There really is more to this issue than meets the eye. They refused COBRA coverage because it was too costly and they could not afford it? COBRA will also cover all ongoing illnesses. But they chose to go to another insurance because they could not afford the premium. COBRA coverage is expensive is expensive because it continues your existing group coverage that was previously paid by your group and those premiums are now yours. Individual policies are pretty much the same, you can choose your level of coverage but it is your choice as to what you are willing to pay for. What is questionable is how long did they wait before they went to another carrier to obtain coverage. Because there is such a thing as creditable coverage that allows the period you are covered under your group policy to be applied to the pre-existing period if it is obtained within a certain period of time when your group insurance terminates. Then this would have never been an issue. Insurance companies are not evil, but you need to be an informed consumer.

The monies are refunded when a policy is rescinded.

First, Fanny and Freddie didn't screw up the housing market until after they were privatized. The problem there was that we privatized what was effectively a government created monopoly without eliminating the monopoly.

Second -- the key distinction of the public option from current non-profit insurance companies is that we'll now have universal coverage as a requirement. The challenge for the US government is to support very affordable options for the most economically challenged Americans without ending up as the "insurer of last resort" as private companies find ways to segment the risk pool. If the public option risk pool doesn't mirror the general population, it'll increase tax burdens.

Government efficiency can be debated, but in the end, if we end up with a public option that is sucking up huge public resources, we should call it for what it is: a tax break for insurance companies under the guise of an entitlement.

I completely agree that that information asymmetry makes pricing risk difficult -- same problem for any form of investing. But then you make a rather obtuse statement that companies will "either make the assumption that everybody is a horrible risk and premiums will rise accordingly or we'll see the complete collapse of the insurance market."

You've painted two complete edge-cases when in fact there is a whole spectrum of possible outcomes, all of which are more probable than the two outcomes you propose.

First, let's define universal coverage in the same terms you are using. I propose: "universal coverage will create a single health insurance risk pool comprised of all legal residents and citizens of the United States." I'm not sure who might get included or excluded from the final definition, but the key point here is that we're talking about a homogeneous risk pool.

The homogeneous risk pool completely removes your information asymmetry argument. Individual patient information is no longer the basis for either customer selection or pricing decisions. Similarly, the risk pool is defined as universal (with fixed and defined boundaries), so there is no further use for rescission.

Insurance companies will still have plenty of data to analyze to optimize their business. Billing, prescription, and prevalence of diagnosis and disease data is all available at the 5 digit zip code level for anyone who wants to pay for it. Just because companies are forced to offer insurance to all who apply doesn't mean that those same companies can't aggressively market to populations that are more attractive. Additionally, supplemental insurance will very likely become a highly competitive (and profitable) segment.

You make another misleading statement: "universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it". That's a hyperbolic statement seemingly designed to define the issue in an unsolvable way. 'Best' is completely subjective and too often correlated with expensive. The United States is by far the most expensive health care system in the world and yet health outcomes are no where near the top of rankings for basic metrics such as infant mortality, obesity, or life expectancy.

The most plausible outcome is a two-tiered system of universal coverage to cost-effectively provide holistic health care services along with supplemental insurance to provide ancillary benefits for people interested in paying for those benefits.

Universal coverage isn't rocket science and its not a new idea in the United States. Universal coverage for auto insurance is standard in the US (with a few exceptions like New Hampshire). In that case, a minimum coverage level is mandated, and consumers then add additional insurance to meet their level of comfort.

There is a lot we can do to improve health care, reduce costs, and increase coverage levels in the US. It pretty much all starts with everyone willing to assume that their currently entrenched position isn't necessarily the best answer.

I'm not saying that either party is right or wrong, but the parent claiming misdiagnosis with no proof deserves to be questioned

D

I hate to break you little capitalistic bubble, but every single insurance company out there is as cold-hearted as you have portrayed the "big gov't". I know this from first hand experience, and you would probably be quite surprised to see how often the terms "cost-effective measures" and "black box assessment" come up when determining the insanely complex quantifiers for health insurance rates and premiums.

Insanely complex. So much so that the people who wrote the original formulae couldn't even understand where to start separating out how the quantifiers interrelate.

And while a health insurance company doesn't have the "spear of the law", they do have the "ton of bricks of fiscal reality" that many people, such as the family in this post" have been clobbered by recently.

And as a final note, every single health insurance company operating in this country will AT LEAST double your premiums if you have gone without insurance for longer than 62 days, and have no pre-existing conditions. You'll likely get lower premiums with a pre-existing condition reported, but then you don't get covered for that condition. Most risk assessment these days does, in fact, assume that you are lying if you do not include some form of pre-existing condition, and any honest actuary in the health insurance industry would tell as much.

@FigNinja: Frankly, that sounds like a dream...were it only in place here already I would be overjoyed. Healthcare insurance should NEVER be about profit. That is where ALL of these problems have come from.

Get your facts straight before you make generalizations.

PS - Unions are communism by definition. Thought you might like to know.

Anyhow; you should probably read the bit where it was said that: "Dale Rice claims the firm cherry-picked the instances from different doctors' visits, and that Brianna had no ongoing health issues. He noted the dizziness to was due to a brief bout with dehydration, the fatigue a result of Brianna staying up late surfing online, and the elevated cholesterol due to an inaccurate test, and said her cough was short-lived."

@Notsewfast: I grow my own cancer at home.
But seriously, dillydallier, glad to hear you caught your cancer early and thank goodness you had someone in your life who could cover the other bills while you paid out the ass to treat it. It is unconscionable that hardworking Americans go broke every day trying to pay medical bills.

Now what would be sleazy is if the medical history was full disclosed, she was offered coverage, and the company pulled it once a large claim was filed.

That reminds of something that happened to a friend of mine. She was working as a consultant so she had to buy insurance on the open market. She's clinically obese. She clearly stated this on the applications. It wasn't easy to get coverage. They charged her several times more than what they would have if her weight had been under BMI 30 or BMI 25. Then when she started having some heart palpitations, they refused to cover her because her weight was a pre-existing condition.

This means that anything they could possibly tie to her weight even without a proven link would be denied coverage. They didn't tell her this up front. They charged her a massively higher premium on the premise that her weight made her high risk. How can they be allowed to do this when they had no intention of covering anything related to her weight? They should have just denied her a policy if that's what they were going to do all along. It may be legal but ethically it's quite fraudulent.

[consumerist.com]

Mistyped:

They actually have a mixture of non-profit and public. = They actually have a mixture of non-profit and private.

Germany has private insurers to supplement public healthcare.

They actually have a mixture of non-profit and public. They don't have single payer or a centralized national health. It's an interesting system and people seem quite happy with it. If you're working, you put in 6.5% of your salary up to a cap. I think it's around $80K/year. Your employer matches that. You choose from one of the many highly-regulated non-profits. Prices are set by a board of doctors and insurers. They pay the bills. I believe there are small copays, though. If you're not employed, the government pays your premium. So that covers children and retirees as well as folks who are just out of work. No pre-existing conditions or junk like that. You can pick your doctor and switch whenever you like. Dental is covered. I believe vision is, too, but I'm not sure. If you make above the salary cap, you can opt to not put into this system and buy from a private insurer. IIRC, 10% of the insurance there is private.

The per-capita healthcare costs there are 1/2 what ours are. Their government spends less per capita than ours does and they get better care and more choice.

@funchy: I was absolutely flabbergasted a few weeks ago when a statement for some routine blood tests was mistakenly sent to me. It's covered by insurance, and I usually get the results of the tests but not the pricing breakdown. The overall cost was somewhat in excess of $3,500. For some blood tests done in the doctor's office, and this was at a special rate between the hospital the doc is affiliated with and the blood test lab.

It's very easy to run up $20,000 in bills with very little treatment.

@mythago: Unfortunately, the insurance companies have a way of screwing you over even if you didn't go to a doctor. They have a clause that lets them turn you down if you had a condition even if you didn't go for treatment, if it was something for which a "reasonable" person would have gone for treatment. Also unfortunately, if OP's family takes this to court, the insurance company is going to pull this clause out to win the case. They'll say that with that collection of symptoms, a "reasonable" person should have gone for treatment.

The insurance companies have very, very, very well-compensated attorneys fighting for them all the livelong day. They have their terms and conditions very tightly wrapped up, it's really practically impossible to get around them. They'll always have some kind of legally-acceptable, morally-repugnant response to weasel out of responsibility.

There are two issues I didn't see mentioned here that are worth being brought up. From the info we have on this case, I don't think they are relevant specifically in this situation, but they're important points.

Issue one - IIRC, when an application form asks for your medical history, sometimes it specifies how many years back you need to report. i.e., "have you had any major surgery in the past five years?" This may not be the case for all conditions, but for those wondering whether they had to report every case of the sniffles back to childhood, I don't think that's the way it works. I assume there are some conditions that, unfortunately and unfairly, mean automatic rejection, but there are some conditions that aren't relevant to eligibility after a certain amount of time has passed.

Issue two - In some cases, and this may not be universal, an insurer may accept an applicant and subject them to a waiting period either for all coverage or for coverage for certain conditions. For example, you may be paying premiums for 11 months before they will start reimbursing you for treatment for certain pre-existing conditions. I had this situation, where I got insurance from BC/BS with an 11-month waiting period (known in advance). After 11 months of paying and paying and paying, the coverage finally "kicked in" and they began reimbursing me.

Both of these are YMMV and not universal situations, and may not be relevant to this family's story, but insurance eligibility and coverage for "pre-existing" conditions is a complex subject, not a black-and-white area.

Watch insurance companies start using obesity as a pre-existing condition under which they'll rescind coverage.

See everyone in the country jump on the public option platform.

@supercereal: No, it's the view from the top of the insurance firms, as explicitly called out in their Congressional testimony. Remember? When they were asked if they would limit recission to actual cases of suspected fraud, and they said no?

We don't have an equivalent option for that last bit in our health care system, right now. That's what the government needs to help make. The government option would not be better because we trust the government to do everything great, but because the private side of things has gotten too bad to go on with as is.

Thank god our daughter is healthy. That was such a stressful situation. It isn't your fault that shit is so messed up in this country, but I still blame insurance companies' greed for this spiraling out of control. Why do insurance company CEOs deserve to make several multiples more than Resident Neurosurgeons?

@Vandelay Import Export: "The space program is a black hole of tax dollars."

Funny you should say that. Know what the single best investment the US Government ever made was?

The microgravity pen. Anecdotal evidence from those who were there says it also saved a couple of good men's lives. And that's before we get into all the other massive benefits from the R&D in NASA's heyday. You know, things like a modern high-bandwidth global communications infrastructure? Maybe now that it's been gutted it's useless, but it actually provided a hell of a lot of benefit when it was taken seriously.

I DO NOT get this shit. We're practically at a point where we need insurance insurance!

How's that?

The menace of the public option

M.C. Blakeman

Saturday, September 19, 2009

Of all the current assaults on our noble republic, perhaps none is more dangerous than the public option - specifically, the public library option.

For far too long, this menace has undermined the very foundations of our economy. While companies like Amazon and Barnes & Noble struggle valiantly each day to sell books, these communistic cabals known as libraries undercut the hard work of good corporate citizens by letting people read their books for free. How is the private sector supposed to compete with free? And just what does this public option give us? People can spend hours and hours in these dens of socialism without having to buy so much as a cappuccino. Furthermore, not only can anyone read books for free in the library, they can take them home, too. They get a simple card that can be used at any library in town. No checking on the previous condition of books they've read. No literacy test. Nothing. Yet, do these libertines of literature let you choose any book you want, anytime you want it? No. Have you ever tried to get the latest best-seller at a public library? They put you on a waiting list for that, my friend. And if you do ask these government apparatchiks a question about a book, they start talking your ear off, and pretty soon they're telling you what to read.

Of course, if you break one of their petty rules and return a book late, you have to pay fines that mount grotesquely each day. Even if you die, your overdue fees keep piling up. Is that not a death tax? How long must the elderly live in fear of burdening their children with these unfair sanctions on their estates?

Don't be fooled for a minute. Somebody has to pay for these "free" libraries, and I'll tell you who it is, pal. Those good ol' suckers, the American taxpayers, that's who.

Have you ever wondered who's really behind this public library option? And don't you think it's fishy that they mask their nefarious activities with benign-sounding names, like Friends of the Library? What's their real agenda - and why do they have so many "volunteer" meetings, anyway?

No, my fellow Americans. We cannot wait until we're all goose-stepped into a massive book checkout line. This assault on capitalism and our very way of life has got to end. Be subversive ... burn your library card! Go out and buy a book!

M.C. Blakeman is the co-author of "Safe Homes, Safe Neighborhoods" (Nolo Press).

This article appeared on page A - 11 of the San Francisco Chronicle

Read more: [www.sfgate.com]

@Geekmom: Not only do we have private insurers in Canada, we have tightly-regulated recission rules. Basically, the insurer gets access to the records they need to verify the patient's info as part of the application process. The onus is then on THEM to find any "pre-existing condition" within 60 days. If they fail to do so, they're locked into the contract even if the applicant was flat-out malicious and lying about everything.

They still seem to be doing fine.

@DoodlestheGreat: But don't you understand, the Earth is flat!

I'm lucky for my insurance. A few months ago, my son got sick and we ended up in the ICU (he was only 6 months old at the time). We eventually ended up with nearly $100k (including a $2500 ambulance ride from one hospital to another 45 minutes away) in bills and my insurance has covered all but like $4k or so. The entire time, I was basically waiting for Aetna to deny all coverage and cancel my plan, since it happens to everyone. I suppose some insurance companies have souls to not deny coverage to a baby that almost died.

@shepd: No, equivalent health insurance in the US would be more than $2K, assuming you can get it in the first place. Most people have no idea what insurance actually costs because their employer picks up most of the tab as a benefit. The last time I was paying the entire premium (about 4 years ago), it was $300/mo.

@Vandelay Import Export: A den of corruption and patronage? I take it you never actualy went to college.

@kahanlon: Not true. People with Celiac disease can have complications, especially if it hasn't been diagnosed for several years. As Crunge pointed out, malabsorption of vitamins can lead to osteoporosis, as well as growth issues for children/young adults and opportunistic infections like pneumonia.

@shepd: If you'd like to learn more about the U.S. health insurance system, the Kaiser Family Foundation has a great website (though it might be info overload). I check it out frequently, and there's always something new. Latest fun fact: From 2000 to 2006, health insurance premiums rose 87% - 4 times higher than wages rose.

Health insurance varies by personal situation, but the biggest difference is between people on individual plans & people in group plans (usually employees, or students at university). Going solo is a terrible, terrible way to do it - but in a group, you become bound to that group. Graduate, change jobs, or make any major life change, and you have left the group, and any benefits you may have accrued. (Not so much financial benefits, but things like relationships with your doctors).

So $200/month premium might be average for someone somewhere in the U.S. but probably not. Here are some real stats:

If you want a super "low-cost", probably never use it plan, you probably will go with a high deductible. It's a gamble, because if you do need it, you're paying a lot later on. This is sometimes call 'emergency insurance' or 'catastrophic insurance'. KFF found that a single, non-smoking male would pay about $54 - $68/month premium, with a $4,000 - $5,000 deductible. So you pay ~$60/month and then keep paying for your doctor visit, prescriptions, etc until you hit ~$4,000. These probably do not cover dental, optometrists, etc.

That's the minimum you can probably find. National averages (which includes people in group plans): $10,880 per family in 2005 or $4,024 for a single worker.

Also, speaking from lots of experience with different U.S. plans and some abroad, even with spectacular health insurance here, you still pay for things that are covered. And you never know exactly what's covered until after you get the bill. The fact that where you work also determines if and how much health insurance you have is very bizarre, and creates medical ethics issues unique to the U.S, because of the strange artificial relationship between your employer and your doctor that doesn't exist in other places.

/sarcasm

So insurance companies are dicks. What a shock. But unlike the dicks who do this kind of crap within the insurance agencies, our well-run government will not do such a thing.

Yeah right. We will get the same crappy coverage if not worse from bureaucrats who will look to deny coverage whenever they can.

Have you ever tried to get your car fixed after hitting a pothole? The same people who look for a reason to say it was your fault for hitting the pothole will be the same people who will tell you that little sickness is not covered...

I f*cking hate insurance companies and I don't hate our government. But sitting here squawking how much better it would be with government run health care is foolish or outright misleading.

If it matters, to pay $11k in tax I make $55k a year. That covers my vermin infested (cat likes to prove it every few weeks) townhouse ($915/month + $40/month parking now), utlities ($250/month), food ($400/month), my wife (stay at home soon-to-be-mom) and debt payments, RRSP (equivalent to 401k, theres no pension at my work) leaving ~$800 a month to spare for everything else (including phone/cable/internet).

My total takehome pay is $8k below the average houshold in this region, although as a single earner that means I earn somewhat above average. As we cannot file joint income taxes in Canada, I lose that tax benefit which I'd have in the US.

I'd live somewhere cheaper than where I am now, but trust me, you can't go much lower in this city. I could save about $150 a month by living in a 1 bedroom apartment, but the last one I lived in also came with insect infestations. Yay...

BTW: Plenty of people in my city avoid going to the doctor because there's a serious shortage of them. Last I heard the waitlist was 3 years long to get a family doctor.

I really have no idea how medical insurance in the US works, but I had once heard that "emergency" coverage that would basically only cover what sends you to the emergency room at the hospital was in the range of $200/month. Apart from the doctor's visits that's pretty equivalent to Canada's healthcare system. If you're in hospital it's free. If your family doctor can take care of it personally (ie: No referrals to psychologists, etc) it's free. Apart from that, there's very few things that are free.

And family doctors aren't all that expensive. Considering my wife sees one every few months, I expect I'd be paying, at most, another $500 a year for the doctor's visits if I were paying out of pocket.

Not saying Canada's healthcare is useless, but I think people in the US don't realize how little it really covers.

@nstonep: For some of us, going to another country is simply not an option. Ever. If you aren't healthy enough to fly, there is simply no way to get there. Thankfully I don't have to worry about it as much now because I am healthy again. At the same time, nova, the fact that private insurance companies are "for profit" is entirely the issue. Want to fix this issue in a hurry? All private insurance companies should be required to file in non-profit status and any extra money left over at the end of the year is paid back to those that paid premiums, with an extra helping to those that weren't forced to use the insurance. And that is coming from someone who had to.

But you knew that.

- OR -

We should all get on the phone and call our representatives in Washington (202-224-3121) and DEMAND we get Health Care Reform NOW with a meaningful public option.

Indeed, these kinds of things are a marketing person's worst nightmare. Insurance companies don't want to deny claims, the thing is they are a bureaucracy. And by their very nature bureaucracies are efficient in dealing with large amounts of generalized work and information, but not efficient in resolving unusual or specific needs. In this case they went by the book and didn't look at the overall picture. What they need (and may already have depending on the insurer) is a quick response team that handles the kinds of issues that slip through the crack. People will be surprised to find out that less than 1 half of 1 percent of claims have this kind of problem, but the bad publicity from these can really taint the industry so they need to make sure they don't happen.

@Stephmo: I already know doctors to will only discuss things directly with their patients, and who will not document *anything* unless it is about to fall off.

This can't be the proper way to get a proper medical history.

I'd like to see some reform in the insurance application system. Why not require insurance forms to be filled out by a medical professional with access to a patients medical records, and then make the application binding so that insurance companies cannot restrict or deny coverage for any pre-existing conditions.

@RogerTheAlien: I knew there was a reason I hearted you, and there was a reason for me to stay the heck out of this thread. I'm so tired of the mud slinging.

I think this case more highlights the need for other reforms more than turning it all over to the government. This whole thing started when the family lost their job and therefore medical insurance. Why in all our omniscience did we decide that health insurance should be tied to employment? If its such a great idea, lets do auto insurance as well! That's the first thing to do - give the same tax benefits to individuals buying their own policies. Find some way to break that connection.

Second, make a law that you cannot be turned down because of "pre-existing conditions" if you have had continuous coverage for the last... X years. Why? That allows people to shop around for insurance and not risk losing everything.

Third... darn we need electronic medical records. And I think we should have a requirement that those records should be translated to plain language for the patient to sign off that they understand their illness/treatment. Not to mention that would help malpractice claims... yeah, we need to fix that fourth.

What legal mechanism allows an insurance company to access and look at presumably private information from a time previous to the application? Is it acceptable that they can search back through previous office visits for past "symptoms"?

And yes, I am married to an insurance company marketing executive.

You cant have a Public Option and expect to gouge the shit out of insurers you are right. But nothing says you cant have both.

The police department often seems to be used as a revenue generator, which is not what is should be doing.

As for the national highway system, bridges are falling down and there are potholes.

The Postal Service is great when I actually get mail or don't have to wait a half hour on line in the post office because all of the clerks except one is on break.

Public universities are a den of corruption and patronage.

The space program is a black hole of tax dollars.

Oh hai! I love living in the UK with evil 'socialised' healthcare that doesn't leave me bankrupt with medical bills.

lololol

I respect your opinion, but I just do not understand what you are trying to say. If my comprehension of your statement is wrong, please correct me. I think you're trying to say the insurers have funded the political hoars for so long, we the people have lost.

@eviladrian: I KNEW it was a good choice for me to want to move there? You don't happen to know of any job openings in the Sydney area for IT-backgrounded, ex-pat Americans do ya?

@veg-o-matic: So it's bad when the Right Wing calls liberals (incorrectly and ignorantly so, as the case my be) "Communists" or "Socialists," but when the Left Wing is accused of doing the same thing, then it's hypocritical? Why don't both of you all grow the fuck up and discuss something like adults?

I don't mean to be an a-hole on here (especially after going through the same)...but there are some options such as going to a different country where the same treatment will be at least 50% less. It's not a horrible idea as I'd imagine the drugs are standardized globally the only thing you'd have to worry about are the ethics of the doctor/facility.

The bad thing with illness is that it will follow you. Not only are you getting stiffed on the cost of your treatment but you'll get stiffed on the cost of continuing your insurance and your follow ups.

Quick, someone find me a picture of a pink wombat!

It's like having a hangnail removed by a doc, and then being denied for arthritis tx b/c you didn't disclose your pre-existing condition.

The thing is, because people aren't compelled to get insurance on pain of death, the companies have to actually offer a useful service, and so they don't pull scummy tricks like this. I had never heard the term "pre-existing condition" used until the recent US healthcare debate started.

Personally I think you must be mad to put up with your current situation, but go on, we could all do with a laugh down here ;-)

If we had had premiums, I would've had to pay around $500/mo out of a $1500/mo paycheck. I'm considered quite healthy. It does not cover dental or the optician. I already lose 28% of my paycheck for other taxes. Basically my insurance is another 20% of my take home pay. So really I have to pay up to one third of my take home pay out of the year before I get them to cover it. Guess how often I avoid going to the doctor. Combined with the two deductibles and my regular tax rate, if I go to the doctor for everything that's ever gone wrong with me, I lose over 50% of my incredibly meager paycheck. Please tell me how horrible it is making enough money where you pay $11k, which is roughly what I end up keeping in my pocket per year.

Also, insurance companies negotiate rates with providers here. So say Aetna pays $80, BCBS pays $100 and United pays $65 for the same service. Tell me how it's right that the same service from the same provider can have such different pricing?

By the way, the states with the highest income taxes also have the highest paying jobs. There are only seven states without income tax.

Unless that cough happens to follow you for two straight months, why should it have to be disclosed. Might as well just say "I'm human". Humans get sick with minor things.

And chronic fatigue is the damn definition of teenager. High cholesterol for anyone with a bad diet and overweight. Isn't more than 50% of the US obese?

It's blatantly obvious that you've never had health insurance that required you do to more than fill out an employment application.

I recently received a major, life altering diagnosis from a hematologist. My insurance policy started June 1, through my husband's employer. It's been three months for me, and I'm getting forms to fill out about pre-existing conditions.

Don't believe the lie that government can't do anything.

U of I costs ~19,000 a year. Northwestern is ~52,000. If it weren't for the public option I wouldn't have been able to afford school. Same thing goes with healthcare.

there's a difference between the Red Necks who marched for unionization and freedom from oppression and the current "rednecks" you know definitions change right? Unless the next time you do something weird and somebody says "wow that was queer of you" or you're happy and somebody says "you're awfully gay today" you should just understand.

There can be other issues to deal with as well; I was recently diagnosed with osteopenia, a precursor to osteoporosis, most likely due to years of malabsorption from undiagnosed Celiac.

It's a misconception that insurance companies exist to give health care. Like any corporation, they exist primarily to make profits for the stock holders. In this case, they make money by selling polices to lots of people who probably won't need them in exchange for a little money, policies to a few people who will need them sometimes for a bit more money, and avoid selling policies to people who will definitely need them altogether. The more people use their policies to get health care, the more it cuts into their bottom line, and as soon as someone starts to cost them more money than they bring in from them, the look for ways to dump them. Underwriters actually get bonuses for saving the companies money by rejecting claims and rescinding policies.

A government employee wouldn't have an incentive to deny or rescind. They'd just be there working 9-5 in exchange for a government paycheck, federal holidays off and a pension. A government program would not have as much overhead, because there would be no multimillion dollar salaries and bonuses for executives. And a government program would not be concerned with turning a profit. Any money left over would stay in the program for health care.

*For the insurance companies anyway- but it makes grocery shopping more expensive.

[www.pluralofanecdote.com]

Tell your story here.

I'm not sure you can get equivalent insurance in the US, at any price.

MEDICALLY CHRONIC =/= MEDICALLY PERSISTENT

They are miles apart. They're hoping jerks will think that they're the same and go, "well, this corporation clearly has a point."

That's what this whole mandated insurance thing is about. Even without it, they could have a conditional contract, where they only agree to pay for problems unrelated to the existing conditions. And while your logic here is good, it ignores abuses like if the insurance company cancels your contract while you're in the middle of chemotherapy because you neglected to mention you had asthma.

Then we'd likely get the big gov't wet dream of a gov't bureaucrat flunky deciding what care we get based on "cost effectiveness" as defined by some "black box" formula drawn up by some gov't actuary. And we'll all have to take it because unlike the insurance company, gov't decisions come at the sharp tip of the spear that is force of law...

Right now we operate under the golden rule: he who has the gold makes the rules. They decide what care we get based on some cost-effectiveness committee, and incentivize employees to find a way to deny care. And sure, you can fight back. Just hire a lawyer while you're thousands of dollars in the red, and hope that they you can either settle, or that they don't appeal. And I'm sure they get off on that too; those dirty, dirty corporate lawyers.

Except you can't have a public option without eventually running all the private corps out of business and depriving everyone else of their choice

For telling someone else to think logically, you sure come to some gross oversimplifications. Wal-Mart has so much more purchasing power than other companies, and can offer goods at a lower price. That's why they've completely run every single competing store out of business and are the only store left in America, right?

American Community reviewed her medical files and found reports of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough.

Quoted from the company, quoted from the article. She's 17. They had her physical from July 2nd, 2008 - they decided AFTER her diagnosis in February of 2009 that these issues were suddenly huge deals.

They went fishing.

"Reports of Dizziness" - dehydration.
Cholesterol - it says elevated. Dad says bad test - could be the girl didn't properly fast OR - it could be the insurance company going 3 points high! And what does high cholesterol mean in a 17 year old girl with celiac's disease?
Fatigue? Wowzers...teens who don't sleep enough and stay up too late. Who would have thought of such a thing?
A persistent cough? Now you're going to tell me that this teen was somehow exposed to a group of other teens that probably were passing things like the flu, bronchitis, chest colds and other things around. And not resting and drinking plenty of fluids!

Keep apologizing for the jackass corporation. Wait until your single elevated blood pressure reading from 2001 gets you denied chemotherapy.

From Tabor's Medical Dictionary:
Chronic: "BODY: 1. Of long duration

While we don't know exactly how long these issues have been present, the use of the words "ongoing" and "persistent" indicate that they are not merely momentary problems.

Further, chronic fatigue is not the same as chronic fatigue syndrome. Chronic fatigue could be the symptom of some other problem or disease, while Chronic Fatigue Syndrome is its own disease with its own symptoms and treatments.

I am not saying insurance companies don't pull crap. But I can't imagine running up doctor bills for "fatigue due to staying up late" and "dizziness due to dehydration". Are the parents hypochondriacs? Crazy? What is the rest of the story?

@AgamemnonV1: You win 2 internets and a wifi awesome ref.

@supercereal: The Insurance company should do their checks of the records BEFORE they extend coverage otherwise it appears as if they are trying to wiggle out of paying the claims. The company says no deception on the parents part so I beleive the truth is that they ARE trying to wiggle out of paying claims thus they SUCK and are poster children of why medical insurance is dooming themselves.The saddest part is that the low paid employees that are enforcing these scummy practices are the ones who will lose their homes when the unemployment runs out but the wealthy exec who come up with this crap to keep profits at 20% will be just fine in that downsized 6000 sq foot home and only 1 summer house.

I don't know what your company's forms are like, but I'm a lawyer and I've seen forms that are so obviously written to allow the company to back out of coverage - vague questions about 'symptoms', wanting a catalog of doctor's visits going back ten years, that kind of thing.

Funny how the parents aren't doctors for purposes of being right about her cholesterol level, but suddenly they're Marcus Welby when you want to argue that they lied on their insurance forms.

I'm guessing that you have insurance through your law firm and that it takes all comers, so you've never had to fill out a form asking you to describe every doctor visit you or your wife have had in the last ten years. You really think you could write your medical history out in such an airtight way that no insurance-company lawyer or claims adjuster could find a loophole?

@VerdaMontufar: Has anyone considered that the girl probably got diagnosed with this stuff to get out of school?

"Mom, I don't feel well, I want to stay home today."

"If you're really sick, go to the doctor"

So she goes, makes up some bullshit excuse for a note, stays at home texting her friends all day. That's not possible at all, right? As for the high cholesterol reading, its pretty easy to get an off reading if the kid was on a fast food binge and Mcdonalds or whatever for a few days before, or if she's a smoker. That'd also account for the cough. Mind you, if she smokes that SHOULD be filled out on a medical app in the states, but not if her parents don't know she does it, which is also possible.

But Obama is Hitler for wanting health care, right? Does the right really want Bush Jr back in power so badly?

The definition of Chronic (courtesy of Apple's dictionary) = "(of an illness) persisting for a long time or constantly recurring"

Granted, I substituted my own word, but chronic is the same as ongoing and persistent.

It's laughable that you tried to turn that into some ignorant, hypocritical tactic of something called "the left."

The article says that the insurance company "found reports of dizziness, elevated cholesterol levels, ongoing fatigue and a persistent cough". Now, setting aside the fact that none of this has a thing to do with her disease, it is absolutely unclear that the family had any reason to think these were medical issues. Your kid is in an AP program at high school? Guess what, she's going to have hours of homework - "ongoing fatigue". She's on the rag and forgot to drink extra water that day? Dizziness. Allergies? Persistent cough.

Go start suckuptobigcorporations.com. You'd probably be happier posting there.

If doctors that actually saw the patient had not determined someone had a specific condition years back I doubt an insurance company can. The claim that policy holders are lying has plenty of holes in it. It is evolving into "you should have guessed your own future condition".

I don't know, man. I just don't know.

If you didn't get dizzy, you weren't as dehydrated as you think you were.

And probably scored well on your SATs/ACTs.

Except you can't have a public option without eventually running all the private corps out of business and depriving everyone else of their choice. It is fundamentally impossible to have a gov't sponsored entity that operates on a level playing field with private enterprise. Fannie Mae and Freddy Mac should have taught people that a long time ago.

Lets look at it this way. A gov't sponsored plan could have a few configurations. It could be subsidized by the gov't or it could not be. It could be required to at least break even or it could not be. Or some combination of those.

Assuming that its not subsidized and/or its required to break even, then its just another non-profit insurance plan like the 1500 or so we already have in the US.

If it is subsidized and/or its not required to break even ie it draws money out of the US Treasury to operate, then it will ultimately drive private insurance out of business as private insurance would have to find a way to operate at a loss indefinitely. Thats a fundamental impossibility.

It might be a good idea to logically think through the implications of the ideas you support before you start running off about "red-neck right wing whack jobs disregarding choice".

I also find it ironic that the left has turned a term (redneck) originally describing unionized coal miners into an insult.

[www.american-community.com]

I've had a false positive on a Pap Smear. FIFTEEN years ago.

Does this men that if I have ovarian cancer in the future that this insurance company can use that false positive which was overturned with subsequent tests to say that I was lying?

This isn't a case based on logic, fact and reasoning. A teenager that stays up all night feels fatigued. A complaint of dizziness that was associated with an isolated diagnosis of dehydration is normal NOT indicative of other health issues.

But in your world, they would have been better off letting their daughter not get treatment for dehydration - because those symptoms can mean bigger and badder things on an insurance form in the future. Kids should never go to the doctor if they've been up all night. Any tests that have false readings should be met with great fighting and furious anger to have them stripped from official medical records.

In your world, doctors are no longer to be trusted - it would be an acrimonious relationship where you'd need to see them only if you had to and you'd demand that all symptoms in your medical record only be those that could be associated with minor illness.

That's not logic, fact or reasoning. In fact, what it does is exactly what that insurance company wants - it makes people avoid medical treatment because they're afraid they'll be denied. Insurance companies like that would prefer you drop dead in your living room because for that are dirt cheap.

For those wondering just what Canadians pay in income-style taxes, here is a calculator.

[lsminsurance.ca]

In Ontario I pay ~$11,000 in taxes. The IRS, however, wants $7,000 in taxes. Considering the dollar is nearly on par, that's a $4k difference. And, I know, some states charge additional income tax. I'd not be living in one of them.

Did I mention everything here will shortly have a 13% tax applied to it, except cheap homes, feminine napkins, and baby formula? Woohoo!

That all being said, the $4k isn't all that bad considering what you get for it. Although, I expect equivalent insurance in the US (Not normal healthcare insurance where you get medication for free, just whatever insuring in the US covers visiting the hospital and seeing a doctor once a year) would be somewhere around ~$2k a year if you're healthy.

If you're not, well, Canada is an absolute bargain.

For stuff like this, Canada is great. But just don't expect to get the sorts of things that happen all the time to almost everyone for free (Dentist, Glasses, Medication, etc). But dying of uncommon diseases or broken body parts? Need stitches? Cancer got you down? We've got you covered (Well, sort of with the last one--you better like chemo injections at a hospital 100 miles away because you're not getting the pills free)!

@MisterE: Wrong. These Shitbags funded an army of people to whip up a bunch teabagger zombies to spread FUD so that they can continue doing what they're doing. We've already lost, because so many people (and the media) have already bought into it.

@supercereal: Oh you mean the same companies that list all sorts of necessary things as, "not medically necessary." Their business model is based on trying to figure out ways not to pay. So, no, they're not qualified to interpret medical forms.

Elevated cholesterol is something I know nothing about, but I'm pretty sure it's not a symptom either.

And a COUGH is not a symptom of Celiac Disease.

We're not going to stop it rescission is the only mechanism by which insurance can mitigate the asymmetry of information about the individuals health that the individual has over them.

Without it there's incentive for people to just not get insurance until they're sick (why pay premiums if you're healthy after all?) and just lie on the questionaires (what exactly are they going to do about it they can't rescind your coverage? )to get it. At that point the insurance companies lose the ability to accurately price risk.

Once they lose the ability to price risk, they'll either make the assumption that everybody is a horrible risk and premiums will rise accordingly or we'll see the complete collapse of the insurance market.

Then we'd likely get the big gov't wet dream of a gov't bureaucrat flunky deciding what care we get based on "cost effectiveness" as defined by some "black box" formula drawn up by some gov't actuary. And we'll all have to take it because unlike the insurance company, gov't decisions come at the sharp tip of the spear that is force of law...

[www.nytimes.com]

"The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it. That soft-hearted aspiration, however, runs into the hardheaded reality that state-of-the-art health care is increasingly expensive. At some point, someone in the system has to say there are some things we will not pay for. The big question is, who? The government? Insurance companies? Or consumers themselves? And should the answer necessarily be the same for everyone?"

@samurailynn: Yes, you can eat rice. You cannot eat wheat gluten, and often have to avoid oat products since they're usually processed in the same facilities.

@supercereal: Please list the dates of every cold, ache, pain, any dizzy spell (even from just standing up too fast), itch, cut or sprain you've EVER had and then we can talk.

When a applicant intentionally hides a serious condition (e.g. failed to disclose tumor), I can sort of understand that.

I believe in a PUBLIC option. If those damn red-neck right wing whack jobs don't want to deal with the "bureaucracy" and "month long waits" then they don't have to. I believe in choice and they can stick with their private insurance companies if they want.

Unfortunately, however, they clearly only believe in what they think is "right", disregarding choice and forcing everybody to live by their standards.

I hate insurance companies and I hate our health-care system. Give me a damn public option and I'll be the first to sign up.

If any normal person fills out this form, and just answers the questions as stated, this can very easily lead to people leaving out info they don't realize can come back to bite them in the ass.

Note: I had to make lots of extra notes on my applications, and ended up being denied for pre-existing conditions. Luckily, my new home state has a 'high risk' pool (run by BCBS, who rejected me).

@Munchie:

But they don't have access to your full medical history. It's not like you have to send them copies of every chart you've ever had at every doctor. You fill out a form where they ask you the relevant questions.

P.S. I wish there were a gender indication next to our username. I have such trouble figuring it out. Lucky for y'all, I went ahead and made my avatar PINK!

@nakkypoo:

It's a state-by-state thing, but generally, yes, the insurance company has to repay the premiums.

Yes, they're a business. Morally and ethically bankrupt behavior is what pays the bills.

Does that mean you believe in a PUBLIC ONLY option? I know I do but getting certain groups of people to understand is the issue.

As far as I know, there is nothing in the law forcing insurance companies to be dicks, they do it of their own free will. Now, if you can find me a law saying that an insurance company must drop patients that once exhibited symptoms that might be a pre-existing condition (ie cough, fatigue, dizziness, etc), I'll change my tune. But until then, I'm not going to hold my breath.

Reminds me of how I heard that there's a lot of untreated depression among airline pilots, because if you go on anti-depressants they take away your medical certificate and you can't work.

The laws were not created by the people who now want to control healthcare though.

Off topic but sometimes it does.

One point that is being overlooked is the time frame of the diagnosis. She started on the plan Nov. 1 and got the celiac diagnosis in February. That's 3 - 4 months after being approved. I can see how that could raise some eyebrows since the diagnosis was so soon after being covered.

Yes, it can be very easy to forget when/what you have been treated for. That said forgetting is not a valid reason to ignore putting something down. The applications make it very clear that by signing the form you are stating that everything is true.

That said, I do hate when insurance companies do this as it gives us all a black eye. Here in MN treatment is considered anything where you saw a medical professional. For example, if you had headaches, but never saw an MD, that is not considered treatment. Same goes for symptoms. If I have horrible symptoms but don't see an MD, that is not considered treatment and an application cannot be denied for those symptoms.

I support socialism, and I'm proud of it.

This should be decided by a jury of their peers. There is no reason to get all emotional and declare all insurance companies evil.

If you include health spending and depending on which state/prov there is actually a net savings to living in Canada.

In public and private funds the amount Canada spends on health costs is half that of the US. The majority of the difference goes toward the massive bureaucracy they require to negotiate the various insurance companies as well as a slice off the top going towards health insurance profits.

So it may work to your benifit economically be young, healthy and working in a state with low state taxes and no sales tax but as you get older the more economically beneficial it is to be a citizen in Canada. The benifit is not that huge as well. As others have pointed out you can generally get taxed as high or higher in many states.

Wow, what sort of genius family is this, if they're telling the truth? They took their daughter to the doctor because she was fatigued after staying up all night playing on the internet? The same because she was dizzy from dehydration? Really? I've been dehydrated to extreme points and I've never gotten dizzy. Was her urine coffee-colored by the point they took her to a doctor? Give me a break, both sides are equally full of crap.

- It takes employee hours to go through your medical history with a fine-toothed comb. Doing that for every applicant is a lot more expensive than only doing it for applicants who make claims.

- They presumably got months or even years of premium payments out of these people before dropping them, so they made money off them. If they'd refused to cover them from the outset they couldn't have taken any of their money.

The actual article, however, states that "On Brianna's application, the Rices noted no prior medical problems." They noted absolutely nothing for a teenager that has elevated cholesterol, among other diagnosed issues.

I don't know how you can get the incentives right without having a system that's either government-run, or so heavily regulated that it's effectively government-run. The profit motive is always going to mean getting the least service for the most money, because that's what markets are set up to optimize.

And the government will do better, by eliminating such laws, right? Or will the government use even more data-mongering to deny coverage?

Instead of acting like some type of political tool such as "Shaftoe" squawking the latest talking points from our government, maybe people should actually look at what they will get from the government?

Insurance companies, love or hate them, must follow the laws set by our government. What makes any of you think the same people who tell insurance companies what to do will act any different?

Listen, most insurance is granted or denied based on past problems, which is completely logical. Failure to disclose issues, regardless of how minor you might think they are, is pure and simple deception. "Minor" things may very well be indicative of extremely major problems. How dare a "douchebag" medical insurance company dig into someone's complete medical history, though.

And yes, I remember every single problem that was significant enough to warrant a doctor's diagnosis. Things like high cholesterol and chronic fatigue aren't exactly "nothing" for a 17 year old.

"and the practice of rescinding coverage on individuals who were OBVIOUSLY NOT INTENTIONALLY attempting to defraud the company by leaving out relevant medical history is standard."

that means the parents did NOT knowingly lie. the diction in the sentence isn't the most clear, but the author clearly meant that the parents did not intentionally leave out relevant medical information on the application.

well, considering they won't cover you when you DO fully and truthfully answer the questions on the form I'm not sure what people ought to be expected to do.

@Orv: Ouch, that is painful.

insurance companies can and do rescind coverage for myriad reasons. practically anything can be deemed a "pre-existing condition" and be denied coverage. insurance companies, just like all other corporations, are run by a board who only care about keeping their jobs - and that requires them to increase profits every year, by any means necessary.

human health should not be for profit.

DO NOT let them win this precedent.
Especially NOT if at any point in the future there is ever the possibility of state/federal mandated health insurance (like car insurance).

Sorry, I couldn't resist.

The insurance companies don't care about your life or your well-being - it's a fact.

None of the issues were serious medical problems, and none stuck out in his mind when he filled out the application, Rice said. He sent the Problem Solver a copy of Brianna's July 2, 2008, physical, which showed no major health concerns.

They're falling back on "complete medical history." Do you even remember everything that you've ever mentioned to a doctor ever? The fact that this kind of stuff is happening is going to start convincing people that annual physicals, tests and mentioning "trivial" issues will do more harm than good. Mention those headaches you've had? Nah. That ongoing pain you've been experiencing in your side? You don't want to bother the doc with that! And, hey, why bother with a pap test - I'm sure that ovarian cancer will make itself known if it's really serious. No pap tests means no false positives or other pesky results that could get future insurance canceled! That will show them...

Do you even understand the insanity in your defense of this douchebag firm?

After that exercise the 30% tax rates people in some other countries report didn't seem quite so outrageous.

Thank God we have the powers of kneejerk fearmongering conservitism to protect these companies from the socialists

This is just an excuse for the insurance company to dump them.

I'm sure glad they're here to protect us from that scary Socialism.

*Insured when beneficial to the Overlords

[www.reuters.com]

@Vandelay Import Export: Canada's government isn't what I would call the picture of competence. But at least if you have a serious medical condition here, you can be treated for it without needing to declare bankruptcy afterward. Nobody cares how long you've had it...

There is huge waste in the system, sometimes people don't get treated quickly enough when they really need it, I pay too much in taxes (30-40% Income, 5% sales, nasty fuel taxes, property tax, etc.),but I still would hate to be living in the States again if I needed medical attention.

On Brianna's application, the Rices noted no prior medical problems, and Brianna was granted coverage starting Nov. 1, with a monthly premium of about $130.

Support Torture, Fight Health Reform!

Gotta love the insurance companies sticking it to another family. That's right up there with car dealerships selling you the car to call 3 days later and say you have to return the car cuz the financing they set you up with fell through!

if the parents did knowingly lie on the application, then it's their own damn fault

Fair point, but I didn't get the parents-intetionally-defrauding vibe at all. Especially since there was a fairly reasonable response to each of the "pre-existing conditions" listed. Granted, the only one who knows for sure is probably the girl's doctor...

OK, maybe not that awesome. I'll shut up now.

Some go the diagnosis-by-contradiction route (ie -- assume it's celiac, and see if it gets better by diet), but even those people usually go through a couple of hoops before they get to celiac as an idea.

And what about the premiums that they have been paying all along? Seems to me that the insurance company is saying 'we screwed up and should never have insured you, so we're not paying out now'. Well if they screwed up, then they ought to be giving back that family's premiums.

Health insurance companies suck. More proof that they are looking for reasons to deny coverage.

I was diagnosed with cancer last year, had "good" insurance coverage, and still, every dime of my net income in 2008 went to pay medical bills. There's something wrong with that. My tumor was caught early and I needed no chemo and radiation, and yet, I used up all my $$ for surgical venues, anesthesia, surgeons fees, pathology, hospital rooms, etc. Thank God my spouse paid all our other bills.

The insurance company is within the law, and the practice of rescinding coverage on individuals who were obviously not intentionally attempting to defraud the company by leaving out relevant medical history is standard, if sleazy.

If it's indeed an actual case of insurance fraud, then best of luck with the self-inflicted bankruptcy.

Despicable. When are we going to stop this kind of crap from happening? Even with insurance, my cancer treatments still cost me $2k in fees and crap. I pay out the nose for insurance, just like everyone else, but when I use it it isn't worth the snotrag it is written on? Figures...

I hope this family gets some justice as this particular instance, eespecially if it was cherry picking, seems awfully shady and illegal to me. Weren't there some recent court cases that would help these people out? There a lawyer out there that can help them?