Illness and Insurance Hell

Multiple Sclerosis Activism Foundation

noreply@blogger.com (Margaret Welman Paez) — Sat, 03 Jul 2010 00:42:00 +0000

What happened to us should not happen to anyone in this country of ours, especially to a man with an incurable and debilitating disease. It's why we've started the MS Activism Foundation, a 501(c)(3)--because we can't wait for a cure.

MS Activism.org or reach me at margaret@msactivism.org.

There Will Be No Further Postings. Thank You All Who Made Reform Possible.

noreply@blogger.com (Margaret Welman Paez) — Thu, 25 Mar 2010 16:41:00 +0000

ERISA Schmerisa or The Lessons I Have Learned Thanks to the Profit-Mongers at CIGNA

noreply@blogger.com (Margaret Welman Paez) — Tue, 23 Mar 2010 18:58:00 +0000

I have been educating myself over the past year about ERISA (Employee Retirement Income Security Act) and quite frankly, the more I read the more I become disillusioned with our current system and those in our Congress and Senate fighting to keep it this way. Their behavior is criminal.

Don't worry if you can't understand ERISA completely, they don't want you to. For instance, from the Department of Labor's website, you can find answers to your questions about claims in clear, concise language and some in convoluted form.

Clear form:

Before you file, however, be aware of the Employee Income Retirement Security Act of 1974 (ERISA), a law that protects your health and disability benefits and sets standards for those who administer your plan. Among other things, the law and rules issued by the Department of Labor include requirements for the processing of benefit claims, the timeline for a decision when you file a claim, and your rights when a claim is denied.

Convoluted form:
Q-A9: What benefits are “disability benefits” subject to the special rules applicableunder the regulation for disability claims?

A: A benefit is a “disability benefit” under the regulation, subject to the special rules for disability claims, if the plan conditions its availability to the claimant upon a showing of disability. It does not matter how the benefit is characterized by the plan or whether the plan as a whole is a pension plan or a welfare plan. If the claims adjudicator must make a determination of disability in order to decide a claim, the claim must be treated as a“disability claim” for purposes of the regulation. As the Department stated in the preambleto the regulation, 65 FR at 70247, n.4, “where a single plan provides more than one type of benefit, it is the Department’s intention that the nature of the benefit should determine which procedural standards apply to a specific claim, rather than the manner in which the plan itself is characterized.” Accordingly, plans, including pension plans, that provide benefits conditioned upon a determination of disability must maintain procedures for claims involving such benefits that comply with the requirements of the regulation applicable to disability claims, including the requirements for de novo review, the consultation requirement for medical judgments, the limit on appeal levels, the time limits for deciding disability claims, and the disclosure requirements in connection with extensions of time. However, if a plan provides a benefit the availability of which is conditioned on a finding of disability, and that finding is made by a party other than the plan for purposes other than making a benefit determination under the plan, then the special rules for disability claims need not be applied to a claim for such benefits. For example, if a pension plan provides that pension benefits shall be paid to a person who has been determined to be disabled by the Social Security Administration or under the employer’s long-term disability plan, a claim for pension benefits based on the prior determination that the claimant is disabled would be subject to the regulation’s procedural rules for pension claims, not disability claims.

This is an illustration of why you hire an attorney if your claim is denied.

However, I found an excellent article on ERISA and long term disability that clarifies every question about procedure here at Physician's News Digest. It's well-written and lays it all on the line so you do know what you will be up against if you decide to fight the fight.

The article by Mark F. Seltzer, Esq (told you it takes an attorney), is written with physicians as his audience, keep that in mind as you read it, but the information pertains to anyone with a LTD claim. Everything in blue is taken directly from the article:

Do you have group long-term disability coverage that pays you if you become disabled? If you get sick or hurt, are you relying on that group LTD policy to pay you benefits? If you do, don’t count on it. There are three primary reasons for this: (1) inferior contract language, (2) ERISA, and (3) relevant court decisions. If you become disabled, you may be in for the fight of your life.

Yes, the fight of your life. And when you are sick, what is the very last thing you want to do? The answer is fight. In our case, we just wanted to be left alone and let Paul try and get better. Insurance companies, like CIGNA, know this all too well. It's one of their tactics in claim denial; wear you down. You are already sick, how much wearing down will it take?

But unfortunately, while disabled, when you are most vulnerable, is the worst time to mount a fight against the big insurance company.

Exactly, and that is one of the first things they are counting on, is preying upon your illness or disability to their advantage. What a racket!

There is a reason that LTD policies cost on average about one-sixth of the premium for a quality individual insurance policy: group policies are designed to limit coverage and the amount of benefits payable. This is done in many ways, including limited definitions of disability, offsets against benefits, as well as significant limitations and exclusions in the policy. Group coverage is inherently inferior to individual disability coverage.

Limited definitions of disability. Interesting the overall, gotcha' quality permeating these plans, isn't it? And that's because it's a pure money-making scheme for the insurance companies, a scam. They collect and collect the monthly premium from their risk pool and never pay out. In my husband's case CIGNA was looking at paying out over $2 million in his lifetime until retirement.

You will, no doubt, be denied your claim more than once. Your recourse then becomes this:

Again, this appeals process is established by ERISA and must be adhered to by both sides. If, after you have gone through the internal appeals process, the claims administrator still maintains its "adverse decision," and in effect, you have "exhausted your administrative remedies," you will then have the right to file a lawsuit in court.

A lawsuit. Of course. And here's where it begins to get ugly.

What is absolutely critical in considering LTD cases is that the burden of proof that must be met by the insured physician establishes that the claims determination made by the claims administrator after considering the information of record was "arbitrary and capricious." This is a difficult standard to meet. Sometimes, under certain circumstances, this standard is "heightened." However, usually, the Court simply reviews the administrative record and determines whether or not there has been an "abuse of discretion" relative to the claims determination.

In Black & Decker Disability Plan v. Nord, the Supreme Court of the United States held that "ERISA does not require plan administrators to accord special deference to the opinions of treating physicians," therefore, effectively ending the use of the treating physician rule in ERISA-governed claims.

Bad Faith. Black’s Law Dictionary defines bad faith as, "the opposite of good faith, generally implying or involving actual or constructive fraud, or a design to mislead or deceive another, or neglect or refusal to fulfill some duty or some contractual obligation, not prompted by an honest mistake as to one’s rights or duties, but by some interested or sinister motive." In 1990, Pennsylvania enacted a bad faith statute relating to insurance carriers. Prior to 1990, there was no such codified statute in Pennsylvania.

You need to read the article to fully digest what the writer is saying here, but in essence there is no real codified body of law regarding Bad Faith, it varies from state-to-state because the "business of insurance" is exempt from federal anti-trust laws due to McCarran Ferguson Act of 1945. The laws are left to the states and each states' laws vary.

The pre-emption issue as to state bad faith has created a major problem for both those attempting to bring bad faith causes of action as well as those defending same. Decisions have been rendered by different District Courts throughout the country concluding totally different positions on virtually the same given set of facts.

ERISA, you see, falls under federal jurisdiction so recourse for you, the insured, falls only on this path of restitution and not the path of using your state's laws. As of this writing, I am still unclear whether any decision had been made by the Supreme Court regarding ERISA pre-emption. If you do know, please contact me. Email link on the left.

There is no question that the current trend in the sales of disability insurance, as well as the high growth area in disability insurance, is group policies. On the surface, this seems to make sense. After all, most group policies are offered by employers (usually hospitals) as an employee benefit. The "policy" is usually part of a greater employee benefit plan, which is part of a benefit package that most physicians are quite happy to have. The "policy," per capita, is cheaper, easier to sell, easier to administrate, and in every way more profitable for the insurance company, as opposed to individual disability insurance policies.

Cheaper, easier to sell, easier to administrate, and in every way more profitable for the insurance company. See, when peoples' lives are at stake, and I mean being given the ability to heal and the continuation of income when the breadwinner is unable to work which is the whole point of a disability policy, then it is clear to see how profitability and health care don't mix.

However, what you may not realize is that the benefits, especially in view of the policy provisions, are far inferior to the benefits in an individual policy, especially those sold in the 1980s and early 1990s.

But wait, it gets worse. Not only are the group benefits inferior, but the very same ERISA procedures enacted as a built-in safeguard for plan participants have been used to sabotage claims. The ERISA procedures in concept were sound and made sense. The insured had the ability to perfect a submitted otherwise defective claim because, under ERISA, the carrier upon arriving at an adverse decision is required to provide the insured with an explanation for its decision as well as any documentation upon which it relied in making its determination. This gave the insured physician multiple opportunities to perfect his/her disability claim by curing the defect.

Your doctor is simply filling out a claim form with simple, understandable answers and sending test results to prove your disability. He is, after all, a physician not an attorney. He went to school to practice medicine and heal the sick and NOT learn how to fill out insurance forms in such a manner as to appease the insurance bureaucrat looking for any way to deny your claim. Here are your bureaucrats, Ms. Palin of Alaska.

However, this very same procedure has been used by the carrier for the exact opposite purpose in order to defeat that same claim. Because of the fact that the Court, upon appeal, will most often only review the administrative file, and further, because the standard of review is usually that of arbitrary and capricious, the insured is forced to produce all evidentiary documentation at the administrative level and during the administrative appeals procedure. This allows the insurance company to simply take a defensive posture in "sitting back" and picking apart the insured physician’s completed claim.

And, even worse, in view of the fact that there is no longer the use of the treating physician rule in order to "level the playing field," as long as the insurance carrier follows the "yellow brick road" map by having its team of internal medical consultants and "experts" properly address the claimant’s medical documentation, it could be virtually impossible to overturn the group carrier’s decision to deny or terminate a claim.

And now, the final coffin nail. The bottom line here is profit and an unpoliced profit motive. If the Supreme Court rules in favor of pre-emption and therefore holds that there is no right to a state bad faith claim under ERISA, it will continue to allow the "icing on the cake." Therefore, not only does (and will) the insured-physician have an untenable burden in prosecuting and prevailing on these claims, with virtually every tool at the insurance company’s disposal but, in addition, the Courts will in effect be condoning the use of any claims practice to defeat the claim. And, what is the worst case scenario for the insurance carrier? Most likely, holding on to the insured’s money for an additional year or two.

If you have a group LTD policy, if you become disabled, and if you expect to collect benefits under that policy, you need to know your policy and the application of ERISA like the "back of your hand." You will have to anticipate every company strategy that will be employed to defeat your claim. You will have to proceed in the face of a "mine field" of unfavorable court-decisions. And, you will have to "paper the file" with the "sun, moon and stars".

The essence of an arms-length good faith business transaction is to get what you bargain for. The problem with ERISA-governed disability policies is that the insured physician most often does not know or understand the bargain. There is an old maxim that says "you get what you pay for." But, between the group LTD policy language, the internal ERISA claims process, the insured’s burden of proof in a lawsuit, the flurry of insurance company-favorable court decisions, and the trend towards (and possibly permanent) pre-emption of state bad faith, it will be extremely difficult to get anything that is paid for. That little "lamb" can’t wait to sink its "teeth" into your claim. I think this will give you food for thought.

Mark F. Seltzer, Esq., is an attorney practicing in Philadelphia, Pennsylvania, representing physicians and professionals in disability insurance claims.

The system is corrupt and broken and does not have your welfare in mind. We need to change this. I urge you all to help fix what's wrong so others don't have to go through what we went through and what many of your friends, neighbors and co-workers are going through now. Please visit Jo Joshua Godfrey's non-profit organization, United Patients of America, dedicated to uniting patients against insurance abuse. Help take back our health care.

The Health Reform Bill has Passed, RIP Bad Health Insurance Practices--Maybe...

noreply@blogger.com (Margaret Welman Paez) — Mon, 22 Mar 2010 23:16:00 +0000

Rest in peace, this whole for-profit, rotting system of a health insurance industry that stands in the way of our national health and well-being. Middlemen who do nothing, that's the health insurance industry. (Although, they are so good at protecting their ability to make billions by doing nothing that they will keep at it; finding new ways to undermine the new bill--those lobbyists have to earn their keep!)

RIP members of the GOP who cemented their fate by this shameful display of hatred and loathing to those very Americans they were elected to serve. Give up your federally-financed health insurance if our government is such a horrible disease to the health and care of our nation. Give up you federally financed pension as well.

Go ahead, try repealing the health reform bill, try rolling us back to abuses we have suffered as premium-paying customers; parents and children whose policies are rescinded because they got sick, women with breast cancer left to die because their insurer did not want to pay, sick children like Kyler Van Nocker whose insurer, Coventry, won't pay for his cancer treatment, Americans with chronic conditions unable to find any policy, let alone an affordable one, that will pay for their medications.

Try. And see how utterly inconsequential you are to the very fabric of our society. You are the patsies of your corporate overlords as you wait lustfully for your campaign coffers to be filled with money, the only intent of which is to purchase your influence. Shame on all of you who fought against reform. Shame.

The Only Certainty in the Fight for Health Reform

noreply@blogger.com (Margaret Welman Paez) — Mon, 15 Mar 2010 23:27:00 +0000

No matter who you are or where you live.

If you are an insurance executive making your living (and stock options) by denying claims.

If you are the claimant who has just been denied.

Maybe you are one of the people who protested against reform, maybe you protested for it.

Maybe you receive Medicare and don't realize it's a government-run insurance program but you feel very strongly against a government reform of health insurance.

Whoever you are, from the former CEO of CIGNA, H. Edward Hanway to the countless people with and without the ability to get affordable health care--Death will find all of us, one way or another.

And we can either treat it and ourselves with dignity or we can keep allowing ourselves to be lorded over and hounded into our graves by an uncaring, profit-driven system.

And because of that, I ask myself and I ask you all: What side of this moment in history do you want to be on?

The side that helps Death along, helps it find us all sooner and with more suffering because we are without affordable care and treatments? Want to be on the side that denies a 5-year old boy his cancer treatment, like HealthAmerica (part of Coventry) did to Kyler Van Nocker? The side that believes the lies paid for by billionaires like the Koch Brothers?

Coventry Health Care, parent company of HealthAmerica, which is denying Kyler Van Nocker's $110,000 claim for life-saving neuroblastoma treatment, is in extra super-duper financial shape these days.
The Dow Jones Newswires reports today that Coventry's fourth-quarter earnings rose 24%, beating profit expectations, as overall membership rose while medical costs fell.

"Coventry's medical-loss ratio, or the percentage of premium revenue used to pay patient bills, declined [to] 83.2% from 83.8% a year earlier and 84.4% in the prior quarter," notes Dow.
This has helped boost Coventry's profits to $109.1 million, or 74 cents a share, up from $88.2 million, or 60 cents, a year earlier. Revenue increased 15% to $3.43 billion as premium revenue rose 17%.

Or do you want to be on the compassionate side that wants this nation to have a Universal Health Plan like every other industrialized nation in this world? The side that wants to limit pain and the indignation of dying from something that could have been easily prevented and treated?

Death finds every single one of us no matter who we are and that is the one certainty of life. From billionaire to the homeless, it finds us all.

I want to be on the compassionate side. I want it to be said that I fought for the health of my fellow citizens because it was the right, moral, just and compassionate thing to do.

It's with this posting (and admittedly some disgust on my part with what I see going on out there, Beck et al) that I, really and truly, say goodbye. I'm done. Let the over-paid talking head idiots like Rush and Herr Beck chatter away. They have chosen their side and it's the wrong one.

Peace and good health and may reform come to this nation because if we are to retain any of our ability to compete globally, we need it.

And Liz Cheney, shut-up and go home.

Image above found here.

How the Health Insurance Industry Became Greedy

noreply@blogger.com (Margaret Welman Paez) — Wed, 10 Mar 2010 22:04:00 +0000

A really excellent article here about how Blue Cross, which started out as a not-for-profit insurer, became part of the mess that is our health insurance industry today. Written by Jonathan Cohn, a senior editor at The New Republic, there is also some history about the health insurance industry in general:

As Robert Cunningham and Robert Cunningham Jr. recount in their 1997 book, The Blues, those early Blue Cross plans had several defining characteristics. Among them were the twin principles of “guaranteed issue” and “community rating.” The plans would sell insurance to anybody who wanted to buy it. And they would charge the same premium to every person, regardless of the person’s medical condition. The plans did this because they were non-profits, designed not to earn money for shareholders but to insure a steady supply of paying patients for the hospitals. (It was the hospitals, who were struggling to pay their own bills during the Great Depression, that established the plans.)

What enabled the Blue Cross plans to succeed was their effective monopoly on the health insurance business. They had a huge, diverse base of customers--one based heavily on large groups of employees, like the Dallas schoolteachers--which meant they had sound finances. The majority of people were relatively healthy, with few medical bills. Their accumulated premiums were sufficient to cover the bills for that small group of people who, because of accident or disease, had much higher bills.

But as enrollment in the Blue Cross plans swelled, the commercial insurance industry took notice--and saw an opportunity. If Blue Cross was selling to everybody and charging everybody the same rate, that meant some people--healthy people--were effectively paying a bit extra in order to subsidize the sick. The commercial insurers figured that if they could target just the healthier customers, by charging higher premiums or refusing coverage to people with medical problems, they could offer lower premiums to these people and still make a profit.

They were correct. And the effect on Blue Cross was devastating. Over time, Blue Cross plans lost more and more healthy customers, leaving a pool of beneficiaries in relatively worse health. In order to finance their medical bills, Blue Cross had to raise everybody’s premiums. With each increase, more and more healthy people fled for cheaper plans, creating a vicious cycle. Eventually, the Blues faced a choice: Start acting like the commercial insurers, in order to compete, or go out of business. They chose the former.

Soon Blue Cross plans were screening potential customers, charging them higher premiums or no coverage if they came with pre-existing conditions. Eventually, some of the plans converted outright to for-profit entities.

Eleven Ugly Truths About Health and the Health Insurance Industry in Our Country

noreply@blogger.com (Margaret Welman Paez) — Wed, 10 Mar 2010 17:19:00 +0000

There are several incontrovertible truths about health and care in our country:

1. Human beings can and do get sick. Some more sick than others. These are simple facts of life.

2. We are at the mercy of our health insurance company to get our health care paid for; from doctors' visits to medicines to hospital stays, without their prior consent we cannot get our care.

3. If you are employed, both you and your employer pay for your policies. Sometimes you have both a health and a disability policy through your employer.

4. Paying your premiums absolutely does not guarantee that the insurance company will uphold their end of the contract (purposely written in vague language) and pay out a claim.

5. Your health insurance company can dump you at any time. This practice is called rescission.

6. Your health insurance company can raise your premiums at any time, and hikes in premiums have outpaced wages and inflation. If you are self-employed and cannot afford a rate hike on your policy, you lose your coverage. This practice is called purging. You may still make too much money to qualify for government help, in which case you are simply out-of-luck and health care.

7. Profits are the only motivating factor for an insurance company. Money is made by the company when they deny a claim, such as I have documented on this blog, or when they delay in paying a claim.

8. We are the only industrialized nation in the world without a National Plan to ensure the health and well-being of our people, to give us the ability to build enterprises and our own wealth because we are chained to any "job" just so we can get some form of health insurance.

9. The insurance industry is immune to federal anti-trust regulations making things like collusion and price fixing, practices they can and do employ. Sometimes they get caught, most times they do not, thanks to their immunity from these laws. See the McCarran Ferguson Act of 1945 for more information.

10. Over 45,000 Americans die each year due to lack of health insurance. Why does this matter? Because the health insurance industry is the gate-keeper to our medical care. We should be able to go see a doctor or receive treatment without fear of losing our retirement funds or our homes or having to declare bankruptcy, but we cannot because we are all (from consumer to provider) slaves to an industry whose only motivation is to secure profits for their shareholders.

11. Health care costs are out of control, thanks in huge part to the health insurance industry. The blame rests squarely with the insurers as they are not only the gate-keepers to our care, they are also the gate-keepers to reimbursing doctors, hospitals and pharmacies. Deals are struck with all the providers, but only after the insurance profit margins are in place.

Finally, if being in the insurance business is so risky and expensive, as Ms. Angela Braly of WellPoint stated before Congress on February 24 of this year, then why do WellPoint, CIGNA, UnitedHealth Group, Aetna and Humana stay in the business? Why not close up shop and forget it?

Why bother with such a risky and expensive undertaking as collecting billions in premiums? If the profit margins are so low, as they claim, why bother spending the countless millions of dollars in lobbying fees to keep everything the same as it is now? Why do they purchase corporate jets, have vast real estate holdings and give their executives such generous compensation packages if the business is just so hard to keep profitable? Why keep at it?

Because the business model of collecting ever-rising premiums for doing absolutely nothing is an extremely lucrative one and they all make an immorally obscene amount of money from infirmity, from the sick and the dying in this country of ours. That is a very ugly truth.

The image above was found here.

America Goes Uninsured While Congress Fiddles--and Gets Lifetime Health Insurance On Us!

noreply@blogger.com (Margaret Welman Paez) — Mon, 08 Mar 2010 19:00:00 +0000

You've gotta' love a good hypocrite--they're so bold in the face of things that contradict what they say or believe--usually what THEY have said or professed to believe.

And the best example of this is the way our dear public servants, especially the ones against any sort of health insurance reform, get treated when they retire. All on us! And look, they don't have to pay premium increases on their insurance--why? Because we pick up the tab for them.

Uncle Sam will continue federal employee's health benefits, as long as you were enrolled in the program for the last five years, however you must pay the same monthly amount that you paid while working.

And health insurance benefits aren't all. They get a nice pension as well--after a mere 5 years of service! Yes, thanks to us.

My fellow citizens, our public servants get a great deal of a ride into their retirement, which is why they campaign so furiously--it isn't about serving the public, it's about serving themselves so they can chalk up the pension dollars.

What I find really galling about the whole mess, besides the obvious selfishness inherent in their voting behavior, is how the National Taxpayers Union grades these same nay-sayers as being friendly or "good" to us taxpayers. But they don't see the ridiculousness in having us pay for their, sometimes, multi-million dollar pensions and for a lifetime of health insurance benefits--all while denying us access to a single payer system? Also, Steve Forbes is on their Board. When's the last time he saw a payroll deduction on his paystub? Like he gets a paystub?

Call your public servants, tell them "Hey, get off the payroll and give up your pension, the one we pay for, or give us all your great, government subsidized health insurance plan." Here's the link, you can email it to them to remind them of their sweet, and hypocritical, deal. http://www.opm.gov/INSURE/HEALTH/

Entire Congressional retirement package PDF here. From this PDF, I leave you with this. Please note how public outrage made it all go away before.

The Civil Service Retirement Act of 1920 (P.L. 66-215) established a pension system for federal employees in the executive branch of government. Coverage under the Civil Service Retirement System (CSRS) was extended to Congress in January 1942 by P.L. 77-411. That law was repealed just two months later in response to adverse public opinion. In 1946, P.L. 79-601 again extended CSRS coverage to Congress, at the option of Members, with higher contributions and greater benefits than those applicable to regular federal employees. In reference to that legislation, S.Rept. 79-1400 (May 31, 1946) stated that a retirement plan for Congress:
would contribute to independence of thought and action, [be] an inducement for retirement for those of retiring age or with other infirmities, [and] bring into the legislative service a larger number of younger Members with fresh energy and new viewpoints concerning the economic, social, and political problems of the Nation.

A Libertarian and Law Professor's Point of View of Health Care Reform

noreply@blogger.com (Margaret Welman Paez) — Mon, 01 Mar 2010 03:17:00 +0000

In my never-ending search/quest for answers, reasons, explanations and peace of mind as to why we don't have a more reasonable, just, moral, rational and, dare I say it? competitive system of health care in this country, I ran across this article, Private and Public Competition In Health Care. I found it at Forbes.com and it was written by Richard A. Epstein.

Equipped with my trustworthy computer, fiber-optic internet account and dogged determination for knowledge, I Googled Richard A. Epstein and I found out he's a very distinguished professor of law and now he's at the NYU School of Law. (I went to NYU, but not the Law School part)

He's staged his Libertarian argument in this article on the idea that enough competition to the big guys already exists within the health insurance arena. The big guys are WellPoint, Aetna, CIGNA, United and the Blues.

Right now a multitude of small firms coexist with such huge operations as Aetna, Blue Cross/Blue-Shield, Cigna, United HealthCare, and WellPoint. But does this medley of firms suffice? In a recent Wall Street Journal column, Robert Reich, a former Secretary of Labor, suggests that the answer is no.

Professor Epstein insists competition from a public entity, as Mr. Reich suggests, won't work.

He quotes Mrs. Reich's article from the WSJ, where Reich says, "Without government as competition, the private sector has little incentive to improve."

What is Professor Epstein's rebuttal?

The claim is a simple economic blunder. The private sector is not some monolithic entity. If it tried to behave as such, its members would be on the antitrust chopping block for engaging in horizontal price fixing. Instead, these large players compete flat out in all market segments. What, then, will one new player do to the overall level of competition?

Let's start with "its members would be on the antitrust chopping block for engaging in horizontal price fixing." If you know anything about how insurance works, as I am sure Professor Epstein does, you know this: It is immune to federal anti-trust laws due to the McCarran Ferguson Act of 1945:

It is fair to say that the McCarran-Ferguson Act antitrust exemption is very expansive with regard to anything that can be said to fall within "the business of insurance," including premium pricing and market allocations. As a result, "the most egregiously anticompetitive claims, such as naked agreements fixing price or reducing coverage, are virtually always found immune."⁽⁶⁾

What then, is Professor Epstein going on about in his article. Is the professor not aware of the law already in place that keeps the anti-trust regulators away? (highly doubtful) Or, is he writing to an audience of people who only want to hear one thing? Who want some affirmation that profiting from the sick and dying is okay. Those who think they can't get sick and who believe the market knows best. What's that saying about the Forbes.com readership?

If you are educated about health insurance practices you also know that as a consumer you have little substantive recourse if your health insurance company doesn't want to pay your claim or denies your disability or causes suffering or kills you. And that's because of ERISA or the Employee Retirement Income and Security Act of 1974.

In the case of employee health benefits, you are covered by the federal courts because employee health benefits plans fall under ERISA. However, ERISA is written in favor of the plan and not you, the disabled person with say, Progressive Multiple Sclerosis. A good attorney-written blog on all things ERISA here.

Professor Epstein goes on to say this:

Worst of all, no government entity ever operates on a level playing field. A government's dual capacity as regulating and regulated party creates a nonstop risk of bias, either by inadvertence or design. What private firm will sue a government corporation for unfair trade practices if they know that the Justice Department, Congress, the Federal Trade Commission or the Securities and Exchange Commission can investigate them? Who wants to litigate an unfair competition case, no matter how solid, and go head to head with a government firm that always has home court advantage? And who wants to compete economically against a firm whose thousand disguised government subsidies allow it to undercut competition?

As it is now, there is no level playing field the way private insurance works. As a premium paying consumer, you cannot go to the Federal Trade Commission for help. Period. So that point is well, pointless. McCarrran Ferguson again is why you cannot seek reprieve from the FTC.

As far as litigation, I urge Professor Epstein to click on the link above in the upper left hand corner of this blog and tell me what's fair when it comes to ERISA litigation when 21 Federal Judges go booze it up at the Helmsley Park Lane Hotel with insurance companies, big pharma and benefits plans general counsels to discuss defending against ERISA claims. I urge the professor to explain the fairness of ERISA, in general, to claimants.

And Professor Epstein asks "who does want to compete against a firm whose thousand disguised government subsidies allow it to undercut competition?"

I'll tell you who, the people of this country, people like my family who are sick to death of the parasitic practices of the private health insurance monopoly we are chained to for life and blood. Literally.

Health care cannot be about the market and competition because of the importance of life, of trying to meet death with dignity and compassion and all the subtleties in between; of the mother of two small children who is dying of breast cancer yet denied her pain medications, of a 5-year old boy trying to see yet another day of his new world yet denied the one treatment that may allow him to see his 6th year, of the woman with lung cancer who had it hidden from her--and why? Profits, the market, the bottom line.

I'll leave you with Professor Epstein's parting words in the article. Don't know what to make of it. I say we are already at disastrous.

The critics who treat the public health care plan as a Trojan horse for a single-payer health care plan have a real point. All libertarians know that private monopolies are problematic--and that state-run monopolies always prove disastrous.

Oh! The Money CIGNA (and other insurance companies) Spend on Lobbying.

noreply@blogger.com (Margaret Welman Paez) — Thu, 25 Feb 2010 22:41:00 +0000

The link to this chart is here. This is taken directly from The Center for Public Integrity. If you are curious as to who is lobbying against you, as a premium-paying, insurance-carrying American, go here and type in your insurance carrier. They spend lots o' cash on desperately trying to keep the status quo alive--which means profits over health and care, America.

Information about the Nickles Group here. Information on Heather Podesta & Partners here. CIGNA's lobbyists' information here. This last link is a good one, from Littlesis.org, since you get to see the filing papers and the amount spent on lobbying. What a system. What a waste. What a mess.

Company or Organization	Lobbying Representative	Expense	Quarter	Sector	Details
CIGNA	The Nickles Group, LLC	$60,750	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$450,000	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$450,000	2009 1st Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 1st Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$260,000	2009 2nd Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 2nd Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 2nd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 2nd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 3rd Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 3rd Quarter	Insurance	View
CIGNA	BLANK ROME GOVERNMENT RELATIONS LLC	$50,000	2009 3rd Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 3rd Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$260,000	2009 3rd Quarter	Insurance	View
CIGNA	Heather Podesta & Partners, LLC	$60,000	2009 4th Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$850,000	2009 4th Quarter	Insurance	View
CIGNA	CIGNA CORPORATION	$640,000	2009 4th Quarter	Insurance	View
CIGNA	The Nickles Group, LLC	$60,750	2009 4th Quarter	Insurance	View
CIGNA	Blank Rome Government Relations, LLC	$50,000	2009 4th Quarter	Insurance	View
CIGNA	Steptoe & Johnson LLP	$50,000	2009 4th Quarter	Insurance	View

Health Dialog, Foundation for Informed Medical Decision Making, CIGNA's Revolving Door and Why Your Health Care is Now One Word, Part I

noreply@blogger.com (Margaret Welman Paez) — Thu, 25 Feb 2010 19:11:00 +0000

(Originally posted October 26, 2009)

Once, sometime in the not-too-distant past, health care was spelled with two words. Then along came some shiny suited corporate marketer, fresh from B-School, full of some ideals, who blended those two words into one, and thereby cemented the hold on health and care in our nation into the hands of The Corporation.

Trademarked and proprietary, thank you very much.

Health care used to be about you and your doctor trying to keep you healthy with your regular check-ups or trying to figure out how to heal what was wrong with you. Remember that quaint notion? Remember when pharmaceuticals weren't allowed to advertise on TV? Oh, the day. Now, I'm all for dissemination of information, but seriously, we've become one hell of a pandered-to nation. The Ambien ad makes me laugh every single time I see it. "Sleepwalking, and eating or driving while not fully awake, with memory loss for the event, as well as abnormal behaviors such as being more outgoing or aggressive than normal, confusion, agitation, and hallucinations may occur."

Our health care has been so grossly intruded upon by so many people trying to get their fair-share, piece of the American health care pie, that we are left with a mockery of what health care is supposed to be about. Your doctor is just one small step up from you on this ladder--and you and I, the sick person, the consumer, we're on the bottom rung.

It's such a wasteful system that it spawns all sort of ways for companies to figure out how to make money from all that waste--a way to grab a piece of that pie. How big a piece? Let's look at one company making a play for the pie, Health Dialog.

Here's an excerpt of an interview at HealthCareEuropa.com with Chris Coloian (formerly of CIGNA) now of Health Dialog. And CIGNA is now a Health Dialog customer! Works out nicely, doesn't it? Full interview here.

We talk to Chris Coloian, Senior Vice President Health Services at Health Dialog, a US population health and health improvement company owned by UK healthcare insurer BUPA. Chris is the former vice president of health advocacy at CIGNA Healthcare, where he provided strategic, product, and marketing direction for the company’s portfolio of care management and health coaching programs.

HCE: How do you see the European market for chronic disease management programmes growing over the next few years?

CC: Very fast, maybe doubling in the next few years. I see no reason why in 2-3 years it shouldn’t be 20-25% of the US market, which today is around $2.5bn and growing at 10-15% a year.

HCE: Why this very fast growth?

CC: I think European policymakers, like our own president, really 'get it'.

HCE: Hmm, I hear mixed reports. In the USA, where people stay with insurers for 4-5 years, I’ve heard that chronic disease management programmes make sense, as they effectively reduce the acute care that an individual will need over that limited time period.
But people in Europe tell me that it is different for healthcare payors like UK primary care trusts, who will be paying out until the person dies. In those circumstances, do these programmes really deliver savings?

CC: To understand the full impact on society, one has to look past medical costs and consider productivity and contributions, such as increased tax revenue. You may extend someone’s life by, say, 2-5 years, but you will also have a much more healthy individual, who will be able to contribute more.
The studies I have seen show that this productivity bonus far outweighs any extra costs. And the cost of the extra few years is not very great anyhow, as most of the costs for any individual are incurred in the last six months of life. I think European policymakers and politicians understand this.

Where to begin. Let's start with the fact that Chris is talking about growth in the European market--growth off which his company can feed in the chronic disease management arena because European policymakers "get it." What do they get? That integrated care is the future. I did not know our President "got that" because we can't even get a Public Option let alone a National Plan. So, who's going to pay for this integrated care of the future? You and I will via our premiums--so that we can help our insurance companies cut costs. Make sense? Think bottom rung.

From the International Journal of Integrated Care.

One big difference exists between the USA and Europe. There, disease related integrated care is provided by independent, mostly commercial disease management programs. They do their work instead of regular primary health care and regular hospitals. In Philedelphia, this approach was at the centre of the congress. Not all speakers agreed with this outcarved, independent approach. Medicare's health care innovator, Linda Mango, preferred to embed DMPs within the regular structures, because persons with one chronic condition (still?) do need all types of services. In contrast, Wallstreet broker Brooks O'Neil has lost all trust in carers as usual, in regular primary care and hospitals, and wants to invest as much as he can in commercial DMPs. He sees DMPs as a tool for a revolution to replace ordinary fragmented working doctors and hospitals.

Yes, yet another way to grab a piece of the Health Care Pie--commercial Disease Management Programs like what Health Dialog peddles, you know, Health Coaching and the like. Go to their website, it's a prime example of some really awful corporate writing.

Our predictive models deliver individual-level information that predicts (don't predictive models already predict?) financial risk and provides insights into the impactibility or readiness of each individual to become engaged in the healthcare process. By incorporating this concept of impactibility we identify those who can most benefit from Health Coaching or other care management programs within a specific time frame, and then match intervention to need.

Psst, Health Dialog, impactibility isn't a word.

And the interviewer asks why the European market should grow like the U.S because here, we use the predominant employer-based insurance system and on average, we change jobs every 4-5 years, thus change insurance. So the programs here reduce acute care costs over that limited time period--but for who? Insurance companies and our employers who have to pay into our insurance.

While I am all for reducing the need for acute care, what is the price for reducing this need? Because as you know, we don't have a great track record here in the U.S for taking care of our sick people--even the ones with insurance. 30% of all claims were denied in the state of California just within the first 6 months of 2009. 30%! That reduces acute care all right.

And don't you just love being thought of as a contributor to "tax revenue?" Thanks, Chris. Really puts the human in your humane thought.

And the only reason I stumbled upon Health Dialog and companies of their ilk was due to my research and personal interest into Ms. Abigail Johnson of Fidelity Investments. I was trying to figure out where she stood on health and care in our country. What I found besides Ms. Johnson's campaign contributions, was her husband, Mr. Chris McKown. He's one of the founders of Health Dialog. From the Health Dialog website:

Health Dialog is a leading provider of care management and analytic services and is a wholly-owned subsidiary of Bupa, a global provider of healthcare services.
Health Dialog Services Corporation (Health Dialog) was founded by George Bennett and Chris McKown in 1997. The company was built in collaboration with the not-for-profit Foundation for Informed Medical Decision Making (FIMDM) to directly address unwarranted variation in healthcare. The firm provides sophisticated analytics that drive actionable and measurable solutions for your population, including care management programs and provider measurement services.

"To directly address unwarranted variation in healthcare" (one word). What's all that mean? Part 2 tomorrow.

How we Bear the Burden of Paying Their Taxes and the Health Insurance Industry Still Denies Our Claims

noreply@blogger.com (Margaret Welman Paez) — Mon, 22 Feb 2010 18:43:00 +0000

When all this uproar over reforming our health care insurance began, I (among others) blogged about how the health insurance industry and its lobbying arm, AHIP, were doing and saying anything to obfuscate in the minds of the American people the real intention of health care reform: giving private insurance some competition.

Most people who come to this blog don't know that the insurance industry is immune to federal anti-trust laws because of something called the McCarran Ferguson Act of 1945. Most people can't conceive that the company they pay premiums to, for health care or for disability, would do anything to not have to pay a claim. Like Coventry denying a 5-year old boy, Kyler Van Nocker, his cancer treatment. Or CIGNA denying a 6-year old girl hearing implants or denying that Jo Joshua Godfrey had cancer let alone treating her for it.

And why deny life-saving treatments or deny a child the ability to hear? Well, because of profits, that's why. Profits have to be made and paying for treatments takes away from profits. And how are we bearing the burden of their taxes?

With the industry's practices involving their executives' pay. Let's look at an excerpt from a story from Reuters below taken from 2008, link embedded. United's CEO is now Stephen Hemsley. Interesting story here about a class action lawsuit (now settled) for back dating of stock options--former CEO McGuire was charged with fraud.

The biggest loss comes from a "stock option accounting double standard" that allows corporations paying executives stock options to deduct more than their actual expenses, they said. For example, when UnitedHealth Group Inc paid CEO William McGuire 9 million stock options, it put on its financial statement that the compensation cost the company nothing, according to the Institute for Policy Studies and the group United for a Fair Economy. But it claimed a tax deduction of $317.7 million, the groups said.

United claimed a $317.7 million tax deduction. Wow.

Here is another study done by Global Subsidies Initiative. Link to full report here. Who Global Subsidies Initiative is, here.

US taxpayers provide 20 billion dollars in subsidies for executive salaries according to report

Taxpayers in the United States are subsidizing the salaries of country's top business executives to the tune of US$ 20 billion a year, according to a report by the Washington-based Institute for Policy Studies (IPS).

The report "Executive Excess 2008: How Average Taxpayers Subsidize Runaway Pay," presents the result of IPS' 15th Annual CEO Compensation Survey, which highlights five major tax and accounting loopholes it argued were directing taxpayer dollars to fund excessive executive pay.

The largest of these tax loopholes, the so-called stock option accounting double standard, cost taxpayers US$ 10 billion last year, according to IPS. The tax rule allows companies to account for stock option expenses on their financial sheets when they grant the options, but then claim the tax deduction when the CEO actually cashes out the options, often years later when their worth has usually increased. The result is tax deductions that are much higher than the original expenses.

Another major loophole is the unlimited tax deductibility of executive pay, which allows companies to deduct executive pay from their income taxes as a business expense so long as the pay is ‘reasonable'. The IRS has failed to define reasonable, and a 1993 attempt by then President Clinton to cap these deductions at US$ 1 million failed.

Senators Levin and McCain introduced a bill to amend the Internal Revenue code to stop all this,
S.1491 - Ending Excessive Corporate Deductions for Stock Options Act.

And what has happened to that bill? Business as usual. It sits. And you and I, who do pay our taxes and our insurance premiums, what do we have to show for it?

We are chained to an industry that preys upon the sick and dying for profitability, an industry that denies a man with Progressive Multiple Sclerosis his disability benefits, an industry who regularly kicks sick people off their policies, who looks at acne and rape as a pre-existing conditions for which to deny life-saving treatments and an industry that doesn't pay its fair share of taxes. They burden us, America.

We need a single payer system. There is still time to be heard, I urge you all to please call your members of Congress and explain to them that the health insurance industry has served up too many abuses, rate hikes and denials to really be in the "Health Care" business.

Here's the Reality We Live In, Now Let's Change It--You Do That by Voting

noreply@blogger.com (Margaret Welman Paez) — Fri, 19 Feb 2010 17:15:00 +0000

This blog started for a reason. I became so incensed over the injustices served up by our long term disability insurance carrier, CIGNA, that I decided I had to call out this behavior and make others aware. And it's not just us, we are no isolated incident--far from it. I've highlighted a few of them on this blog. Read below, link embedded, to see how far the insurance industry will go to not have to pay a claim, any claim, from health services to disability, emphasis is mine:

After MetLife rejected Glenn’s claim, asserting that she was still physically capable of performing full-time sedentary work, Glenn brought suit against the insurance company under ERISA, which authorizes federal courts to review the decisions of benefit plan administrators. Glenn lost her case in district court but prevailed before the Sixth Circuit. In concluding that MetLife had abused its discretion in denying Glenn’s claim, the court of appeals relied on what it regarded as several key factors. For example, although Glenn had qualified for permanent Social Security disability benefits, MetLife ignored the findings of the Social Security Administration in deciding to deny her claim. The company also disregarded certain medical reports that supported Glenn’s claim, withheld some of those reports from the expert hired to review Glenn’s medical files, and failed to address evidence that job-related stress of any kind exacerbated Glenn’s illness. These factors, plus the existence of MetLife’s conflict of interest, convinced the Sixth Circuit that the claim denial was unreasonable and should be reversed.

We the People, can do something about this. It's called civic action. You are responsible for who represents you, well, you were until the Supreme Court Decision that just got handed down, but we still have a voice. It may not be a well-funded corporate voice, but we can still bug the hell out of our Congresswomen/men by calling, writing and letting them know health care reform must take place in this nation.

We can fund unnecessary wars but we cannot reinvest in our national health and well-being? I think we can and you must tell your representatives that.

Welcome to the Blog, Coventry Health Care, Denier of Kyler Van Nocker's Cancer Treatment

noreply@blogger.com (Margaret Welman Paez) — Wed, 17 Feb 2010 17:21:00 +0000

Instead of wasting time (and money) on perusing my blog, wait, on second thought it's probably good you are here because maybe you will now begin to understand that human life and profiteering don't mix. Welcome, take a look around, and learn!

Coventry is the parent company for HealthAmerica who denied 5-year old Kyler Van Nocker his cancer treatment because it was considered "experimental," rather it was too expensive and they did not want to pay.

Coventry Health Care (208.66.124.31)

Cranberry Twp, Pennsylvania, United States

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WellPoint Cancels Investors' Day and Californians are Still Facing 39% Rate Hikes

noreply@blogger.com (Margaret Welman Paez) — Tue, 16 Feb 2010 18:18:00 +0000

With 2.7 million Americans now uninsured in the last year alone, and WellPoint poised to hike rates by almost 40%, you think our public servants may come to our rescue and you know, introduce a single payer system for those of us who want it? You want to keep paying these profit mongers, have at it, but I'd like my premiums to actually help pay for my, and my risk pool's, care rather than paying for corporate jets, millions in executive pay and denial of care so Wall Street is happy.

Shares of WellPoint fell to $57.67 and I say, good. Trading in the shares of a company that deals in the health, life and death of human beings sickens me. How many individuals and institutions make money from denying claims to sick Americans--like HealthAmerica (part of Coventry) denying 5-year old Kyler Van Nocker his cancer treatment? The health insurance industry is a dinosaur, set for extinction because their time on this earth has come to an end.

This is taken directly from the Wall Street Journal.

By Russ Britt

A congressional hearing into WellPoint Inc.'s (WLP) proposed rate increases in California has prompted the health insurer to cancel its investor day, taking a bite not only out of its shares but those of other carriers as well.

Shares of WellPoint traded off nearly 3% to $57.67 in recent action, on the heels of the insurer's disclosure that its investor day, scheduled for Feb. 23, would be cancelled.

The news seemed to put a chill on all insurers, with virtually all of them in the red by a percentage point or more despite the broader equity market's gains.

The company said in a press release that the House Energy and Commerce subcommittee on oversight and investigations has requested information on premiums it planned to charge in California. WellPoint's Anthem Blue Cross of California plans to raise premiums on individual health plans by up to 39%.

The panel also is asking that a senior WellPoint officer appear before the subcommittee at the Feb. 24 hearing.

"The investor-day program was canceled in order to allow the company to prepare appropriately for the hearing," WellPoint's press release said. "The company is confident that its rates were established consistent with actuarial principles and state law, and welcomes the opportunity to discuss the underlying rise in health costs and actuarial dynamics."

Anthem was supposed to impose the rate increase by March 1 but, amid continuing controversy over the raise, it has decided to postpone it until May 1.

WellPoint said management would review its 2010 financial outlook during a conference call on March 17. The company said it still expects net income for the year to hit at least $6 a share.

Analysts polled by FactSet Research are forecasting the company will post earnings of $6.10 a share, while a ThomsonOne estimate calls for WellPoint to earn $6.12.

Among major insurers, UnitedHealth Group Inc. (UNH) was off 1.7%, Aetna Inc. (AET) lost 1.4%, Cigna Inc. (CI) dropped 1.3% and Humana Inc. (HUM) was down 1%.

-By Russ Britt; 415-439-6400; AskNewswires@dowjones.com

Hypocrisy and How Dana Rohrabacher Said the Taliban Were Not Terrorists

noreply@blogger.com (Margaret Welman Paez) — Mon, 15 Feb 2010 18:44:00 +0000

I always knew my congressional representative, Dana Rohrabacher (R), was firmly on the side of anti-health insurance reform. Looking at his voting record is depressing. He has voted against, that is a big, fat NO to:

-Restructuring Medicare payments and the Pay-As-You-Go Budget Rule
-Health Care Reform including getting rid of pre-existing conditions
-Food Safety Regulations
-FDA Oversight of Tobacco Products
-Economic Package aka Stimulus
-Farm Bill
-Mental Health Coverage Bill
-Children's Health Insurance Program Reauthorization Act
-Four weeks of paid parental leave for federal employees
-Medicare Prescription Drug Price Negotiation Act

But he Voted YES on decreasing gun waiting period from 3 days to 1! Why?

Let's see, he votes for abstinence only programs, but doesn't vote to help pregnant mothers in need. If you are anti-abortion (Dana is) then help out the women who do wind up getting pregnant, Dana. Or better yet, teach them to use birth control and the whole abortion issue wouldn't be an issue.

But it was this that truly made me realize that Dana is so waay out of touch with his constituents and the problems we face. Dana liked to fancy himself CIA-guy or a character out of a Ross Thomas novel as he was flitting around the mid-east as late as April of 2001. Read here what Dana had to say about the Taliban, link is embedded within text:

The potential rise to power of the Taliban does not alarm Rohrabacher, because the Taliban could provide stability in an area where chaos was creating a real threat to the U.S. Rohrabacher says that under the previous situation Afghanistan was becoming a major source of drugs and a haven for terrorists “an anarchistic state of narco-terrorism.” In contrast, the Taliban leaders have already shown that they intend to establish a disciplined, moral society.

Rohrabacher calls the sensational media reporting of the “harsh” imposition of strict Islamic behavior, with the underlying implication that this somehow threatens the West, “nonsense.” He says the Taliban are devout traditionalists, not terrorists or revolutionaries, and, in contrast to the Iranians, they do not seem intent on exporting their beliefs. Rohrabacher would have preferred to see a negotiated compromise among the various factions (but with no role for Gulbuddin Hekmatyar) rather than a bloody confrontation. But in the absence of such a compromise, he believes a Taliban takeover would be a positive development.

Calls the sensational media reporting of strict Islamic behavior as a threat to the West "Nonsense?" The Taliban are "devout traditionalists, not terrorists?" You changed your tune quickly after 9/11, didn't you? Even went as far as blaming Clinton for 9/11. But here's a reminder from August 6, 2001 when Bush was in office.

See that's called hypocrisy, Dana. And you and whole slew of your fellow public servants seem to operate solely on hypocrisy. You profess one thing but really hold another view. And when the landscape quickly changes, proving your views to be unworthy, you quickly change your words to go along with the current trend. What do you really believe?

And where was Dana in April of 2001? In Qatar. Doing what you may ask? He met with "Taliban Foreign Minister Mullah Wakil Ahmed Muttawakil, an advisor to Mullah Omar. Diplomatic sources claim Muttawakil sought the congressman’s assistance in increasing U.S. aid—already more than $100 million annually—to Afghanistan and indicated that the Taliban would not hand over bin Laden, wanted by the Clinton administration for the fatal bombings of two American embassies in Africa and the USS Cole."

Time to go, Dana. Retire. The 80's are so over, Dana. Hell, the 90's are gone too. Get out of public service because you are doing absolutely nothing to serve the public, your constituents. We have real issues to deal with involving affordable health care and jobs and we don't need you wasting tax payer money on things that don't matter. You voted yes to fund a baseless war yet you won't vote to re-invest in our nation by funding health care and jobs creation?

Stay home, help your wife take care of the triplets and leave law making up to people who don't fancy themselves, CIA-guy.

HealthAmerica, the Company Denying 5-Year Old, Kyler Van Nocker His Cancer Treatment

noreply@blogger.com (Margaret Welman Paez) — Fri, 12 Feb 2010 20:31:00 +0000

HealthAmerica is part of Coventry Health Care. From HealthAmerica's website:

Whether you are an employer, broker, provider, or health plan member, we’re constantly improving the quality of care and service you receive.

If by improving you mean working only to satisfy your investors, then denying a life-saving cancer treatment to a 5-year old boy Kyler Van Nocker, seems the profitable thing to do. Coventry and HealthAmerica are businesses, after all, right? They have to be profitable, yes?

But if they were actually involved in the process of health and care, then concern over achieving greater and greater profits would not be an issue. After all, health care is about saving lives and not about making a quick buck because that would be immoral. Profiting at the hands of very sick and dying people, well, that's really reprehensible, isn't it?

A government sponsored system, like Medicare, opened up to all United States Citizens, would free-up small businesses from having to insure their workers, would put money back into the system by increasing the risk pool with a larger, premium paying base, would allow us the choice of getting out of companies like HealthAmerica who refuse treatments based on the fact that it's expensive (never mind about saving 5-year old Kyler's life) and would save lives.

And no, saving lives is not socialism.

Keep at it members of the GOP, you are all revealing yourselves as heartless profit-mongers, interested in keeping the American people under the thumb of the Health Insurance Industry, securing your campaign coffers with huge health insurance and big pharma donations and not much else--certainly nothing to do with your constituents, the American people. John Boehner, have you ever had an original thought that did not involve yourself? Why are you in politics? Eric Cantor, same for you, what motivates a person to fight against equal health care for all in this, the supposedly richest nation in the world? You can throw money and lives at needless wars, but not put it back by investing in the health and well-being of our nation?

Here's Coventry's stock quote for today for all you investors out there:

Feb. 12, 2010 12:38 p.m. ET

Minimum 20 Minutes Delayed

CVH	$22.22
Change:	0.38 (1.68%)
Volume:	549,633

Previous Close	$22.60
Today's Open	$22.30
Intraday High	$22.38
Intraday Low	$21.87
52 Week High	$27.27
52 Week High Date	01/20/10
52 Week Low	$7.97
52 Week Low Date	03/06/09
Rolling EPS	2.14
PE Ratio	10.3832
Shares Outstanding	147,983,000
Market Capitalization	$3,288,182,260

I Say We All Stop Paying Our Premiums and Let the Industry Die a Slow Death

noreply@blogger.com (Margaret Welman Paez) — Thu, 11 Feb 2010 21:28:00 +0000

Anthem Blue Cross to hike California health premiums as much as 39 percent

Associated Press

Posted: 02/05/2010 08:37:08 AM PST

Updated: 02/05/2010 08:37:09 AM PST

LOS ANGELES — Anthem Blue Cross has told some customers it will raise their health insurance premiums as much as 39 percent beginning March 1.

The increases, reported today by the Los Angeles Times, involve as many as 800,000 customers who buy individual coverage. People with group coverage aren't affected.
In a statement, the Woodland Hills-based insurer declined to specify the size of the rate changes or how many people will be affected. The company — which is the largest for-profit health insurer in California — blames the increases on rising health care costs. It says its prices may be adjusted more frequently than its typical annual increases.
Anthem's rates are under review by the state insurance department.

Go to Anthem's web site here. They have a lot of web copy about "affordability." I don't think they know the meaning of the word. I'd like to go back to when my health care was between me and my doctor. If we all stop paying...

What Part of This Financial Crisis Does the GOP Not Understand?

noreply@blogger.com (Margaret Welman Paez) — Wed, 10 Feb 2010 16:18:00 +0000

I'm going to say "all of it," in light of this genius idea by Republican Senator Kit Bond. You know, as an aside here, I'm giving up trying to be totally civil in this blog so here goes: When are all these old, stupid, white guys, who are so out of touch with reality, going to stop dicking around in the Senate and actually do something for the American people? They're not, they're too out-of-touch.

What genius idea am I talking about? Why Senator Bond's idea to privatize Medicare. Kiss your health insurance safety net goodbye, senior citizens! As for the seniors who were on my block a few months ago with signs that read "Government Run Health Care Makes Me Sick?" Great, my protesting friends already on Medicare, you may get your wish.

You see, the problem with Genius Bond's idea here is that privatizing Medicare means handing it over to the people who don't really want to pay for your care: The Insurance Industry. He wants to hand you over to a voucher system. From St. Louis Today:

Even before he asked, Missouri's senior U.S. senator was outlining his: Privatize Medicare and limit benefits for upper-income retirees.

Meeting with Post-Dispatch editors and reporters on Friday, U.S. Sen. Christopher "Kit'' Bond suggested radical changes to the federal health insurance program that covers 45 million elderly and disabled Americans...On Friday, Mr. Bond called for giving Medicare enrollees a voucher to buy health insurance on their own.

"You're going to have to means-test the benefits," he said, adding that upper income retirees wouldn't "get much of a voucher."

U.S. Rep. Paul Ryan, R-Wis., the ranking Republican on the House Budget Committee, recently released an "alternative budget" that calls for privatizing both Medicare and Social Security.

Ah yes, privatizing Social Security. Let's see, does anyone remember what just happened on Wall Street? Banks too big to fail? You saw your 401-k evaporate overnight, what do you think would have happened to your Social Security benefits if George W. Bush had gotten his way and privatized Social Security. That's your money, Mr. and Mrs. Citizen--if you've been paying into Social Security all your working life, those are your dollars, and poof! they'd be gone now if George and his band of middle class wreckers had gotten their way.

The idea that corporations can somehow do things better than the government is an idea that has just been totally disproven during this financial meltdown.

To mistrust our own government, the same government that runs our military to protect our borders, the same government that we freely elect our officials to, is simply an absurd notion, it makes no sense and quite frankly, it's unpatriotic. But to hand over our health care and retirement to the very industries that don't want to pay claims (see Kyler Van Nocker) and that took the world to the brink of a financial meltdown, that is pure, unadulterated idiocy.

Insurer, HealthAmerica, Denying 5-Year Old Boy Cancer Treatment

noreply@blogger.com (Margaret Welman Paez) — Wed, 10 Feb 2010 00:26:00 +0000

The entire article below this photo is taken directly from Think Progress.org. All of you out there protesting against health care reform--you really want to go there, really? Saving lives is a "slippery slide into socialism" is that still true, Ms. Ding?

One of the worst abuses of private insurance companies is the practice of using spurious reasons to deny claims for medical treatments, which are often necessary for saving patients’ lives.

Kyle Van Nocker’s story shows that even 5-year-old kids are not exempt from this insurance company abuse. Van Nocker has neuroblastoma, which is a very rare form of childhood cancer that targets the nervous system and creates tumors throughout the body.

Due to successful treatment in 2007, Van Nocker’s cancer went into remission, giving him 12 months of pain-free life. Unfortunately, in Sept. 2008, the cancer returned, and Van Nocker was once again in need of treatment. Unfortunately, his health insurer, HealthAmerica, refused to pay for one form of treatment doctors believe could save his life (MIBG treatment) because they consider it “investigational/experimental” since it has yet to be approved by the FDA.

Yet in April 2008, the insurer approved cheaper treatment for Van Nocker that was also “experimental,” prompting Philadelphia Daily News columnist Ronnie Polaneczky to ask, “So why, pray tell, is HealthAmerica playing the ‘experimental therapy’ card in the case of the MIBG treatment Kyler now needs? Gee, money couldn’t have anything to do with the decision, could it?”
Van Nocker’s parents are suing HealthAmerica, citing the fact that the company has apparently been dishonest about its criteria for the types of treatment it will cover and is denying payment for treatment in this case because of the high cost of the procedure — $110,000 pays for only two rounds of MIBG treatment. “These companies have to be brought to the courthouse to get them to do the right thing,” says the VanNockers’s family attorney. “This child needs this treatment, or else.”

The sad truth is that Van Nocker is certainly not alone in having his claim denied by a major health insurer. The California Nurses Association (CNA), a nurses’ union and health care advocacy group, recently released a comprehensive study of claims denials across California. The study found that the six largest insurers in California rejected 47.7 million claims in the first half of 2009, nearly 22 percent of all claims submitted.

The United States is the only industrialized nation without cradle-to-the-grave, universal health care. In no other developed country would a child with cancer have to go without care because an insurance company decided it was not profitable enough to cover him.

A Guide to Awareness for Friends and Family of Those With Multiple Sclerosis

noreply@blogger.com (Margaret Welman Paez) — Tue, 02 Feb 2010 17:27:00 +0000

Full size of this great image found here.

Even though I originally posted this with the holidays in mind, the guide below is useful year round.

With the holidays fast approaching, I thought now might be a good time to post some facts and thoughts about Multiple Sclerosis awareness--before the parties and get-togethers begin and social tensions hit their impending highs. You know they will, it's the holidays.

Friends and family can help their loved ones just by being equipped with some knowledge about MS. Uncomfortable situations can be avoided if you have an understanding of what MS can do and how someone who has been diagnosed may feel.

1. Let's start with this fact: Multiple Sclerosis is different for every individual afflicted with the disease. My husband's case of MS is particularly aggressive as he has Progressive MS. Not everyone is affected the same as Paul. Be aware that if you know someone with MS who shows no signs of affliction, there may be another person with the disease who is using a cane, has been blinded or is in a wheelchair. The course of the disease varies greatly with each person.

2. Educate yourself. Take 30 minutes or so and read about Multiple Sclerosis. What is it? It's an autoimmune disease that attacks a person's brain and spinal cord by destroying the myelin. What's that? Myelin is the protective coating we all have around our nerve cells. And autoimmune diseases are diseases that occur when a person's immune system attacks and destroys their healthy body tissue--like myelin. Why does a person's immune system attack their own body? No one is quite sure why this happens. What does it do? Any number of things and I have many links for you on this site where you can read more. The MS Society is a good place to start. Read about the symptoms (extreme fatigue, numbness, tingling, loss of balance, tremors, spasms, spasticity, headaches, double vision, vertigo) of the disease. This will go a long way in helping you understand what a person with MS may be feeling, which can be lousy, so be aware.

3. Sensitivity to someone with MS, or any chronic disease, is a very important step in helping shape the way you communicate with that person. Think of it this way, you wouldn't ask someone with a full cast on their leg to go for a jog, would you? It's the same thing with MS, there may be no cast but body parts are still broken but in a different way. So before you ask a potentially uncomfortable question like, "Well you look fine, Fred, why don't you get out and bike again?" find out from your friend or family member what they are capable of doing. It never hurts to ask and it shows you are concerned.

4. Health care tips are best kept to yourself. As well-meaning as advice on health may be, it is not a brilliant idea, at all, to give this advice to someone who has Multiple Sclerosis. "Taking vitamins and eating well has helped my friend with MS," may be true for your friend and it is certainly true for everyone, but when you are faced with uncertainty about what your body is going to allow you to do today, tomorrow or next year, these bits of information are best kept to yourself. And again, it's because this disease is different for everyone. Had you told me after Paul's first exacerbation that he'd be getting much worse and have to go through chemotherapy 4 years later, I would have broken down on the spot.

5. Put yourself in their shoes. Think of your favorite activity--and I don't mean having a pint at the pub--your favorite physical activity. For those of you with filthy minds, fine, MS can affect sex as well so go ahead and think it. Paul's favorite thing in the world was skiing. He was an excellent skier; a natural. He can never ski again. Why? Because the myelin has been eaten away, the nerve damage is done and he can no longer feel anything from just above both his knees downward. If he does feel something it varies from horrible pain, numbness, tingling and what he describes as "Like I have two dead weights strapped to me that I move around with my thighs."

6. Disease modifying drugs are no walk in the park. People with Multiple Sclerosis are usually on one of 5 disease modifying drugs, plus whatever other medications are needed to help them with pain, fatigue or depression. I won't highlight Tysabri here because it hasn't been proven to be safe yet and may never be--both of Paul's doctors did not recommend it. The drugs (chart below) are injected on a daily, weekly or somewhere in between basis. These drugs have their own special side effects as well. I can speak from our experience with Rebif that Paul was made to feel horribly sick for one to two days after he injected himself and since he had to inject himself every three days, this was pretty much ALL the time. He has since been prescribed Copaxone and is doing much better in handling that drug.

Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Novantrone (mitoxantrone)
Rebif (interferon beta-1a)

* Flu-like symptoms ( fatigue, chills, fever, muscle aches and sweating during initial weeks of treatment. Therefore it's recommended that the injection be taken at bedtime. Taking Tylenol or Advil or Motrin before each injection and during the 24 hours after the injection may help relieve the symptoms
* Reactions at the site of injection (swelling, redness, discoloration and pain). Contact your health care provider if the injection site becomes hardened. Do not inject into that site.
* Interferon drugs can cause ongoing sadness, anxiety, irritability, guilt, poor concentration, confusion and difficulties sleeping or eating. These symptoms should be reported to a health care professional immediately.

7. Give to your favorite MS foundation. Okay, you got me, that's not advice on how to talk to your friend, brother or sister who has MS. It's a request to help us fight this disease. Our favorite foundation is the Myelin Repair Foundation. Send a donation in the name of your friend or loved one--they (and we) will appreciate your kindness, generosity and help.

Why Multiple Sclerosis Patients Can't be Denied Coverage--Ever

noreply@blogger.com (Margaret Welman Paez) — Tue, 02 Feb 2010 01:00:00 +0000

Image above found here.

I write about our particular situation with MS and work and insurance because that's my experience--it's what I know. CIGNA's denial and reprehensible tactics were my call to action to bring attention to what is not just an isolated incidence of insurance abuse. Let's face it, they are hurting some very ill people.

In all my postings about the politics behind health insurance, lack of corporate responsibility, how some of our public servants have thrown their own constituents under a bus, I sometimes lose sight of the fact there's a disease Paul has to live with every day; the daily injections of Copaxone, a medication to try and control the neuropathic pain and another to fight the constant fatigue and the constant underlying fear he may slip back to where he was a year ago.

I found a story today about a young couple struggling with a new diagnosis of Multiple Sclerosis and want to share it with you because access to good and affordable care should be everyone's right in this country, not just the lucky ones or those with enough money--everyone. And it's important to keep in mind that Multiple Sclerosis treats everyone differently. A lesson the insurance companies need to learn.

The man in this story, Chad Green, is in a wheelchair. But he is strong. He is resolved to get up and walk again; get back to work and live his life to its fullest. No mention of Mr. Green's insurance is made other than to say the family does have medical insurance. I'm not sure why his infusion treatments, as you will see below, are not being covered either partially or in-full. Donation information is given at the bottom.

Link to the full article is here. It is taken from Greene County Daily World written by Anna Rochelle.

I read it with a very heavy heart and all I could think of was my husband's same reaction a few days before we knew what he had, "Why am I limping all of a sudden, this is embarrassing." And Chad Green is only 25 years old.

WORTHINGTON -- Officer Chad Green was on patrol on a Monday evening last February when he was dispatched to the scene of an accident on the highway south of Worthington near the "Flasher Light" junction.

A pickup truck had rolled over twice and landed upside down in the southbound lane of the highway.

The driver was injured and an ambulance crew took him to the hospital.

The truck was carrying a load of rabbit feed, and rabbits.

Green remembered, "There were rabbits scattered all over!"

Green helped with picking up the rabbit feed and as things wrapped up, headed back to his patrol car. "I was walking across the highway going back to the car, when my feet started dragging," said Green.

Remembering that night, he said he would pick his feet up like normal, but his legs wouldn't lift high enough and his toes were dragging the pavement with each step. He didn't know why.

"It was embarrassing," said Green. "I didn't know what was going on."

That was the last night of patrol duty for Officer Green.

"When I woke up the next morning, I tried to get up. But I couldn't walk," said Green.

He has since been diagnosed with Relapsing Multiple Sclerosis (MS), a chronic, often disabling disease that attacks the central nervous system. Symptoms of MS may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another.

In Green's case, it hit him fast and it hit him hard. He's confined to a wheelchair.

About a week or so before working that accident scene, he'd been to the WalMart Vision Center for a checkup and everything was fine. Four days later, he noticed his vision was getting blurry in one eye. He thought a high pressure weather system might be to blame but he went back to see the optometrist. He was told to see a specialist right away because one of his optic nerves was extremely swollen.

Visits to a neurologist followed along with MRIs on his spine and brain, tests, tests and more tests, infusions and injections.

For six months, Green was giving himself an injection of steroids every other day.

Over the last few months, there have been times when he felt like he was getting a little better then he would backslide. Whenever he has been able to take a few steps, it's extremely difficult.

"It's like walking uphill through two feet of snow," said Green.

He's been in pain and extreme discomfort every day for months.

"It's like my hands are asleep and my joints are glued together," said Green.

His legs won't work, he can't move his toes, his ankles and his feet are asleep all the time and he has constant pain in his hands and wrists.

The Greens have medical insurance but it doesn't cover all their expenses plus there's the loss of Chad's full-time income.

Besides financial distress, Green struggles every day to keep his chin up and maintain hope for the couple's future.

Jaimie has had to learn how to drive a fence post and toss out hay while her husband watches and feels helpless. On Tuesday, Green posted a picture on his Facebook page of Jaimie learning to drive a tractor. He says she hasn't complained but it bothers him.

"I tell her all the time I'm sorry," said Green.

Early in October, Green started a new therapy that requires him to go to the Bloomington Infusion Center for an infusion of medication every 28 days.

"It's supposed to stop it -- put it in remission," said Green.

The cost of each infusion is over $7,000 and it's not known how long it might take before he sees results.

After the first infusion, Green reported his vision had improved but he still wasn't able to walk. Faith, and a positive attitude, is said to help the healing process and Green has that. He believes the new treatments are going to work and that he is going to get back up on his feet again.

Suggestions that he might never be back up to par again, should just go on disability and collect a check every month don't sit well with Green.

"No. I want to go back to work. I want to go back to work at the hospital. I love what I'm doing, I love all the people I work with and I want to be a police officer. And I want to be able to take my wife out to dinner again," said Green.

The community is invited to a "Benefit Dinner for Chad Green" featuring an auction and a beans and cornbread dinner on Nov. 6 at the Greene County Fairgrounds. For more information, see the "Benefit Dinner for Chad Green" event page on Facebook or contact Officer Eric Floyd at 384-5909 or Officer Don Richardson at 798-1068.

How Broken is Our Health Care System? An Article from a Republican--Who is Headed in the Right Direction.

noreply@blogger.com (Margaret Welman Paez) — Sun, 31 Jan 2010 20:54:00 +0000

And he's headed in the right direction because he came face-to-face with just how messed up our current system is. Until you experience navigating the system, including getting sick or losing your job, then you can't fully realize how corrupt and insane the current private health insurance system has become. No one would believe you. It's why I write this blog; to educate the naysayers to reform and to illustrate that our experience can happen to you. Look, it happened to a Republican!

I found Mr. Hewko's article at the Washington Post. Mr. John Hewko is a Republican, a lawyer and public policy scholar at the Woodrow Wilson International Center. Here he describes what he found when he tried to buy private insurance--not through his employer.

Wonder what the company he applied to, CareFirst BlueCross BlueShield, would say about someone with Multiple Sclerosis? Mr. Hewko was denied for "borderline hypertension" and having to take an occasional Advil for muscle stiffness. Holy _____!

(Try having your COBRA subsidy reversed like Fidelity did to us, that smarts too, Mr. Hewko. Update: The Department of Labor reversed Fidelity's reversal upon appeal so we now have the subsidy.)

Link to the full article here. Emphasis below is mine.

I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath -- and it isn't pretty.

Recently, I left my job with the federal government -- I was a political appointee, so my tenure was limited -- and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51-year-old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication and mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "pre-existing conditions" -- conditions that millions of Americans my age experience -- was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

So I am forced to roll the dice with my health. What happens when my COBRA runs out (coverage might be available under the Health Insurance Portability and Accountability Act, but CareFirst's premiums for my family would be $3,000 a month and annual prescription coverage is limited to $1,500)? Will I again be denied when I apply for coverage after 18 months, particularly since my "pre-existing conditions" aren't going anywhere and many companies ask whether a previous application has ever been declined? Should I cancel my annual physical for fear that some new condition might pop up? Or, do I take a job, any job, so that I can get covered through an affordable employer group health plan?

And, even if I am able to get nongroup coverage, will my policy be rescinded later because I forgot to list a medical condition on the application, however minor or unrelated the omission was to the illness being treated?

William Kristol, in a recent commentary in The Post, stated that "there is no health-care crisis." He either has a cynical hidden agenda or he's ignorant of what millions of Americans who don't have access to employer-based plans face. The system is broken. I'm one of the lucky ones, because I have the means to pay for COBRA and to cover any catastrophic prescription costs and high deductibles under CareFirst's guaranteed coverage policy. But what about the laid-off factory worker or office clerk who cannot?

No silver bullet will solve all our health-care problems, but four measures would address one of most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can't afford the premiums; a prohibition against denying or rescinding coverage for "pre-existing conditions"; and meaningful tort reform. Yet Congress continues to make the ideological perfect the enemy of the desperately needed good. Democratic ideologues reject tort reform and insist on a public option that many suspect is a Trojan horse to a single-payer system, while their Republican counterparts deny that a crisis exists, decry any reasonable attempt at reform as a government takeover and fail to articulate an acceptable alternative.

Meanwhile, millions of honest, hardworking, self-employed or laid-off Americans continue to play Russian roulette with their health. Maintaining the status quo is unacceptable. A failure to adopt at least these four measures would be a national disgrace.

And to those Americans who are insured through their employers and are puzzled by all the buzz about a health-care system in crisis. Just remember: You are but a pink slip and a minor pre-existing condition away from insurance hell.

Indeed, hell is just one life-altering disease or condition away.

Image above found here.

SCOTUS Schmotus and Calling all Members of the Tea Party

noreply@blogger.com (Margaret Welman Paez) — Thu, 21 Jan 2010 18:51:00 +0000

Well I had to come out of my non-blogging shell to write about the latest fiasco put upon us by the conservatives. Yes, all my Republican and Tea Party friends, the conservative-appointed members of the Supreme Court seem to think it's okay to allow corporations to behave like individuals when it comes to federal campaign finances. The Supreme Court, a bitterly divided one (can you guess the line of division?) "ruled that the government may not ban political spending by corporations in candidate elections."

Guess who is going to win? We the People? Hardly. We the Corporation, now they stand a good chance.

Here's a comment I found today on the New York Times website, by Dave from Tucson. He sums it up rather well I think.

Maybe the candidates should wear jumpsuits, like the NASCAR drivers, with the logos of all their corporate sponsons emblazoned on them. That way we can vote for the candidate that is sponsored by our favorite corporations!

"Under today's decision, insurance companies, banks, drug companies, energy companies and the like will be free to each spend $5 million, $10 million or more of corporate funds to elect or defeat a federal candidate -- and thereby to buy influence over the candidate's positions on issues of economic importance to the companies."

"With its ruling today, the Supreme Court has given a green light to a new stampede of special interest money in our politics," said President Obama in a statement. "It is a major victory for big oil, Wall Street banks, health insurance companies and the other powerful interests that marshal their power every day in Washington to drown out the voices of everyday Americans... That's why I am instructing my Administration to get to work immediately with Congress on this issue. We are going to talk with bipartisan Congressional leaders to develop a forceful response to this decision."

I don't see the Republicans jumping on this one, unless they actually decide to listen to their constituents--for once. Tea Partiers, the ball is in your court. I can't think your movement would in any way support the purchasing of federal elections by large corporations. Corporations are not individuals and do not deserve the same rights as individual citizens. Time to step up.

CIGNA, Fidelity Investments and the Reality of the Precarious Nature of Health: Why We Need Reform

noreply@blogger.com (Margaret Welman Paez) — Thu, 03 Dec 2009 00:48:00 +0000

For now, this will be my last posting as Paul and I are moving forward with our new non-profit (more on that at the end of this posting). Over the last few months, I have learned quite a lot and, I hope, I have shed the light of reason and sanity on a few things for you as well, kind readers.

For instance, how anti-reform protest really has its roots in sponsorship from billionaires who don't worry about how to pay for their health care, how GOP politicians who are supposedly serving their public receive much campaign finance money from health care special interests and how the GOP has offered no reasonable plan for reform. Like this, this, this and this.

This blog started as a result of CIGNA's denial of our coverage. My husband became too ill to work and we thought, rightfully, our disability insurance policy would cover us. After all, he has Multiple Sclerosis, a chronic disease. Disability insurance, as I have demonstrated, is an enormous corporate scam. A gigantic money-making scheme for the health insurance industry and one where they have no intention of actually following through on their contractual obligations.

It's cheaper for the health insurance industry (makes Wall Street happy) to let you file an ERISA claim in Federal Court and maybe one of the judges they have in their back pockets will be there to help them find a way not to pay you.

They hope for one of two things, 1. To wear you (the sick person with no income) down to where you give up or; 2. You will settle for less than the amount of the policy. Either way, they come out ahead and you, the disabled, sick or injured person, come out stepped upon by a large, faceless, inhumane corporation, jobless and without any recourse since insurance is exempt from federal anti-trust laws. You cannot seek assistance from the Federal Trade Commission Consumer Protection agency for example.

Health and disability insurance are not about your health or seeing you get better. Insurance is about profits. And you, premium-paying consumer, get in the way of that.

Illness happens. It's the luck of the draw; the throw of the dice in the great genetic crap shoot that is humanity. We thought we were protected. After all, we did the right things: had disability insurance, we even purchased extra, special, in-case disability coverage. My husband worked hard at his new job. He even worked in a new position at Fidelity Investments all through his chemotherapy treatments.

And while I'm at it with Fidelity, I learned something else. The management of Fidelity is so insulated from the people who work for them, from their own clients even, and are so paranoid they hire companies like Cyveillance (who use free Google searches as part of their "internet monitoring" and "sophisticated intelligence gathering") a regular visitor to my site, to keep up with what is being said about them on the internet. My site? This blog, written by a woman whose husband has Multiple Sclerosis and was forced into signing a separation agreement with Fidelity or allow his health to suffer? I shudder at my own dangerous self.

Fidelity can sponsor a million MS Bike-a-Thons, but their actions with my husband speak volumes about how they really feel about Multiple Sclerosis. Not in my backyard, comes to mind.

Here's an investment tip: Many socially responsible funds do way better than Fidelity funds. Check them out for yourself. Start here. Put your money where people count first.

What Paul and I didn't quite grasp, even in the face of CIGNA's denials, was how insurance companies will do absolutely anything to not have to pay their claims. You really have no idea of this unless you have experienced it yourself. I would have never believed it myself, it is that surreal. We are living proof of their unethical and inhumane behavior. In my blog, I have brought to attention all kinds of claims that CIGNA has refused to pay. They have a particular habit of not paying disability claims to people with Multiple Sclerosis.

Facing a $1400 per month COBRA payment while unemployed is insane. And that's why Health Care Reform needs to pass now, because we should not be faced with this payment while unemployed nor should we be so scared, as we are, to never have coverage again because with Paul's illness, no private health insurer will ever cover him. Why? Having Multiple Sclerosis can be expensive. Is that a good reason to keep someone from receiving health care, America?

But now it's time for me to do more than just write this blog.

Paul and I have started our own foundation, a non-profit 501(c)(3) that will, for now, focus on helping all people with Multiple Sclerosis.

It's the Multiple Sclerosis Activism Foundation, and our aim is twofold. First, we hope to be a resource for questions or issues regarding MS, care, treatments, doctors who specialize in MS or any issue you have that can't be easily answered. We are here to help you. And if we don't have the answers, we will get you to where you need to find the answers. We'll do the work for you. It's a dizzying maze of information out there and we will act as filters and conduits to the correct answers and sources of information.

Second, we are aiming to affect policy when it comes to people with MS and other chronic, debilitating conditions. We do not just want to take a "stand" on a position, we want to affect change as well. And this takes your voices. Let us know your issues, questions and stories. We are here to get your voice heard, to help and to make things better for all people with disabilities.

Finally, our Constitution, which has been thrown around by so many of the anti-reform protesters, the GOP and the Hair-Bumped One's fans as their reason for everything that emanates from their mouths, especially anti-health care reform rhetoric, has made me wonder if these people have even read it. The Preamble clearly states (click on the links for historical context):

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

Promote the general Welfare. That means addressing our national happiness, health and well-being. It means it's time to get out of the dark ages of serfs (us) and feudal lords (insurance industry) and take over a program that should not have profit as its most basic of motives.

The Foundation's website will be coming shortly. In the meantime, if you have questions, want your story heard, have a way to help or just want to tell us you are glad we are here, you can reach the MS Activism Foundation at (310) 363-0197.

Fight for Health Care Reform, it's a right you deserve as a citizen of these United States.