AIG denied claims, and Jay Leno wanted to know . . .
EVERYONE, anyway, at least many people are up in arms this morning over the stories being splashed across America concerning the shabby way AIG has denied medical claims to several who quite clearly were entitled to receive them.
For those few who may know no more of AIG than that, while it was being bailed by US taxpayers it's top privte-jet execs were being feted lavishly with bonuses, the business it was and remains in is that of insurance.
When you’re setting out to build a damn, one of the first things you’ve got to do is to create a diversion for the stream or river. That’s what’s going on with all the stories about the legitimate health insurance claims that AIG repeatedly denied. (Example: Blind Amputee Iraq War casualty John Woodson tells his AIG story on ABC’s 20/20 http://abcnews.go.com/2020)
For emphasis, I repeat, “the financial business it [AIG] was in is that of insurance.”
Prior to my retirement a few years ago, for nearly a decade and a half, I was a licensed and appointed life and health insurance representative in Nevada, Florida and California (Nevada lic: 507599; Florida lic: E112351; California lic: 0B84780), fully authorized to transact life and health insurance contracts on behalf of every major health insurer.
In 1975, separated by only 20 days, I underwent two separate small bowel resection surgeries. From that point on, approximately every three to four years, I repaired to the ER at El Camino Hospital in Mountain View, a consequence of small bowel adhesions that were the product of the wounds and surgeries I’d sustained in the past. The surgeon who treated me in 1975 became my primary care physician. From time to time we’d chat.
For a period that lasted nearly four years, until the fall of 1999, I dated one of the staff of a nephrology doctor in San José. And from time to time I drop into the office, to say hi. And, from time to time, if my lady was busy wrapping up some office business, the doctor and I would chat.
Whether it was my surgeon-physician or the nephrologist-MD employer, the conversation, with fair frequency, sidled onto some of the undesirable aspects of their professions. Both had college-age kids, and both told me how they just could not recommend the field of medicine to their offspring. The why of their disenchantment was common: Too much time, about two to two and one-half to three hours every day, was consumed arguing with insurance company clerks — Repeat: Insurance company CLERKS; predominantly women with absolutely zero medical training were reading computer monitors that listed the permitted therapies for any given set of symptoms, and for which the insurance company would pay — for permission to treat their patient as the doctor’s education, training and professional experience directed. “And they won’t talk to anyone in my office besides me.”
Now let me take you to a screed from the right that has become a clichéd ad nauseam mantra on the topic: “There shouldn’t be some government bureaucrat coming between decisions that should be left to a doctor and his [Too often the male pronoun, despite the fact that, for the past several years, women compose the majority of medical school students] patient.”
The preceding is always the opposing argument to a government sponsored single-payor system, and on behalf of the present private insurance system. The thought that some federal government bureaucrat would interfere with a physician’s and a patient’s decision concerning a suggested medical therapy or procedure . . . The horror! Perish it!
To one and all who propound the argument, and to one and all who listen to it, recall the question Jay Leno asked actor Hugh Grant, while a guest on the Tonight Show in 1995, “What the hell were you thinking?”
That famous question has become as much a part of the American lexicon as “Frankly my dear, I don’t give a damn.” Nonetheless, it has purchase coinage for so many topics besides the one Leno confronted Grant with: Why would a fellow, married to Elizabeth Hurley, surely one of the most beautiful women in Hollywood, traffic with Divine Brown, a prostitute, in a quasi-public setting, in his car?
As it does concerning any argument that supports retention of our for-profit, private insurance medical care delivery model, the mind swims, trying to find any reasonable answer that any reasonable person could come up with as to why the argument should be given a moment’s credence. The sole function performed by the insurance company clerk — CLERK — is to enhance corporate profits by COMING BETWEEN DECISIONS THAT SHOULD BE LEFT TO THE DOCTOR AND THE PATIENT, by DENYING the physician and the patient the opportunity of receiving the care the doctor recommends!
Consider what’s involved in our current system, the one Republicans support. Profits are earned by maximizing revenue and minimizing expenses. By far the biggest expense insurance companies bear is the payment of claims. Other expenses include the millions to 100 million-plus dollars paid individually to the CEOs and top management, and the very nice up front commissions paid to the appointed sales staff. Also included are the opulent periodic trips to Mexican, Caribbean, Asian, and European resorts that are lavished on top management and sales personnel. Those, however, are not, as are claims paid, subject to being cut. Those are production incentives that are in addition to the commissions paid. Overall, the average “administrative” expenses for insurance companies run in the 30% range. (As comparison, Medicare and VA administrative costs run in the 5% range.) That means, for our private insurance contrivance, 30¢ out of every $1.00 of paid premium doesn’t get those trapped in it a single cent of medical care.
Who else besides a for-profit insurance company could remain in business carrying that kind of overhead? No one, which goes to explain a large part of the reason US companies, large and small, if they provide health insurance to their employees, are non-competitive versus their foreign competitors, why so many US jobs have been shipped outside US borders, why so many US employees have forever lost their jobs.
This, however, does not consider any of the externalities that are part of the present scheme. The doctor has a gross revenue target that must be met to pay the costs and expenses of office space lease, staff salaries, equipment and supplies, etc. As every minute a doctor spends on the phone with an insurance company clerk is time he or she cannot devote to billable patient care, the fees charged for patient care have to be increased, to compensate. Every minute wasted with an insurance clerk is time that cannot be devoted to enhancing the doctor’s professional knowledge through review of medical journals. That translates as care that may not be completely current, which can further translate into less efficacious therapies and procedures that then raise other costs, costs in longer hospital stays that have poorer results than might otherwise be the case, all of which add to US medical care insurance premiums.
What must also be added as an externality are the costs presented by the non-paying under- and uninsured who primarily (exclusively?) access the healthcare system through the Emergency Room doors. The costs that occur there are the highest within the system, and all get transferred to those who do pay, via insurance contracts or out of their own self-insuring resources. Statistically, those who for whatever reasons do not regularly avail themselves and their family of healthcare services and education are the least healthy in our population. They are many times more likely to be obese, to have an unhealthy lifestyle, have unhealthy habits, have low-weight babies, less vigorously healthy children, and are therefore more prone to all the ailments that will prove through their lives to be exponentially the most expensive to treat.
One thing the media promulgators of the AIG claims-denying brouhaha are not making clear, while you’re seething over just one more loathsome behavior those bonus-gobbling corporate welfare bums engaged, is how AIG’s practices and policies are manifestations that are part and parcel reflections of the entire for-profit private health insurance industry. Reread my professional and anecdotal bona fides, then let me shout this from the mountaintop: THEY ALL DO THE SAME THING! It’s what for-profit, private insurance is. So long as profit is part of the proposition, it simply is impossible for it to ever be otherwise.
Listening to anyone orating on behalf of a proposal that would keep the insurance companies involved? Giving them any part of your time? What the hell were you thinking?
— Ed Tubbs
