Blog Archives
Archive Page

HOME

8/31/2009

I've been a bit down the last few days. I miss Teddy Kennedy, I am sad to see the end of the political powerhouse that was the Kennedy Brothers and I just couldn't muster the gumption to write about anything.

Until I saw this group. Billionaires for Wealthcare. They like to dress in black tie and pearls and go to healthcare reform townhall meetings to mock the teabagging nutters. And they mock them so very, very, very well.

Survival of the Richest!

A 428% increase in premium costs is just GOOD business!! (we have to eat too).

It's a class war, and we're winning!

Healthcare is for profits!

Mocking mercilessly and hilariously the 20%'ers who are probably just slobbering to read Cheney's new CYA and Throw Bushie From The Train book?

It just doesn't get any better than that.

|

8/26/2009

You all know by now that Ted Kennedy died last night. I guess I knew it was coming soon when last week he was requesting the Senate to hurry up and replace him, or to allow him to pick his successor for the remainder of his term in office. So while the news this morning wasn't unexpected, I still find it to be a shock.

I don't shock easily. I don't get upset when a movie star or musician dies...maybe they are too far removed from my reality for me to feel anything much about their deaths.

But I'm feeling a loss right now that many in this country are expressing, and a great loss it is.

Teddy Kennedy, for all his faults and mistakes in life, was at the end of the day, a good and decent man.

He was a man of the people. One of those few ultra-wealthy who can feel a sympathy and empathy with the non-wealthy. The type of man who only comes along once in a very great while. His brothers also truly cared about other human beings, even the ones who didn't live in mansions - and they both died for it. They never lived in the gutters of America, they never had to. But all three had the ability to think beyond their own personal wealth and priviledged lives, so see, actually see those who did have to live in ghettos and shanties, who had to suffer daily from the soul, body and mind-crippling effects of deep poverty.

Teddy, as a young man, wasn't very good at it, expressing empathy for those far less fortunate. However, he grew into a man who was very, very good at it.

I think Teddy carried his brothers' mantles well throughout the last few decades, when he fought in the Senate for the common man and woman.

He fought long and hard for minimum wage laws, and always fought long and hard for minimum wage increases. Not because he wanted votes, not because he was bought by labor unions or whatever else he may have been accused of by our insane brothers and sisters on the right, but because he believed that a worker should not have to live their lives at the mercy of the good graces or petulant whims of their employers.

What was clear throughout Ted Kennedy's career as a Senator was that he felt that humans deserved some measure of dignity for the simple fact that they were humans. Wealth and priviledge did not factor into that belief, because the American People were not subjects to royalty, but human beings who deserved respect.

He put his money where his mouth was on many, many occasions.

He was instrumental in getting the Family Medical Leave Act passed, despite strong opposition from the right. The bill isn't perfect, but it sure does provide some breathing room for many Americans who need some time off to care for a sick relation, an elderly parent or a new baby. Those of us who work for companies with more than 50 employees no longer need to worry about being arbitrarily fired by our employer for daring to take more than a week off after having a baby, or when a parent falls ill or when a spouse is injured. He fought for this, and saw it as a social safety net.

He was instrumental in getting the Americans with Disabilities Act passed, which helps to keep the deck from getting stacked against our disabled brothers and sisters who are perfectly capable of working, loving and living with just a little help. All of this came with strong opposition from the right, of course.

NOW has this to say tonight:

"We lost a true legislative hero in Ted Kennedy -- a defender of women, children and all those who are discriminated against and underserved in this country," said NOW President Terry O'Neill. "We have Kennedy to thank for the Civil Rights Act of 1964, the 1965 Voting Rights Act, the Americans with Disabilities Act and the Family and Medical Leave Act. He was a great leader in the fight for health care reform, and I only hope that we can honor him by passing real reform designed to benefit the people -- not insurance CEOs."

Kind and heartfelt words, considering that NOW doesn't really like anyone.

Ted Kennedy really will be a difficult act to follow. Ask me if I can think of anyone in Congress who could follow in his footsteps, and I'll tell you that true leaders aren't made, they are born. You never know who will step up and take the reins when adversity comes around. You just never know who, when called upon, will have the nerve to step forward and keep up the good fight against tyranny in all its varied forms - be it stark-raving mad corporations who would destroy the world to gain a dollar in profit, or be it tyrannical Presidents who are unable to exercise control over their own petty and misguided beliefs.

Kennedy was also a long-time champion of healthcare reform in order to level the playing field for the poor and for the constantly struggling middle-class by forcing insurance to play a fair, clean game.. A good friend said we should rename the healthcare reform bills "Teddy Care." I think that is a good idea. It may smack a bit too much of the warm fuzzies, but it is catchy, there is no denying that. (Thanks, Jess.)

So I will go to bed tonight feeling just a little more alone, faced with the prospect that there is one less person in the world who gives a damn about me, and you, and our families.

|

8/23/2009

If you watch the news reports, the mainstream media seems to believe that a huge percentage of the american people do not want any kind of healthcare reform. Flawed polls show it! It must be true! Millions are showing up all over the country protesting any kind of industry reform! We must take them seriously!!

Congress, meanwhile, has certain members (Grassly, et. al.) who want to whip up the base, get them riled, get them out there putting a face on what Palin called Real America. We all know they are fighting it tooth and nail and that they will not, under any circumstances, negotiate. By God, they are the chosen ones, and Obama and all us librul scum can just go do some physiologically impossible things to ourselves.

Sounds pretty scary. Republican grass-roots organizations mobilizing by the millions, marching in the streets in order to stop healthcare reform. Crowding by the thousands into civic centers and public libraries across the nation, in every county, city and state, carrying placards and signs urging their House and Senate representatives to read the bill...where's the birth certificate?...keep your government hands offa my medicare...no pubic option (see below post dated 8/18/09 for a particularly good image of all that "sic")... And some of them even come armed with guns strapped to their legs like they are Han Solo come to blast away those pesky liberal stormtroopers and save the day from the Democrats who will, mark their words, destroy this fine country by making life more equitable for more American Citizens.

Yeah. Sounds scary, all those millions who oppose any type of healthcare reform, because they are perfectly happy getting scammed by their private insurers, and the rest are on Medicare or Medicaid, but dammit, keep those government hands off their Medicare and Medicaid.

But pesky little facts keep getting in the way. Like the fact that Medicare and Medicaid are government funded programs.

The fact that there are MILLIONS of people protesting ObamaCare. Er, well, maybe not so much.

A friend of mine tried to get into a townhall meeting near San Francisco, where the protesters numbered in the tens. Tens, not Tens of Thousands.

On August 15, 2009, several thousand showed up for a protest. Not Tens of Thousands, not even Ten Thousand. Several Thousand. Note that the population of Atlanta is more than 5 million. Conservatively estimating a turnout of 5,000, and estimating that the anti-Obama crowd outnumbered the Pro-healthcare reform crowd by 3,000, then that means that approximately .006% of the population of Atlanta is so against healthcare reform that they bothered to go out in the heat and scream and holler about it. It really isn't all that impressive when you look at it that way, is it?

In Corpus Christi, Texas, where the population of the immediate area tops 286,000, a whopping 200 protesters showed up to complain about government intervention in their lives. They are perfectly happy to go broke without the government helping them, thank you very much.

That's .006% of the population of Corpus Christi that turned out to make their demands know, dammit! .006% of the population in a state that went 55% for McCain last November. Not very impressive.

YahooNews says today that Obama may finally abandon all attempts at negotiations with the republicans over healthcare reform.

It is about time, and what took him so long to figure that one out? I know he wants bipartisanship, but he hasn't gotten any yet, and he's certainly not going to get it now. So screw'em, move on and get a decent bill passed, and take this opportunity to leave the public option in, to put make some of the private industry's practices illegal and punishable by law, and forget fines, I'm talking jail time. Forget about all that opposition, because if you take the number of protesters in every major city, throw in the smaller cities, the towns, counties and villages, you get the sum total of the people who thought Bush was still doing a good job when he left office.

In other words, you get 20% of the population totally against you.

Big deal.

In the meantime, 46 million Americans are uninsured, and I think that number is extremely conservative, given that is the number that was floating around last year before the massive layoffs of millions began. Most of those people have already lost their COBRA coverage, if they had any to begin with, or are about to lose it shortly, because the jobs aren't coming back just yet. My guess is the number of uninsured Americans right now is around 55-60 million. That number will only soar if healthcare reform isn't passed now, because the insurance companies will just become more brazen in their thievery of the Entire Country. They are sinking untold amounts of money into the battle against healthcare reform, and doing a piss-poor job of it still, given the examples we see above of just how much protesting is going on against it. They are shelling out money in the hundreds of millions because they are running scared - they know that their days of "business as usual" are numbered. The correlary between the twisted behavior of the Private Insurance Industry in financially fueling the fire of the 20%'ers and the even more twisted behavior of the entire republican party since November 4, 2008, is strikingly direct - both are running scared, because they know deep down that their days are numbered.

But, at the end of the day, the only people out there squawking about how evil healthcare reform will be are the 20%'ers. I for one am not inclined to let this opportunity of the reform of a dirty, thieving and murdering industry fall to the wayside on the whims and delusions of 20%. Not even 20% of the country, either, just the 20% who managed to get themselves polled when Bush was about to leave office. Someday I'll crunch those numbers, but my gut tells me we're talking in the hundreds of thousands in a country with a population of 300+ million.

Big deal.

|

When I saw yesterday that the President said that the public option can be dropped in favor of consumer owned co-ops, I said "Mr. President, WTF??"

Then I said to myself:

Well Bee, let's think this one over. Social Security wasn't by any means perfect when it was signed into law by FDR in 1935. It didn't cover domestic workers - (conveniently at the time) most of whom were black. It didn't cover agricultural workers (most of the country), but today, it covers everyone. We all pay into it, we all collect it when we come of age or disability, and despite all the ballyhoo'ed cries of "it won't be there when I get old" (which, by the way, has been said since 1935), it is the holy of holies. It is untouchable. Remember the reception that Bush got when he talked about turning it over to Wall Street, like a 401-K, back in 2005? Not a warm reception. Not even from his own side.

So can we live, for now, with a co-op plan, rather than a public option plan? Sure. As long as the door is opened, as long as everyone can get covered, as long as the insurance companies get some kind of competition to force them to start playing a little more fairly, at least. As long as they aren't allowed to use the "pre-existing condition" excuse to drop sick people any longer. As long as the healthcare system improves, even if only a little. Because the improvements can be made over the long run, it can be tinkered with bit by bit until we have a workable system that has some semblance of equitableness. The door has been shut tight, bolted from the inside and electrified to kill for decades - if we can only get it open a crack, maybe we can get our foot in it and force it open later.

That was yesterday.

Today, my heart is a little more hardened, by dander is up, the panties are in a wad, and I said to myself:

Yeah, Bee, but let's face it. The time is ripe. Despite the bullpucky coming from the extreme right wing (those same 20% who thought Bush was still doing a good job when he left office a total disgrace) and the main-stream-media, which doesn't have the sense of a bag of hammers, most people in this country want a public option plan. Most people want some fairness in the system for a change - many have been burned. Few of us don't at least know second-hand of someone who has been burned badly by the private insurance industry. We know the entire industry is crookeder than a dog's hind leg. So why give up the public option? Why let that die in committee when we could reach for it and get it right now? Why take it off the table at all? Put the entire private insurance industry out of business entirely, hire up their paperpushers to work the paperpushing jobs for the government side, and let the executives fend for themselves. Why drop the option?

Why, indeed. To appease this?

This woman can't even spell Public. Notice the woman in the wheelchair - bet you dollars to donuts this bitch is at least on Medicaid, most likely drawing social security disability benefits and is protesting that gubmint run heathcar.

They prattle on and on with the talking points they get from the traitorous bastards Glenn Beck and Rush Limbaugh and Michelle Malkin and some of the congressmen like Grassley (who now denies he ever said 'death panel' give me a f-ing break). They believe this crap, because they have let their own minds be twisted to the point where they don't have a clue what fairness is. They would cut off their own nose to spite their face. So why are they even a factor? Because CNN says they should be? Because the NYT thinks they should be? Because they bleed, so they lead?

I call bullshit. Leave them behind, let them rot in their own self-importance born of disaffection stemming from the fact that they are no longer the center of the universe in the rest of the country's eyes. Personal experience tells me that when a public option is introduced, and this bunch finds it will be cheaper on their wallets to join up, they will be the first in line with their hands out.

I work for a man who all but called me a socialist in a staff meeting right before the election. I heard him talking recently about getting his son's car traded in so he could get some money back with the Cash for Clunkers program. In the next breath he decries the "socialist liberal agenda."

A woman I work with hosts "teaparties" (more like tailgate parties, really) and then scrounges all the federal dollars she can get to send her kids to college.

I hear people every day crying about socialism this, socialism that, but they don't turn down those social security checks, and they sure as hell won't turn down that Medicare enrollment. No, their principles are for everyone else, not themselves. In backassedwards world, this is how it works.

But in the real world, where the rest of us live, public option cannot be made into "not an option."

So, Mr. Obama, just what the hell are you doing, saying the words even distantly resembling "public option can be dropped"? Stop trying to cater to the nutters. In the end, it is the rest of us that matter.

|

8/16/09

In May 2009, Health Care For America Now issued a report entitled Premiums Soaring In Consolidated Health Insurance Market with information which covers the years 1999 through 2007 and with hard data gleaned from sources such as the AMA, Henry J. Kaiser Family Foundation, Government Accountability Office and others, the HCAN report is damning in its indictment of private health insurance monopolies.

Here is a short breakdown of the report's findings:

1. Under the Justice Department anti-trust guidelines, 94% of health insurance markets in the United States are considered "highly concentrated." Read: Monopolies in 94% of the country. Markets are considered "highly concentrated" if any one insurer holds more than 42% of any given market. In 10 states the 2 largest insurers control 80% of the state market. In Alabama, one company holds 89% of the market share for the entire state. 30 states have localities in which one company holds a monopolistic stranglehold on the local insurance market.

2. In the past 8 years, nationwide premiums increased 120% vs 29% average US wage growth, an utterly unsustainable gap. Free Market naivete is not working, and in fact has given these companies carte blanche to put the entire country in an economic stranglehold, with more than 60% of new individual bankruptcies the direct result of a medical bill, and 78% of those insured.

3. The report came to the same conclusion that I came to in the recent series on health insurance CEO's and the companies that they helm. These companies are ripping off the american people, ripping off the government when they come anywhere near medicare or medicaid, there is no competition because the industry operates in such a way to make sure that competition does not occur.

4. The 10 largest publicly-traded insurance companies saw their profits rise 428% from 2000 to 2007. CEO pay in 2007 totaled $118.6 million (see previous series for each CEO's annual compensation).

5. Private insurance companies buy back their own stock to pad their balance sheets and entice Wall Street investors, and to keep them happy. Again, the insureds do not even begin to factor into this equation.

The only rational conclusion is that the private insurance companies have rigged the entire system for maximum profit generation/retention and maximum shareholder satisfaction. Forget about the insureds who pay exhorbitant, and skyrocketing premiums with no end to the increases in sight.

All of this occurred after Bill Clinton left office, and spiraled out of control during the Bush administration.

Let me repeat that: All of this spiraled out of control during the Bush administration.

Bills are pending in the House and Senate to put some reigns on the economic and health bludgeon that the insurance companies wield against the average American citizen.

But the so-called townhall mobs, riled by various right wing websites, who are in turn paid for and coached by lobbying firms who are in turn paid by...who else? The insurance industry), are told to yell and holler and bring their guns. They are told to disrupt the meetings, forment chaos, not allow a word to be gotten in edgewise, and to basically make asses of themselves on any camera they can get in front of. All 50 of them at any given "protest", from what I've seen.

Rachel Maddow, who is proving to be one of the few actual journalists out there in the MSM right now, really nailed the Astroturf movement in this clip:

Rachel outstandingly outed the Astroturf Regime as a fraud. Just like the companies that they holler and spit and throw bile in favor of at various townhall meetings.

Frauds. We should not be suprised, however, because this Astroturf movement is a sham. The people showing up with their hand-lettered signs and WalMart attire are the same 20% of voters who still thought Bush was doing a good job when he left office last January. Bush was a fraud, so like begets like. We should all stop wasting our energy trying to understand how average americans could be so against their own self-interests, because rational thought for those astroturfers went flying out of their heads long, long ago.

What are the consequences if healthcare reform dies on the Senate floor this year? More of the same, and maybe something worse. Increasing profits for insurance companies, increasing numbers of uninsured or under-insured americans, more individual bankruptcies and destruction of the American heart and soul under the weight of debt burdens that no person could shoulder.

We'll see more of these:

This isn't a healthcare townhall "mob", this is a free-healthcare mob in Inglewood California recently, where free medical care was being offered for those who had no insurance and can't afford to see a doctor.

We'll see more stories like this, from my great state of Virginia, where free-clinics were swamped by more than 2,000 in one of the poorest areas of my state.

As more jobs are lost, as COBRA runs out for those already unemployed (if they had it to begin with) we will see more and more of this demand for free healthcare by those with no other options. I will leave you today with an not so hypothetical question: What happens when that mob, which far outnumbers the Astroturfers, decides it has had enough of the top 1%, supported by the base 20%, determining their individual liberty from increasing debt burdens and lack of the simple human right of healthcare?

Red faces and hollering and spitting bile and hand-made signs will be the least of that backlash, I suspect.

|

8/9/2009

Meet Jay Gellert, CEO of Health Net. Jay makes in excess of 4 million dollars a year.

Jay's company dabbles in Medicaid and Medicare, acting as an HMO "middleman" between patient/doctor and the government. Jay's company was the subject of a class action lawsuit in Connecticut in 1999 by EVERY SINGLE ONE OF THE 76,000 MEDICAID PATIENTS IN THE STATE at the time. Also named as a defendant in the suit was the then-commissioner of the state's Department of Social Services.

The suit alleged that Health Net was, as a matter of course, denying Medicaid claims and then not bothering itself to allow patients who had received claims denials an avenue to appeal the insurance company's rulings. The plaintiffs sought no damages, no monetary gain - only that the court force Health Net to abide by state and federal laws governing those private companies which administered the Medicaid plans. They only wanted this company to stop BREAKING THE LAW.

This was the first class action lawsuit that would be filed against insurance companies which were ripping off Medicaid and Medicare. As we have seen in the course of my Trials, they would certainly not be the last.

Health Net was also sued in California for illegal business practices. One of which led to a 9 million dollar settlement when they canceled a cancer patient's coverage smack in the middle of chemotherapy.

Health Net was also engaging in one of the Insurance Industry's favorite pastimes: Encouraging and rewarding, employees who rooted through the files and ferreted out any policy they could possibly rescind.

And still, the most that any one of these thieving, scamming, conning companies get is what amounts to a slap on the wrist, if that. Health Net settled in California for $255 million. A drop in the bucket, even 8 years ago. Let's say it again: $255 million settlement for practices that the Judge even called egregious.

This will be the last of my series of trials of Insurance Company CEOs. In every single part of my series over the last couple of weeks, we have seen how EVERY SINGLE insurance company profiled has caused terrible bodily and mental harm to their insureds. Every single company in this series that is contracted by the Federal and State governments to administer Medicaid and Medicare plans have completely ripped off Medicaid and Medicare - meaning that they have ripped off YOU AND ME regularly and without constraint. They have received slaps on the financial wrists when someone should have been going to jail.

In every single company I have profiled, we have seen that recissions of policies by beancounters who get bonuses for finding that cancer patient who will cost the company a pile of money, but who had acne treatment 20 years ago that they did not disclose. The companies, in their twisted sense of non-logic and corporate greed-driven culture, figured this gave them the right to rescind the policies of untold numbers of people whose only crime was to get sick. Who cares if the patient was in the middle of chemo? Or was scheduled for major and necessary surgery the next day? Who cares?

I do. I care, and you should too, because that could be any one of us any day now. Lose your job, you're screwed. Better not have had any health problems up to and including acne, because you'll never get covered even if you find another job that offers health benefits. Better hope your kids aren't born with deformed skulls, because Cigna thinks that the simplest and cheapest way to treat a deformed skull on an infant is "cosmetic" in nature and thereby exempt from coverage under their fatally flawed policies.

It all comes down to this: These thieving bastards have been ripping off the american people for decades. With all the money they have ripped the government off for in their Medicaid/Medicare scams alone, we could have already been a long way toward paying for universal coverage.

I've heard it said that insanity is trying the same thing over, and over, and over again with the same results each time, and then refusing to try a different course of action. Insanity reigns supreme in this country today. Lobbying firms in D.C., paid by Insurance Companies like Health Net, Cigna, Aetna and all the others I have profiled, bus blubbering idiots to townhall meetings where democratic Senators and House Reps try futilely to inform the populace of the various healthcare reform bills facing Congress right now.

White Power-mongerers are calling for these "protesters" to carry firearms when they go to these townhall meetings. The country feels like a powder keg ready to blow, and over what?

Over exercising some control over these insurance companies, each one of which has been sued time and time again, "warned" by state insurance offices to cease their fraudulent practices? Over trying to gain a little bit of power of these thieves and rogues who are paid millions of dollars each year to perpetuate the illegal and murdering activities of the companies they helm?

All the so-called protests are about one thing, and one thing only. There is a black man living in the White House, and they can't stand it, can't fathom it, can't believe they have lost the power they spent the last eight years shamelessly grabbing. The sad and pathetic part is that the actual people who go to these "protests" never had any power to begin with - they have been just as firmly under the thumb and subject to the whims of the Healthcare Insurance Industry just like the rest of us. When a company like Health Net or United Health rips off government sponsored and taxpayer subsidized Medicaid and Medicare, they get ripped off along with the rest of us taxpayers.

So why aren't they angry about that? Why aren't they protesting being held in indentured servitude by the Insurance Industry? Why aren't they protesting that their elected representatives have been paid off by the Insurance Industry?

Because there is an African-American living in the White House and they can't stand it.

The protestors bigotry, hubris, personal greed and sorry ambitions of cultural exile of all of us "others" will hurt themselves in the end more than it would hurt us actual "others." You see, we "others" are used to it - we know what the score is. We are non-white, or non-christian or totally non-religious and we know, from years and years of experience, what we are up against. Those white, middle class protestors who have never come up against real adversity in their lives, don't have a clue what kind of damage they are doing not just to us "others," but to themselves in the long run. Not unlike serial killers, they got a little taste of political blood these last 8 long years, and they liked it, got a real taste for it, and only want to indulge that craving for power. When BushCo left office, he had about a 20% approval rating. We're seeing that 20% in those townhall meetings, disrupting, trying to cause chaos, trying to cut off any talk of healthcare reform at all, because they know that if the other 80% who didn't approve of BushCo when he left office just a few months ago hear the real deal, they might like it. They might want healthcare reform once they find out that no, it's not true we're going to euthanize granny, but we might want her to have a life-directive to determine what SHE wants to happen to her if she is incapacitated. The insurance companies know full well that if america starts down the European/Canadian paths of coverage for all, then there will be no turning back, that it will be as popular as the Holy of Holies, Social Security.

And they know it will be politically untouchable.

And they also know that the right wing will be wandering the wilderness for the next generation, not unlike one of their favorite biblical icons.

When the violence really breaks out at one of these townhall meetings and someone ends up dead, or once a few good union folk are murdered in their driveways because they dared to attend a townhall meeting, or once some wackjob decides to pull a "suicide bomber" on a local civic center meeting, then the protestors will learn that hardest of lessons which Ghandi, Dr. King and even Malcolm X, toward the end of his short life, espoused: only non-violent civil disobedience can achieve maximum results. Once violence is factored in, all is lost for whatever the cause may be. Too bad these cretins couldn't just open a book occasionally, instead of reinventing the civil disobedience wheel all over again. Too bad they do not even have a good reason to engage in civil disobedience.

If we do not get some kind of healthcare reform, even flawed reform, the insurance industry will eat us all alive. It is no coincidence that these companies really started their era of record profits and total disregard for any existing law after the Clinton's failed initiatives in the 90's.

And if we don't get it, we will have the paid "protestors for hire," along with the Insurance Companies, to blame.

|

8/6/2009

Meet Dale Wolf, CEO of Coventry Health. He makes in excess of 9 million dollars a year.

Wolf is an appropriate name.

Dale took over Coventry in 2005, so he just missed this little gem: the State of Maryland Insurance Administration had a little audit of the business practices of Coventry Health in the state in 2004.

Here are a few of the nasty little doings that the Maryland Insurance Administration found about the way Coventry did business in their state:

Failure to process claims within 30 days of receipt. Failure to consistently pay interest on claims processed in excess of 30 days of receipt. Failure to give the proper reason for denial. Failure to provide coverage for prescribed contraceptives. Failure to render a final decision in writing to a member or a health care provider acting on behalf of the member, within 45 working days after the grievance was filed. Failure to send a copy of the written notice of the coverage decision to the treating health care provider. Failure to send a notice of the coverage decision.

In case one might think this was an isolated case, Nebraska found similar problems with Coventry operating within its state. This is from a lawsuit filed in February of this year against Coventry Healthcare of Nebraska, Inc., a subsidiary of Coventry Health:

...part of the inquiry revolved around why a claim was denied several times as a pre-existing condition despite policy terms dictating that if the treatment for said preexisting condition was outside of six months, it was no longer considered a preexisting condition.

Coventry was found to have violated state law in regards to denials for preexisting conditions. They were hammered with a fine of $2,500. Meanwhile, someone had to suffer without treatment because Coventry denied their claim 3 times, even though Coventry's own terms of contract stated the condition was not preexisting.

In short, Coventry has been ripping off its insureds by not paying on claims, then not even having the common decency to even notify anyone of the denial. They were ripping off the doctors. They were pretty much ripping off everybody. They didn't bother to abide by their own contract. Of course, arbitrarily choosing to disregard its own contract terms with its own insureds is standard operating procedure throughout the industry, as we have seen over the course of this series of trials.

If you want a really clear view into the simple fact that insurance companies are corporations whose sole reason for existence is NOT healthcare, but shareholder profits, read a couple of pages of the June 28, 2008 call transcript of Coventry trying to explain to the financial media and shareholder why the company tanked just a bit in the 1st quarter of 2008. It was all because of, they claim, higher prices and not more sick people after all - and they were suprised. The language is pure corporat-ese. It is anti-septic, cold, aloof, uncaring inhuman, inhumane and full of industry jargon like "acuity." They're talking about people there. People are "acuity." How can you tell? Go looking for that word in a standard dictionary, a business dictionary, and health-insurance industry dictionary (yes, there is one) used in that context. It isn't. So, when Coventry's CEO Dale Wolf talks about more acuity in Atlanta and Utah than in other areas, he's talking about sick people. How nice, they've even twisted language to describe - people.

Insurance is big business, friends. Dale Wolf makes more than 9 MILLION dollars a year to speak in corporat-ese that is on the face of it absurd, and below that face, obfuscating. Many of us have seen just that language in a claims denial letter.

But if you're insured by Coventry, as the Insurance Administration office found in Maryland, you might not even get an obfuscating letter denying your claim. They just won't bother.

|

8/3/2009

Meet Micahel B. McCallister, CEO of Humana:

Mikey makes in excess of 15 million dollars a year.

Mikey's company, Humana, got itself sued under the RICO act. RICO - that usually means Mafia, right? Right.

Humana found itself in a suit under the RICO laws, filed for summary judgement claiming that in Nevada, where the suit was filed in District Court, Humana couldn't be sued under RICO because it conflicted with State law. The Federal Appeals Court found differently - and the Supreme Court upheld the Appellate Court's opinion that Humana could indeed be sued under the RICO law. These guys must be pretty bad boys, because RICO stands for "Racketeer Influenced and Corrupt Organizations Act." In other words, this is the law that the Feds use when they go after the Mafia. In fact, it was created specifically for that reason. To take down the Mafia.

RICO fits these guys to the T. They were sued for not paying the full 80% they were obligated to pay after insureds' hospitalizations. Humana paid 80%, alright - 80% of the discounted fees once they finished wheeling and dealing with the hospitals. The insureds paid their 20% based upon a non-discounted rate. In effect, Humana was paying way less than their obligated 80%. Much, much less. Now we see where those Mafia Laws come into play.

But the Mafia always had its standards, whereas Humana doesn't. Humana also plays in the Medicare sandlot, and has hiked senior's premium rates for this "preferred" plan, which includes prescription drug coverage, by 13% over last year.

Insurers who offer the "Advantage" plan managed to rake in $5 billion dollars in premiums last year. While this is a Medicare plan, it is an enhanced Medicare plan, and seniors pay out of pocket for this plan, on top of the $96/month they pay for Medicare.

And Humana hikes the rates just when many seniors have been hit hard by the economic crisis. They have seen their retirement savings (if they had any to begin with) shrivel up and blow away with the winds of greed, and Humana has been right there to harden that blow by hiking rates. Why?

Because they can. The government doesn't pay these increased rates - these are paid for by seniors who have been convinced that this enhanced plan will serve them better than basic Medicare. What's the come-on when pushing "Advantage" plans? No premiums. Until the "free trial" period is over, then companies like Humana start slapping seniors with fees of $50/month, or more.

Doesn't sound like much, huh? $96, plus another $50, that's only $146 a month. But try paying that on a monthly social security check and not much more.

Personally, I think that suing Humana under the RICO statute was perfectly reasonable and completely warranted.

Something is badly broken in this country when RICO laws can, and should be used against a health insurance company. That broken something is the entire private insurance industry.

Congress has gone on its summer break, with the Congresspersons flitting off to Camp Thunderbird to play tag and swim in the lake for the month of August, or off to Tahoe to do whatever it is the rich and powerful do in Tahoe, or maybe to St. Thomas for some sand'n'surf. While they are away enjoying themselves, or working on their 2010 campaign, how many seniors barely making it as it is are going to see their premiums shoot sky-high for a Medicare plan run by the Humana goons?

|