Welcome to OpEdNews, Margie. As an investigative journalist, you've delved deeply into the issue of health care over the last few years. With legislative reform in the offing, your research takes on extra relevance. Let's talk about it. Can you get us started?
Hello, Joan. Good to be here. In fall 2007 and going forward, I was doing research on health insurance abuses--refusing coverage, denying claims, delaying settlement, the whole gamut that we are not becoming more familiar with. At the time, the issue was not being widely discussed in big media outlets; the Washington Post (the newspaper I subscribe to), for example, literally did not mention the issue of bad-faith insurance practices--for years. I interviewed a number of people including law professors, attorneys, a researcher at the Rand Corporation--which had produced a study on class-action lawsuits against insurers--and submitted questions to carrier spokespersons.
Here are some findings.
Regarding insurance bad faith, there are two areas of solid consensus uniting industry critics, defenders and observers:
First, it is currently impossible to gauge accurately the exact extent of the problem--insurance bad faith--because hard data on the national level are lacking. Insurance, unlike banks and stocks, is regulated at the state level; there is no SEC for the insurance industry.
Second, whatever the extent of the problem, it can be ameliorated by good administrative processes in the industry. Whether you're talking to policyholder attorneys (plaintiff's attorneys), insurance company spokespersons or industry observers, the consensus emerges that much of the problem lies in claims. Skipping ahead to Chapter Two here--to my mind, that means that the industry is well aware of where disputes are liable to arise. If the public at large were equally well aware--claims handling needs some rigorous standards--then we could have good national policy on claims handling.
This applies to health insurance itself, health coverage whether group or individual, and to other kinds of insurance with an impact on health including disability, long-term care, and medical benefits under automobile insurance.
I started digging into this issue when an editor then at a glossy health mag asked me to write an article on it. But I had been thinking about it long before. Here's a family memory with a satisfactory happy ending. I remember that my parents had three insurance policies--that was what people did back then, if possible, and ours was a union household--paying premiums on all three for years, probably throughout my childhood. And when my father became ill and had to be hospitalized, a rare occurrence, all three companies paid up. Rightly so, of course; that's what the policies were for--coverage. You know, insurance.
That's why it used to be called "hospitalization." You paid your premiums for years, and if you actually godforbid had to go to the hospital, your insurance company wrote that check for the $150 per night or whatever unthinkable amount.
Okay. So you've laid the groundwork. Why has this whole topic of health insurance abuses not been widely covered over the years? What's your theory?
Good question. It's easier to explain why some things do get reported than why other things do not. Take the Vietnam War, for example. War deaths were reported--after enough public outrage at failures to report them made reportage respectable--and rightly so. But even after war deaths came to be nationally reported, U.S. highway deaths did not. In spite of the old "If it bleeds it leads" approach in local television, few or no newspapers reported that as many Americans died in car wrecks, every year, as died in the entire war.
Obviously the death of a celebrity will generate stories about the celeb, a natural disaster or catastrophic accident spawns headlines, etc.--'It's the airplane that doesn't land that makes the news.' But that in itself does not explain why insurance policies cancelled when people became ill--'rescissions'--or claims denied, or premiums going up faster than the rate of inflation, were not reported as outrages, or even as abuses for the most part. You'd think there would have been some pretty good stories, for any reporter with a real nose for news.
Thinking about that, I would draw a parallel from a different topic, children's literature. Back when my child was in elementary school, I became interested in children's books. So since I was doing research at the Library of Congress anyway, I decided to poke around and see whether I could turn up any really interesting children's books, not too dated or otherwise hokey, like about trains. Results were mixed: I found a title that looked promising, checked the book--and it wasn't really about trains at all. It was anti-labor propaganda disguised as children's fiction. The moral of the story was obvious: the union organizer amidst the other stalwart railroad workers in the book was this great hulking brute, smelling of beer, perhaps foul-mouthed (by implication), sulky. A ne'er-do-well malcontent. The book was really just an example of management in one business--publishing--looking out for management in another--railroads. Too bad; I love publishing and railroads, myself.
The parallel is that for more than thirty years, we've had basically that quality of publishing on insurance abuses: It's been management in news media protecting management in the insurance sector. Mostly the whole issue--'insurance' that did not insure--just did not get reported. Insurance execs like other execs got paid better and better, more and more risks got legally excluded from the pool, and premiums just kept rising, while the big media outlets pretty much let it slide. Big media outlets seldom or never attributed 'the rising costs of health care' to the rising cost of health insurance, even while the business press routinely reported that premiums were rising, were projected to rise, had risen, etc. (N.b.: Have you ever seen premiums go down? Anywhere? In your life?) Astronomical malpractice premiums are still not being written about. And, generally, the news media do not even report how many claims a company denies, an item that would be useful for comparison shopping. But comparison shopping among insurance companies is nearly impossible anyway when one or two or a few companies dominate the market in a state.
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