Black People : What do you realy know about the HMOs

Discussion in 'Black People Open Forum' started by Ankhur, Oct 18, 2009.

  1. Ankhur

    Ankhur Well-Known Member MEMBER

    Oct 4, 2009
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    They Dump the Sick to Satisfy Investors”: Insurance Exec Turned Whistleblower Wendell Potter Speaks Out Against Healthcare Industry
    As the debate over healthcare reform intensifies on Capitol Hill, we spend the hour with a former top insurance executive who’s now exposing the industry’s dirty secrets. Wendell Potter once served as the head of corporate communications at CIGNA, one of the nation’s largest health insurance companies. We speak to Potter about his own transformation from industry mouthpiece to whistleblower, the healthcare industry’s extensive PR and lobbying machine, the campaign to discredit Michael Moore’s film Sicko, and the insurance industry’s most pressing task: the fight against a public option, let alone a single-payer system. [includes rush transcript]
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    AMY GOODMAN: As the healthcare reform debate intensifies on Capitol Hill, we spend the hour today with a former top executive from one of the nation’s largest health insurance companies who has begun exposing some of the industry’s dirty secrets. This whistleblower testified before the Senate Committee on Commerce, Science and Transportation last month.

    WENDELL POTTER: My name is Wendell Potter, and for twenty years I worked as a senior executive at health insurance companies. And I saw how they confused their customers and dumped the sick, so all they—so also they can satisfy their Wall Street investors.

    AMY GOODMAN: Wendell Potter joins us today for the hour.

    Up until last year he was the head of corporate communications at CIGNA, one of the nation’s largest for-profit health insurance companies. He served as CIGNA’s chief corporate spokesperson. He also once headed communications at Humana, another large for-profit health insurer. In 2007, Wendell Potter helped spearhead the healthcare industry’s campaign against Michael Moore’s movie Sicko. Today he is a fellow at the Center for Media and Democracy and is becoming one of the most prominent industry whistleblowers.

    I sat down with Wendell Potter earlier this week.

    WENDELL POTTER: I worked for CIGNA for fifteen years, and I was a spokesman or spokesperson for CIGNA for all of that time, and probably the last four or five years I was the head of corporate communications and also the chief spokesman for the company.

    AMY GOODMAN: So why have you decided to speak out?

    WENDELL POTTER: You know, when I left, I left voluntarily. It was a little over a year ago. I just decided I didn’t want to keep doing that. I had no longer felt that what I was doing was the right thing. But I didn’t decide to start speaking out until just earlier this year, when I started seeing the evidence that the insurance industry’s PR and lobbying campaigns were apparently paying off, like they did in the early ’90s when they were leading the effort to kill the Clinton plan, and how they’ve killed every meaningful healthcare reform initiative since then.

    AMY GOODMAN: But you were a critical part of that, being in communications and then head of communications at CIGNA.

    WENDELL POTTER: I was. I was a person who was often speaking for not just the company, but sometimes the industry. I spent a lot of time working with my colleagues at other companies on task forces and trade association committees to help develop the strategy and the tactics. So, yes, I did a lot of that. So, as a consequence, I know pretty much the game plan that they have developed and used and the talking points that they use and send out to people who they think will say the things they want them to say.

    AMY GOODMAN: And what are those talking points? What is the game plan of the health insurance industry?

    WENDELL POTTER: Well, the game plan is based on scare tactics. And, of course, the thing they fear most is that the country will at some point gravitate toward a single-payer plan. That’s the ultimate fear that they have. But currently—and they know that right now that is not something that’s on the legislative table. And they’ve been very successful in making sure that it isn’t. They fear even the public insurance option that’s being proposed, that was part of President Obama’s campaign platform, his healthcare platform. And they’ll pull out all the stops they can to defeat that.

    And they’ll be working with their ideological allies, with the business community, with conservative pundits and editorial writers, to try to scare people into thinking that embracing a public health insurance option would lead us down the slippery—excuse me, slippery slope toward socialism and that you will be, in essence, putting a government bureaucrat between you and your doctor. That is—you know, they’ve used those talking points for years, and in years past they’ve always worked.

    AMY GOODMAN: What turned you? Why did you change?

    WENDELL POTTER: I changed because over the last two or three years I began seeing more than I’d ever seen before and became more knowledgeable of how health insurance—how health insurance companies make money, how they maximize profits.

    The companies that I worked for were two of the biggest for-profit health insurance companies. And over the past fifteen years, since the last time we had this debate, the health insurance industry has consolidated to the point that now there are about seven very large for-profit health insurance companies that dominate the market.

    They have begun shifting their business model away from managed care, which, frankly, I used to think was a great model, a great concept, for the delivery of healthcare. But they’ve moved—they’re moving away from that to what they refer to as consumer-driven or consumer-directed care, and it really is just a euphemism for shifting the financial burden from insurers and employers onto the shoulders of working men and women. I saw that happening. But I also saw how—you know, the things that they do to maximize their profit, which really boils down to dumping the sick.

    AMY GOODMAN: What do you mean, “dumping the sick”?

    WENDELL POTTER: Two different ways that they do this. In the individual insurance market, we’ve seen quite a bit of news coverage, especially in California. When insurance companies who are active in the individual market—and this means when you don’t get your insurance coverage through your workplace, about the only option you have is to buy it directly from an insurance company, and usually it’s much more costly than it is through—if you buy it or get it through your employer. Once you file a claim, if you are unfortunate enough to get very sick or have an accident and file a claim, you very often will find that your insurance company will go back and look at your application to see if there might be a chance that you either didn’t disclose something that you knew about in the past or inadvertently didn’t disclose something or might not have known about a pre-existing condition. They’ll use that as evidence that you were committing fraud, and they’ll revoke your policy, or they call it “rescinding” your policy, leaving you holding the bag, making you completely responsible for all the medical bills. That’s one way that they dump people who need insurance the most.

    Another is, if you are employed, particularly with a small business, and your insurance—your employer gets his or her insurance through one of the large insurers, and if just one person in your company files a claim that the underwriters think is too high, if it skews what they think is the appropriate medical experience or claim experience, when that business comes up for renewal, they very likely will jack up the rates so much that your employer has no alternative but to leave and leave you and all of your coworkers without insurance. Either that or they may cut benefits or try to shop for coverage somewhere else. But the end result is, you may find yourself dumped into the rolls and the ranks of the uninsured.

    AMY GOODMAN: Was there a seminal moment when you were head of communications at CIGNA that really made you start to look? And how were you isolated there from, well, most people in the country, you know, who were increasingly talking about the massive problems of healthcare and access to it and being cutting off, the dumping of the sick, as you put it?

    WENDELL POTTER: I was very isolated, along with most insurance company executives who deal with numbers all the time—profit margins and medical loss ratios and earnings per share and how many millions of members you have, or things like that. It’s just—they’re just numbers. And I didn’t really associate that with real people as much as I should and as much as most insurance company executives should, until I went to visit my relatives in Tennessee.

    And while I was there, I happened to learn about a healthcare expedition that was being held at a nearby town across the state line in Virginia. And I was intrigued, borrowed my dad’s car and drove up to Wise County to see what was going on there. And this expedition was being held at the Wise County fairgrounds, and it was being put on by this group called Remote Area Medical that got its start several years ago taking volunteer doctors from this country to remote villages in South America, where people really don’t have any access to medical care. The founder realized pretty soon, though, that the need in this country is very, very great, and he started holding similar expeditions in rural communities throughout the country. And this one was nearby. I decided to check it out.

    I didn’t have any idea what to expect, but when I walked through the fairground gates, it was just absolutely overwhelming. What I saw were people who were lined up. It was raining that day. They were lined up in the rain by the hundreds, waiting to get care that was being donated by doctors and nurses and dentists and other caregivers, and they were being treated in animal stalls. Volunteers had come to disinfect the animal stalls. They also had set up tents. It looked like a MASH unit. It looked like this could have been something that was happening in a war-torn country, and war refugees were there to get their care. It was just unbelievable, and it just drove it home to me, maybe for the first time, that we were talking about real human beings and not just numbers.

    AMY GOODMAN: And so, what did you do with that?

    WENDELL POTTER: Well, it took me a while to just really process it. I came back to work. I knew at that time that I couldn’t continue doing what I was doing. It just didn’t seem like it was ethically the right thing for me to do. My first career, I was a journalist, and I had been in PR, though, for many years. And I came to realize that much of what I was doing now—or then—in my PR career was just the opposite of what I was trying to do as a journalist. But still, you know, I had mortgage payments. I had other bills to pay. And it was just—it was difficult to work through this and figure out what do I do and how do I—what do I do next?

    But then, you know, just two or three weeks later, I was having to fly to a meeting, and I often would fly on one of the corporate jets. And while I was doing that, I was served my lunch on a gold-rimmed plate, was given gold-plated flatware to eat my lunch. I was sitting in a very spacious and luxurious leather chair. And it just dawned on me for the first time. I had done this many times. But because of the Wise County experience, I just realized for the first time that someone’s premiums were helping me to travel that way and were paying for my lunch on gold-trimmed china. And then I thought about those men and women that I had seen in Wise County, undoubtedly not having any idea that this is the way that insurance executives lived and how premium dollars were being spent. And that got me closer to making an ultimate decision that I had to leave.

    AMY GOODMAN: Wendell Potter, the former chief spokesperson for the health insurance giant CIGNA. We’ll come back to this wide-ranging conversation in a minute.


    AMY GOODMAN: We return to my conversation with the former health insurance executive Wendell Potter. He was the former head of corporate communications at the insurance giant CIGNA, now a fellow at the Center for Media and Democracy. I asked him whether he felt many of the journalists covering the health insurance industry are acting as PR agents for the industry.

    WENDELL POTTER: I do think so, maybe unwittingly in many cases, and probably mostly unwittingly. But also, just the way the mainstream media’s influence has changed and the—excuse me, the decline in newspaper circulation and just the way that people get their information, that has changed, and that has worked to the favor of people like I used to be—PR professionals and corporate executives. There aren’t as many reporters as there used to be. The so-called news hole isn’t as big as it used to be to have investigative pieces.

    Reporters who are still there are much busier, I think, than reporters were when I was there, and I was very busy. I think that they too often, or more often than they should, will just accept a statement that’s given to them from a corporate PR guy, like I used to be, and run with it and think their obligation is done, or just don’t have the time to explore it or do any in-depth stories. So, in that regard, I think they really are unwittingly helping the insurance industry.

    AMY GOODMAN: Can you think of an example of when you told a reporter something that you felt was not true, and that reporter did not investigate further?

    WENDELL POTTER: Two or three things. I think insurance companies and, well, anyone can—one of my favorite textbooks when I was in college was How to Lie with Statistics, and I think that we in PR often will throw statistics out that are true to a certain extent but are also misleading and don’t disclose the full story. That is what, more often than not, was what I was doing. I don’t recall intentionally or knowingly lying to a reporter; I wouldn’t have done that. But I think there are times when by withholding all the information or providing selective information or data, you definitely are misleading. And that’s what I did more often than not.

    AMY GOODMAN: Can you give us an example?

    WENDELL POTTER: One of the things you’ll see that insurance companies are doing these days, they do their own surveys of members. And one of the objectives they have right now is to try to persuade people that these consumer-directed plans are really popular with their customers and with the membership that they have. And the other data that we see that’s done by non-affiliated organizations show that people really don’t like these consumer-directed plans and are concerned about the cost shifting that is going on. But the insurance companies do their own surveying of their members, and they will—they’ll send out news releases with selective data about certain responses to certain questions, without disclosing the questions they ask or much of the methodology that they use. And as a consequence, they’re painting a picture that really is not necessarily the full picture. And I think that that’s an example. That’s one of the things I think people need to be very aware of and that journalists need to be very aware of, of the techniques that corporate PR people use to influence public opinion.

    AMY GOODMAN: In 2007, CIGNA denied a California teenager, Nataline Sarkisyan, coverage for a liver transplant. Her family went to the media. This is her mother.

    HILDA SARKISYAN: The insurance company can’t decide who’s going to live and who’s going to die. Only doctors and nurses. Thank you.

    AMY GOODMAN: The California Nurses Association joined in. Geri Jenkins is head of the CNA.

    GERI JENKINS: It’s just really atrocious that we let decisions be made based on money and not on human life and what’s necessary to keep people alive. The Sarkisyans had insurance. And that’s the telling thing here. They had insurance. They had done everything that was expected of them. They worked hard. They provided insurance. And yet, when they needed it, it wasn’t there for them.

    AMY GOODMAN: Under mounting pressure, CIGNA finally granted coverage for the liver transplant. But it was too late. Two hours later, Nataline died.

    AMY GOODMAN: Wendell Potter, can you talk about—well, I’m sure this was a challenge for CIGNA—and how you dealt with this story?

    WENDELL POTTER: It was a challenge. And frankly, it was probably within a month or so after I first learned of Nataline Sarkisyan that I told the company that I worked for—pardon me—that I had come to the end of my career and had a long run at CIGNA, but it was time for me to go.

    Nataline Sarkisyan, as you know, was a seventeen-year-old girl in California when her doctors at UCLA suggested—or requested coverage for a liver transplant that was denied. That request was denied by CIGNA. And it was one of those things that became what we called a high-profile case. The Sarkisyan family reached out to the media, to the California Nurses Associations and others to help them put pressure on CIGNA to try to get the company to reverse its decision. Ultimately, the company did.

    It was a very, very difficult time for—I can’t imagine what it was like for the family. I don’t want to suggest that the difficulty that I had was anything close to what the family was going through. My heart went out to them and still does. But it was difficult to serve as a spokesman for the company during that time. And as you know, the company did make a decision to cover the procedure, but regrettably that decision came too late, because Nataline died just hours after that decision was communicated to the family.

    AMY GOODMAN: And how were you feeling at the time?

    WENDELL POTTER: Oh, just devastated. I have a daughter myself. And I—even though I was having to represent the company, and again was being as truthful as I could, I all the time was just thinking about the family and the grief that they were going through and the way their—you know, they were briefly optimistic that the decision to cover the procedure might save her life, and then so quickly for that hope to be dashed was just devastating for them, I know, and it was just crushing for me and a lot of people that I worked with at CIGNA, too. I want to make sure that that’s understood, that it, you know—I was so disappointed, and I was hopeful, too, that this might be something that actually would save her life. It was just a dreadful, dreadful experience for everyone concerned; there were no winners in that at all.

    And certainly, from a public relations point of view, CIGNA really suffered a black eye. And I, as the spokesman for the company—there were two people who really spoke for the company during this time. It was me and the chief medical officer. And I was—my name was on the website, and my contact information was on the website, CIGNA’s website, and so people were venting their frustration. I received—I can’t tell you how many emails, how many voicemail messages and calls from people who were just outraged. And it was a very difficult—very, very difficult thing to go through.

    AMY GOODMAN: Wendell Potter was the former head of corporate communications at the insurance giant CIGNA.

    I also asked him about the case of Thomas Concannon, the former head of the Federal Defenders of the Eastern District of the Legal Aid Society here in Manhattan. In 2002, Concannon was suffering from multiple myeloma, a rare form of cancer. His doctors planned to perform a bone marrow transplant, but as Concannon lay on the operating table, his insurance company, CIGNA, announced it would not cover the operation. Days later, Concannon came on Democracy Now! This is part of our interview seven years ago, on April 24th, 2002, with Thomas Concannon and Elisabeth Benjamin, supervising attorney in the Health Law Unit of the Legal Aid Society. This is Tom Concannon.

    THOMAS CONCANNON: On April 9th, they actually put me in the surgical—put me in an operating room, and through general anesthesia, put a tube in my chest that was—it’s called a catheter, a three-lumen catheter that’s meant to be the vehicle through which they extract for blood tests and where they put chemo, different forms, chemical cocktails in. And so, that was put in. And we thought, after a day of rest, that I’d get—begin two other days of certain kinds of photopheresis, other blood-cleansing processes and other things that would prevent grant-versus-host disease. And then, the following week, to get—I expected to get radiation and my sister’s transplant. In fact, last Friday, on my enchantress’s birthday here, that was the day that [inaudible]—

    AMY GOODMAN: That’s your wife?

    THOMAS CONCANNON: Yes, that’s my sweetie here. She—it was to be put in on that day. And that was the day we got the notice from—we got the letter from CIGNA saying we’re not—from Dr. Janet Maurer, saying we’re not going to—they were not going to approve that.

    AMY GOODMAN: What can people do, Elisabeth Benjamin, in a case like this?

    ELISABETH BENJAMIN: Well, if you want to help Tom, I think a good thing to do would be to call CIGNA’s vice president and corporate spokesman and express your utter dismay at their conduct in this case. His name is Wendell Potter, P-O-T-T-E-R. His telephone number is (215) 761-4450.

    AMY GOODMAN: That was Elisabeth Benjamin. At the time, she was with the Legal Aid Society, giving out Wendell Potter’s office number on Democracy Now! It was seven years ago, on April 24th, 2002. At the time, Wendell Potter was the top spokesperson for CIGNA. As a result of our coverage, the company reversed its decision and paid for the surgery.

    I asked Wendell Potter if he remembered the case of Thomas Concannon.

    WENDELL POTTER: Oh, I absolutely do. I mean, that case, the Nataline Sarkisyan case are two that I will never forget. I absolutely do.

    And it does speak to the influence that you have at Democracy Now! I came into work the next morning, and my inbox, my email inbox, was—I’d never seen anything quite like it, before or since. It was just phenomenal. I was just being inundated with emails and phone calls and faxes. It was just extraordinary. And I knew that the influence of the media was important in situations like this. And it just—I guess it just proves what I said before: it makes a big difference when someone can get the media or someone on their side to bring this—to make it a high-profile case. It was unforgettable

    full article;

    CITIZEN Well-Known Member MEMBER

    Jul 26, 2009
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    Insurance companies don't care about us.
    They probably sighed in relief when Nataline died because they knew they wouldn't have to pay for the transplant after all. If they can't "dump" the sick, they triple their premium so it can't be paid.
    Insurance companies are a business, operating for-profit. The premium paid every month, even for 10, 20, 30 years, is not going to cover the $500,000 liver transplant. In order to be profitable, they have to take in more money than they pay out. To do this premiums are invested in stocks to turn profit and payout costs. So the money is there, but they are too greedy to pay out. They would rather tell that mom/husband/family that their loved one's life is not worth the $500,000. They want the big salaries and even bigger bonuses, and payouts interfere with that. I hate those SOBs.
  3. Ankhur

    Ankhur Well-Known Member MEMBER

    Oct 4, 2009
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    "Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage.

    We will do this by creating a new insurance exchange

    – a marketplace

    where individuals and small businesses will be able to shop for health insurance at competitive prices.
    Insurance companies will have an incentive to participate in this exchange because

    it lets them compete for millions of new customers.

    from the president

    And since purchasing health care will become a law, the HMOs will come out, hand over fist

    Published on Wednesday, August 26, 2009 by The Ottawa Citizen (Canada)
    A Bailout for the US Healthcare Industry
    by Rose Ann DeMoro

    The fractured U.S. healthcare debate, replete with wild distortions of Canada's medicare, must seem incomprehensible to many north of our border.

    News images of fabricated "death panels" or traumatized seniors on U.S. Medicare -- a government-funded program -- urging legislators to keep the government's hands "off my Medicare" must seem especially hard to fathom.

    Equally puzzling, no doubt, has been the reaction of the administration and many of its allies in Congress whose response to the attacks is to move further away from comprehensive reform.

    Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.

    Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.

    Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo -- leading to further compromises by both Obama and the leading Democrats.

    This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying "I want us to be mindful we may need to take less than a full loaf."

    But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.

    Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.

    What's left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.

    In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.

    To residents of all other industrialized countries, terrors over a government role in promoting and protecting the health and safety of its citizenry, and the reluctance of political leaders to effectively respond to these attacks must be especially confounding. Among major nations, only in the U.S. is health care not a fundamental right, but bartered for profit by a maze of health-care corporations. The result is that the U.S. continues to fall far behind other industrial nations in a variety of measurements, from access to care to equality in treatment, and even in the much discussed issue of waiting times for medical care.

    While the U.S. spends twice as much as every other nation on per capita health care, there remain more than 45 million Americans with no health coverage and tens of millions more with insurance who are routinely denied medical care because their insurer doesn't want to pay for it.

    Medical bills account for 62 per cent of personal bankruptcies. Half of all Americans skip doctor visits or immunizations for their children because of high out-of-pocket costs, troubling news indeed with the U.S. already leading the globe in swine flu infections and deaths.

    full article;
  4. cherryblossom

    cherryblossom Banned MEMBER

    Feb 28, 2009
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    Health Insurance is for HEALTHY people, not SICK people.

    I used to sell it.
  5. Ankhur

    Ankhur Well-Known Member MEMBER

    Oct 4, 2009
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    That is why the Single payer System should be used

    President Obama’s Longtime Physician Opposes White House Health Plan, Advocates Single Payer
    Dr. David Scheiner was President Obama’s doctor from 1987 until he entered the White House. Today Dr. Scheiner is publicly opposing Obama’s health plan and is calling for a single-payer system.


    Dr. David Scheiner, internist based in the Chicago neighborhood of Hyde Park. He was Obama’s doctor for twenty-two years, from 1987 until he entered the White House.

    AMY GOODMAN: As the healthcare debate reaches a fever pitch, President Obama is holding a primetime news conference tonight in a bid to win wider support for healthcare reform. His remarks are expected to respond to skepticism fueled by the Congressional Budget Office’s scathing assessment of the expenses involved in the House legislation, concerns from conservative Blue Dog Democrats, and broad opposition from Republicans.

    But will the President address concerns of single-payer advocates, who think his public plan will not go far enough?

    I’m joined now from Chicago by Dr. David Scheiner. He was President Obama’s doctor from 1987 until he entered the White House. He treated Obama for twenty-two years but has publicly opposed Obama’s health plan, calling for single payer. Dr. Scheiner was disinvited from ABC’s recent healthcare forum, where he was planning to ask about single-payer healthcare.

    Dr. Scheiner, welcome to Democracy Now! It’s good to have you with us.

    DR. DAVID SCHEINER: Good morning. Thank you very much.

    AMY GOODMAN: What do you mean you were disinvited by ABC? What happened?

    DR. DAVID SCHEINER: Well, on the Friday before the Wednesday, I was notified by ABC that they thought it would be a great idea to have me come to the White House for that forum, that town hall, as a surprise visitor, that President Obama would not be informed, and I would ask a question from the audience. That Sunday, I received an email outlining the trip, and I canceled two days of the office to prepare for this. And then, Monday, another producer called me and said that they had too many people showing up and that they didn’t need me, and my trip was canceled.

    AMY GOODMAN: What is it—

    DR. DAVID SCHEINER: The question of who—yeah.

    AMY GOODMAN: Go ahead.

    DR. DAVID SCHEINER: The question of who—the question of who was responsible, of course, is hard to know, whether it was ABC or whether it was somebody at the White House.

    AMY GOODMAN: What would you have asked?

    DR. DAVID SCHEINER: I would have asked about single payer, insofar as we already have one that works, and why we just couldn’t have universal Medicare and eliminate the insurance companies, which are causing incredible costs and havoc on the system.

    AMY GOODMAN: Can you talk about your relationship with President Obama? You were his doctor for more than two decades in Chicago?

    DR. DAVID SCHEINER: Right, exactly. I didn’t talk politics with him, really, because—although I must say, the very first time I saw him, the very first time, he was a community organizer, and he walked into the office. One of the first questions I asked him is if he was going into politics, because he had a presence. He walks into a room, and there’s a presence about him which is extraordinary. And I think about ten or fifteen years ago, a friend of mine from Florida called me, told me I had said I had a patient that I thought could be president of the United States someday. And it was—there was something about him. And there still is. He’s an incredible man. And we had a very good relationship. It wasn’t a close relationship, personal relationship, but we saw each other often, and for minor problems. He’s in superb health.

    AMY GOODMAN: Did you ever discuss the issue of healthcare with him?

    DR. DAVID SCHEINER: The only thing that I ever discussed with him was the question of malpractice and tort reform. And the response was somewhat negative, as it was when he spoke to the AMA.

    AMY GOODMAN: You were the partner of Quentin Young, well-known advocate of single payer. We’ve had him on the program a number of times.


    AMY GOODMAN: He was the former head of the American Public Health Association.

    DR. DAVID SCHEINER: Oh, yes, a close friend and, I have to say, my mentor, and influenced my life in innumerable ways. I owe a great deal to him.

    AMY GOODMAN: So, can you look—tell us about the plan that is presented by the House and whether or not you support it?

    DR. DAVID SCHEINER: The problem, overwhelmingly, is the issue, in my mind, of the private insurance companies being a part of the program. Their record has been so abominable that to have them in the program just doesn’t make sense. The cost—Ezekiel Emanuel, Rahm’s brother, made a comment in the Journal of the AMA that just the administration costs of employers’ health is over $300 billion a year. And that money will still be wasted. There will probably be even more advertising. The huge CEO salaries will continue to be made. I think the head of Aetna makes $23 million a year.

    Insurance companies repeatedly interfere with the care of patients. The opponents of health reform keep saying that if the government gets into medicine, you won’t have a choice of your doctor, you won’t have a choice of your hospital, your care will be restricted. I don’t know where they got that. Medicare, if anything, is too permissive. Medicare never gets in my way. But insurance companies—I have to use special labs. I have to—I can use certain hospitals for one person; I can’t use them for another. I’m repeatedly getting responses from the insurance company disallowing certain procedures, disallowing certain medications. The insurance company is in the room every time I see a patient. And somehow, the patients think they have free choice. Medicare gives them free choice. They will have their choice of doctor. They will have their choice of treatment. With private insurance, that will not be the case. It’s an extraordinary waste of money.

    And the public—if I had a single point to make about what is going wrong with this health reform is that the public is so uniformed. They think somehow that they get the best care in the world. We know by health statistics we’re thirty-seventh. Even people with good health insurance don’t realize that the healthcare they get is often not appropriate. Sometimes they get unnecessary treatment. The whole issue, for example, of prostate cancer, which is an extraordinary industry today, and there’s no proof that doing anything is of any value. But, you know, if I have a patient with prostate cancer, there’s no way I would sit back, because I know the trial lawyer is also in the room watching me. That’s another issue, which—there’s no way you’re going to control costs, if you don’t get that under control also.

    AMY GOODMAN: We’re talking to David Scheiner, who was an internist in Chicago—continues to be—in Hyde Park, the personal doctor of President Obama for, oh, twenty-two years, from ’87 ’til he entered the White House. Your assessment of the Health and Human Services head, Kathleen Sebelius?

    DR. DAVID SCHEINER: Well, my—you know, the greatest problem I had was that prior to becoming governor of Kansas, she was a lobbyist for the trial lawyers. And that, you know, certainly makes me a little bit nervous. I think President Obama, and I think much of the media, discount the significance of defensive medicine. The New York Times had a piece on this, I think two or three weeks ago, and they say it’s just a small part of healthcare. This is a major part of healthcare. We practice incredible amounts of defensive medicine. And I can tell you now that no matter what health program comes through, if they don’t reform that system—

    AMY GOODMAN: “Defensive medicine” means?

    DR. DAVID SCHEINER: —I’m going to be ordering tests—pardon me?

    AMY GOODMAN: “Defensive medicine” means?

    DR. DAVID SCHEINER: Practicing—doing things in medicine to prevent getting sued. We do this constantly. And we’re going to order more tests and more tests and more tests and do unnecessary care.

    AMY GOODMAN: Gallup poll and others show the concern of people. For people who have healthcare, they like their healthcare, which is why those who support a public plan say you’ve got to ensure that people—you’re telling people they can keep the healthcare if they like it. How do you answer that, Dr. Scheiner?

    DR. DAVID SCHEINER: Well, they’ll get more freedom under Medicare. The insurance companies—there’s no question—they restrict care. Under Medicare, people have incredible freedom. I can’t remember in the last forty years that I’ve been taking care of patients under Medicare that they have ever gotten in my way, but the insurance companies are constantly getting in my way.

    There was this thing in the New York Times, the story of a man with a $150,000 health coverage. He had multiple procedures done. It turned out all they paid for was room and board. The insurance companies do incredible things to people, and the public doesn’t know it. They think because they’ve got health insurance, that everything is right with the world. But it isn’t. They don’t even know the quality of care they’re receiving. The public is incredibly naive. Patients go into the hospital. They’re not—most of the time they’re not even adequately examined. The history in physical examination is becoming old hat. It’s becoming like Star Trek with—when Bones would have a machine that he would scan you, so you don’t have to talk to the patient or examine them. And that’s extraordinarily costly. There is so much medicine that—practice that’s wasted.

    AMY GOODMAN: And how would that change under a single-payer plan?

    DR. DAVID SCHEINER: Well, there would be more—there have to be more controls. You know, effective medicine, what works. And some of the incentive for doing unnecessary procedures would be gone. There have to be—there have to be these kinds of controls. And under single payer, there will be much more—

    Pharmaceuticals, we haven’t even addressed pharmaceuticals. The cost of pharmaceuticals is off the wall. Patients can’t afford it. I have a patient now who’s lost his insurance. He’s had coronary bypass. He needs—he’s a diabetic. I have to scout around for samples on my shelves to keep him going. This is unconscionable. Single payer would—there would be bulk purchasing. There would be negotiation over the price of medications.

    full article;
  6. Ankhur

    Ankhur Well-Known Member MEMBER

    Oct 4, 2009
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    owner of various real estate concerns
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    US Health Insurers Up the Ante????

    US Health Insurers Up the Ante

    By Robert Parry
    October 21, 2009

    The chutzpah shown by the U.S. health insurance industry in taking aim at the weakest reform bill in Congress – the one approved by the Senate Finance Committee – reflects the insurers’ sense that they have beaten back other proposals that might have represented significant threats.

    Not only was a national single-payer approach never allowed on the table – since it would have been the death knell for the private industry – but even the most “robust” public-option bills contain major concessions to the insurers, including sharp limits on who could qualify for a government-run program and delays on when the new program might take effect.

    Perhaps the most striking passage in the House Ways and Means Committee’s 1,018-page bill – regarded as one of the most liberal – is the definition of “Y1,” year one when an insurance “exchange” with a public option would become available to individuals and small businesses.

    “The terms ‘Y1’, ‘Y2’, ‘Y3’, ‘Y4’, ‘Y5’, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively,” the bill states on page 14.

    In other words, even if Congress approves a public option, the health insurance industry gets more than a three-year reprieve before it would have to begin competing and then the competition would be limited to small businesses and to individuals.

    It also means that Americans facing a health-care crisis today can’t expect meaningful help on health insurance until 2013. In the meantime, they are to be left to the mercies of private insurers.

    The industry also won a major concession when Democrats agreed to exclude large companies as possible enrollees in the public option.

    At the start of the congressional debate, Republicans cited an industry-backed study from the Lewin Group warning that if a public option were approved, an estimated 119 million Americans might defect from private plans. That, in turn, might badly damage the profits of the health-insurance industry.

    Or as Sen. Chuck Grassley, R-Iowa, put it in a column for, the exodus of so many customers would “put America on the path toward a completely government-run health care system. … Eventually, the government plan would overtake the entire market.”

    So, Democrats made moves to protect the industry. Rather than a public option available to everyone, including large companies that are currently struggling to pay health-insurance premiums for their workers, the public option would be allowed only for individuals and small businesses. Private insurers would get to keep the biggest and most lucrative part of the market, the large companies and their employees.

    Based on that concession, the non-partisan Congressional Budget Office estimated that the number of Americans who might sign up for a public option was about 10 million, a much smaller threat to the private insurers.

    The time horizon for the public option also began fading into the fairly distant future. To minimize attacks on the 10-year cost of the program, Democrats pushed the starting point for the exchanges, where private insurers supposedly would compete with the public option, back to 2013.

    The delayed implementation pushes higher costs for health reform outside the 10-year window (and thus makes the program look cheaper), but it means that Americans can expect little improvement in their health-insurance coverage for the next three-plus years. [To see the expected annual costs of the Ways and Means bill, go to the CBO analysis and look at the table on the last page.]

    Political Risk

    So, Americans who right now are facing financial crises over health costs or who are going without necessary medical care because they are uninsured or underinsured will be expected to somehow suck it up for several more years.

    Politically, the Democrats have put themselves in a position where even if they pass a bill with the public option, they will have to survive the 2010 and 2012 elections based not on what they have done for the American people but what the future might hold – and Americans are notoriously impatient.

    Meanwhile, the Republicans will get to pummel Democrats for promising better health-care results – and for delivering nothing of note.

    There’s also the prospect that a new Republican Congress in 2011 or a new Republican President in 2013 could move quickly to repeal any public option that might have survived in the legislation. Since the people will not have experienced any benefits from the not-yet-implemented public option, there wouldn’t be a powerful constituency to fight for it.

    And, a Republican-controlled Congress and GOP President wouldn’t hesitate to ram revisions of the health-care reform through on a majority vote under the budget “reconciliation” process, as a Republican Congress did with tax cuts during George W. Bush’s presidency.

    With these political prospects ahead, the health insurance industry apparently believes it has weathered the worst of the reform storm and can begin zeroing in on a few lesser irritants, like trying to get Congress to ratchet up the coercion on the nearly 50 million uninsured Americans so they will be forced to sign up for private insurance policies.

    In a brazen act that took Democrats by surprise, America’s Health Insurance Plans, the industry’s lobbying arm, went on the attack against the industry-friendly Senate Finance Committee bill because of relatively weak penalties of only a few hundred dollars a year assessed against people who don’t buy insurance even with government subsidies.

    AHIP feared that the fines wouldn’t be coercive enough to force young people to buy insurance. Thus, the worry was that the industry's new sign-ups would be customers the industry doesn’t want, people who need medical attention.

    So, industry lobbyists warned that if Congress didn’t raise the fines on the uninsured, the industry would jack up its premiums across the board. "The consequences of this would be an upward spiral; rate shock to everyone who stays in," AHIP president Karen Ignagni said.

    A Blunder?

    While the White House and congressional Democrats suggested that the industry had committed a blunder and risked a political backlash, the assault on the Finance Committee bill, which already had bent to the industry’s will by excluding a public option, could be read as an act of confidence.

    On Tuesday, Ignagni published an op-ed in the Washington Post defending an industry-sponsored study that warned of higher rates if harsher penalties were not included to force Americans to buy insurance. But the article also revealed how modest the industry sees likely cost savings from reform.

    Without reform, “the CBO projects that health-care spending will rise at an annual rate of 6.2 percent for the next decade,” Ignagni wrote. “We believe the nation can bend the cost curve by 1.5 percentage points annually if reform includes systemwide efforts to reward best practices, shrink the wide variation in care, expand care coordination, and equip doctors and patients to make decisions based on what works.”

    Ignagni then chastised Congress for its supposed unwillingness to address these medical changes. She wrote:

    “The shared promise of health-care reform is guaranteeing access to affordable coverage for those outside of the system while ensuring that those who have coverage can keep what they like. That promise can be kept only if Congress puts the nation on a path to universal coverage and confronts what lawmakers have thus far been unwilling to address: the need for tangible, effective steps to reduce the growth in health-care costs and make the system sustainable for generations to come.”

    Remarkably, Ignagni’s suggestions for trimming the annual increases in health costs – from 6.2 percent to a still hefty 4.7 percent – rested on restraining costs associated with what doctors and hospitals charge, not on demanding sacrifices from the insurance industry.

    Indeed, the industry may believe it has dodged the most dangerous bullet aimed at its administrative expenses and profits, stiff competition from an across-the-board government-run plan.

    According to the CBO, the only meaningful way to wrest significant savings from the insurance side of the cost equation is to force private insurers to compete with a public option.

    full article;