Full disclosure: I qualified for Medicare a year and a half ago. I had a terrible time with that. Everybody knows I am not disabled and I certainly am not old enough for Medicare. Sure, I was born in 1942, but what the hell does that have to do with anything? Medicare is for old folks. I am not an old folk. It is that calendar thingy.
But it turns out to be a mandatory calendar thingy.
In general, if you hit 65 (the idea I am even close to that is a vicious lie, the calendar is just wrong) your insurance company will bid you adieu and send you on your way. I had to send in two pieces of paper: a Medicare form and a copy of my birth certificate (why they needed that, I do not know; they had been collecting money from me based on my Social Security number for decades). But I sent them in. Bingo, I was an official Old Goat on Medicare.
Then I suddenly needed serious surgery. No delays to get pre-authorization. No issues about preferred providers. I got it. It was paid for. Push, pull, click, click. Done and dusted.
I have clients who had the same surgical procedure who were not on Medicare but had private insurance, or thought they did. They have been unbelievably waltzed around. They have been mercilessly hounded by creditors for bills that should have been taken care of by companies to which they paid good money for protection.
Some employers take money from their employees’ paychecks for health coverage that is only as good as the employer’s word. Do you remember Lumberjack, the company that used to be at the southwestest intersection of Highway 44 and Airport Road in Redding? They took money out of their employees’ paychecks every month for “health insurance.” It turned out they had no insurance at all, but had some kind of self-insurance program. It ended, of course, when the company went into bankruptcy. The employees who had been counting on that program were left high and dry.
There is a funny thing about government-provided health care. The highest satisfaction rating from people who are insured goes to a government plan: the Veterans Administration. For all its problems, people who get their health care through the VA like it better than any other group likes their health care provider/insurance carrier. If you want to check this (I know – Walter Reed made me pretty skeptical at first), try Googling “VA satisfaction.” I found several articles published in a number of journals between 1994 and 2006 that support this conclusion.
Have you heard of a man named Wendell Potter? Mr. Potter recently testified before the Senate Commerce Committee. For 20 years, he was an executive in some of the nation’s biggest health insurance companies, most recently CGINA (a company created when insurance giant Connecticut General merged with insurance giant Insurance Company of North America). He detailed all the efforts the insurance industry goes to so it can bank a healthy percentage of the premium dollars it collects every year.
He told the committee that any health insurer that paid out more than 79 percent of the premiums it collects in claims would watch as the stock analysts trashed the stock and the stock price tanked. Note we are not talking about 79 percent of the company’s total income, which includes the interest it earns on the money it collects from policyholders.
That should make you feel warm and fuzzy all by itself. Your health insurance company takes all its policyholders’ money, invests it, keep the earnings and still pays out no more than 79 percent on claims or its stockholders will take a huge hit. It feels so good to know that you might get back up to 79 percent of what you pay in. You have better odds than that at a crap table.
Mr. Potter described in detail how insurance companies do that. One primary method is to get rid of anybody who really needs health insurance. They do that simply by raising rates until you cannot afford them anymore. As long as you are healthy, they are happy to take your money. But if you develop any kind of significant health problem, they start looking for ways to abandon you. You can also see this in group policies that are kept by small businesses. If the group starts using the insurance much, the premiums go up. When your health insurance comes up for renewal, whether your policy is individual or group, expect the premiums to go through the roof if anybody on the policy has been truly sick.
The other scheme insurance companies use is to take an application that asks lots of questions about your history. They don’t check anything but just take your money until you have a claim. Then they get all of your medical records and go through them with a fine-tooth comb to find something, whether related to your current problem or not, to use as an excuse to cancel your coverage.
The Commerce Committee also heard from a woman named Robin Beaton, who had insurance (or thought she did) with Blue Cross. She developed a very dangerous form of invasive breast cancer. The day before her scheduled double mastectomy, she was told Blue Cross would not pay for her treatment because she had not reported two conditions that were in her medical history: acne and a rapid heartbeat. It took a year of begging and pleading for her life to get the surgery done. In the meantime, her cancer had gotten much worse. Sadly, this is not an isolated case by any stretch of the imagination.
I know I am glad I am on Medicare. I wish we all were. Even more than I wish I were not an official Old Goat.
This is the second of a two-parter. Click here to read Part 1: Refusing to Talk Honestly About Health Care.
Dugan Barr has practiced law in Redding since 1967. He has tried more than 200 civil jury cases to verdict. He is married and has five children. The offices of Barr and Mudford, LLP, are at 1824 Court St. in Redding and can be reached at 243-8008.
