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<DIV class=blogger><A
href="http://www.michaelmoore.com/blogger/DonnaSmith"><FONT size=3
face="Times New Roman"><IMG class=blogshot
src="https://dwoq5s27enw2w.cloudfront.net/uploads/blogshots/donnablog-64x64.jpg"></FONT>
<P class=name>Donna Smith</P></A>
<P class=oneliner>Donna Smith, is a national single-payer healthcare
advocate and community organizer with the California Nurses Association/National
Nurses Organizing Committee</P>
<DIV class=clear></DIV></DIV>
<DIV class=article><SPAN class=date><STRONG>July 29th, 2012</STRONG> 8:46
PM</SPAN>
<H2><A
href="http://www.michaelmoore.com/words/mike-friends-blog/insurance-companies-gaming-system-dont-be-fooled">Insurance
Companies Gaming the System – Don’t Be Fooled</A></H2>
<P class=byline>By <A
href="http://www.michaelmoore.com/blogger/DonnaSmith">Donna Smith</A> </P>
<P>Has your insurance company called you recently to ask you to sign up for a
wellness or disease management program? Has that same company told you
it’s a free service to policyholders and promised you that they do not share the
information with the departments and people who administer your benefits and
claims? You – like me and millions of other Americans – are being
scammed. </P>
<P>Follow the money, my friends, and do not believe for one minute that the same
company that would deny medications, health treatments and care to you would
suddenly have your best interests at heart. It’s the money. It’s
always been the money.</P>
<P>As soon as the Patient Protection and Affordable Care Act (PPACA) was passed,
we were all told that finally the insurance companies would have to spend more
of the premium dollars they collect on actual healthcare. Look it up <A
href="https://www.federalregister.gov/articles/2012/05/16/2012-11753/medical-loss-ratio-requirements-under-the-patient-protection-and-affordable-care-act"
target=_blank>here</A> for the nitty-gritty.</P>
<P>In short, The Kaiser Family Foundation writes, “The provision requires most
insurance companies that cover individuals and small businesses to spend at
least 80% of their premium dollars on health care (i.e. medical claims) and
quality improvement, leaving no more than 20% for administration, marketing, and
profit. Large group plans must spend at least 85 percent of premium dollars on
health care. Insurers failing to meet these standards will have to pay rebates
to consumers beginning later this year.”</P>
<P>And those rebate checks some policyholders are getting are also attributable
to this provision of the Affordable Care Act. Sounds great, eh?
What’s not to like about making the for-profit insurance companies spend more on
actual healthcare or give us some money back?</P>
<P>What’s not to like is that never doubt for one instant that the for-profit
insurance companies have found ways to subvert that well-intentioned – or at
least well-scripted – nod to more accountability. Insurance companies like
to make money – it is what they are for and what they are all about. </P>
<P>Health insurance is not healthcare. Health insurance is a financial
product sold to you and to me to protect our health and our wealth which may
well do neither thing. Health insurance companies do not exist to make you
healthy but to make their stockholders wealthy. If you think otherwise,
you are not understanding the fundamentals of corporate life or the laws
governing what corporate CEOs are to do for their primary customers – their
shareholders.</P>
<P>So, if required to provide more actual care that might reduce actual profits,
what’s a good health insurance executive to do? Well, go to work changing
what qualifies as actual healthcare under the new rules and then find ways to
make even more money by providing that while denying more real healthcare
services. And that’s exactly what is being done to you and to me.</P>
<P>Wellness and disease management programs now qualify under the ACA as part of
what insurance companies can call “medical loss” for purposes of meeting the
criteria required to be spent on healthcare. Having that nurse or other
insurance company employee call you and me monthly and recount which medications
we take and for what conditions and then set an appointment to do it again every
month is considered spending on health care. That’s right. </P>
<P>Just last week, on the same day my insurance company, Aetna, was denying
medications ordered by my doctor during the diagnostic and early care phases of
my latest cancer journey, I was being absolutely dogged by the Aetna Connection
folks (their wellness and disease management plan) wanting me to reconnect with
the nurse who “needs” to engage with me on a monthly basis. Imagine, on
one call I am begging Aetna to approve a medication needed to help me and
relieve gut pain while on another call, I am telling the front person for Aetna
Connection that I really don’t care about setting a new appointment with the
wellness plan while Aetna is denying my care. I even told the caller I was
groggy from the general anesthetic and that I couldn’t talk because of a sore
throat from the intubation tube and that I hoped they’d call back another time
when I could think more clearly, but she didn’t care. Like a collector of
a very serious debt of some kind, she needed to get me assigned to a call
date. </P>
<P>Imagine how many millions, if not billions, of dollars Aetna and every other
insurer can now claim are being spent on healthcare through these
programs. And imagine then how they will be actually able to deny real
healthcare services when those millions spent on non-care figure into the totals
they are required to spend on the new law.</P>
<P>We are screwed. At least I know I am. Aetna didn’t care for one
moment if I got through this weekend in pain or was able to eat or rest
comfortably. Aetna did care if I stayed in the Aetna Connection
program. So, beware, fellow Americans. There is big money at stake
in our healthcare system until it is changed to a more sane and honest system
that values human life over cash. We need an improved and expanded
Medicare for all for life system that cannot be gamed for profit. </P>
<P>Right now, we are still just part of the profit base for large health
insurance companies and other healthcare corporations. We are not
patients. Not yet. Follow the
money.</P></DIV></FONT></DIV></BODY></HTML>