Reeling under the scourge of insurance profiteering

Reeling under the scourge of insurance profiteering

A few years ago during a heated online exchange on a political discussion board, a rightwing Tea Party activist exuding a maximum degree of bravado made it clear to me that I along with everyone else of my ilk and even his was NOT, repeat NOT entitled to an income!  I replied to the guy “Okay” and he proceeded to excoriate his perceived tyranny of mandating everyone buy their own health insurance under the Affordable Care Act, the passage of which was pending in the Congress.  I thought about that specific assertion regarding income and entitlement and after mulling it over a bit I actually found myself in agreement.  There is nothing in the Constitution, U.S. or state, that directly entitles any citizen to a set level of compensation for goods or services or to any income at all.  Since at least for the purpose of debate that point has been well established, I will take that sentiment one step further.  No business or corporation is entitled to a profit.  Accepting the risk to succeed or fail is all part of endeavoring in the free market system.  That may not sound entirely pro-business and perhaps to some outright anti-capitalist but at the end of the day even I believe a merchant or company providing an essential  service in good faith to a customer base is deserving of a modest profit.  That said, I do not think that any business, regardless of how wonderful their services may be, is entitled to win the lottery year in and year out.  They are certainly not entitled to win the lottery amid a crisis within the purview of their industry.  And they most certainly are NOT entitled to win the lottery on an annual basis by charging their clientele an exorbitant rate for basic services or products.  This ongoing display of upward spiraling profits is a clear demonstration of the one big downside to poorly regulated capitalism.  Profiteering at clients’ expense may not illegal, may or may not be ethical but most certainly is not sustainable for customers whose wages are stagnant or fixed.  It was reported earlier this year that profits are booming for health insurance companies.

Health Care Service Corp. — the parent company of the Blue Cross and Blue Shield affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas — recorded an $869 million profit in the first quarter of 2017, according to the company’s latest financial documents. That was a $1.3 billion turnaround after HCSC lost $442 million in the first quarter of 2016.”

I will vouch.  It was widely understood that the only single policy provider in Oklahoma took measures to recoup losses they claim were generated by having to provide low cost policies in accordance with the ACA.  Yours Truly is a Blue Cross Blue Shield policy holder.  In January of this year, my premium for my individual BCBS policy jumped from $649 to $1193 per month, a sum which is more than my mortgage!  On top of this I still have a $3250 deductible.  If I go to a hospital, as I did this week for a minor foot surgery, I learned that I also have a total out of pocket cost of over $6000 before my insurance carrier  picks up 100% of expenses.  In America, even along this the most conservative stretch of Old Route 66, we have a city full of fine health care professionals and facilities where they practice their profession.  Health insurance is still viewed by those in office as an economic commodity and customers simply pay for it like any other luxury.  We just cannot make those in the majority of our legislature and those taking up space in our state offices understand that the finest health care system on the planet is not worth a bucket of warm spit if nobody can afford access to it.

On the upside, if it can be called an upside, I was able to withstand the hit with this latest health insurance tussle.  It will likely wipe out my Health Savings Account and cost me a fair amount of interest putting the rest on a credit card but I can at least say I took the hit.  I totally understand why some people prefer to pay the fine and not have health insurance at all and that is certainly one way to irresponsibly cheap out.  If I had no insurance at all I would likely have been able to negotiate a cash payer discount on this latest operation.  The problem is when these uninsured citizens are say involved in a hospitalizing accident or are stricken with a sudden onset of chest pain (a problem for which they receive priority triage at every emergency department in this city) they often run up a healthy tab for which they often cannot cover.  The facilities and providers usually have to eat the loss and pass along the misery to paying patients and their insurance carriers.  Also, these high deductible individual policies are generating a great deal of hardship for rural hospitals in Oklahoma.  When such a policyholder presents in a rural emergency room with a problem requiring further definitive treatment like a cardiac catherization or specialized surgery they often run up a tab exceeding their deductible (which may be as high as $5000 or more) before they are transferred to a facility to receive their definitive care.  Too often these high dollar deductibles go unpaid because they are simply not affordable.

This was not my first go-around with health insurance.  Over a decade ago before the ACA became law, my then spouse had bariatric surgery.  Two weeks after her surgery I received a letter from my then insurer specifically stating “…..lifetime payout related to bariatric surgery has been met.”  Some eight months after her operation she developed a bowel obstruction.  This required admission to the local hospital and a trip to the operating room.  It was found by the general surgeon that there was failure of a repair made during her bariatric procedure and required further surgical treatment.  In the end all was well with the patient but the week after she was discharged home I received a letter from the insurance company reiterating the above statement and informing me I was on the hook for an eight day hospital stay and a trip to the operating room amounting to $28,000.00.  What did I do?  I went to hospital cashier and asked if they give discounts to cash payers.  Answer:  Yes.  The bill was then reduced to $22,000.00.  I then liquidated two mutual funds and paid the entire tab.  I was then told at the time it was very rare for someone to do that.  I may be the exception but I certainly could see from that point forward the need for some regulation on health insurance business practices.  The ACA may not be perfect but it does impose some regulation on one sector of industry that badly needs it.  It was the fact that health related expenses accounted for some 62% U.S. bankruptcies in 2007 that led to the pushing of the ACA, imperfections and all.  Some of the lesser touted consumer benefits of the ACA is the elimination of lifetime caps such as the one noted above, pre-existing conditions are no longer disqualifying for the purchasing of coverage and children may remain on their parent’s policies until age 26.  Although the ACA is not a perfect law, some of the regulations imposed by it serve a badly needed purpose.  It currently remains the law of the land in spite of the GOP-controlled Congress’ best efforts to get rid of it.  As was well demonstrated this summer, the Republicans have nothing with which to replace it.  As it turns out, there is a large segment of ACA critics who seek to derail it because of it’s alternate name, “Obamacare.”  If a poll were taken, I’m sure we’d find a fair number of those who refuse to buy health insurance numbering among this segment as I have had my share of less-than-diplomatic discourses with them in person and online.  The ACA actually promotes and long touted conservative core value known as PERSONAL RESPONSIBILTY (if that is no longer a conservative core value then mea culpa).  For people like me this is where it becomes personal so I am going to issue a personal message to all who, for whatever reason, have no bones about imposing their irresponsibility onto the rest of us when they become ill or get injured:


We have a crisis in our nation and our state.  It is my hope that suffering the abuse of health insurance profiteers will motive enough voters reeling under the strain to campaign for agents of change who are willing to do something definitive about the problem via legislation.

Times like this sure make a single-payer system look pretty damned good!

1 Comment

  1. Carl A.
    Nov 4, 2017

    I’ve said it before & I’ll say it again – insurance companies have no business being in the health care industry! They do not “insure” anything, except that you get screwed TWICE monetarily, and they get to make lots and lots of money off of people’s misery…

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