What's Obama Going To Do This Evening?

John Conyers knows something about simple arithmetic; I hope Barack Obama is playing attention. And Maxine Waters knows something about having a backbone, about real change and about fighting for America's working families and small business instead of corporate predators. If Obama isn't paying attention he might as well take a three year, 3 month snooze and enjoy his one uneventful term.



Conyers alluded to how bad Obama's team has played this round. By allowing the two worst corporate shills on the team-- Emanuel and Baucus-- to take single-payer off the table from day one, the compromise position, the so-called public option, became the target for the obstructionist far right and for the crooked Insurance empires. A better way to have handled it would have been to round up all the insurance CEOs and throw them in prison for their crimes and then negotiate from there. What crimes am I talking about? Yesterday's Washington Post scratched the surface of what these vicious predators have gotten away with:

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

"This is probably the most egregious of examples of health insurers using their power and their resources to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous activity on the part of the insurers."

Insurance company officials say they need to be able to cancel policies to control fraud, which by some estimates reaches $100 billion annually.

"We do not rescind a policyholder's coverage because someone on the policy gets sick," said Peggy Hinz, a spokeswoman for Anthem Blue Cross, a subsidiary of WellPoint. "We have put in place a thorough process with multiple steps to ensure that we are as fair and as accurate as we can be in making these difficult decisions."

Much of that process was a condition of settlements with state overseers, who fined Blue Cross $11 million over the past two years and required it, and all other major insurers in California, to restore canceled policies. Insurers still face court challenges, including a class-action suit targeting Blue Cross on behalf of 6,000 canceled policyholders.

"These cases are very, very good in front of a jury," said Bill Shernoff, whose Claremont law firm has settled 90 cases and has 130 cases pending. "I wish I could tell you the amount of money they throw at us just to make it go away and keep quiet."

In the only case to go to trial in California, an arbitration judge awarded $9 million to a beautician who had to stop chemotherapy for her breast cancer after Health Net dropped her policy. Company officials declined to comment.

In a pending case, Blue Shield searched in vain for an inconsistency in the health records of the wife of a dairy farmer after she filed a claim for emergency gallbladder surgery, according to attorneys for the family. Turning to her husband's questionnaire, the company discovered he had not mentioned his high cholesterol and dropped them both. Blue Shield officials said they would not comment on a pending case.

Officials from three insurance companies told a House Energy and Commerce subcommittee this summer they had saved $300 million by canceling about 20,000 policies over five years.

Critics charge that companies, rather than vetting applicants, wait until a claim is filed. "It only happens if you create this bill. Then they go back into your application," said Dev GnanaDev, president of the California Medical Association, which lobbied Democratic House leaders to include restrictions on cancellations in their legislation. "Costco doesn't let me take something back after 90 days," he said. "If they want to investigate, let them do it within 90 days."

Regulators say many omissions appear to be honest mistakes on forms that are needlessly complex. Others result from ambiguous conversations between patient and doctor.

Yvette Thomassian of Glendale, Calif., lost her Blue Cross policy because she did not declare a deviated septum. She questioned why a common misalignment of the nostrils would disqualify anyone but emphasized that her doctor never clearly indicated she had the condition. They spoke Armenian in the exam room, she said, where the physician's words were "You have a bone in your nose."

"It's been three years of hell," said Thomassian, whose suit over the $31,000 in bills is scheduled for trial in January. Blue Cross officials said they would not discuss specific cases.

For Teresa Dietrich, it was fibroids. The Northern California real estate agent was left to pay $19,000 after Blue Cross said she did not disclose a diagnosis of the benign uterine tumors. But Dietrich said the doctor who had written "fibroids" on her medical record never mentioned his suspicions to her. The bills destroyed her credit and cost her her home-- and, in a comically cruel twist, the surgery proved the doctor was wrong.

"They said I had a condition I didn't even have," Dietrich said. "And they canceled me."

If federal health-care reform bars companies from screening for preexisting conditions, insurers note that cancellations will no longer be an issue. But Melinda Beeuwkes Buntin, an economist at the Rand Corp., said that unless for-profit companies are compensated for taking higher-risk patients, the firms will continue to look for ways to unload them.

"They wouldn't be able to overtly kick you out, but that doesn't mean that they might not put, for example, more onerous preauthorization requirements on services that people who are at risk might need, and that might discourage you from re-enrolling next year," Buntin said.

She said one solution would be for Washington to subsidize insurers that take on higher-risk patients. The government does such "risk adjustment" for the private insurance provided through Medicare Advantage-- though Obama has called for ending those subsidies to finance reform.

"You can ban rescission," Buntin said, "but what we really want is a system under which insurers' incentives are aligned with treating all of their patients well, whether they're sick or healthy."

Or maybe we should ask ourselves, as a society, what place for-profit insurance has in the health care system. Their cost is gigantic and their value-add is exactly zero. That's why thoughtful members of Congress like John Conyers and Maxine Waters have always been for single payer. And that's why the Insurance Industry has spent $1,269,279,506 on lobbying since 1998 and another $209,397,634 on thinly disguised bribes in congressional elections. Public officials who take bribes-- your Baucuses and Emanuels, and your Republicans-- are even more guilty (since they are breathing their oath of office) than the crooked CEOs who hand them out. Do I think all these members of Congress taking money from Big Business and then voting for their special interests belong in jail? If you have to ask that question, you must be new to DWT. Welcome; stick around.