As a health insurance agent

[Minimus]

I have witnessed first hand what a shitty system we have.

I live in NC - in an area where textile mills used to be the biggest employer. As more and more of the mills closed I would see so many people trying to get health insurance but they were "un-insurable."

The typical scenario:

A man or woman in their late fifties, early sixties - too young for Medicare - gets laid off. They have worked at the mill their entire life and have no other skills so finding a new job is pretty much impossible. They no longer have group health coverage so they come in to purchase an individual policy.

They have many of same medical issues people of their age often do. They may take a pill for high blood pressure, and another pill for arthritis. They are usually smokers (well this is NC where we have a city named Winston-Salem). So with three medical issues they are an underwriting nightmare.

I run a quote - rating up for known medical issues - and come back with a rate of $1,200 a month. I feel like crap telling them the cost. The look on their face is disheartening. Of course they cannot afford that premium, they no longer have an income. They ask what they are going to do. They need their medicine. I don't have any answers.

Now the other side of this issue - the insurance carriers. There are not many that offer individual plans - Blue Cross Blue Shield is the main one in NC. They used to just deny coverage for anyone with several medical issues but changed their policy to approve everyone but they can rate up to about seven times the base rate.

What is really sickening is the amount of money this insurance carrier spends on things like sponsoring golf tournaments, tickets to all the sporting events, bonuses to employees, huge bonuses to the big wigs, and commission to agents.

I no longer sell health insurance - it became too depressing. I still hold my license but I now work in retirement planning which includes long term care insurance and life insurance. It makes it a little easier to sleep at night.

[durrrty libby]

1. Have you seen Sicko yet ? If not you must.

[Minimus]

18. I am going to see it today -

with my sister who is a PA. She has first hand experience on the medical provider side and she is also frustrated with the system.

[napi21]

2. You're absolutely right! Between what the Ins. Cos are spending

on "Admin" if you want to call all those sponsorships admin too, and the amount of disgusting drug ads on almost every damn TV program 24/7, it's surprising that they pay any calims at all!!!!

I've seen through all of this BS, what is the matter with the rest of the American public that haven't? Don't tell me they have but feel helpless either! Sure looks like they got it together enough to force a NO vote on the immigration bill, now didn't they?

It CAN be done, but, as I've said many times before, somehow they have to feel PERSONALLY THREATENED! They are NOW, but many don't realize it until they end up in a situation like you described. By then, they are so dishartened, I guess they just don't have the fight left to fight with Congress!

[pinto]

3. Thanks for your post.

[Tandalayo_Scheisskopf]

4. If this movie has the effect I think it will...

And personally, I think that it has the potential to create a very huge societal shift in the US, if I was a health sector executive, I would be very scared. For my personal well-being. There are some people out there who just don't think things through and act rashly.

I see the lid about to blow off this societal pot.

[tbyg52]

7. I saw it today

And it is incendiary, if enough people see it.

I wish I had taken notes--may go back and see it again this weekend to do so.

Quote, as best I remember it:

In France, the government is afraid of the people.
In the US, the people are afraid of the government.

I ask (rhetorically, of course): Which is the proper relationship?

[Telly Savalas]

9. Neither.

Government should be the people, not an external entity.

[tbyg52]

11. There you go.

Edited to say:
And I stand corrected for a false dichotomy.... ;)

[blondeatlast]

23. But "of the people, by the people" seems to have been redacted.

:cry:

[Warpy]

5. I'm in that uninsurable hell of being over 50

and partially disabled, unable to get SSD and Medicare, too "rich" for Medicaid, and unable to get any health insurance policy I can afford. BC/BS quoted me a price close to the one you cited several years ago, but they don't even want to talk to me now.

I underwrote health insurance in the mid 60s. To say this country has changed from when it was all non profit to now when it's making a very few families unbelievably wealthy can't be diminished by calling it a mere understatement.

There are systems where profit was never meant to intrude. For profit health care has been such a spectacular failure one is forced to wonder why either party would let it continue another single day.

What SICKO points out so beautifully is the way other countries look at their citizens that is so radically different way that the US government looks at us. There, they ARE the country. Here, we're an infestation, annoying but occasionally necessary, and certainly never worthy of consideration or care.

It's a very sobering look, indeed.

[tbyg52]

8. Nonprofit is the only proper way to go

Sicko quote again, as best I remember it:

Benefits paid out = less profit.
Benefits denied = more profit.

In other words, profit-making entities have no business being in charge of health care.

[Minimus]

20. BCBS of NC is non-profit (hard to believe) -

Back in 2002 they tried to convert to for-profit. It was quite a big to-do in the insurance industry. Jim Long, Commissioner of NC Dept of Insurance was instrumental in stopping them. Long is a democrat.

Blue Cross/Blue Shield has higher profits as a non-profit than most for-profit companies. Following are a few tidbits about the ordeal:


http://www.ncjustice.org/publications/details.php?id=280

How Current NC Blue Cross Conversion Documents Allow Bilking of the Public Trust
08-08-2002

<snip>
As the first formal steps down the road to a possible conversion start, advocates should be very alarmed about the way things are going. Blue Cross's payment to the people of North Carolina to continue their historic non-profit mission of improving the health of the underserved would be 100% of their initial stock to a new nonprofit Health Foundation. However, complex legal agreements govern how much control the Foundation has as the largest stockholder over the new for-profit Blue Cross. These documents have just been filed with the NC Department of Insurance and the Attorney General.

<snip>
In the initial public documents that lay out how Blue Cross would convert a disturbing pattern emerges about these two critical major decisions regarding the company. Blue Cross would be able to give ridiculous and huge stock option packages, severance packages, etc. to its top executives. Sweetheart deals to sell the company could be made with the incentive being outrageous "golden parachutes" for those in the executive suite. The Foundation, as the major stockholder, would effectively have NO say in these decisions. Even worse, the documents SEEM to say the Foundation would have a say in these two major decisions but then use weasely lawyer-language to take that right away.



http://www.ncjustice.org/publications/details.php?id=238

The consultants, hired by the state Department of Insurance, said Blue Cross failed to show how conversion would help it grow faster or expand outside North Carolina; defend itself against predatory pricing by competitors; tap new sources of investment or explain what that money would be used for; or develop innovative products and services. The report is part of the state Insurance Department's analysis of what conversion would mean for affordability and availability of health insurance.

<snip>
The consultants also found that Blue Cross has a surplus larger than most of the top 20 health insurers and other large Blue Cross plans across the country.

The company aims to keep profits at 4 percent a year to further build the surplus, the report said. The money is intended to see the company through tough times, but also to pay for expenses that could include buying a multistate life insurance company or computer technology over a five-year period. With those goals in mind, Blue Cross "must increase profit margins above those in the current business plan," according to the report. With tough competition for insuring large groups of employees, Blue Cross could raise rates for small groups and individuals, the report said. By converting, Blue Cross also risks takeover by a competitor if it fails to deliver the kind of profits investors expect, the consultants said.


http://www.consumersunion.org/conv/pub/statenc/

In 1998, North Carolina passed a comprehensive conversion law that details the regulatory review that must be undertaken after a conversion proposal is made and that requires the full fair-market value of the assets to be set aside in a foundation.

In 2002, Blue Cross and Blue Shield of North Carolina (BCBSNC) filed with the Insurance Commissioner its proposal to convert to a for-profit corporation.

A sophisticated and politically savvy group of consumer advocates, led by the North Carolina Health Access Coalition (NCHAC), urged state regulators to carefully scrutinize the proposal. Enabled by the state’s strong health conversion law, NCHAC emphasized the risk involved in the company's attempt to maintain a virtual stranglehold over a foundation that would have been established to receive charitable assets in the conversion. Active consumer participation was well matched by responsible public officials who became concerned about BCBSNC and the Blue Cross and Blue Shield Association’s insistence that the company retain ultimate control of the stock that would have gone to the foundation. Under intense scrutiny, the company's efforts to argue that the conversion was good for consumers fell flat. Instead of suffering a rejection of their proposal by regulators, BCBSNC withdrew its proposal in July 2003.



http://hcrenewal.blogspot.com/2005/08/procare-claims-slapp-by-north-carolina.html

ProCare is a group initially founded by physicians and pharmacists to oppose the proposed conversion of North Carolina Blue Cross to for-profit status. The conversion did not take place, but ProCare, run by two well-known NC political operatives, one a Democrat, one a Republican, continued to operate.

In June, 2005, it released copies of internal Blue Cross documents revealing that Blue Cross had spent about $500,000 on expenses related to the US Open golf tournament. ProCare had previously revealed that Blue Cross spent about $600,000 on a Caribbean cruise for its brokers and sales agents. The context of these revelations included Blue Cross' large surpluses, estimated to be around $350 million in 2003 and 2004, which had inspired state legislators to write bills constraining its surpluses and the size of its reserves. Blue Cross Chief Executive Officer Bob Greczyn earned $900,000 in 2002, and more than $2 million in 2003.

Blue Cross' response to ProCare's revelations was to file a law-suit against ProCare... quoted CEO Greczyn, "our customers depend on us to safeguard sensitive information every day. We're left with no choice but to act swiftly to protect our company against unlawful schemes to take and misuse confidential business information to further a narrow political or economic agenda."

Carter Wrenn, one of the leaders of ProCare, disagreed, "If you want to call this what it really is, it's harassment. They don't want to have anybody debating whether they're acting like a nonprofit." ProCare leader Gary Pearce added, "how can disclosing the fact that they sponsored the Open be private business information? They boasted about sponsoring the open." ...

...it appears that Blue Cross may have been spending more lavishly than befits a not-for-profit, and is far too uncomfortable having this publicized. Threatening a lawsuit that contends that confidential business information was released, unfortunately, seems to be becoming an all too common tactic for health care leaders who don't want to look bad in public. More transparency would be a wonderful thing for health care.

[marions ghost]

19. Exactly--other countries invest in their citizens' health

but we don't. Here the system works to keep people UNhealthy.

Yes, the difference is attitude--other countries treat citizens like they matter while we treat ours like they are completely dispensable.

The effects of stress, disease and depression because of this exploitative attitude are never factored in.

[madrchsod]

6. gee sounds just like my wife and i

fortunately my wifes job has health insurance so we are covered again after almost two years. i really doubt at my age i will ever be hired full time with benefits,so i just pray nothing happens in the next 4 years before i`m on medicare

[bleedingheart]

10. and if you weren't the one giving them the bad news....it would be someone else

because until the system is fixed....folks like you have try your best not to crack under what you know is unfair.

I too worked in healthcare for about 5 years and it was an eye opening and awful experience.

[datadiva]

12. I just found out I am in danger of losing my legs.

No insurance, I'm on state disability for a year. I had to go to a county hospital/clinic for care. I understand its almost impossible to get SSD. I am going to try anyway. I had insurance which did not pay for any tests and its just about bankrupted me. My husband is 72 and I'm 62. I really don't know what I am going to do in the near future. It's a freaking nightmare. I don't answer the phone anymore unless I know who's calling. Its a terrible way to have to live after working my entire life to get to this point. I absolutely love Michael Moore and I don't give a flying crap who knows it.

[tbyg52]

13. Best wishes to you

And hope that we take back our government soon.

[datadiva]

14. Thanks tbyg52

I am holding out hope and doing exactly what I'm told. I smoked for years and years and years and it took its toll. I am wearing a patch and trying to quit. I have never done anything so hard in my life. And considering I raised 4 boys thats saying something. I appreciate the good wishes. They help alot.

[proud2BlibKansan]

25. My thoughts are with you

What a lousy system we have here in this country.

[farmboxer]

15. Talk about Sicko, CNN makes me puke!

I just can't stand them anymore, watched Larry King to see Michael Moore, then Anderson Cooper came on with his Doctor and insurance company crap! We the People know the truth, they can't lie to me! CNN said we are so happy with our healthcare system?! With whom did he speak? The truth to a Republican is like a cross to a vampire!

[tbyg52]

21. You know what? I don't think it's so much *doctor* and insurance company crap

As *high-ranking*, *big-bucks* doctor and insurance company crap. I bet the rank-and-file doctors are just as sick of it as we are.

[blondeatlast]

26. In many cases, I think you are correct. The paperwork alone is a killer.

I've had the same wonderful primary care doc for over twenty years and she's gone to the mat for me many times regarding denied procedures. She has a teeny, tiny practice and is as wealthy as hell if she didn't practice, but she loves the work.

Her teeny practice employees FIVE staffers and only one of them is a nurse. Guess what the others do?

I knew you'd get it. Of course, if she didn't truly care about her patients, she could have a smaller staff or have an independent agency do the billing, but if she had done that, I would not have had a procedure that ended my severe anemia, since it's still considered "elective" surgery--but it saved my sorry hide.

There are some deeply greedy docs out there (my ex-cardiologist, for instance) but most doctors would love to spend more time with patients. The insurance companies even dictate how much time they can spend.

I've had plenty of doctors and seen our health care deteriorate like crazy. I've had a chronic illness requiring maintenance medication since age 7.

Good docs are as tired of the bullshit as we are.

[Quantess]

30. Many doctors are "bleeding heart" types.

Health care professionals are not to blame, IMHO.

[knitter4democracy]

31. My hubby, an internist, sure is sick of it all.

Single payer, national health care (including vision and dental) for all. Period. He's so sick and tired of the insurance messes.

[proud2BlibKansan]

27. How about that insurance company lady who was on Anderson Cooper?

She actually tried to defend the insurance company refusing to pay for the ambulance for that woman in the car accident!! I was screaming at my TV.

[puebloknot]

16. I was an insurance agent years ago. I left for self-employment...

...and found a group for the self-employed, underwritten by Blue Cross. I joined and I paid premiums for a couple years, never needing to use the insurance.

And then I got a notice that they were cancelling the whole group (they couldn't legally cancel an individual). The claims ratio got too high for them, so they cancelled and then turned around and offered insurance to people who had pristine health. I didn't. I lost my insurance.

Time for change...big change.

I wonder if we can trust life insurance to be a stable retirement approach. That could go down, just as Enron pensions got lost in the shuffle, it seems to me. Your opinion will be appreciated.

[Minimus]

17. Life insurance is really for those you leave behind

but there are some types of life insurance that can also help you build assets to meet needs during your lifetime. We use it as part of an overall financial plan along with annuities and mutual funds. Of course the earlier you start investing the more you will have for retirement. This is hard for young individuals and families struggling to make ends meet.

I would not trust any one investment strategy - diversification is a must.

As for your health insurance getting canceled - I too would not be able to get individual health insurance due to myriad medical issues. I have to make sure I always have coverage through an employer, either my husband's or mine. That is why it was so hard quote the "un-insurable." I always thought, "there for the grace of god go I."

When I was selling health insurance it would always amaze me how the insurance carriers would increase the group premiums because of the claims ratio. I sold many small group policies and just one sick employee with several claims would affect the whole group. I actually had a group of about 20 employees that had a 90% rate increase at their yearly renewal. The employer could not afford to continue offering group coverage so all the employees were forced to get individual coverage. Some found the individual coverage less costly (the young healthy individuals) but the ones that were middle-aged with some health issues could not afford the individual premium.

In NC groups cannot be refused coverage but you have to prove you qualify as a group by submitting an employer tax ID number, quarterly tax forms, articles of incorporation, K-1, etc. A sole-proprietor could qualify but they could only receive what is called Basic and Standard rates - less coverage with higher premium, but still sometimes cheaper than individual. I had a few self-employed and I would tell them to see about incorporating. A corporation qualifies for all plans - PPO, HMO, etc. - better coverage and less costly than the Basic and Standard group coverage and the individual plans. Someone that would be paying $1,200 a month for individual could get a group policy for probably $500 a month. Still costly but worth it to someone that has medical issues that need on-going care such as diabetes.

The system really does need to change.

[tbyg52]

22. "just one sick employee with several claims would affect the whole group"

Which is why the largest group possible has to be covered--i.e., all of us.

[puebloknot]

28. I'm hoping "Sicko" will raise the ire of this country enough...

... that the sleeping masses will demand change, now not later. It would be interesting to be able to find out how many casualties there are in the war against the People with regard to allowing insurance companies to make it impossible to get life-saving medical attention.

As Dennis Kucinich frequently says, that kind of thing is a weapon of mass destruction.

[proud2BlibKansan]

24. My sister works for a pharmaceutical company and my cousin is a doctor

I can't wait to hear their opinions when our family gets together on the 4th of July.

BTW, my sister told me a couple years ago to just put $200 a month in savings instead of buying long term care insurance.

[SharonAnn]

34. I don't know your age, but $200 would pay for day in a nursing home.

[Joanne98]

29. Thankyou so much Minimus

[warren pease]

32. For profit medical insurance companies are not in the business of health care...

They're in the business of making money, and paying medical bills is the very last thing they want to do with their money. And, as I've written so many times I could do it blindfolded, that is exactly what they should be doing under the most basic SEC mandates governing for-profit, publicly traded companies.

US public companies' sole obligation is increasing value and equity for their shareholders. That's it. They don't have to do anything else to meet their responsibilities as publicly held corporations.

The concept of "loss ratios" illustrates that fact perfectly. The loss ratio is the percentage of annual gross income that goes to pay claims. Which is to say, the money they have to spend performing their alleged function is considered a "loss," and the lower the loss ratio, the better Wall Street likes them.

A 69 percent loss rate is fairly typical in the health insurance scam. That means 31 percent of gross revenue is spent on things that don't have anything to do with paying medical bills. Things like executive salaries, perks and platinum parachutes. Like sales and marketing and advertising. Like dividends on publicly held stock. Like obsessive paper shuffling. Like real estate investments. Like paying an army of snoops to pry into your medical history in hopes of finding some little nugget that will enable them to deny your claim.

And now the the American public is slowly waking up to the carnage that passes for a health care system in the US, all Dem presidential candidates except Kucinich are babbling on about some kind of "expanded insurance" or "universal coverage." "Coverage" implies the continued involvement of for-profit insurance carriers in the US health care system, which means that their plans will carry within it the seeds of its own destruction. If you're going to build a new health care system around the most destructive element in the current mess, why would you expect different outcomes?

Only Kucinich advocates a single-payer, universal access system, which would completely remove the influence of the for-profit vampires and force them to look for honest employment elsewhere. Possibly shoveling burgers or washing cars. Couldn't happen to a more deserving bunch.

Anyway, Minimus, I wonder if you could fact-check this. I'm pretty certain it's accurate, although some of the stats are a bit dated. But I'd really like to have an insider's viewpoint.

And thanks for writing the OP. It's a horrible, inhumane system and I'm glad you got out when you could.


wp

[mbee]

33. As a Country we need to ask ourselves why it is possible

to have auto insurance, homeowner's insurance, but insurance on our precious humans is too expensive. Ask the Greedy Family Values Crew that question and see what their answer is?