BCBS acts up in North Dakota (another reason for insurance reform)

RN1982 · Sep 10, 2009

I believe that BCBS was just in court recently about insurance hikes here in Michigan. If I remember correctly it was our attorney General Mike Cox ®, who wanted to prevent the hikes, that took them to court but I believe they won.

ozoneranger · Sep 11, 2009

and what of the government you want to replace them with......

let's take a peek.....shall we?

congressional perks: how the trappings of office trap taxpayers

ntuf policy paper 131

by

peter j. sepp

nov 1, 2000

executive summary

since the founding of the republic, americans have had a healthy skepticism of the concentration of power. the framers of the constitution established a system they hoped would prevent not only the disproportionate accumulation of influence in one branch of government, but also the disproportionate accumulation of privilege.

today, members of the united states congress enjoy a vast web of perquisites that benefit them personally as well as professionally, including:

comfortable salaries that are often determined through legislative sleight-of-hand. contrary to the arguments of many washington "insiders," the cost of living has rarely eroded the historical value of lawmakers' pay, which on a constant-dollar basis is hovering near the postwar high.

pension benefits that are two to three times more generous than those offered in the private sector for similarly-salaried executives. taxpayers directly cover at least 80 percent of this costly plan. congressional pensions are also inflation-protected, a feature that fewer than 1 in 10 private plans offer.

health and life insurance, approximately 3/4 and 1/3 of whose costs, respectively, are subsidized by taxpayers.

wheeled perks, including limousines for senior members, prized parking spaces on capitol hill, and choice spots at washington's two major airports.

travel to far-flung destinations as well as to home states and districts. despite recent attempts to toughen gift and travel rules, "junkets" are still readily available prerogatives for many members.

a wide range of smaller perks that have defied reform efforts, from cut-rate health clubs to fine furnishings.

but the very nature of public office itself demands a more comprehensive definition of a "perk" than that normally applied to corporate america. members of congress can also wield official powers that allow them to continue to enjoy the personal benefits outlined above, such as:

the franking privilege, which gives lawmakers millions in tax dollars to create a favorable public image. experts across the political spectrum have labeled the frank as an unfair electioneering tool. in past election cycles, congressional incumbents have spent as much on franking alone as challengers have spent on their entire campaigns.

an office staff that performs "constituent services" and doles out pork-barrel spending, providing more opportunities for "favors" that can be returned only at election time.

exemptions and immunities from tax, pension, and other laws that burden private citizens -- all crafted by lawmakers themselves.

congressional pay and perks directly add hundreds of millions of dollars to the yearly bill that americans are forced to pay for the federal government -- a significant cost for taxpayers, even if pundits dismiss the amount as a "drop in the bucket." yet, beyond the basic issue of dollars and cents, congress's perks have other pernicious effects. they distort the budget process, by diminishing lawmakers' moral authority to say "no" to special interest spending requests and benefit boosts for other government officials. they distort the electoral process, by tilting the playing field against challengers. most importantly, they undercut efforts for long-term economic and budget reform, by insulating members from the real-world effects of their own policies.

american taxpayers and american government would be better served by benefits for members of congress that look more like incentives than perks. enactment of proposals for a defined-contribution pension plan, a scaled-back franking privilege, a pay level tied to government efficiency, and a term-limit constitutional amendment would help to restore balance to a system plagued by the trappings of office.

they receive an automatic 'cost of living' pay raise at the first of every year (about $5000 in january). they can vote themselves pay raises whenever they feel like it (usually in the dead of night when not too many taxpayers are paying attention).

they have the best, most comprehensive health care benefits in the civilized world (better than most average americans could ever hope for).

they get lifetime government pensions, far more generous than social security benefits.

even when they 'retire' during a scandal, they keep their benefits.

if there's much difference here....i can't find it.

Moogie · Sep 11, 2009

I agree with you that our elected officials also feed from the government trough, costing the American taxpayer a tremendous amount of money that could be spent perhaps more wisely. But, pray tell, where in my post did I recommend that the government take over health care? I am saying that there must be insurance reform and I applaud the President for recognizing that states like North Dakota need health insurance competition, not monopolies that can run rampant.

Moreover how can anyone defend a company that spends over $250,000 on trips for sales managers to the Grand Caymans while cutting the benefits of customers who have faithfully paid their insurance bills only to see their coverage get cancelled when they get sick? The grey-haired woman who was seated to Mrs. Obama during the President's speech is from Carrington, North Dakota and BCBS cancelled her policy when she was diagnosed with cancer. Too expensive to pay for her treatment, they said. This when they put 3.5 million dollars into the pocket of ONE individual, the CEO under whom these abuses took place? And I don't recall any senator or representative getting a $35,000 retirement party, paid for by the customers who lost their coverage because their care became too costly. Oh, now the insurance lobbyists---to them $35,000 is a paltry sum, a painless amount to donate to some politician's PAC in return for a vote in their favor. But to working people in North Dakota, as well as in many states, $35,000 represents a yearly income.

I believe the President also addressed the Congress' health care plan and said that such coverage should be available to all Americans. I did not hear anything in his speech that said we need to go to socialized medicine or a government-run health care system. He said that insurance companies are essential to the national economy, that he does not want to destroy that industry, but that it does need reform. When did reform become tantamount to takeover?

The situation in North Dakota is indicative of a system that is deeply flawed and does not serve the interests of the consumer. In other industries, monopolies are illegal and if consumers are not happy with the product, they vote with their dollars and the corporate profits suffer. Why should the insurance industry be any different? Why are companies like BCBS having conniptions over the prospect of reform? Could it be that it might hit them in the wallet?

What should we do? Throw out everyone in Congress? (Hmmmm...that might not be a bad idea...)

If we do nothing, we will simply put off this problem until it gets worse and destroys the lives of many more people, like the woman from Carrington. BTW, her insurance was reinstated eventually, but not without a fight. How many others fight and lose? How many others are too sick to fight or die before they have a chance?

ozoneranger · Sep 11, 2009

"When did reform become tantamount to takeover?"

On, uh, I think it was page 221 lines 11-14, I could be wrong, it's early & I haven't had my coffee yet.

K98 · Sep 11, 2009

[quote name=

What should we do? Throw out everyone in Congress? (Hmmmm...that might not be a bad idea...)

[/quote]

All of them. Democrats and Republicans. Their replacements serve ONE term. :yeah:

Moogie · Sep 12, 2009

"When did reform become tantamount to takeover?"
On, uh, I think it was page 221 lines 11-14, I could be wrong, it's early & I haven't had my coffee yet.

Apparently it is early. Page 221 is an overview of what is going to be discussed in the next sections of the bill. Here are the subjects:

221
*HR 3200 IH
Subtitle D--Access to Information Needed To Prevent Fraud, Waste, and
Abuse
Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and
Abuse.
Sec. 1652. Elimination of duplication between the Healthcare Integrity and
Protection Data Bank and the National Practitioner Data
Bank.
Sec. 1653. Compliance with HIPAA privacy and security standards.
TITLE VII--MEDICAID AND CHIP
Subtitle A--Medicaid and Health Reform
Sec. 1701. Eligibility for individuals with income below 1331⁄3 percent of the
Federal poverty level.
Sec. 1702. Requirements and special rules for certain Medicaid eligible individuals.
Sec. 1703. CHIP and Medicaid maintenance of effort.
Sec. 1704. Reduction in Medicaid DSH.
Sec. 1705. Expanded outstationing.
Subtitle B--Prevention
Sec. 1711. Required coverage of preventive services.
Sec. 1712. Tobacco cessation.
Sec. 1713. Optional coverage of nurse home visitation services.
Sec. 1714. State eligibility option for family planning services.
Subtitle C--Access
Sec. 1721. Payments to primary care practitioners.
Sec. 1722. Medical home pilot program.
Sec. 1723. Translation or interpretation services.
Sec. 1724. Optional coverage for freestanding birth center services.
Sec. 1725. Inclusion of public health clinics under the vaccines for children program.
Subtitle D--Coverage
Sec. 1731. Optional medicaid coverage of low-income HIV-infected individuals.
Sec. 1732. Extending transitional Medicaid Assistance (TMA).
Sec. 1733. Requirement of 12-month continuous coverage under certain CHIP
programs.
Subtitle E--Financing
Sec. 1741. Payments to pharmacists.
Sec. 1742. Prescription drug rebates.
Sec. 1743. Extension of prescription drug discounts to enrollees of medicaid
managed care organizations.
Sec. 1744. Payments for graduate medical education.
Subtitle F--Waste, Fraud, and Abuse
Sec. 1751. Health-care acquired conditions.
Sec. 1752. Evaluations and reports required under Medicaid Integrity Program.

Please provide a link that will support your contention that reform equals takeover. President Obama, in his speech Tuesday, said that the abuses by insurance companies have to stop, that insurance companies must have competition in their markets so as to avoid having monopolies, and that the insurance companies need to be reformed and regulated.

ozoneranger · Sep 12, 2009

Apparently it is early. Page 221 is an overview of what is going to be discussed in the next sections of the bill. Here are the subjects:
Please provide a link that will support your contention that reform equals takeover. President Obama, in his speech Tuesday, said that the abuses by insurance companies have to stop, that insurance companies must have competition in their markets so as to avoid having monopolies, and that the insurance companies need to be reformed and regulated.

You mean the same Obama that promised to have our troops home in 100 days?

The same Obama that said we had to curb government spending?

That Obama?

That's hilarious.

Read the bill, and all references to current law to find your answer (it will take you days, believe me), I don't have the time.

I will, however link you to healthcare reform *cough* takeover*cough in Oregon

Where care is rationed (that is the intent)....... "It was intended to make health care more available to the working poor, while rationing benefits."

And a lottery was instituted......."New enrollment in the program were closed from mid-2004[6] until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan.[7][8]"

And physician assisted suicide became the states answer to patients with advanced cancer who wanted to try drugs that were prescribed by their doctors......Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.[15] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month[16] drug for free.[17] Wagner's plight garnered a flurry of attention from the media,[18] the blogosphere,[19][20][21][22] and triggered protest from religious groups.[23][24][25] Wagner died in October 2008.[26]

http://en.wikipedia.org/wiki/Oregon_Health_Plan

allnurses Guide · Sep 13, 2009

We are not discussing the plan in Oregon in this forum yet.

Do you want to start one here?

Or in the Oregon forum?

Moogie · Sep 14, 2009

You mean the same Obama that promised to have our troops home in 100 days?
The same Obama that said we had to curb government spending?

That Obama?

That's hilarious.

Hmmm--I thought we were talking about corporate greed in an insurance company in a state with basically no competition. Funny how we got into a debate about George Bush's war; I thought that was strictly a liberal tactic.

Besides, I don't really have time to discuss the war with you. I'm a little too busy dealing with my spouse's PTSD from three deployments. Moreover, it's well-known that an immediate pullout of troops would be unwise, dangerous to our soldiers and dangerous to the civilians in Iraq. But I digress...

Read the bill, and all references to current law to find your answer (it will take you days, believe me), I don't have the time.

I did read the original bill. Did you? Fascinating stuff, really. Not perfect by any means, but certainly better than settling for the way things are.

I will, however link you to healthcare reform *cough* takeover*cough in Oregon
Where care is rationed (that is the intent)....... "It was intended to make health care more available to the working poor, while rationing benefits."
And a lottery was instituted......."New enrollment in the program were closed from mid-2004[6] until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan.[7][8]"
And physician assisted suicide became the states answer to patients with advanced cancer who wanted to try drugs that were prescribed by their doctors......Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice, but lost both times.[15] Tarceva drugmaker Genentech agreed to supply her the $4000-a-month[16] drug for free.[17] Wagner's plight garnered a flurry of attention from the media,[18] the blogosphere,[19][20][21][22] and triggered protest from religious groups.[23][24][25] Wagner died in October 2008.[26]
http://en.wikipedia.org/wiki/Oregon_Health_Plan

I didn't realize Wikipedia was considered to be an accurate, credible source. I'll make sure to include it on my next research paper and we'll see how well that flies.

And since when is what the insurance companies doing NOT considered rationing? Oops, my bad. When a state limits health care due to scarce resources, it's sentencing someone to death. But when an insurance company does it, it's just good business. And making sure those deserving CEO's get their golden parachutes and sales trips to the Grand Caymans.

Interesting thing in the Fargo paper: apparently ND BCBS went through this same sort of BS back in the 1990s. The CEO's, their paws stuck in the corporate cookie jar, promised to behave, promised to be better stewards of their companies and more responsible to the customers. Yeah, right. Fifteen years later, they're back at it, worse than before.

It's a damned shame that the marketplace cannot regulate itself. But corporate greed has gotten way out of control and, because big business cannot control itself, the government will have to. When does it stop? The country has already weathered the greatest recession since the 1930s, thanks in part to tax cuts for the wealthy, a mismanaged war on two fronts and the mess of letting corporations police themselves.

Why is it that the country has been spending so much energy on health care since Teddy Roosevelt was President? Harry Truman wanted reform. Richard Nixon proposed reform. Bill Clinton tried to enact health reform---clumsily---but at least he tried to do SOMETHING. Now we have rocket scientists like Minnesota's own MIA governor Tim Pawlenty saying that the states should be able to opt out of the system and do their own plans---after he cut Minnesota Care---a public option meant for the working poor who cannot afford private insurance and whose jobs do not provide group insurance. We don't know how many people have died since he came up with that brilliant method to cut the state budget---but then again, as long as it's a Republican governor doing it, obviously it's good business, unlike those godless liberals out in Oregon who want to kill everyone. :icon_roll

So, if you don't like the President's plan, think he's a pretty funny guy and are going to spend time griping and picking it apart, do you have any viable alternatives? I challenge anyone who knows more than the President, the legislators and every single health related industry---come up with something that works.

Have a nice day!