California Legislature
Votes to Kill the Health Insurance Industry....
Opinion
by Consumer Advocate Tim Bolen
Sunday,
November 26th, 2006
There is a war
on in the United States over health care. On one side is the "status
quo" represented by the medical monopoly, the pharmaceutical industry, the
health insurance carriers, and an entrenched bureauracracy wholly beholden to,
and run by, the people they are supposed to regulate.
The US system,
according to the World Health Organization, is rated 72nd in quality, but
number one in cost, worldwide. The "Death by Medicine" study
shows that the system itself is the number one killer of Americans. The
number two and three killers of Americans are heart disease and cancer,
diseases which those of us outside of the "status quo" know are
curable, and preventable - but those cures and preventive treatments are being
suppressed by agents of the "status quo."
On the
other side is a beleaguered America simply trying to find ways to survive.
(1)
The medical monopoly is so evil, in itself, that medicine is no longer an
honorable profession. For it isn't about helping people - it's about
gouging money out of an unsuspecting public. For instance: there
are five million legitimate health professionals working in the United States,
three million of which are licensed by individual States, and two million of
which are unlicensed. But only seven hundred thousand (14%) of those can
bill health insurance, Medicaid, or Medicare for their services.
Why is
that? Because the American Medical Association (AMA) has a contract with
the US Department of Health & Human Services (DHHS) to write billing codes
(about 6,500 CPT Codes) for ALL health professionals - but will not invent
codes for anyone but those seven hundred thousand medical doctors (the number
one killer of Americans). This, of course, means that all four million
three hundred thousand other health professionals in the US, in order to get
paid, must bill THROUGH an MD using "their" codes - so that the MD gets
a cut of the money (and increases the costs). There are only two
exceptions - out of the approximately 6,500 CPT Codes available, there are
four codes for Chiropractors to use, and one for Acupuncturists.
(2)
The pharmaceutical industry is so corrupt few Americans believe anything they
say - despite their massive television advertising campaigns. Since the
drug industry got permission from the US FDA in 1998 to advertise directly to
the consumer the only change we've seen is a 500% increase in the price of
prescriptions. The money seems to go for television news hour
advertising.
(3)
The US health insurance industry is rotten to the core. The biggest group of
individual bankruptcies in the US are those that had health insurance for an
illness and found out, the hard way, how the health insurance system actually
works.
For
instance: If you have an 80-20 policy, supposedly where the insurance
company pays 80% and you pay 20%, and you end up in the hospital, generating a
bill for $100,000, you are, very suddenly, handed a bill (to be paid
immediately) for $20,000. Do you think the insurance company is going to
pay $80,000? No, they are not, for the have a "deal" with the
medical monopoly, and they generally pay, by my calculations, only about
twenty two cents on the dollar - so their part of the hospital bill is going
to be 22% of $80,000 or $17,600. Hardly 80%. YOU will write bigger
checks than the insurance company will...
Only God
can help you if you have a 50-50 insurance plan.
Worse
yet, is that the average cost to a US employer for this health insurance is
$14,7000 per year, and employers in the US with over two hundred full-time
employees are REQUIRED to provide coverage. Out of that $14,700 premium,
by my calculations, only about 9% goes to pay health claims. The rest is
divided up long before - 40% commission to the health insurance broker that
sold the policy to the company, 35% goes to overhead (insurance companies own
marble buildings), 10% goes to the stockholders as a dividend, and 6% goes to
miscellaneous, including the costs of lobbying Congress. That leaves
only 9% to pay claims.
And if that
isn't enough - several sleazy health insurance companies are filing "fraud"
charges against health professionals with licensing boards simply because they
don't want to pay claims - and several of those boards are actually
prosecuting doctors over those billing disputes.
(4)
The bureauracracy that regulates health care in the US is shameful.
There is no arguing for the system. It has turned against America, and
is operating not to regulate the industry, but to protect it from competition
and change. Period. There is nothing more to be said. Facts are
facts. Change is necessary.
Things are being done to fix these problems...
I don't need
to go into detail here about how each of these problems, described above, is
being attacked. Read my other newsletters, and you'll get the idea.
Today I'm going to tell you about how just one of those issues is being
addressed in, and by, the State of California. The health insurance
issue.
Why is it
important to study what California is doing? Because California is the
fifth largest stand-alone economy on Planet Earth. It is a vibrant
State, with vibrant people. What happens here migrates to other States
quickly.
Sit down before you
read this next section. You're going to be shocked...
The California
Legislature, both the Senate and the House, have passed Senate Bill 840, which
in effect, will make it illegal to sell health insurance within the State of
California. The bill is heading for the Governor's desk.
I have, below,
copied a section from a website for a group called
"Health Care For All,"
where you can go to get even more information about SB840. The section
is self-explanatory.
The bill incorporates the following features:
Security - Everyone is covered. No one will ever lose coverage for any
reason.
Choice - Everyone can choose their doctors and other providers. Under
this single payer plan, health care delivery is in the private sector.
Comprehensive Benefits - Everyone has full benefits that include
prescription drug coverage and mental health care.
High Quality - Doctors and patients, not administrators, make medical
decisions. Hospitals can afford safe staffing levels for registered nurses.
Primary and preventive care are priorities.
Efficient Administration - Huge savings result from removing insurance
companies from health care. Provider and patient paper work is slashed.
Fair Cost sharing - Employers and employees pay a modest health care
premium, which is less than most pay now.
Fair Reimbursement - Providers receive fair and full compensation for
their services.
Cost Controls - Health care inflation is controlled by efficient
administration, global health care budgets, bulk purchases of drugs and
durable medical equipment, coordination of capital expenditures, and linkage
to growth of the State Gross Domestic Product.
I am an Orange
County California Conservative Republican. SB840 is sponsored by Liberal
Democrats and I wholly support it. Absolutely. It can't happen
soon enough. I applaud the bill's sponsor, Senator Sheila Kuehl and her
staff for their efforts.
Stay tuned...
Tim Bolen -
Consumer Advocate
