Monday :: Dec 28, 2009

Health INSURANCE Is Not The Same As Health CARE


by Turkana

A common misunderstandings drives much of the online debate over the health insurance bill. It is the difference between health care and health insurance. They are not the same, yet defenders of the various and increasingly compromised iterations of the health care bill frequently argue as if they were.

As previously diaried, the most obvious example of this fundamental difference comes in the literally deadly form of denial of treatment. Insurers sometimes refuse to pay for the expensive treatments that could save the lives of policy-holders. Without again going into the details, this Los Angeles Times article gives a concise explanation. So does this Philadelphia Inquirer article (h/t aravir). So, with this in mind, it's worth revisiting some of the arguments made by defenders of the health care bill, to elucidate how this fundamental misunderstanding obfuscates very real problems with the bill. The defense of the bill will be italicized. The response will follow.

Some 30 million more people will be covered.

This is the classic misunderstanding, because being covered means having insurance, it does not mean the insurance has to pay for expensive treatments. There is no defined rule to ensure that the newly insured will receive adequate health care.

But insurers won't be able to refuse people with pre-existing conditions.

Insurers will be forced to take money from people with pre-existing conditions, and give them insurance policies. But because there is a difference between providing coverage and providing care, this doesn't mean insurers will be required to pay for the expensive treatments those pre-existing conditions require. Some people with pre-existing conditions will be forced to buy policies that simply won't meet their medical needs. A nice lose-lose for people suffering from chronic and/or severe health conditions.

But people will be able to shop for different policies, on the exchange.

Why do you think the antitrust exemption is so important to insurers? It gives insurers impunity to collude with each other to ensure that options on the exchange are limited. Nothing is to prevent all insurers from agreeing that certain expensive treatments are not worth paying for, and that people with the conditions requiring those treatments won't have any good alternatives. Once again, they will be forced to buy policies that won't meet their medical needs.

But there are mechanisms that allow people to appeal denials of treatment.

And such mechanisms exist, even now. But there are no strict guidelines as to how such appeals are to be resolved, and there are no strict guidelines as to how long the appeals can take. In some cases, those appeals run out the clocks on people's lives.

But there are mechanisms that prevent insurers from stopping coverage during the appeals process.

But once again, this confuses health insurance with health care. The insurers won't be able to drop people from being covered, but that doesn't mean they will be forced to pay for the treatments. During the appeals process, the policies will remain intact. But treatments can still be refused.

But insurers will be required to spend 90% of their premiums on patient care.

Not only are there are no enforcement mechanisms, but because insurers can own providers, that 90% of premiums that supposedly goes to care can be whittled down as the profit margins of those owned providers. Don't be surprised if this bill is followed by waves of corporate consolidation.

Once again, it's not complicated. Semantics. A deliberate confusion that will take many people by surprise. But the insurers themselves won't be surprised. They know better than we what loopholes will be protected in the new health insurance laws. And they already know, very well, that the new health insurance laws will not be health care laws. They understand the difference between health insurance and health care, even if many supporters of the bill do not. And do not for a moment delude yourself into believing that they aren't already planning how to exploit those loopholes.

Turkana :: 11:20 AM :: Comments (7) :: Digg It!