HEALTH INSURANCE FRAUD

13 05 2006

Governor Bredesen has been showing his for-profit health industry stripes in his treatment of the Tenncare issue. After dropping 220,000 people from the program, many of whom were uninsurable, he is now proposing to create a program for the healthiest, most insurable of those individuals and their families—who are willing and able to pay for a barebones insurance policy that will not cover a lot of the things people buy insurance for. It won’t cover maternity or newborn babies; it won’t cover disabled dependents of the insured individuals; it won’t cover diabetes self-management (but it will probably cover diabetes-related amputations–but hey, that’s a lot more expensive than prevention, it’s a good thing they’ll cover it, right?)

The premium level is also high enough to make it only marginally affordable to low-income workers, and completely unaffordable if you lose your job, because then the cost doubles. Isn’t that thoughtful?

Well, it’s a nice election-year sop, not that Phil needs to worry too much about getting re-elected. Republican main contender Bob Bryson is flailing so badly that the Green Party’s Howard Switzer may out-poll him. Switzer is the only candidate who can credibly claim to speak for the hundreds of thousands of low-income, underprivileged voters in the state who need a government that’s genuinely on their side.

Meanwhile, I recently found out that Blue Cross Blue Shield of Tennessee has over a billion dollars in its contingency fund and pays its director seven hundred thousand dollars a year. I’ve talked before about the importance of turning health care into a not-for-profit enterprise, but I’m going to have to amend that by saying A WELL-REGULATED not-for-profit enterprise. The last Tennessee legislator to call for an investigation into Blue Cross bloat found himself facing a well-funded opponent and lost his seat. Gee whiz…you don’t think they….? Naw, they wouldn’t do that.

And Bill Frist—our fine, upstanding Senator—his family paid a 1.7 BILLION dollar fine for defrauding Medicare not long before he bought a US Senate seat here in Tennessee. When asked, Frist said he didn’t think the country could afford universal health care. Why, his FAMILY could afford to take care of a sizable portion of the country’s health needs—especially if we’re not paying bloated executive salaries to for-profit health providers. Private health care providers commonly pay abut 15% for administrative expenses, while Medicare does what is generally considered a good job on 4%. That 11% difference could amount to between two and three hundred billion dollars a year in savings. No wonder the Frist family could afford to give back a measly 1.7 billion. Ain’t relativity wonderful?

We need to draw back from the immediate anguish of those who are getting shafted by their inability to afford the cost of the American medical system, and change the system itself if we really want to do something about health care in this country. A recent study comparing American and English health and health care brought that into sharp focus. Average health care expenditure in the U.S. is about $5200 per person, while England spends about half that, but the English get a lot more bang for their buck—or is it pull for their pound? Anyway, the study compared Caucasian Americans with Caucasian Britons, to eliminate distortions due to racial differences, and found that half again more Americans than English are overweight and, and half again more Americans also suffer from heart problems—and we’re just talking physical heart problems here. Americans are twice as likely to be diabetic, 25% more likely to suffer from high blood pressure, and nearly twice as likely to be diagnosed with cancer. The study found, predictably, that richer people tend to be healthier than poor ones, but still, the wealthiest Americans have more health problems than the poorest Britons.

Researchers think this may relate to the more stressful nature of life in the US, although part of England’s stress relief program is its much better health safety net—that costs half what ours does. Another reason cited for the less stressful nature of life in England is that the standard of living has risen across the board in England over the last thirty years, while here in America only the wealthiest 20% of the population has seen their real income rise.

Some of that lucky 20% are in the upper echelons of the health care industry. In his book, Hostile Takeover: How Big Money and Corruption Conquered Our Government – and How We Can Take It Back, David Sirota points out that

In 2003, HMOs nearly doubled their profits from just a year before, adding $10 billion to their bottom line. That year, top executives at the 11 largest health insurers made a combined $85 million in one year. In the first three quarters of 2004, HMO profits increased by another 33 percent. The sheer numbers behind these profits are staggering: In 2004 alone, the four biggest health insurance companies reported $100 billion in revenues. That’s $273 million a day, every day, 365 days of the year.

That’s why there’s such an effort being made to blame the Tenncare shortfall on its victims, and ignore the real perpetrators of this crisis—the bloated health care industry. Sure, diabetes, high blood pressure, and acid reflux, the most common problems treated by Tenncare, are “lifestyle diseases” that a prudent person could avoid; but the entire force of the American economy, from the food we are urged to eat to the rents, taxes, and mortgages we have to pay to the cars we have to buy and drive and the jobs and low wages we have to put up with, is designed to get us to make imprudent choices.

It’s not enough to try and cover everybody’s insurance needs under the current system. It’s not even enough to switch to single-payer coverage. We need to create an economy that promotes the health of its citizens over the wealth of its corporations, and that is going to take a radical, nonviolent revolution in thought and government to create. That will be difficult. The alternative—for the current situation to devolve still further—would be much more difficult. Let’s roll, eh?

music: Greg Brown, “America Will Eat You”

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