Friday, November 09, 2007


And you thought Sicko is old news?

by Larry Geller

A major insurer reportedly paid one of its workers big money in bonuses based on how many policy-holders she dropped. [Insurer Gave Bonuses For Dropped Policies?, Report: Health Net Senior Analyst Given Bonus After Dropping Hundreds Of Policies - CBS News]

(CBS) Hairdresser Patsy Bates is working through the pain -- the pain of living with breast cancer.

“I’m trying to live here, you know, I don’t want to die,” said Bates.

The pain of having almost $200,000 in medical bills because her insurance company, Health Net, pulled the plug on her policy right in the middle of her cancer treatment, reports CBS News correspondent Bill Whitaker.

“I had cancer, my life was on the line, and these guys did not care, did not care at all,” she said.

In fact, she was in the hospital getting prepped for surgery when she first learned Health Net was dropping her.

Bates is now suing the giant insurer for $6 million, causing the company pain.

Documents Health Net was forced to hand over reveal senior analyst, Barbara Fowler, single-handedly dropped hundreds of policy holders like Bates from the rolls every year.

This is one way that health insurers make money. I Hawaii they cut doctors' reimbursements and deny coverage. As a result of low reimbursements, Neighbor Islands are critically short of several medical specialties.

There should be bills introduced this coming legislative session to increase reimbursements and correct other abuses. So I wanted to capture this story, which is hot today, just in case anyone is feeling sympathetic for these insurance companies and their well-paid executives.

We'll come back to this issue soon.

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So, what kind of treatment would Patsy Bates have gotten if she had had medical insurance? Chemo? Radiation? Bone Marrow Transplant? ...and what are the success rates of these methods? It is my understanding that living to 5 years is counted as being successful regardless of if the patient died a day later after surviving 5 years. I mean, what kind of success is that when alternative therapies have had longer success rates? Also, are increased doctor reimbursements really the answer to our health crises? Will our health really improve if we give these doctors more money? I don't think so. Our medical situation should be measured by how healthy we are and not by how little the doctors are getting paid. While I am not sympathetic to the insurance companies, I don't think the health of Hawaii's people will improve with increased doctor reimbursements. Sorry. Unless our health care system is radically overhauled whereby the doctors aren't pushing toxic treatment methods and harmful drugs for the drug companies, which continually make us ill, I cannot and will not support increased doctor reimbursements.

Still, though, if you are on the Big Island and break your leg, maybe in an automobile accident, are you going to put it together yourself?

If orthopedic surgeons there get any fewer, there won't be someone on the island to handle cases like that.

See, I found an example that has nothing to do with toxic treatment methods.

HMSA keeps cutting reimbursements. Medical services are a business, they can't run at a loss.

Larry, thanks for bringing up that important example. Perhaps those increased reimbursements should be paid to the surgeons and doctors in certain specialized fields that fix us up and get us back in working order. But the medical system still needs an overhaul that might include eliminating insurance companies but definitly includes eliminating drug company influence. JMO.

I agree with you completely on eliminating drug company influence.

They are such big spenders, though, I wonder how it would be possible to eliminate their influence on politicians.

We feel it even in Hawaii. The Rx Plus program was supposed to be implemented in 2004. It was designed to cut prescription drug costs for seniors. Our governor, of course, would not do anything to cross the drug companies, would she? So despite strengthening the law this past legislative session, the administration is still not implementing the law. Drug companies win, seniors lose.

If only seniors knew that most of the drugs that they think they need they really don't need. Take for example the statin drugs, which are a 20 billion dollar business for drug companies, there are no clinical trials that show that seniors benefit from them. None, nada. In fact, they do just the opposite with harmful side effects (congestive heart failure, amnesia, muscle wasting, muscle pain, cancer, etc) that are greater than the miniscule benefits. So while you might think seniors are losing, they are actually winning healthwise if they in fact can't afford to take drugs like statin drugs. Its unfortunate however that we allow our politicians to receive political contributions in the first place.

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