Do you ever wonder what would happen to all the people who make their living in doctors' offices and hospitals performing jobs with titles like "billing and coding specialist" if we ever actually got universal healthcare coverage in this country and the health insurance industry one day just dried up and blew away? Well, picture what would happen to all the people who make a living in Vegas running gaming tables and serving drinks to gamblers if gambling were suddenly illegalized.
These are threatening pictures for a lot of people, "little" people, not the bosses or the owners, but everyday folk who rely on these trickle-down types of jobs to pay rent and buy groceries and put shoes on their children's feet. However, this kind of legitimate, personal fear is not why we still don't have universal healthcare coverage in America, just like it's not why there's still greyhound racing in Massachusetts. Nope. Gambling and insurance* are both self-perpetuating industries in the United States. They are set up to profit, yet everyone who buys in thinks s/he can beat the system and walk away a winner. Buying in, of course, is what responsible people do, because bad things happen to everyone, and no one should expect other people to pick up the tab, right?
This perception is the result of marketing and lobbying, the judicious application of a calculated amount of cash, your cash. The people who own these industries have made a lot of money, intend to keep this money, intend to keep making more like it, and will spend what portion of it they must to insure, if you will, the status quo. After all, as long as the status quo remains, there will always be more money.
Let's speak perfectly plainly. Insurance is a form of gambling. Just like casino owners, insurance providers go into business to make a profit, and not a slender one, either. When you purchase insurance, you are making a bet with the insurance company that nothing expensive will ever happen to you. The funny, twisted thing is, you are actually placing your wager with your own money but on behalf of the insurance company. If your wager is a good one, the insurance company wins and gets to keep your money. The only way you can win is if something awful happens to you and the insurance company has to pay for some part of it with some portion of what you paid it.
See how this works? If nothing expensive (in other words, horrible and traumatic) ever happens to you, the insurance company wins. It gets to keep your money and use it to make other money. However, if something expensive (in other words, ghastly and maybe even life-taking) does happen to you while you are still paying premiums, you win! No, you don't get your money back, but the insurance company, the loser, has to pay to third parties a portion of what you have already paid the insurance company over the life of your policy. In perfectly ghastly circumstances, the insurance company might even have to pay out to third parties an amount equal to the amount you have paid it plus whatever interest that sum may have accrued while it rested in the insurance company's tender care. In truly dire circumstances, the insurance company might even have to pay more than this, not just your money and its earnings over time but other people's money and its earnings over time, and you might even get to put some in your own bank account before you die. Or your heirs might. That's when you win really big!
Of course, if you stop paying premiums before something wretched and costly to the insurance company befalls you, you do not get back the premiums you have already paid, just like if you walk away from a slot machine before hitting a jackpot the casino cashier does not give you back whatever quarters you put in. No, the only way you can win at this game is to have something so terrible happen to you that it forces the insurance company to disgorge some of the money you have already given it, or more.
Unless the law forces it to act otherwise, the insurance company will not do business with you if this last scenario seems likely going in. The insurance company is not an idiot. Also, the insurance company is running the game.
A Vegas casino can only stay in business, and only wants to stay in business, if most of the people who gamble there lose most of the games they play. The insurance company can only stay in business, and only wants to stay in business, when most of the people who pay for its services do not use these services most of the time.
Don't ever let anyone tell you otherwise. And don't raise your hand here just to tell me you work for an insurance company and you help people all the time. I'm sure you personally do. However, your company is not in business to help people. Your company is in business to make money. Every business makes money by being paid more than it pays. Your company makes money by being paid to offer but not actually have to provide services to more people than it ends up really having to serve.
The people who started your company started it to get rich, not save lives. The people who run your company, who set policy and standards, do so to collect the most money possible and pay out the least while still, if it's a reputable company, honoring every one of its commitments to the letter.
In the insurance system, some people do get help, and a very few people get really quite a lot of help. Likewise, a very few people have what it takes to successfully cheat the system.
Most people who find themselves having to use the services of an insurance company to which they've been paying premiums find themselves having to spend even more time, energy and, yes, sometimes money to collect said services, and most people never get all the help they need. Some people never get any help at all. Some people are damaged additionally by the process of trying to obtain help, of trying to collect services for which they have -- or think they have -- paid in advance.
The table for this game is very intricately laid out, you see, and the elaborate rules are not clear going in and have been known to shift during the game. Most people who play the insurance game lose. We all keep playing this game, though, hoping we never have to do more than put our money on the table, thinking we can beat the odds, hoping we won't be punished too severely if we ever actually have to ask for any part of our investment back.
Oh, you know what? That's not gambling. That's a protection racket. You can see how I might confuse the two.
Doesn't matter. We all have to keep playing because there's nothing else.
_____
* Credit, by the way, especially the credit card business, is also gambling, and also self-perpetuating. When you apply for a credit card, you are betting the credit-giving company that you will not spend more than you can pay in any given thirty-day period. If you do, you will have to draw out your payments, and that will cost you interest and fees. If you don't, the credit card company loses money...
...but not really, because every credit card company charges every business that offers customers the convenience of paying with credit cards a percentage of the total of every purchase completed with one of its cards. Some cards charge more per purchase than others, e.g., American Express, which is why some businesses only allow payment using certain cards. The fees businesses pay cover things like purchases made with stolen cards, for which the real cardholder does not have to pay, nor does the merchant under certain circumstances -- but sometimes the merchant does. Sometimes the default position of the credit card company is that the business could have taken precautions to prevent use of the stolen card, e.g., ID checking. Businesses also do not get reimbursed fees if someone buys something using a credit card and then returns the item three days later for a cash refund or partial merchandise exchange.
Most people shop using credit cards. Businesses have to make up for the surcharges they are forced to pay on every credit purchase. This means that every time you or I buy something using a credit card, we are personally raising prices for everyone. To personally help raise the cost of living, we don't just have to default on a debt, thereby forcing the credit card company to do things like raise its various charges across the board in order to maintain its profit growth. All we have to do is avoid cash.
Oh, and if you're using a check card, a credit card which isn't really a credit card but a debit card you can use in all the same places, just the same way, with a signature not a PIN (and that's what I do every time I purchase something online), you're still part of the problem, because the credit card companies still charge merchants a percentage of every sale. That's why so many brick-and-mortar stores which let you buy with either credit or debit want you to choose debit. The merchant pays a fee no matter what, but when you select debit, the fee is lower for the merchant. (Some banks charge users a fee of $1.00-3.00 on every debit purchase, though, an amount which may be determined by the size of the purchase, and this amount is not shown on your purchase receipt, only on your bank statement, so be careful.)
Of course, unlike insurance, credit cards and check cards are things we can choose not to have and not to use. It becomes increasingly difficult to live in the modern world without them as the shape of commerce changes. It's so easy to use a credit or check card. It's faster in stores, and it's so much easier to shop online. And with the tiny purchases I make, surely it can't have that big an effect, can it? How much damage can just one person here and there do?
Where have we thought this before?
A comment from the insurance gambler who "won" a bundle by trauma...the insurance companies were the very first folks to call me upon discharge from the hospital asking if there was a pending lawsuit (wich there is), and if a scale tips in my favor, they get first dibs AND they can still deny me insurance as I now have a "pre-existing condition". Talk about intricately laid out!
PS...dig your NaBloPoMo seal, girl!
Posted by: bonnie | November 03, 2006 at 03:28 AM
Bonnie, that's a trap of sadistic genius. Gotta hand it to the (insert obscenity here)s.
Two more notes about insurance: Once upon a time, e.g. when Wallace Stevens was doing it, selling insurance was one of those do-gooder jobs, like social worker or nurse. How times change.
I catch Blue Cross/Shield -- or, to be fair, Joe catches them because he handles insurance stuff mostly -- all the time in the act of gaining vis incompetence. If the current person in the minimum-wage job in Red Bluff knows little enough, and so does her supervisor, it gets frustrating trying to get bills and benefits straightened out, and a less dogged person then Captain Dogged Himself would give up and drop the matter. These incidents invariably are about money the company owes, rather than anything we owe them.
You know what's become even worse? Federal worker's comp. It's scary -- and one of these days I'll have to get that story written (not by me) somewhere.
Posted by: Ron Sullivan | November 03, 2006 at 10:53 AM
Yes, Bonnie, because of the special circumstances at your particular table, you have also been given a copy of the Milton Bradley home edition of another popular game, Civil Litigation. This is a very, very difficult game, very time-consuming, expensive, and fraught with physical challenges as well, and many people are surprised to discover once they enter it how few of the other players are interested in concepts like justice or fairness. Besides being eager to place a judgment lien on your lawsuit or even enter it as a separate party, what you might not know is that if you had not filed a suit of your own, depending on the circumstances, it is entirely possible the insurance company would have filed one itself and you would have been required to make yourself available for depositions and medical examinations. Why? Because the insurance company is entitled to protect its profit growth.
Ron, yes, Bonnie's, as she calls it, California "big box insurance company" who's name rhymes with "miser" is a diabolical cesspool in my opinion, though it is not just her case which makes me think so. Her case is good enough fodder for this opinion, though. Her wheelchair was almost repossessed out from under her ass recently because of a "snafu" on their part, plus a nicety of their policy which seems to say that she can have a wheelchair or a prosthetic leg, but not both. The amount of money this company spends advertising itself as an institution devoted to caring for people could buy wheelchairs and prosthetic legs for many, many people. That's where the money is going, not to competent staff.
And I am quite certain you are so right, that the company is in effect placing a side bet that if it spends as litle as possible being competently and efficiently staffed, most claims or complications that might arise from them will evaporate. Though the insurance company covering me when I gave up my leg was United HealthCare, and the insurance company supposedly contracted to provide me short- and long-term disability coverage in the event of such a traumatic incident was CNA, I have experienced with both of these companies exactly the syndrome you have described. I even had a woman at CNA tell me that CNA was entitled by HIPAA -- which, and I quote directly, she told me was "all the fault of the Democrats, I believe" -- to ask me to waive privacy over such a blanket range of things that it included my history of drug and alcohol use, AIDS status, even my college and Social Security records, before processing my claim for a month of benefits (which equated to my projected number of working hours missed for that period paid at a percentage of my then-rate of pay, $8.50/hour) after I hurt myself and was ordered by an ER doc to sit down with my leg up for six weeks. Because I worked for lawyers for 18 years and have actually read HIPAA, I know this to be a complete lie, and I told her so, and I wrote my own release granting CNA the right to look at anything related to my work and medical care that actually related to my claim, and they had to take it, because they are not in fact entitled to more without a pending lawsuit and a subpoena duces tecum. However, there was no easy sailing after that, and I never did get all the money to which I was entitled. But by then I was worn out and needed to get on with my life. I f*cking have cancer, and I don't have time to waste arguing with morons, and they know this.
What is so very offensive about all this is that my case is hardly the worst they will ever see. I mean, look, three years later, I'm still alive, against all odds. What if I had never worked in law, couldn't read insurance-ese and didn't know my rights? What if, like a significant number of my coworkers covered under the same benefits, English was hardly my first language? And what if it had been a brand new diagnosis of pancreatic cancer?
Why do people have to give up their rights to human decency just to collect services for which they have paid in advance?
The other thing which offended me is how Whole Foods, whose contractors United HealthCare and CNA are (though employees must opt to pay extra for the CNA coverage), did not protect me from UHC's or CNA's probably calculated incompetence, and did not help me, and even while all this was going on -- and I heard while this was going on that lots of other people were having similar problems -- renewed their contract with UHC for another three years because UHC offered the cheapest product on the market. The contract has again been renewed since.
Whole Foods makes a big PR fuss about having all the employees vote for the benefits they most want to have every so often, but the voting is electronic, set up so you can't go back and change your mind, and none of the choices are what people really want and need. And then once it trumpets out a proclamation of what the employees have "chosen," and people try to actually use these benefits, there is no one competent to help them when things go pear-shaped. In my store, when all this began for me, there was one person who was smart enough and interested enough to help me, but she got promoted -- and I even recommended her promotion, even though I knew it was bad for me. Her job, which had been Human Resources Administrator, was renamed company wide around the same time to "Payroll and Benefits Specialist," and the person who replaced her right in the middle of my battle came from the Whole Body department. That's right, shampoo and vitamins. Yup. The only other person in my company who could help me was the regional head of whatever they are calling human resources today, and she was very nice, but she did not have time to make this her battle, and honestly neither did I, nor strength. And this is only part of why I have PTSD around the subject and find it so hard to write about, and this an extreme simplification of why I'm still very, very angry at Whole Foods, so angry I can't even work there anymore, even though I also have a lot of good things to say about it, as large corporations go.
Insurance companies make calculated choices in order to insure their gamble that they will not have to pay out as much as they take in. Employers like Whole Foods gamble that they can offer great benefits on paper for as low a price as possible and not be called upon to actually have to enforce the contracts they make with the benefits providers. The people who lose are the employees. At least at Whole Foods basic health insurance is "free" (if you don't look too closely at deductibles and out-of-pocket maximums and coverage limitations which render the insurance not exactly complete) to every employee who works a minimum of 30 hours a week. So full-time Whole Foods employees pay for their health insurance with labor, not money, though part-time employees who want to enroll have to pay very high premiums. Most companies also require participants in their health insurance plans to help cover the costs out of their paychecks, and as Bonnie's case proves among so very many others, are not guaranteed better service when the time comes to ask for some of those benefits for which they've been paying with their own hard-earned cash. Benefits you "choose" and pay for via deduction from your paycheck: It's the new company store.
The sad fact on top of all this is that universal health coverage in this country probably won't be better. After all, there's the phenomenon of bureaucracy, which might have something to do with the Fed. worker's comp. you mentioned. I think there may even be laws of physics that describe bureaucracy. And all these incompetent staff have to go somewhere, and we are not living in a Douglas Adams novel, so they're going to have to go somewhere here.
But we have to do something. People are suffering and dying because of the system we have, because the system we have is driven by profits, not care. This is proving untenable, except for those collecting the profits.
Posted by: Sara | November 06, 2006 at 10:48 AM