A big "strawman" against a National Health Insurance system

[SHRED]

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One of the"straw-man" arguments against a National Health Insurance system is that the government would end up "choosing" who is covered and who is not.
Let's pretend this would happen...at least in a governmental system we have recourse via the democratic process and the petitioning our representatives. They do get involved when you contact them enough.

A recourse far different than these people face if they wanted to take on the private health corporation and it's teams of well funded attorneys.

The fear that some try to install in us by claiming that a NHI system would "pick and choose" who is covered is happening right now in the private, "for-profit" health insurance industry. Their motive? ...profit margins and shareholder gains. Recourse? Hire an attorney and try to fight a multi-billion dollar industry.

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From the Los Angeles Times
Health insurer tied bonuses to dropping sick policyholders
By Lisa Girion
Los Angeles Times Staff Writer

November 9, 2007

One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

These cancellations have been the recent focus of intense scrutiny by lawmakers, state regulators and consumer advocates. Although these "rescissions" are only a small portion of the companies' overall business, they typically leave sick patients with crushing medical bills and no way to obtain needed treatment.

MORE: http://www.latimes.com/business/la-fi-insure9nov09,0,4409342.story?coll=la-home-center

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[NMMNG]

1. More garbage from the "haves"

Who are fearful of the "have nots" getting something that's rightfully theirs. Funny how all of these things the detractors scream the government will do are things the private insurance companies do--yet they find nothing wrong with the private insurance companies.

[yellowdogintexas]

2. um, isn't the whole point of National Health Care that nobody is excluded?

so the argument that a national plan would pick and choose who could be covered is totally illogical to me.

..the current system that exists (for those not fortunate enough to have a huge group plan to join) cherry picks every applicant and every first claim submission, looking for undisclosed medical conditions, which is about the only way a policy can be rescinded in most states, by the way, especially California which has one of the strictest PreExisting rules in the country.

Basically if you answer no to all the medical inquiry questions on the application, and you file a claim for something that is on that company's "no no list"of diseases and disorders within the defined pre-existing period of the state in which you reside, then medical records can be ordered to Look Back the number of months your state allows. If you were treated for said condition within that period then your policy can be rescinded.


Example: state has a 6 month pre ex period ..and a 6 month Look Back period. You buy insurance in June, and answer no to all the nosy questions. You go to the dr in September and your diagnosis is Chronic Obstructive Pulmonary Disease....the insurance co can order medical records to look back 6 months from date of application to determine if you were being treated for COPD within that 6 month period. This includes medications, dr visits, labwork etc. Sometimes these researches reveal other undisclosed conditions that are also on the no no list. Heart trouble, diabetes, MS, history of Cancer, severe Rheumatoid Arthritis, Lupus.

If the research indicates you never were treated for COPD before, and all you ever showed on your records was colds, occasional Upper Respiratory Infections etc, you might not be rescinded. But if other dread diseases showed up, you would be.

Now if your first filed claim is not until January of the next year, using same scenario the company can't investigate.
If you disclose the diagnosis on the application and they cover you anyway then you will be ridered for that condition for a set period of time.
If you had coverage that was in force prior to the effective date of the new insurance and the gap between the two is less than 60 days, no investigating allowed.

Big Group Plans, like huge employers have, are normally not allowed to cherry pick at all. If the plan is a self funded one they can write exclusions into the contract though.

Not so long ago, insurance could look back as far as they wanted to...5 to 10 years of history. Most states have instituted very narrow windows of opportunity. New Hampshire's used to be 90 days forward and 30 days back! I know there are a couple of states with no pre ex allowed at all, just can't remember which ones they are.