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Tilting at Windmills

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February 23, 2008
By: Kevin Drum

DNA AND THE INSURANCE INDUSTRY....Amy Harmon writes in the New York Times today that patients often refuse to undergo genetic testing because they're afraid that negative results will make it impossible to get health insurance:

"It's pretty clear that the public is afraid of taking advantage of genetic testing," said Dr. Francis S. Collins, director of the National Human Genome Research Institute at the National Institutes of Health. "If that continues, the future of medicine that we would all like to see happen stands the chance of being dead on arrival."

....Insurers say they do not ask prospective customers about genetic test results, or require testing. "It's an anecdotal fear," said Mohit M. Ghose, a spokesman for America's Health Insurance Plans, whose members provide benefits for 200 million Americans. "Our industry is not interested in any way, shape or form in discriminating based on a genetic marker."

Still, a recent study by the Georgetown University Health Policy Institute found otherwise. In 7 of 92 underwriting decisions, insurance providers evaluating hypothetical applicants said they would deny coverage, charge more for premiums or exclude certain conditions from coverage based on genetic test results.

Of course insurance companies are interested in discriminating based on a genetic markers. That's what insurance companies do: they evaluate risks and then offer pricing and coverage that are appropriate and profitable based on those risks. If they don't do that, they aren't being insurance companies.

It's worth saying this over and over: insurance companies don't discriminate because they're evil. They do it because it's what insurance companies do. It's a core part of their business, and if they don't do it they'll go belly up.

This is the biggest reason for wanting to get private insurance companies (mostly) out of the healthcare business. If it were just a matter of their being corrupt or evil, that actually wouldn't be so bad. We could figure out ways to regulate them into good behavior. But it's harder than that. The kind of behavior that most of us want — comparable coverage for everyone under nondiscriminatory pricing rules — is flatly not something an insurance company can offer. If they do, they aren't being an insurance company. And if they aren't being an insurance company, then what good are they doing?

In this case the answer is: impeding progress. In other cases they're merely adding huge amounts of overhead to the system. But positive benefits? Those are a little harder to make out.

Kevin Drum 4:55 PM Permalink | Trackbacks | Comments (58)

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Health Net ordered to pay $9 million after canceling cancer patient's policy

...One of California's largest for-profit insurers stopped a controversial practice of canceling sick policyholders Friday after a judge ordered Health Net Inc. to pay more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.
The ruling by a private arbitration judge was the first of its kind and the most powerful rebuke to the state's major insurers whose cancellation practices are under fire from the courts, state regulators and elected officials.
Calling Woodland Hills-based Health Net's actions "egregious," Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.
"Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured," Cianchetti wrote in a 21-page ruling.....

Sometimes the word evil seems appropriate.

Posted by: Mike on February 23, 2008 at 5:01 PM | PERMALINK

Didn't Hilary "Go Off" today? What? Do you spend the weekends in your garden, or what?

Posted by: elmo on February 23, 2008 at 5:04 PM | PERMALINK

"But positive benefits? Those are a little harder to make out."

Well, if people had to face the full costs of medical treatment, they'd probably forgo a lot of treatment. The fact that most people don't have to really face the real costs leads to an increased amount of medical care. While it's not clear that the extra treatment actually improves the lives of those receiving it, it is clear that those of us in the health care industry profit from it. For some of us, the positive benefits of the insurance industry are very clear. Who knows? Maybe I'll make enough money to actually be able to afford medical treatment myself.

Posted by: fostert on February 23, 2008 at 5:10 PM | PERMALINK

You're being a squish again, Kevin. Insurance companies are evil. They might, but not necessarily, deserve a small break, if this were all they do.

But, they also fight against national healthcare, even programs that would keep private insurers around. They fight against largely toothless oversight by state regulatory agencies. And, don't even get me started on the lack of a federal insurance regulation agency.

Repeat after me, Kevin: Insurance companies are evil.

Posted by: SocraticGadfly on February 23, 2008 at 5:14 PM | PERMALINK

Great post Kevin, spot on.

Great point fostert, and the high costs in the medical industry have nothing to do with an almost complete lack of free market competition.

I know it makes your brain hurt, but trying to equate the health care industry with cheap Chinese trinket industry is ludicrous.

The world has already proven the American system is NOT a more cost effective solution for health care. Give it up and move on.

Posted by: says you on February 23, 2008 at 5:23 PM | PERMALINK
It's worth saying this over and over: insurance companies don't discriminate because they're evil. They do it because it's what insurance companies do. It's a core part of their business, and if they don't do it they'll go belly up.

Analogy: Vampire bats are not "evil." Sucking blood is just what they do.

Posted by: Duncan Kinder on February 23, 2008 at 5:40 PM | PERMALINK

The purpose of insurance is to spread risks so that many people contribute to the pool and those who need it get compensated when the risk happens to them.

But if we can spread the risk to, in effect, the entire country, then the need for private insurers disappears. This is the point of universal coverage. If everyone is covered and everyone pays in via taxes (income, payroll, special tax, whatever) then insurance companies are not needed. Providers can be compensated directly (single payer) or enter into deals with the gov't as HMOs and make money (or don't) based on treating their patients for an amount that roughly equals what the gov't gives them. Either way, the risk-spreading mechansim isn't needed because we have spread the risk to the whole population, and the HMO can let Drs practice medicine instead of arguing with accountants.

The key is to take the profit out of health care. Preclude companies from declining to cover someone, and they will go into another line of business. The not-for-profits and government-run providers (liek an expanded VA), plus some top drawer level of care for people willing to pay for special attention can provide health care. The real issue is how to collect the revenue. And how to get from here to there.

Posted by: Mimikatz on February 23, 2008 at 5:45 PM | PERMALINK

Private insurance companies: not mostly out of healthcare business, completely out!

Posted by: capitalistpig on February 23, 2008 at 5:48 PM | PERMALINK

Its not necessarily what insurance companies do. If it were illegal to discriminate based upon genetic tests -they might be OK with that, i.e. it doesn't change their competiveness/profitability vis a vis the competition. But if it is possible to do so, then market forces dictate that the do. We ought to be able to regulate them, as long as the regs are seen as providing a level playing field. But single payer would be better. The republicans have insulated the country against government run solutions, by making government so disfunctional that no-one will want it to run anything. Kinda clever selfserving policy that.

Posted by: bigTom on February 23, 2008 at 5:52 PM | PERMALINK

When an insurance company cancels insurance due to a pre-existing condition clause (, a genetic test is the perfect smoking gun. They will not want to know about it early, or they will have to deny coverage. They want to know later so they can cite pre-existing condition as the cause for cancellation after collecting lots of premiums.

Posted by: Mudge on February 23, 2008 at 5:53 PM | PERMALINK

Insurance companies evil? They're just capitalists. They maximize their profits, control costs, etc. They lobby the govt to affect legislation, playing the game as constructed.

All companies maximize revenues and minimize costs. The difference is the service you are buying with health insurance isn't clear cut - they agree to pay your bills, but within a very complicated contract - one rife with subjective definitions, technical procedural requirements, etc. All opportunities for an insurer to avoid liabilities.

You have recourse - lawsuits, appealing to state boards of insurance regulators. Insurers bet that the cost of forcing payment is more than the cost of the medical procedure itself. More class action lawsuits and punitive damages might help.

The #1 dodge used by insurance companies is just to delay payment. They do this systematically, massively denying covered services for violations of billing technicalities which are the providers (dr.'s) responsibility. The Dr's offices and the insurers play a game of hot potato with the responsibility, trying to avoid the cost of researching, refiling, bookkeeping, follow-up. It's costly, requiring full-time staff to handle billing problems. They pass on this responsibility to the patient, if possible. Even if the insurers eventually pay, they have held on to millions of dollars months, earning interest.

They stretch and break the rules when it benefits them, the probability of penalty is low, and dollar amount of penalties small.

Many businesses have insurance for all sorts of non-healthcare situations. I'm sure insurance companies are much better behaved in such arrangements, because large companies have teams of lawyers to attack the insurers if they violate the contract. Consumers are just too easy to exploit. We should eliminate the private insurer middlemen from our healthcare industry.

Posted by: luci on February 23, 2008 at 5:58 PM | PERMALINK

As Ezra and others have pointed out, the job of insurance companies (allocating risk in a profitable manner) is fundamentally contrary to health care as most folks say (I hope feel, as well) is what is all about...more healthy people, more comfortable lives, and effective treatment for horrible diseases and conditions REGARDLESS OF COST.

Questions of efficiency aside, if you think that health care in the U.S. is a right, not a privilege you pay for, insurance companies make no sense for basic care. They might for "pampered care" such as nicer accommodations, quicker access times, spiffy retirement care, etc., but for life-saving and basic care they do not.

Of course, it is hard to advocate for a "if you can't pay, you don't get care" model. But that is what we have, and the bright shiny distracting objects of "efficiency" and "choice" mask the fact that a lot of folks in the U.S. don't get health care because it requires insurance. It takes a special type of cognitive dissonance to argue that everyone is entitled to health care, but at the same time insurance companies are a critical and necessary of the system that will deliver this care. Care provided sans insurance (or, alternatively, guaranteed insurance, which is more like national healthcare, not insurance) is what is required to make sure all people get care.

If you think health care is a right, insurance makes no sense, as the risk-assessment side has nothing to do (your risk of health problems has nothing to do with your ability to receive care). If you think it is a privilege, you need to make the argument as to why getting health care is something that should be contingent upon your ability to pay.


Posted by: abject funk on February 23, 2008 at 5:59 PM | PERMALINK

Evil?

Nice strawman. Corporations can't be evil because the word means nothing outside religion.

Corporations are sociopathic, and we excuse them because we worship wealth. In that religious context corporations aren't evil, they're the highest moral example imaginable.

Let's stop worshiping money, then we can see how harmful the pursuit of ever-increasing profits are to our society, and our bodies, and our kids, and the world in general.

Capitalism is like fire; best used under tight regulation.

Posted by: Joey Giraud on February 23, 2008 at 6:00 PM | PERMALINK

It's worth saying this over and over: drug cartels don't sell drugs because they're evil. They do it because it's what drug cartels do. It's a core part of their business, and if they don't do it they'll go belly up....

Posted by: Stefan on February 23, 2008 at 6:02 PM | PERMALINK

This isn't quite correct. Insurance companies can offer coverage for everybody -- albeit at different prices -- and still stay profitable. Case in point: California auto insurance. "Uninsurable" drivers who can't get insurance on their own get it from the "Assigned Risk Pool," which is collectively covered by -- yes -- those same insurance companies, under a plan required by the state as a condition for doing business here.

So the question is not, can universal coverage be provided by private insurers? It can. The question is, does the profit-seeking behavior of private companies have, on balance, a net positive effect -- thanks to efficiencies motivated by profit-seeking behavior -- or a net negative effect -- thanks to what amounts to deadweight loss?

I happen to come down on the single-payer side. But it's not because universal coverage is somehow alien to the insco animal, and certainly not because they're intrinsically "evil."

Posted by: bleh on February 23, 2008 at 6:12 PM | PERMALINK

Revenue stream...revenue stream...revenue stream...what will the insurance companies do without the skim? Wherever shall they go? What's to be their fate without the immense profits of the insurance-bloated sickness and death racket? FEEL the fear and seething rage that comes from seeing mountains of cash wasted on...human health, instead of profit margins. LISTEN to the diversionary bleating of cash-addled parasites and their sycophants as their meal ticket gets punched for the last time. SEE the amazing contortions that vampiric skim artists and fear merchants put themselves through in order to justify sick and dead babies, lifelong health insecurity, reduced economic effectiveness, administrative bloat, Byzantine policies and regulations, preemptive claim denial, and the worst overall national health in the industrialized world. I have to side with the "evil" judgment on this one. The structural implications of "insurance" as an idealized concept do not excuse the amoral behavior of its proponents.

Posted by: Conrad's Ghost on February 23, 2008 at 6:14 PM | PERMALINK

How about separating the claims business from the money side of the business.

I believe this is how South Korea handles their healthcare system. By law healthcare is mandatory and the amount of the cost is dictated by the state along the lines of how much a person makes. The money is handed to the 'private health insurance companies' and they are free to make money with the money. An independent agency then pays the doctor and extracts the money from the insurance companies accordingly.

In essence, the health insurance companies are nothing but banks.

The agency that processes the claims has no skin in the game of whether to deny or allow care - they simply process the claim. The insurance company, like all banks, has to cough up the money upon demand.

If the claims processor needs incentives, they can make it under the number of claims processed.

The insurance companies, wanting to hang on to the money have no influence or control over the processing.

I'm not sure what Republicans really object to.

You can have universal payer, single payer and private insurance running things this way or as a utility.

It would be cheaper.

If its socialism they are afraid of - well all forms of insurance are a form of socialism.

Posted by: Tim on February 23, 2008 at 6:16 PM | PERMALINK

It's worth saying this over and over: insurance companies don't discriminate because they're evil. They do it because it's what insurance companies do.

Criminals, too, are only doing what criminals do. It's hard, sometimes, to differentiate between unregulated capitalism and garden variety crime, and our current health care system is very lightly regulated. We are living and dying with the results.

Posted by: Martin Gale on February 23, 2008 at 6:20 PM | PERMALINK

Tim's last point is a good one.

Pooling risk is a very un-individualistic thing to do. Pay for your own goddamn health costs.

Of course, there is money to be made insurance...which does the same thing single-payer does, but with a large added financial bonus for the certain few.

Posted by: abject funk on February 23, 2008 at 6:22 PM | PERMALINK

MHR:

My parents rely almost completely upon social security (after losing the bulk of his pension, progressively from five bad stock brokers) and upon medicare.

These are all government run programs. They work perfectly. They don't have much wiggle room and my 79 year old father has to work as a greeter at Walmart for any extra's they want in life, like visiting my Sister, but they work.

My father is a Korean Era war veteran, who worked hard his entire life, paid taxes, educated, housed and fed his family, but still got screwed over by stock marketeers and industry specialist that hosed him completely.

I doubt if my parents are the only people like this. They get lots of phone calls from other 'marketeers' who are obviously preying upon the elderly. I think that stock broakers are hardly any different.

The real republican agenda is to have us all living in shit most of the time, except when there's a war on, then they want us to fight in shit.

Fuck you Republican bastards who shit on this country for a few more dollars.

Posted by: bub on February 23, 2008 at 6:26 PM | PERMALINK

Consumers are just too easy to exploit.

And they are going to become even more exploitable whenever more and more employers stop offering health insurance coverage that provides some protection of a large group and everybody is on their own out there getting their own policy-subsidies or not. That's when they will really get reamed. Offering a chance to buy into a public plan is a big step, but there are still shortcomings here because folks with pre-existing conditions will tend to go to the public plan and that will skew that pool making it more expensive. Single payer is the only way out of this mess.

The one possible hope for it to happen is that you've got a huge chunk of boomers that haven't retired yet and aren't yet eligible for Medicare that are getting the boot from their employers after they turn 50 or losing their jobs when their employers go under and then facing age discrimination in the job market (primarily because of health costs) and they can't afford coverage on their own. Maybe when the system collapses, then something positive will then happen.

Posted by: Doc at the Radar Station on February 23, 2008 at 6:30 PM | PERMALINK

MimiKatz: "the real issue is how to get from here to there"

Two ways to do that:

(1) - Nationalize the entire industry- have the goverment buy out the health insurance companies (then their resistance will go away).

(2) - The Telecom Model: Force the industry to merge into one large company. Then regulate it. Just like the phone monopoly circa 1979. - Then later if you want to nationalize it you can.

The telecom model has a nice way of providing single payer universal health insurance and still be private - though heavily regulated. .

The idea is to buy out the interest that are holding back progress. If shareholders interest is bought out there's no reason for them to bitch.

Frankly this is the model that Obama should have embraced.

Posted by: Tim on February 23, 2008 at 6:33 PM | PERMALINK

Free market capitalism really hurts a lot of people. Where is the competition in the health care industry? How can prices keep racing skyward when obviously people can't afford it? Why is there no competetive pricing when there is in other industries?

Maybe we need to outlaw health care insurance. If they're not going to distribute costs to many people to keep costs low, but just distribute costs and then jack them up anyway, then what good are they?

If there's no mechanism (competition or insurance) which keeps rates down then you have to wonder about the entire capitalistic economic system. It's a shame really since most of us prefer not to have to consider such fundamental changes as that might require.

Same goes for all the other price-fixed industries: oil and food are I suppose the two biggest. Today at China-Mart I saw a loaf of whole wheat bread at $2.24. What kind of craziness is that?

Posted by: MarkH on February 23, 2008 at 6:52 PM | PERMALINK

It's a core part of their business, and if they don't do it they'll go belly up.

Uh, that's WHY they're evil.

Duh.

Posted by: MNPundit on February 23, 2008 at 6:57 PM | PERMALINK

True, insurance companies don't discriminate because they're evil.

They're evil because they discriminate.

Posted by: Cap'n Phealy on February 23, 2008 at 7:00 PM | PERMALINK

Would it be possible to regulate the risk categories the companies are allowed to use? I ask because I'm generally favor of a universal system, but I'm uncomfortable with the idea of subsidizing people who choose to live a less healthy lifestyle than I do.

Posted by: matt on February 23, 2008 at 7:14 PM | PERMALINK

Insurance companies provide a no-value-added service, and cost at least 18,000 American people their lives every year. We must replace them; for-profit medicine is the worst kind of extortion. And legal so far. Freaking incredible, really.

Posted by: Sparko on February 23, 2008 at 7:22 PM | PERMALINK
Would it be possible to regulate the risk categories the companies are allowed to use? I ask because I'm generally favor of a universal system, but I'm uncomfortable with the idea of subsidizing people who choose to live a less healthy lifestyle than I do.

Posted by: matt on February 23, 2008 at 7:14 PM | PERMALINK

Of course it's possible, from a legislative standpoint. From a political standpoint it's probably impossible, and besides, once you start going down the regulatory road you might as well go the whole way, and that means "socialized medicine" with a useless layer of insurance companies between the consumer and healthcare. My own suspicion is that partial regulation of the sort you are asking about gives a good shot at the worst of both worlds.

Have you ever seen the cost of emergency room treatment in this country? The lost productivity from chronically ill people who could be made well if they had access to healthcare? You are subsidizing the choices other people make. It's why what passes for a healthcare system here is so expensive.

Posted by: mg on February 23, 2008 at 7:27 PM | PERMALINK

As per capitalistpig, why "(mostly)".

What benefit, exactly, does the insurance industry bring to healthcare, if one accepts that the objective is efficient, cost-effective preventive and outcome oriented health care for the nation's citizens?

Posted by: notthere on February 23, 2008 at 7:34 PM | PERMALINK

fostert wrote:
> The fact that most people don't
> have to really face the real costs
> leads to an increased amount of medical care.

Of course most people have to pay the real costs of medical care. Who do you think is paying all the insurance premiums and the taxes for government medical programs? The people--no one else. In fact, subtract insurance company overhead and profits and government overhead and the people are paying *more* than the sum total of all medical expenses, collectively. This implies that most people are, over their lifetimes, paying for *more* care than the actually receive. Only a minority get more care than they pay for. If this weren't true, the entire system would collapse.

Posted by: David on February 23, 2008 at 7:40 PM | PERMALINK

Applying capitalism to needs as well as wants is a sure recipe for the denial of essentials to the lower end of the economic spectrum. As income disparity increases the problem is only aggravated.

Capitalism, as theoretically portrayed, is at its best only on the cutting edge. For established, successful procedures and services, it is mostly parasitical. That is fine, or at least tolerable, for non-essentials, otherwise it is not.

Corporations or individuals who dogmatically follow a system based on insatiable greed will not be abhorred by the suffering of millions as long as their bottom lines look rosy. Collateral damage is as irrelevant to them as it was to the conquistadores. For them, to feel otherwise, would be apostasy.

ANY dominant idealogical system, even capitalism, that pursues its ojective, no matter how lofty(e. g. equality), without regulation and/or viable competition must ultimately be destructive to the aspirations of most for a free, humane society.

Rapidly evolving, hi-tech industries such as health care pose the most difficult problem because they are both cutting edge and essential. No perfect separation is possible. It should be based on services,procedures, and technologies. When they are deemed non cutting edge, they should be socialized via a single payer system. The welloff can still have their cutting edge advantages,without excluding others from non- economically catastrophic health care.

Posted by: Michael7843853 G-O/F in 08! on February 23, 2008 at 8:21 PM | PERMALINK

Kevin,

The one thing you have profoundly right is that public health care policy is not about medicine, it's about insurance.

Canada does not have "socialized" medicine; if anything Canadian medicine is much much freer that American, where everybody, doctors, patients and institutions, is under the thumb of the insurance people.

What Canada has done is socialize the insurance function.

After all, what's to insure? Insurance is about chances and doubts, and nine people out of nine need full health care. Hence there's no insurance function to be performed.

Canada spends about 9.6% of GDP on health care -- and 0.5% of *that* goes on administration.

America pays something north of 16% of GDP on health care -- and maybe a third of that goes for whatever it is the insurance companies claim to be doing, mainly triage, it seems to me.

And Canadians, despite the truly scandalous state of health care on some First Nations reservations, on average live a couple of years longer than Americans.

Maybe that's because to a large extent we look after our health, because it's already paid for, rather than waiting for expensive treatment once we get sick.

Posted by: David Lloyd-Jones on February 23, 2008 at 8:42 PM | PERMALINK

elmo: "Didn't Hilary 'Go Off' today? What? Do you spend the weekends in your garden, or what?"

Probably -- but only because you spend the weekends glued to your computer screen, and he wants to see if he can drive you insane with impatience ...

Posted by: Donald from Hawaii on February 23, 2008 at 8:45 PM | PERMALINK

One sentence from the article Mike links to in the first comment about the award to a patient whose insurance was cancelled in the middle of her chemotherapy kind of epitomizes everything wrong with our system:

Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.

See. They only insure healthy people. And that's their public defense for cancelling her insurance and endangering her life.

Not to mention:

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.

Best 37th place health care system in the world, eh?

Posted by: R. Porrofatto on February 23, 2008 at 9:00 PM | PERMALINK

Whatever truth there may be in your commentary, and however non-"evil" insurance companies may be, soulless corporations that they are, much of the cost of modern medicine is owed to the greed and, yes, evil, of most doctors. And, OK, pill companies, hospitals, etc.

Posted by: Anon on February 23, 2008 at 9:09 PM | PERMALINK

It's worth saying this over and over: insurance companies don't discriminate because they're evil. They do it because it's what insurance companies do. It's a core part of their business, and if they don't do it they'll go belly up.

I think this is a very good point, but I'd add to it. I know some analogies have been offered already, but I'd like to offer one that strikes me as a little more complete:

Ebola doesn't make people sick because it's evil. It does that because that's what viruses do.

There's nothing moral or immoral about a virus. But many viruses are nonetheless bad things that I'd like to see eliminated some day, as soon as practically possible.

Likewise, there's nothing moral or immoral about the insurance industry. But it is nonetheless a bad thing that I'd like to see eliminated some day, as soon as practically possible.

Posted by: Adam on February 23, 2008 at 9:09 PM | PERMALINK

It's good to remember that health insurance companies are not actually in the health business. Hospitals are in the health business, so are doctors, so are medical companies. But health insurance companies are in the money business. They take money in, and pay it out, and they make profits by maximizing the difference between those two sums.

Posted by: bobo the chimp on February 23, 2008 at 9:11 PM | PERMALINK

Excellent posting on the health insurance business.

By the way, the widespread fear that DNA tests would reveal your early death are overblown. Genuinely fatal mutations -- such as the one that causes Huntington's disease -- tend to die out fairly rapidly. It's basic natural selection 101.

Most everything else is a trade-off -- this gene variant will make you more likely to die of X, but less likely to die of Y. So, I doubt that DNA testing will change insurance too much, but your critique of health insurance is quite accurate right now.

Posted by: Steve Sailer on February 23, 2008 at 9:24 PM | PERMALINK

Darn that insurance industry!

Posted by: Swan on February 23, 2008 at 9:59 PM | PERMALINK

Q. Do you know why criminal investigations are so difficult in Arkansas?
A. All of the DNA is the same.

Posted by: The Conservative Deflator on February 23, 2008 at 10:08 PM | PERMALINK

Insurance is one activity that simply makes no sense as a private, for-profit business. The interests of the insurance company and of its "customers" are completely at odds with each other. Insurance only works as a nationalized, single-payer system, with everyone automatically enrolled.

End of story. Anything else is just free-market religious dogma.

Posted by: craigie on February 23, 2008 at 11:08 PM | PERMALINK

This is the biggest reason for wanting to get private insurance companies (mostly) out of the healthcare business

Yessss!!

Posted by: David in NY on February 23, 2008 at 11:32 PM | PERMALINK

I teach anthropology students, many of whom are fascinated by human genetics. I urge then _not_ to be typed for any marker, and if they have to be typed (for instance, if they're doing ancient DNA work where everybody in the lab is typed for some markers to check for contamination) to insist on absolute confidentiality and destroy any information as soon as possible. Until we get legislation, really good solid airtight legislation (which I am absolutely convinced is not possible, insurance companies will build in a loophole for themselves somewhere), you don't want to have this information available anywhere.

Posted by: jhill on February 23, 2008 at 11:50 PM | PERMALINK

Umm, ever heard of ASO, as in administrative services only, as in what Prudential and others do for Medicare? In other words, processing claims, arranging networks, securing discounts etc. on a nice, comfy cost-plus basis.

In fully insured plans, you're right. But I'm not at all sure that is, at this point, a growing part of the business of UHC, Aetna, the various evolvements of the Blues etc.

Posted by: Wendell on February 24, 2008 at 12:11 AM | PERMALINK

Apply that comment to computerized medical records in spades. Computerizing and sharing records among med personnel would be easy. Keeping the insurance industry out of the loop, impossible.

Posted by: bakho on February 24, 2008 at 9:09 AM | PERMALINK

NADER? Someone please tell him to go away. Was the great and powerful "W" elected because of his malfeasant thought process? Go away RALPH. China needs a consumer advocate more than we do these days. Maybe you could chair their party......?

Posted by: COLDLOUIE on February 24, 2008 at 9:40 AM | PERMALINK

Part of my company's plan is an incentive plan that gives you a 200.00 refund for joining a gym or similar expenses. Fair enough. But to get it, you have to fill out a detailed online questionnaire and get a full physical. They also encourage you to use a variety of "wellness tools" online to track weight, etc. etc., using a personal login.

That's not DNA testing, but to my mind, still too intrusive; I should not have to trade personal medical info to join an incentive program. And I really don't want to just put info about my health online in any identifiable fashion. I worry that it could be used against me later if I develop a condition of some kind. Possibly paranoid, but in this era of massive database thefts in the news every freaking day, it seems wiser to me. DNA info, even more so.

Posted by: emjaybee on February 24, 2008 at 12:48 PM | PERMALINK

I nominated this, above everything Kevin penned on McCain/Iserman, as his "weakest post of the week" for last week.

Posted by: SocraticGadfly on February 24, 2008 at 2:29 PM | PERMALINK

The real problem is the scabrous toad asshole known as Tom Coburn. He has a hold on GINA (Genetic Information Non-Disclosure Act). Why does this TOTAL ASSHOLE, who retains his medical license despite his history of sterilizing poor black women against their will, block this vital medical act?

I dunno. If you live in OK, call the asshole and make it clear that you want GINA to pass.

Posted by: POed Lib on February 24, 2008 at 2:33 PM | PERMALINK

Here begins a brief class in Capitalism 101:

In a capitalist system, the sole motivator is profit. Anything else which comes out of the capitalist system is a side effect.

Case in point: Mr. X wants to open a factory to create the ever popular widgets. Mr. X does not do so b/c of the deep societal need for widgets, but b/c profit can be gained from providing widgets. So, Mr. X opens a factory + hires employees to create widgets (this is, of course, a ridiculously-simplified capitalist model, but please bear with me). What is the end result? Let's look:

1) If there is, indeed, a societal demand for widgets, and Mr. X prices his widgets appropriately, Mr. X will yield a profit from his factory. The fact that the factory creates widgets is irrelevant; if widgets were not popular, Mr. X would, logically, open a factory to create something else.

2) In order to create profit, Mr. X needs to produce widgets; this should be self-evident from point 1. However, in order to produce widgets from his factory, Mr. X needs workers.

3) In order to attract workers, Mr. X needs to pay them. Bear in mind that, if it were possible to produce widgets w/o any workers at all- say, though, automation- then Mr. X would, logically, do so.

If we look @ steps 1-3, it is self-evident that employees- that is, workers paid to do something- are a side-effect to creating widgets. If there was any other way to produce widgets, Mr. X would use it rather than hire employees. Note: this assumes that Mr. X is being 100% logical; where humans are concerned, this is not always a logical assumption. There *are* cases where Mr. Xs choose to pay employees *rather* than make more of a profit. This is, needless to say, a major exception to the rule.

Why do I point this out? Because we have a profit-driven health care system. More specifically, we have a profit-driven health insurance system. Meaning that, since profit is the sole motivating factor behind the system, healthy people are a *side effect.* Think about that for just a fraction of a second: if health insurers could make more money by allowing people to die- THEY WILL DO SO. This is not mere rhetoric: there have been many examples where health insurance companies have denied coverage for care which would save a person's life, simply b/c doing so would cost money.

Until the profit motive is *removed* as the primary motivating factor behind health insurance, this will be an inescapable problem. Again, think about it: healthy people are a *side effect* of the current health insurance system. If that doesn't enrage you, well, I can only assume that you are never going to require medical care.

-Z

Posted by: Zorro on February 24, 2008 at 3:03 PM | PERMALINK

Another "gentetic tests vs. insurance" article. I think cooperation between insurance companies and clients will be inevitable. Genetic tests could 1) help people to save their health 2)help insurance companies to design better products and aim healthcare more precisely. Of course there are some threats - but one example. Smokers are in very big risk of getting some critical (and very expensive) illness and are they able to get insurance? Yes they are! Market always creates offer, that is what I believe. If you are more interested about insurance and medical tests (in Canada)check our life insurance brokers Toronto website!

Posted by: Life insurance in Canada on February 25, 2008 at 4:46 AM | PERMALINK

Health insurance companies should be outlawed. Only mutual benefit societies should be allowed to sell health insurance.

Posted by: Brojo on February 25, 2008 at 11:00 AM | PERMALINK
It's worth saying this over and over: insurance companies don't discriminate because they're evil. They do it because it's what insurance companies do. It's a core part of their business, and if they don't do it they'll go belly up.

If they don't do it to the degree they are legally allowed to, they'll go belly up due to competition perhaps. Limiting the basis on which insurers can discriminate in pricing and coverage, though, doesn't prevent them from being able to function profitably.

This is the biggest reason for wanting to get private insurance companies (mostly) out of the healthcare business. If it were just a matter of their being corrupt or evil, that actually wouldn't be so bad. We could figure out ways to regulate them into good behavior.

Unlikely; if it were (and some of it is, of course) simply a matter of being corrupt and evil, then corrupting the regulatory and oversight process could become cheaper than complying, frustrating any effort to regulate them into good behavior.

A matter like the competitive issue with discrimination (on genetics or anything else insurers can consider) is more easily regulated, since the main problem for each insurer is if they don't take advantage of the power to use the information and other insurers do, those that do will have a competitive advantage. So simply prohibiting a given basis of differentiation solves that problem. (It doesn't solve the corrupt and evil problems, though.)

Posted by: cmdicely on February 25, 2008 at 1:33 PM | PERMALINK

Here's a thought: health insurance co-operatives.

In short, these would be health insurance companies which were entirely subscriber-owned. Since they would be subscribed-owned, profit should be irrelevant, as any expenditure beyond operating costs would be hurtful to the co-operative as a whole. Clearly, this would require some sort of government oversite- AKA regulation- but it doesn't seem entirely impossible. I can even see a way in which converting a for-profit insurer to a co-operative could be done in a way which is both profitable to the current owners + gives the new co-op ready-made infrastructure.

Wild conjecture, I know. But what else can the Prince of Swords do?

-Z

Posted by: Zorro on February 25, 2008 at 1:38 PM | PERMALINK

Blue Cross got dinged by California's department of insurance a few months ago because they denied a woman's claim based on the fact that it was a rare genetic disease that she hadn't disclosed on her application.

Of course, she didn't even know she had it when she filled out the application, but the mere mention that it was genetic was enough for Blue Cross to cancel her policy. After all, she should have known that she might possibly someday develop this condition that no one else in her family had developed, so therefore she lied on her application.

Genetic testing is for suckers.

Posted by: Mnemosyne on February 25, 2008 at 3:25 PM | PERMALINK

MESSAGE

Posted by: ISHMAel back on March 5, 2008 at 2:51 AM | PERMALINK

MESSAGE

Posted by: ISHMAel back on March 5, 2008 at 2:51 AM | PERMALINK




 

 

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