Profiteers

How much is your insurance premium going up? Is your insurer on this list?

• WellPoint 2008 cash/cash equivalent assets: $ 2.18 billion
• Premera Blue Cross 2008 reserve: $840.1 million
• Regence Blue Shield 2008 surplus: $1.779 billion
• Aetna 2008 operating earnings: $3.93 billion
• United Health Group revenues: $81.186 billion

"The Public Wants Options"

Inspired.

A Ginormous Tragedy

While you wouldn't think the health insurance reform debate ventures into green territory, a current experience of mine does exactly that.

• My health insurance company took away my choice of pharmacy. I usually go to Bartell, but for one particular drug I need, my insurance made me choose between two national mail order pharmacies. This is being done for excellence in service and for your convenience, the letter read. In reality I tried both companies, and one was incompetent and the other one involved a lengthy intake interview. Like they think they're my doctor. And they'll be calling me every month when I need a refill for another friendly chat. Yessss, much more excellent and convenient. With Bartell (which is located right down the street) I can call the automated refill line and be done in less than a minute.

• Of course the real reason my insurance has taken away my choice is because it saves money, i.e. it allows them to make more money (because it is one of the Blues, they put the money into their ginormous reserve and give their executives massive salaries).

• The green connection involves the way the mail order pharmacies send me my prescription: with massive amounts of styrofoam packaging. It has to be refrigerated, so what UPS drops on my porch is a massive box containing a ginormous styrofoam vault as well as gel cold packs.

• I get to throw all that packaging away. More precisely, I get to pay to throw it away, either via municipal trash pickup or by transporting it 23 miles to Ikea.

It's a clear, compelling example of The Tragedy of the Commons. My insurance company is saving money, savings physically represented by petroleum-based material that ends up in the landfill. The mail-order pharmacies don't offer styrofoam mailback.

What are you people afraid of?

Pollsters are supposedly finding that 70-75% of respondents favor some kind of single payer national health insurance. The right wing is going to ramp up its anti-single payer propaganda to eat away at that majority.

A lot of the progressive talk programs I've been listening to of late have been getting calls from the 25-30% who are against single payer. The thing is, most of them have trouble articulating their reasons.

It's really sad to hear their plaintive reasoning: if only everyone could take responsibility for themselves (in an employee-based coverage system?); if only we give the free market a chance (how can a choice be free if you must have coverage?); a government-run plan will lead to rationing (we have rationing now -- appointments and pre-authorization).

After listening to the fear I hear in their voices, I suddenly hit on what I think is the underlying cause of those fears.

The Resmuglicans keep screaming things like, "do you want a bureaucrat between you and your doctor?" I think the fear being triggered isn't fear of government, so much as the fear that the government will operate health insurance the same way the private insurance companies do now -- if not worse. And single payer would mean no recourse.

I think what people aren't realizing is that the reason for the private insurance system being such a miserable one wouldn't exist under single payer. Insurance companies create profits by denying claims, whereas under single payer there is no profit motive, and therefore no reason for a bureaucrat to deny claims! And because the federal government can run deficits, budget ceilings do not have to be a cause for denial of coverage either.

Under single payer, if you're a citizen, legal resident or legal visitor, you'd be covered.

The Cost Conundrum (Update 3)

The New Yorker looks at an example of the craziness that is the U.S. health care system:

The Cost Conundrum
by Atul Gawande
...
McAllen (Texas) calls itself the Square Dance Capital of the World. "Lonesome Dove" was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

Article

Update 1: Following on this news comes a letter from my health insurance carrier. That private health insurance company has written to inform me that it has decided to limit my choice of pharmacy. Instead, they have formed an exclusive arrangement with Accredo and Walgreens in order to provide, and I quote, "excellent service" and "greater convenience."

Thank gawd, it's SO about time. Because Walgreens is located a whole block closer to my house than my current pharmacy where I've been forced to do business for the last 10 years.

Update 2: So Premera gave me two numbers to call (at least it was toll free). I have a choice between Accredo and Walgreens (then how is the arrangement "exclusive"?). One turned out to be a general public number with a robot. No thanks.

The other number was picked up by an actual person; but it was clear they had no idea of their special relationship with Premera. I was kept on hold while she read something, then sought instructions from a supervisor. Then she took down my doctor's name and number so they can bother her too. I suppose they're going to have to call me back to get my address, which they'll need if they're going to ship me the prescription.

All I have to say is keep up the good work, guys. Much more of this "excellence" and "convenience," and even more Americans will be on board with single payer.

Update 3 (6/19): My prescription arrived today, by UPS. The box was crammed full of non-recyclable materials, including a massive styrofoam 'vault.' Grrrrrrr. I called the service, who passed me to a pharmacist, who first said he would connect me to their (alleged) Green Team, but then couldn't remember who was on that team -- could he have them call me back? They haven't.