligned with making money.
The notion of insurance for profit is a basic conflict of interest. Insurance companies are in making cash.
These are the bottom dwelling dregs of the business world, next to traders and other wankers in the financial sector who do nothing.
Redshift @ 47
Yep. The reason “the market” can’t do healthcare efficiently is that it is more profitable to deny care than to provide it.
Contrary to the faith of market-worshippers on the Right, free-market efficiency is only oriented toward making money, not toward “doing everything better.” It provides a social good only if that social good is aligned with making money.
Hear, hear. Well spoken, Bruce!
LJ/Aquaria @ 10
This cr*p is going on everywhere, and is frankly on the rise. It isn’t just for the aged, either. My 13 year old fractured a bone in his foot last year. The podiatrist recommended a walking boot, but forced us to sign an agreement to pay if the insurer didn’t – and of course, they didn’t. $399.00 for the boot, plus no evidence that the claim for the boot was ever even submitted to the carrier. My 15 year old is seen for annual check up. The doc notices significant acne, recommends topical antibiotic, writes us a scrip. Our Rx drug coverage doesn’t cover so ZAP, its $150 for a month’s worth of treatment. I read my coverage documents (have been practicing law for a decade and a half) and I still can’t figure out why this was not paid – was it not covered med or was this in satisfaction of a deductible. Its not clear. Now, boo hoo for us – its a pinch but we can afford the $500 bite for this, unlike a lot of other Americans. But what the hell are we getting for the 700.00 a month a 30.00 co-pay per visit charge? Not that damn much.
And don’t get me started on property/casualty insurers, or my former office partner’s trials and tribulations of dealing with California’s W/comp system – which seems to operate on the unwritten principle that everybody is full of Sh*t.
Redshift @ 39
One of my discussions with one of my wingnut friends last week (paraphrased):
ET – so you think if I don’t support the Israeli government 24/7, I’m supporting terrorism?
WN – yeah, they’re the only democracy in the ME, and our closest ally.
ET – do you think we’re supporting the terrorists by rejecting their medical care system?
WN – WTF?
I confess fellow firepups
I do not know how to link.
can someone provide the link for us Iowa connected firepups? McClatchy Aug 23 USA civil rights division article.
ps I love Mc Clatchy on this scandal
I was going to stick this in my comment From Waxman’s email:
”
Sachem515 @ 43
You forgot “…making sure you pay your premiums so we can invest them in shady stock market schemes that belly up, so we can then can raise your premiums to pay for that loss”.
Stand in for Snowblower is Dana Perino.
Remember when one person could go to work and support an entire family?
Remember when you didn’t have to decide between food and medicine.
Remember when there was light at the end of the tunnel.
We are all commodities and/or serfs to the corporate world.
Just wait for ‘08.
Ed*ard Teller @ 52
Snork. Which is why, when a majority of Israeli citizens–a slim majority, but a majority nonetheless–opposed that little adventure in Lebanese cluster-bombing, the Israeli goverment ignored them and did it anyway. Democracy at work in the Middle East, right?
Christy this topic reminds me of my ongoing conversations with my new friend my Afghanistan. When I have asked him and other International students what they believe to be this countries strengths and weaknesses, most of them end up on the same page. They often say that our education system is to be admired and respected. Many of them are in shock when they witness the way we treat our elderly.
They believe that we leave toss our elderly aside , do not listen to them enough and that our elderly are alone far too often. They wonder where is the respect?
OT– Dana Perino keeps saying over and over:
“we could have said we’re not going to talk to you at all”
um, no you couldn’t.
Kathleen @ 59– our treatment of the elderly is appalling and has been for a very long time now. We seem to have lost our respect, indeed. What kind of cultural values do we really have?
lost_nacf_gop @ 50
Don’t get me started on auto insurance in TX. Rates are tied not only to driving record and type of car, but also to one’s credit report.
What the F does one’s credit history have to do with insurability?
Just one last post before I resort to lurking again, anyone who believed the last few rounds of Supreme Court appointments were for the benefit of “social conservatives” should stop reading Pollyanna long enough to smell the sulfur emissions.
These “justices” were installed to protect the insurance industry, the health-care industry and the general corporate world as a whole, I’ve said it before, the Pelican Brief was only part fiction.
The stuffing of the courts, Supreme on down, with corporate protectionists in “strict constitutionalist” clothing has been accomplished with historic subterfuge and subtlety.
“They” did not need an assassin to clear the room of liberal judges, the moment Gore V. Bush “wasn’t” a precedent, there was no doubt “the fix” was in.
angie @ 60
They could, but it would have made an even bigger ricochet than the nonsensical conditions they did come up with.
Subpoena, and be damned!
Posts @ 44 and 42
Of course if you rig the justice system it doesn’t even make any difference if there is oversight. Because it will just get buried, along with the overseer. And whoever does the burying will be promoted.
I also agree about veterans. One healthcare for all would take care of this. That way, no matter how, where, or when they were injured, they would receive good care.
Imagine being a therapist at the beginning of this war, KNOWING both the moral jeopardy into which the troops are being sent and the PTSD, not to speak of the physical wounds, with which they would be returning. My heart was breaking long before these things came to light!
I am sure these people will need treatment, of many kinds, for life.
Oops, not August 23 but March 23
The former is the date GWB and Darth will resign in disgrace. Must have been a Freudian slip
Fallenmonk @ 38
This would be one of the first issues that Hillary would deal with. She had a solid plan back in the 90’s. The Republican controlled congress kicked her ideas and Health care plans in the ass.
EvilDrPuma @ 29
Well, I favor Edwards more on this as well, but I actually agree with Hillary that having a detailed plan is not necessarily a good thing during the campaign (just as with Iraq in the ‘06 campaign.) The final plan isn’t likely to look much like what’s proposed during the campaign, so a lot of detail is both a waste of effort, and gives opponents more nits to pick at.
I was also impressed that Hillary said clearly that she meant the insurance companies (among others) when she talked about how some people who were doing well in the current system were going to have to give up some of that. The health insurance companies are part of the problem, and anyone who implements universal healthcare is going to have a big fight with them. While it may be politically necessary to make them part of the solution (hopefully temporarily), I like to have candidates who recognize that while doing that may reduce the fight to a manageable level, it won’t it.
Boy Christy you hit a sore spot this morning.
I have a friend in her 50’s who just had to move home with her parents because while she has a job and health insurance she has a chronic illness that costs her thousands and thousands of dollars over and above the pitance the insurance companys will pay.
I’m so angry yet I feel helpless. Even Edward’s health care plan doesn’t help people like my friend. As long as the insurance companies are incharge of medicine in this country we are screwed.
We need single payer NOW
Meanwhile, Slate has a Gonzo-meter set up here. The meter, frequently adjusted to refect the latest revelation, puts today’s chance of a Gonzo resignation at 75 percent.
AZ Matt @ 54
I just thought of something else, have to get to somebody in Waxman’s office pronto.
Any Blackberry-originated/-received email actually goes through TWO servers. They need to snag the Blackberry server and compare all emails in/out to see if they match what’s been turned over.
Anybody got Waxman’s office on speed dial???
“Culture of life.”
Heh!
LJ/Aquaria @ 61
Of course, that’s all about prognosticating who is “more likely” to file claims. It ain’t a whole lot different from the red-lining on geographic grounds so prevalent in California’s not so distant past.
Oops, I meant March 23 McClatchy article on USA scandal. Aug 23 is the date dubya resigns with darth.. Freudian slip
Some years ago, we suffered extensive damage from flooding in Texas. One of the most important things you can do is to take video and pictures of everything you own and your property BEFORE a storm hits. Also, make sure you have a total replacement value clause in your policy. We fought the insurance company for over two years and were eventually paid. Right now as I write this, Austin is about to get slammed by just such a storm. The radar looks ominous down here and due to recent rains the ground is saturated. Heads up if you are in the area and good luck!
Neil @ 19
Can they subpoena Fitzgerald? When asked by Waxman to testify a couple of weeks ago. Fitz said he could not since Libby had not been sentenced.
I sure hope he testifies after Libby is sentenced.
Universal healthcare would also eliminate the cost to employers to provide this “perk” its something of a no-brainer.
If the Natl. Chamber of Commerce was actually more concerned about America’s small businesses than book-cooking, multi-national HMO-type health-care corporations, they would openly endorse public financing of health-care.
Take the cost of employee health care out of the bottom line and most small businesses would get an immediate boost.
Rayne @ 70
Ask, and ye shall receive…
Committee on Oversight and Government Reform
U.S. House of Representatives
2157 Rayburn House Office Building
Washington, D.C. 20515
(202) 225-5051
Go check out the elderly sign again. We need those here in the states!
With apologies to the many fine physicians who frequent FDL, I could not let a fine insurance bashing thread go by without mentioning the American Medical Association’s
bought and paid forLiaison Committee on Medical EducationThe LCME artificially restricts the number of seats that any US Medical School can graduate. The resulting shortage of MD’s in primary care, cosmetic surgery, and every other specialty also has a role in driving up the cost of health care. It also drives down the willingness of physicians to hold their peers accountable. This wholly unnecessary shortage of physicians also causes them to be chronically overworked and no doubt contributes to medical mal practice, which they complain about, as though it was someone else’s fault.
Mary McCurnin @ 57
One of the most infuriating op-eds I ever read was back in the late 80s, I think, by the head of that National Association of Manufacturers. His thesis, essentially, was that it was okay that wages were stagnant, because now that most families had two parents working, household incomes were up.
Just evil.
I’ve worked for local governments for 20 years and using private email for government business is NOT anything remotely viewed as acceptable practice on the local or state level. I can’t in my wildest dreams imagine that the Feds would have a loser standard.
FishGuyDave @ 25
Scanalicious. Exactly, Mr. Waxman, exactly!
FishGuyDave @ 77
Thanks, FishGuyDave…any chance you got a phone number for Chief of Staff?
LMAO loser, I meant LOOSER, must have been a Freudian slip!
Imagine the rate of return on a five hundred thousand dollar donation to Mr. Bush, his supporters, and the RNC.
Mr. Bush produces one, no, let’s make it three laws that cut the corporate donor’s taxes and the taxes paid by its executives. An initiative blocks a law that would make it illegal to incorporate in a beach-laden foreign tax haven while keeping all execs and decisions in the US.
A regulation delays increased scrutiny of the company’s activities, while an interpretation allows one donor to merge with another. A new law limits class action law suits, making it harder for individuals to join forces against powerful companies.
Another regulation limits the money juries can award, even if those now disparate individual plaintiff do win. A tiny budget cut makes less money available to report and index those cases, delaying access to them. And a final lack of self-regulation means that Senators can delay revealing how much money they’ve received from that donor until after an election.
Yes, Virginia, there really is a Santa Karl.
FishGuyDave @ 77
Waxman webpage contact
Is this the one Jim Clausen?
http://www.realcities.com/mld/…..962753.htm
While we are rightly focused these days on the Executive branch we also do need to keep a close watch on the legislative as well. The Senate just passed a budget resolution including the Inhofe amendment:
Inhofe Story
Now Christy I was really wanting to cash in on my beach front property when CA falls into the Ocean and global warming makes it so…..
I worked for 11 years as an RN in many of the Big insurance companies. When I stared in the early 90’s Aetna really tried to be the good guys as they were managing the employer health plans that really cared about their employees. I saw a dramatic change when Aetna bought US Healthcare. It was weird because the bad behavior of US Healthcare took over Aetna.
In 1995 my youngest son was hit by a car, lifeflight to trauma hospital with 15 day stay in ICU and Rehab. It was around $48,000 with three insurance companies involved. I coordinated with a claim payment supervisor to get all these claims paid but it took a whole year to finally get the books closed. I cannot imagine a layperson trying to deal with this situation and the repeat attempts by subrogation trying to get any proceeds from from legal action against the driver. I sent the police report that sited my son for the accident over and over again. In the end, I had to have a lawyer make them go away.
This is from the Committee webpage. Also includes an E-mail Comment form to send info directly to the Committee:
http://oversight.house.gov/contact.asp
Is it just me, or does it seem as if this thread is being deliberately bent away from the health-care issue?
This is an important thread, and anyone who has read me will tell you I am not one to complain about variegated threads, but to toss Fitz in here out of the blue, it seems manipulative, if not provocative.
Our credit histories are now used to churn our money through corporate pockets.
If you are late paying say an electric bill some credit card companies will raise their interest rates on their card. If you are late on bills then your insurance rates will go up in some states. If your credit gets bad enough you cannot find work. Background and credit checks are standard for almost any job. As is drug testing. The parameters for living the American Dream are narrowing to the point of excluding many. The power that this government has allowed the business community insures the destruction of our country. They are actively letting us die. They are actively poisoning us. They are actively looting the treasury. They listen and watch every move we make. F**k ‘em I say. That is why I use my real name on the blogs. I really have little left to loose.
TheraP @
3
Republican Family Values in action . . .
My fear is that we will get a “universal health care system” that is pushed through by the mega-corps who want to unload their employees onto the tax payers. It will be administered by the insurance industry who will rake off %-40 fees for “overhead”. Using an expanded Medi-Care structure with
JEP @ 76
I would also add imho, that it would put US industry on a more level playing field with the rest of the world. That helps the trade deficit, which is killing our long term prospects.
Off-topic, but, then ManOnDogRicky is always relevant….
Get ready, Sundance Festival, Santorum is going into production….
These may turn out to be the comedy hits of the year.
One of my rellies used to work for an insurance company. She’ll tell anyone who asks that we should go to single-payer.
Paul Wolfowitz…Wolfowitz
me @ 94..90% of my comment “went away”..I just got a new Mac..I guess I have some problems to solve.(maybe it’s better it went away, it was a rant about “corporate murder”)
Well, the framing has changed from “universal health CARE” to “universal health INSURANCE” shortly after Bill and Hill failed to get it passed under the former framing…
Amazing, how a single word can empower and inspire an entire industry of book-cookers.
I work in healthcare myself. The drug prices are highway robbery. And dont’ get me started on medicare part D. Sometimes it work, and the donut hole that has become standard in a lot of insurances? Ripoff and then expecting someone on a fixed or low income to pay those prices? Um yeah.
Meanwhile, New York Magazine today has something on the young and uninsured:
Individual cases worth a read.
I had an ER visit claim denied by my insurance company, several years ago.
“We don’t regard migraines as ER-worthy.” It was the first migraine I’d ever had, and I didn’t know what was going on.
I asked a nurse where I worked about that. She said, “Well, you were vomiting for hours. You got dehydrated. Left alone, you could have had cardiac arrythmia and so forth. Much cheaper to give you a shot of Imitrex then to treat you for an MI.”
I told the insurance company this and they changed their minds.
lost_nacf_gop @ 72
I’d still like to know why TX wanted a pink slip for the car before I could get a TX license. (Moved from CA to TX, then a few years later back to CA. I’ve voted against Shrub three times.)
Amen katymine – we chose Aetna then over less expensive HMO’s -
me – premature labor and a private room (due to infection risk) for a month at a major hospital
baby cbl – 1 week in an intensive preemie nursery and a month in an intermediate care nursery
hospital bill = $317,000
“patient responsibility” = -0-
oh yeah, things have changed
OT, Ruben Navaratte has a rebuttal on CNN.com for the piece he did that Pach took apart. It has really gotten under my skin today.
http://www.cnn.com/2007/US/03/…..index.html
If you have any type of insurance policy also be aware that your policy contract can be sold to another insurance company at some later point in time….
Waxman has been having hearings today on the high cost of bio-tech drugs. The hearing is over but statements have been posted.
Bio-tech drug hearings
One case from New York Mag:
Margot @103
The shear number of denied ER claims has caused states to enact Reasonable Layperson laws which state if a layperson would perceive the situation is urgent then it should be paid BUT now the insurance companies are downcoding them. That is the latest scam. Several of the big boys are being sued in a class action case where Signa and others were downcoding Physician visits and other care.
Downcoding works like this, the MD bills with CPT code of 99243(high tech visit) for $130.00 but the insurance company pays for CPT 99214(general 15 min visit) which has a contracted PPO payment of $30.00. Now in the real world and if insurance commissions really do work, the patient CAN NOT be balanced billed because it is against the law. But how many “Laypeople” know that?
Just found out that my PPO Dentist was balance billing me and my two adult kids and raked them over the coals. In AZ it is against the law. Gee that $245 buck bill just dropped to Zero!
I agree with the general sentiment about insurance companies, but I have to say that we were treated fairly on a couple of claims (home, auto).
I remember my mother telling me about the insurance she had (from my father’s company). It started out as them paying everything that Medicare didn’t cover. Then it became 80% of what Medicare didn’t cover. Then they started saying ‘Oh, well, Medicare covered that, so we don’t have to pay anything.’ And she had to pay what the insurance should have covered.
Iglesias on CNN now…
We are rich enough country to provide for young and old. Chosing between the two should not happen.
Has it occurred to anyone else that the way we run our economy amounts to a system that in myriad ways provides discounts for being rich? And the poor pay premium prices? I mean, think about it. If you’re rich, you get lower interest rates on loans, and higher interest rates on savings. You don’t have to pay bank fees if you keep a minimum amount in your checking account. Ever seen advertising on the sides of new, upscale apartment buildings that offer no move in costs? How about buying in bulk for cheaper? You have to be rich enough to afford a certain standard of living before you can take advantage of those lower prices. You have to be able to afford and keep a car to get to the suburban areas where grocery stores or big box stores are. You have to also have a car to transport said bulk items. And you have to live in a large enough dwelling to provide storage for bulk items. What other ways do we routinely offer discounts for being rich, or premium pricing for the poor?
A whiule back, during the immpotent 109th, when Congress looked into the scam about rising health-care costs, there was a small booklet that was handed over to be included in the public record.
There was no attempt to convey the message in this report to the public, even in a short synopsis, despite the fact that it held the key and clues to what is really happening beneath the covers.
The report was titled, simply, “Synthetic Drugs.”
In that report hides more answers and illumination than we have ever been given access to, and if FDLers know anything about its contents, please elucidate for us, because if there is any one issue we should try to influence, it is this one.
TheraP @
3
The Hartford Courant had a story last week about a firm in the subprime market that had gone bankrupt and even as the lawyers were liquidating the old firm, the principles were setting up a new firm in the same office building to offer mortgages…
Bugboy @ 81
I’m a Federal employee. We can check our personal email accounts (Yahoo et alia) on our time — i.e., lunch or breaks. We cannot use our personal accounts for Federal business. Period.
Another “funny” insurance story. I just got off the phone with the insurance Co. I had emergency eye surgery two months ago. It was “out-of net-work”, I had the option of waiting until the next day for an in-net work “OR” time. I figured since half the vision in my left eye had gone black in 6 hours, waiting 18 more hours was not a good idea. The insurance paid $540 on a $16,000 bill. If I had been traveling in another state they would have paid most of it.
The response was basically “tough shit” but you can file an appeal. I asked if it would be easier for me to bypass their appeal and go directly to the state Insurance Commission for mediation. They suddenly got a lot nicer. We’ll see what happens.
Ed*ard Teller @
26
Net-webbed Think Tank?
Virtual Link Tank
Canadian friends in Toronto & Midland, Ontario figuratively shook their heads when I sent them your post, CHS, & sent me this re: their health plan:
OHIP
Katymine @ 110
Are you saying that if you go to a PPO provider that they are not suppose to bill you the balance after the copay? Or did I read this wrong?
AZ Matt @
90
Thanks for the Oversight Committee info, Matt.
Sure sounds like they are busier than heck there, can’t get a warm body, was put on hold, may have to call back in the morning.
Heh. I guess that’s what real oversight looks like.
Mini rant here. I really am tired of tepid steps toward solving our health care crisis. Start with the children. Prescription drug coverage for the elderly. These are tested population segments that get sympathy. (Old advertising saw…you can never go wrong with cute kids and puppies. Guess that includes grannies too.) God forbid our politicians advocate for full-out reform, that includes those not-so-cute, unsympathetic age cohorts that raise and care for those cute kids, and are also caring for all those deserving grandparents.
But wait. A few Dem presidential candidates do. Edwards, Gravel, and Kucinich. Not sure about Obama, but he’s promised something in the next couple of months.
Clinton, Biden, and Richardson, while offering up no plans, have made comments. Tepid steps. Start with the kids. Richardson moves on to uninsured adults next.
As Christy’s post reminds us, even insured adults are getting screwed regularly by the insurance industry.
This is a crisis. Edwards has stated that we need to move now, with bold steps. Believe Kucinich is there too. As for Hillary’s deal that it’s not wise to offer specifics, bullshit. She’s triangulating again. Dazzle them with my ability to diagnose the problem, but don’t piss off those centrist voters who might be squeamish about “socialized medicine.”
Rant over. I feel moderately better.
Making it difficult, if not impossible, for elderly to access their long-term care policies seems to be what it’s all about. Yes, there are some good eggs out there, to be sure, but being vigilant about getting policies honored is essential in my experience.
When my father’s mind started slipping, I started my telephone calls to the long-term insurance policy provider he had been paying for
20 years. I was given the total run-around. Without exaggeration, I spent at least two days on the phone to track down how he could get coverage. The company he originally bought into, was subsequently bought out by another company and yet another. Of the three companies, each time I called one of the entities (all of which still exist), I was referred to the other one. Finally, when I began to show my frustration (read=I began to sound like I might be someone to be reckoned with or who knows, even a lawsuit in the offing?) I got a person willing to spell out the requirements for my father to get his deserved coverage. Ultimately, the policy kicked in when my father started to reach two of the 6 requirements for getting coverage. (But don’t think that your average senior assisted living place will get covered, ’cause it won’t unless it meets certain requirements!)
Happy ending in the sense that the company did regularly send the check covering the equivalent of $100 per day for his care in an Alzheimer’s assisted living residence.
Lesson? Persistence is the better part of valor.
Sleepless in Seattle.
A similiar post over at Dkos:
Murder by Spreadsheet: Insurance industry targets elderly by nyceve over at the DKos
Link
Twisted Martini @ 106
I see we’re all “condescending liberals” and all because Pach noted that he was about 10 stories behind the curve in acknowledging the facts. But they seem to be finding him anyway. Stand back; his head may burst. Wail ’till he finds out about Rove.
Rayne @ 124
Sorry, Rayne, I tried to get the direct line, but couldn’t find it. Sounds like Waxman might have to hire an extra staffer or two!
Rayne @ 124
Put a note into the E-mail comment section for the committee.
We all are aware that Karl Rove endangered our national security by participating in the leak of Valerie Plame’s identity.
Now, it appears that Karl Rove may also be putting our nation at risk by using the RNC email server for government-related work.
Here’s a comment from TPM Muckraker that really cuts to the heart of the matter:
————————————
Consider the National Security angle here too.
Karl and team was purposefully lobbing e-mails outside of the government provided White House systems. And the story has been in the press for two weeks – identifying the RNC servers and their locations.
Might foreign intelligence services have already paid a visit to some of these servers to see the 95% of government government business that Karl and Co was doing through that server?
http://www.dailykos.com/story/2007/3/24/172031/681
Posted by: Citizen 92
Date: March 26, 2007 01:43 PM
Advice from New York Mag:
Other resources at the link.
punaise @
121
Online ThLink Tank?
Read over at Kos where Waxman has told the RNC and Bush/Cheney 04 to hang on to emails from the White House. Henry’s smokin’!
hell, we’re gonna need an extra Henry or two to get through all this – to the Cloning Pod !
FishGuyDave (129) — yeah, I’ll bet there will be a run on auditors for a while…never thought I’d be so glad for auditors!!!
AZ Matt (130) — I asked about email; the person I spoke with said it would actually be faster to speak with someone.
Not to worry. I will get a warm body by the end of the day.
Celtic Music @ 134
here’s the story from thinkprogress
angie @ 87
Thanks Angie,
Another reason I love this site. Collaboratopn!
Rayne @ 136
Go Girl!!!!!
fyi Tom Harkin holding hearings right now on cspan 3 on Fiscal Year 2008 National Institutes of Health Budget.
(booshco has cut the funding for NIH and other critical research– no suprise there.)
Last week’s hearing had NIH Director Zerhouni calling for expanding federal funding for embryonic stem cell research. Today’s hearing will include:
Battey, James Jr., M.D. Director, National Inst. of Deafness and Comm. Disorders
Li, Ting-Kai M.D. Director, National Institute on Alchohol Abuse and Alchoholism
Insel, Thomas R. M.D. Director, National Institute of Mental Health
Landis, Story C. Director, National Inst. of Neurological Disorders & Stroke
Volkow, Nora D. M.D. Director, National Institute on Drug Abuse
(Seems that the hearing is delayed so right now a replay of a hearing re: long term care and Alzheimer’s now)
Wow. David Stockman, ex OMB honcho indicted
for stock fraud…
Corruption
Jack
twolf1 @ 137:
Thanks for the link. Waxman sure isn’t wasting any time jumping on whatever new info comes his way, is he?
TheraP @ 3
So well said……it’s time for an extreme make-over on every level of gov’t here in the USA. Hell, demographics don’t lie, so expect a lot more of this in the next ten years when the Boomers really get cranked up, and have to tap into the system. Greedy crooks can be dealt with if we get a real government back in this country. One that works for the people…..I believe it’s not too late.
AZ Matt @ 139
Oh foo, will have to settle for the poor person who took my detailed message as Chief of Staff was out of the office in meetings.
But I did explain and leave the message; I may yet send an email directly to COS as well.
Keep your fingers crossed, hope they realize there’s a lot of virtual shredding going on even as we type here at FDL.
Unless we work to insure everyone (not just children or the elderly) I fear we are simply playing along with a gamed system. I was over-employed during Bill Clintons first term so I didn’t have nearly enough time to get all of the details as I watched the big insurance dollars beat his presidency to a pulp, but, that is what I felt like happened to him/us for even considering fighting for a shift in our nations health care.
I have been self employed for the last twenty years and would not consider any so called coverage available to me for under ten grand a year. And I am very healthy with no priors (as if that should make one damn bit of difference!) Anyway, I check out a few possibilities a year and remain uninsured because I think my money would find better odds in Vegas. (not that that is where it goes.)
Attention journalists: Want to learn about the nasty side of insurance health, home, auto, etc. Join up in entry level insurance sales seminars and learn quickly. That group of staff are the first in a long line of liars, just like military recruiters.
I hear Steve (an md.) when he worries about the side effects of universal care but can’t help wonder if we were all under the same plan that many corrections would take place a little more quickly with a larger unified voice.
Bay State Librul @ 141
“trickle up” justice
Celtic Music @ 142
No, he isn’t… and I like it!
angie @ 140
Harkin is my Senator.
Thanks for the info. I heard that Harkin kicks a## in the segment. Virtual Think Tank. Take that,right wing wulitzer
Stockman stockfraud linky
http://www.huffingtonpost.com/…..eagan-aide
about those e mails . . .
Henry is waaay ahead of ‘em
they are going to use this fig leaf to drag their feet . . .
http://en.wikipedia.org/wiki/Executive_Order_13233
too bad, it seems there was a bi partisan sponsored bill that passed the House overwhelmingly that repeals this – it is now in the Senate
Topanga-lib @ 123
You need to check your state laws and what your EOB says… EOB – explanation of benefits. I took my EOB’s into the dental office where the column that states “Patient Responsibility” which was Zero. Did the dumb blond act at first… gee you must of made a mistake here….. then hit them with telling them that I would notify the AZ DOI (Department of Insurance) about their practices. NO ONE wants the DOI notified. Seen the AZ DOI close down a local office of an insurance company for bad practices.
Also do not believe a provider who is Non-Network who says that they will waive the out of pocket if you bypass the PPO providers. THAT is a crime and they know it. Unless you get that in writing(which they won’t), DO NOT do it.
punaise @ 146
Ah yes, the Stockman-Voelcker deathmarch from the early Eighties helped to kill my fledgling business enterprise.
Eureka Springs, AR @ 145: Spot on. See my post at 125. We must get beyond children and the elderly.
I, too, am self-employed (barely, lately). But I do pay for insurance. Good news: I live in NY, and state law mandates that individuals be covered. No ifs, ands, or buts. Bad news: It’s breaking me.
Thanks Katymine @151 for the info.
I have learned to check my EOBs carefully and I think in California everything that is left is the patient’s responsibility. Oh well. But I will remember your lesson for the future. Who knows
So why does Wm Kristol want Gonzales gone?
Ok– the cmte hearing I cited in my 140 is not being covered on cspan3 but they are playing a hearing from 3/20.
“The Senate Retirement and Aging Committee held a hearing on the state of Alzheimer’s disease research. Witnesses testified about the impact of the disease on individuals and families, the pace of medical research, as well as funding for scientific research and potential treatments.”
Margot @
103
Sometimes, you just have to know how to play the system. “Migraine” may not be covered, but “worst headache of my life” certainly would be. Go figure. When I have to write letters to insurance companies, I always find a way to say (truthfully) that the patient could die if they don’t pay for the damn test or treatment. I usually don’t have to ask twice.
Thank goodness we know so much about Anna Nicoles medicine chest.
Kathleen @ 155
Symbolic. With a body put on the fires of rage, Kristol thinks we dirty f*cking hippies will calm down and go away.
Um, no. Not likely.
Jane’s up.
http://www.firedoglake.com/200…..man-mowar/
John Casper @
79
Shrug. Bash away. There are a lot of good reasons why many physicians aren’t part of the AMA.
cbl @ 150
Speaking of “bad faith”, this is CLASSIC. Why in 2001 less than 8 weeks after 9/11 did George Bush need this Executive Order?
And why did they force out the National Archivist in a manner that was completely out of character with previous transitions of Archivists? (hello, politicized archives…)
montag @
96
It would be SO worth bringing back Mystery Science Theater 3000, just to have Crow and Tom Servo’s comments on lil’ Ricky’s master(ahem)work!
Redshift @
80
Back in the 1950s, Harvard Business School students argued the merits of moving the U.S. auto mfg. industry overseas to cut labor costs.
It was another of those “Slam Dunk” deals.
Deep in epu land here….
John Casper @
79
John, if this were accurate I would be very distressed.
The Liaison Committee on Medical Education is jointly accountable to the American Medical Association and the Association of American Colleges (AAMC).
Due to the politics of the times (70’s) the AAMC governance is comprised of:
Medical specialty societies (forgot acronym) -
Teaching hospital CEO’s (COTH) –
Medical school deans (forgot acronym). -
Students (OSR)
Each of the these four constituency groups is formally represented in AAMC governance and attends the annual/quarterly governance meetings of the AMMC.
From 1983-1987 (8?) I participated in the AAMC’s OSR. In the first year I represented was OSR from Hahnemnan University (now merged with Drexel). For three years I served on the OSR Board an attended the quarterly and annual meetings with the med school deans, teaching hospital heads, and specialty society chairs. When DC and the Washington Hilton were snowed in, we sat in the pubs together and drank.
That was during the Reagan years, and the AAMC governance was trying to figure out how to protect resources and restart growth in medical education.
At the time, the AAMC lobbied for more medical eduction funding, and we lobbied right along with the LCME. The LCME director came to our meetings….the same meetings where senior med school educators plotted to get more medical schools funded and built, and seemed to support the goal.
IF the AMA were directing the LCME not to support expansion of the number of medical schools, they appear to have failed to inform the LCME.
OF course, things may have changed a lot since 1987. Can you share any direct information from the LCME supporting the assertion that the AMA has directed the LCME to oppose medical school expansion?
I’m perfectly willing to believe the AMA would act (or has acted) to restrain competition in the past, but I just don’t have data toconfirm this account.
Cheers!
How about this for a 2008 health-care plank?
“It’s the insurance, stupid.”
The health-insurance system is the cause of, the basis for our health-care related problems. Just ask the hospital administrators, the physicians, and the nurses — not to mention the patients.
And then ask the people who made Medicare into an insurance-based system rather than a true single-payer system.
Don’t buy JC Penney Life Insurance. My father bought a $1000 policy for $15 a month at the age of 65, at 68 Jenney’s called on his birthday and he added another $1000 for $30 a month at 70 they called again on his birthday, he added another $15 a month. He paid $45 a month until he turned 78 when JC Penney called the mentally confused man and offered to buy him out for $600. My father paid Penney’s from his Social Security Check over $5000 for $3000 policies that they bought back for $600 saving the $3000 benefit….now, that is a scam.
This is probably posted too late but I got busy and just got to it this morning. Gar Lipow had an excellent post on single payer healthcare a while back at Maxspeak