Monday, March 29, 2010

Taking Back Our Country

The Tea Party movement is spreading its message across the country by visiting cities and holding rallies, and garnering quite a bit of media attention.  From all the news reports you would think it was a very large movement, but in reality, it's not.  Just a very vocal one.  It can, however, do quite a bit of damage if left unchecked.

To that end, it is important to counter their rhetoric, particularly to our elected officials.  This is the time to write to your Senator and Congressman and tell them what you want to see from your government.  If you believe health care reform is a good thing, tell them.  If you think student loans need to be modified, let them know that.  If you believe the wars in Afghanistan and Iraq need to be ended, be sure they understand you.

You can find your Senators by going to and clicking the link on the upper right that says "find my senators."  To find your representative, go to and on the upper left enter your zip code.  If your zip code has more than one representative, you will need to know your four digit extension.  If you don't know it, go to the United State Postal Service website at and click on "Find a Zip Code."  Enter your address and city and you will get back your zip with extension.  Then enter that on the House site to find your representative.

Letters and telephone calls are the best ways to reach your elected officials, followed by faxes and emails.  You can also write to representatives outside of your area, but they generally will not respond to you.  It is, however, a very good way of letting them know your feelings.  So, for example, when I write to Barbara Boxer (one of my Senators) and tell her how pleased I am that the government has finally modified health care in this country, I make sure I copy Mitch McConnell on that message so he'll stop lying to the American people about how many of us don't want such reform.  

If we all get involved, the system works.

Wednesday, March 3, 2010

Mitch McConnell on Healthcare Reform

With the Democrats getting closer to passing a healthcare reform bill the Republicans are characteristically gathering forces and bombarding the media with rhetoric.  Take Senate Republican Leader Mitch McConnell as an example.  He stated that the actions of the Democrats are against the will of the American people, and that healthcare reform will be the undoing of the Democratic majority in Congress.

What Mitch doesn't bother with are the facts.

According to the most recent Gallup poll on healthcare reform, 49% of Americans are for it while 47% are against it.  While this is certainly close, it does not substantiate McConnell's argument that the American people are against it.  Clearly, the majority (albeit a very slim majority) are for this reform.

What McConnell also doesn't bother to mention are the breakdown of Americans polled.  When split into parties, 82% of Democrats support healthcare reform, while 13% are against it.  The remaining 5% had no opinion.  One can't help but wonder what kind of healthcare those 5% currently have.

Among Republicans only 20% support the measure, while 76% are against it.  Again, the remainder (4%) had no opinion.  

Since Republicans insist on stretching the truth, or completely ignoring facts in order to press their point, why can't Democrats do the same?  For example, using the recent polling numbers, let's spin it this way:

82% of Democrats and 20% of Republicans support healthcare reform.  82 + 20 = 102, therefore 102% of Americans support healthcare reform.  By this same logic we would be left with 89% who are against it, but we'll simply ignore that number just as we ignore the 9% who don't have an opinion and only concentrate on the 102% who are in favor.  Republicans are experts at ignoring anything that doesn't agree with their arguments so why can't the Democrats do the same?

Of course this is absurd and we, the Democrats do not manipulate the truth in this manner for one very simple reason; we are not liars.  We present to the American people what is true.  In this country our healthcare system is out of control.  Insurance companies are making decisions that should be left to the doctors.  Premiums are ridiculously high and not because of rising healthcare costs, but simply because insurance companies are greedy.  Insurers have been making record profits and paying their executives exorbitant salaries, all the while denying coverage to those who need it most.

Mitch McConnell is a liar.  The American people DO want healthcare reform.  More importantly, America NEEDS healthcare reform.

Tuesday, March 2, 2010

Anthem Blue Cross' 39% Rate Increase

When I heard the news that Anthem Blue Cross intended to raise premiums by as much as 39% for Californians, I was a bit puzzled as to why such a hefty increase would be necessary.  When the reason was stated as "rising healthcare costs" I realized that Anthem Blue Cross was not being honest.

While it is true that healthcare costs do increase, those increases do not have any effect on the profits of an insurer.  Let me give an example that will help to explain this:

Dr. Jones and Dr. Smith are both medical doctors, sharing an office in Los Angeles.  They both charge $100 for a physical exam, with an additional $50 for x-rays.  Dr. Jones accepts all PPO insurance plans (including Anthem), but is not an in-network provider.  Dr. Smith also accepts PPO plans, but is in-network with Anthem.

Mary and Blanche are patients of Dr. Jones and Dr. Smith, respectively.  Both women are policy holders of Anthem Blue Cross and have PPO insurance plans.  When Mary sees Dr. Jones, her insurance is charged $100 for the visit and $50 for the x-rays for a total of $150.  When Blanche sees Dr. Smith her insurance is charged the same.

According to Anthem's Fee Schedule, they allow $60 for an office visit, paid at 100% and $30 for x-rays, paid at 75%.  This means that Anthem will pay $60 for the office visit and $22.50 (75% of $30) for the x-rays for a total of $82.50.  Since Dr. Smith is an in-network provider, he has agreed to accept Anthems fees rather than his own.  His $150 invoice is reduced to $90 (he writes-off the remaining $60) of which Anthem pays $82.50 and Blanche pays the remaining $7.50.  Since Dr. Jones is not an in-network provider, he accepts Anthem's payment of $82.50, but then bills Mary for the remaining $67.50.  He does not have an agreement to accept Anthem's fee schedule, so his fees are what he charges.  

Note that in both cases Anthem pays the same amount.

Now, let's assume that Dr. Jones and Dr. Smith both raise their rates by 10%.  This increase only matters to the policy holders.  Anthem does not raise their fees because doctors raise theirs.  In fact, they have limitations on how often a doctor may raise their fees.  For out-of-network doctors, the increase in their fees will be passed along to their patients.  For in-network providers, the increase in their fees must be written-off as they are still bound by Anthem's fee schedule.  Anthem agrees to pay $60 for an exam.  Whether an in-network provider charges $100 or $1,000 they still can only collect the $60 agreed-upon fee.

What this means is that Anthem blatantly lied when they claimed that rising healthcare costs were the impetus for their increase in premiums.  Under questioning from the legislatures, however, Leslie Margolin (President of Anthem) and her cronies changed their tune.  They claimed that due to the economic downturn many healthy individuals had dropped their healthcare coverage as it had become too expensive to keep.  Those people who needed the coverage because of existing medical conditions kept the coverage, but were now costing the company too much money resulting in $68 million in losses.

From the sound of it, it would seem that Anthem has a good argument for raising rates, but consider that with $68 million in losses Anthem still managed to pay $39 million in bonuses and spent another $27 million on executive retreats.  If these unnecessary bonuses and retreats had been curtailed, their losses would effectively have been reduced to $2 million.  Added to this, if their need for revenue was due to policy holders dropping coverage because they could no longer afford the premiums, reducing the premiums would have kept those policy holders, and possibly attracted more, resulting in increased revenue for the company, since by their own testimony many of those who had dropped their coverage were healthy and rarely used the coverage.

It seems that Anthem did just the opposite of what it should have done.  Rather than a) reducing spending and b) lowering premiums to hold on to policy holders, Anthem chose to a) spend wildly and b) raise premiums, which would result in even more loss of policy holders.

Now Leslie Margolin is surprised that the legislature wants the government to regulate insurance rate increases.  Go figure.