After a brief hiatus during which I was busy enjoying the festive seasons, I'm back to writing about health care. There are two great stories from LA Times staff writer Lisa Girion describing reasons private medical corporations won't insure you. Also, we have some information about the newest "universal health care" plan to be proposed by a Republican Governor.
In her first story, Lisa Girion exposes into the health conditions that insurers deem too risky to insure.
Health insurers in California have been allowed to keep secret their underwriting guidelines that determine who gets individual coverage and at what premium.
...According to regulators' postings, rejection letters and interviews with brokers, conditions that can lead to outright rejection or a higher premium include:
AIDS, allergies, arthritis, asthma, attention deficit disorder, autism, bed-wetting, breast implants, cancer, cerebral palsy, chronic bronchitis, chronic fatigue syndrome, chronic sinusitis, cirrhosis, cystitis, diabetes, ear infections, epilepsy, gender reassignment, heart disease and hemochromatosis (a common genetic disorder that causes the body to absorb too much iron).
Other conditions are hepatitis, herpes, high blood pressure, impotence, infertility, irritable bowel syndrome, joint sprain, kidney infections, lupus, mild depression, muscular dystrophy, migraines, miscarriage, pregnancy, "expectant fatherhood," planned adoption, psoriasis, recurrent tonsillitis, renal failure, ringworm, severe mental disorders, sleep apnea, stroke, ulcers and varicose veins.
It becomes obvious that these corporations are only picking the very healthiest Americans. What a better way to "insure", pardon the pun, that they rake in record profits? Explained Bryan Liang, executive director of the Institute of Health Law Studies at California Western School of Law in San Diego, "The idea is to avoid all risk."
In her second article on private insurance in California, Lisa Girion shows that health care providers have a hot-list of occupations and drugs that they use to deny coverage to anyone and everyone who applies. What sort of affliction limits the ability of these folks to find health care? They either belong to the group commonly known as "the working class", or they take one of a long-list of popular prescription drugs.
Health insurers in California refuse to sell individual coverage to people simply because of their occupations or use of certain medicines, according to documents obtained by The Times.
Entire categories of workers — including roofers, pro athletes, dockworkers, migrant workers and firefighters — are turned down for insurance even if they are in good health and can afford coverage, according to the confidential underwriting guidelines of four health plans.
Although Blue Cross of California, the state's top seller of individual policies, does not exclude applicants based on occupation, three others do: Blue Shield of California, PacifiCare Health Systems Inc. and Health Net Inc. Actuarially speaking, they say, certain workers pose too big a risk.
All four health plans look at prescription drug use to decide to whom they will sell individual policies. Dozens of widely prescribed medications — including Allegra, Celebrex and Prevacid — may lead to rejection, according to the underwriting guidelines that the health plans provide to insurance brokers but not to the public.
The PNHP response to this article says it best: "Cream-skimming, cherry-picking policies are great for the insurers...but protecting the markets for private plans is terrible when it is done so by destroying the risk pooling function of insurance...We desperately need an equitably-funded universal risk pool."
We have several takes on the Schwarzenegger "Universal Health Care" plan. First, at the left-leaning American Prospect blog "Tapped", Ezra Klein takes issue with "a lot of hating on the individual mandate".
Some are complaining that the mandate "criminalizes the uninsured," others are saying "The uninsured shouldn’t have a financial penalty onto top of the health and financial consequences of being uninsured." So let me try and say this clearly: Single-payer health care is an individual mandate. The enforcement mechanism, in that case, is taxation. If you don't pay your taxes, you're breaking the law. If you decide to withhold the portion of your taxes that go towards health care, you're a criminal. In fact, there is absolutely no universal health care system that wouldn't include a mandate of some kind -- that's how you make it universal. Indeed, without a mandate, you can't have a decent health system: If the healthy can opt-out until they get sick, coverage will be unaffordable for everyone. For a risk pool to work, it needs members at low risk.
The question with an individual mandate is subsidization and affordability....(read the rest)
Next, California state Senator Sheila James Kuehl (D-Santa Monica), who chairs the state Senate Health Committee, writes an opinion piece in the LA Times (what is it with the LA Times?).
Four healthcare proposals are now before the Legislature, including one crafted by Gov. Arnold Schwarzenegger, which will be spotlighted in his State of the State address tonight.
Unfortunately, that plan and two others — state Senate President Pro Tem Don Perata's SB 48 and Assembly Speaker Fabian Nuñez's AB 13 — are short-term solutions that have the potential to expand coverage but at the end of the day can't be relied on to achieve what 80% of Californians say they want: a government guarantee of access to affordable healthcare coverage in the state.
The fourth proposal before the Legislature is SB 840, which I wrote last year. It is the only proposal that establishes universal, affordable, comprehensive health insurance for all Californians and guarantees the right of each patient to choose his or her doctor.
SB 840 would replace insurance companies with a statewide trust fund that collects premiums paid by employers and individuals, who together would share the responsibility for funding the program. The creation of a single state fund reduces the administrative portion of California's healthcare costs from nearly 30% to under 10%. With everyone in one pool, which spreads the risk as widely as possible, no one would be denied coverage for a preexisting condition. Individuals would be free to change jobs, start a business, go to school or start a family without losing coverage or doctors they trust.
SB 840 mandates truly comprehensive coverage; it keeps down the overall cost of healthcare; and it specifically limits the out-of-pocket costs to individuals.