When every man on the street or female head of household knows that choosing to file a claim may mean getting a premium increase, the continuing lack of exact information on insurance bad practices comes to seem rather expedient. This is not rocket science; if claims processing is the locus of widespread problems, then claims handling needs some attention, some enforced standard of good practice.

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Amid all the smarmy attacks on health care reform and on reforms of insurance abuses, public discourse in the United States has undergone a watershed moment. Before now, discussion of public policy on health in this country has suffered because it omitted any meaningful emphasis on problems with health insurance and the responsibility of private insurers. Now that topic is no longer being omitted.

Quick overview

Health policy, in public policy, has three legs:

health care or maintenance, supporting wellness and preventing disease and injury;

health treatment, meaning the wonders of medicine from pharmacology to surgery; and

health insurance. All three should maintain and fortify the health of over 300 million Americans to the extent possible.

American know-how being what it is, the U.S. always tends to pitch in most aggressively on health treatment. We may not be the world's best at warding off illness or injury—OSHA is consistently under-funded, understaffed, and under-utilized--but with our fix-it mentality, when we do get sick or injured those of us with access to medical care can get everything from laparoscopy to transplants. Professionals around the globe flock to U.S. medical schools, and both private and public entities finance medical research.

The national policy on health care--ordinary health maintenance--is somewhat more mixed and obscure. Although an ounce of prevention is universally recognized to be worth a pound of cure, preventive care--wellness, as our mostly defunct HMOs called it--is relegated largely to individual responsibility, excluding public attention to the many obstacles to individual health including those obstacles created by the marketplace. Since behavioral remedies are unquestionably required for health problems with behavioral causes–obesity and eating disorders, poor nutrition and exercise, substance abuse, tobacco use, high-risk sexual practices, aggression and violence–subsidized information campaigns focus almost exclusively on abuses of health at the individual level. Federal public information campaigns have never adequately targeted environmental factors, dubious pharma, or abusive medical or insurance practices; it's always been up to you. Federal efforts even to reduce tobacco consumption have been mixed and contradictory, fluctuating with changes of administration.

Everyday health for the individual in this country depends partly on an ability to stand aside from an avalanche of advertising boosting over-consumption and sometimes harmful products. Having a little sophistication in regard to mass enculturation, whether one puts it that way or calls it enlightened skepticism, is key to survival and one benefit of the good upbringing presumably implied in ‘values' campaigns. The essentials of proper nutrition and exercise were hammered by among others 2008 GOP presidential candidate Mike Huckabee, former governor of Arkansas (‘the other candidate from Hope, Arkansas'), who made self-help health virtually a campaign plank. Even the television networks--somewhat ironically given their advertising base--have begun to focus on widespread obesity in America as a health epidemic. We are all well acquainted with abuses of health on the individual level.

But the pull-yourself-up-by-your-own-Thigh-Master perspective has limitations. Death in childbirth, for example, and infant and child mortality do not stem solely from individual choices. Even while some federal public information campaigns have targeted environmental hazards such as lead paint and touted the benefits of breast-feeding, dubious practices posing larger health concerns have often gone unchallenged for years.

Health insurance, the 800-pound gorilla in the room

Particularly, up to now, in insurance: Up to now, this country has pitched into health insurance by far the least; insurance has been the health area in which the “countervailing forces” that famed economist John Kenneth Galbraith imagined have most gone slack.

The authentic national objective in health policy, as this writer said in January 2008, is health care for all Americans, not ‘health insurance' for all. Insurance is a means to an end, theoretically facilitating health care, not an end in itself. A historic combination of industry consolidation and laissez-faire public policy made the insurance companies the gatekeepers to health care, but as written elsewhere, ‘health insurance' does not substitute for actual health care any more than ‘job training' substitutes for actual jobs.

Today we are at that moment of recognition, and--win or lose this round, on the public option--it is a watershed moment. Not for the foreseeable future will either national politicians or corporate media outlets be able to conceal the key issue of insurance bad faith.

Of course, raising the problem of bad faith still takes political courage. As conservative commentator Kevin Phillips remarked through several election cycles, while pro-corporate absolutists in the GOP refuse even to raise such issues, Democratic candidates and officeholders have refrained from driving hard on them--leading to perceptions before 2008 that “the Democrats can't fight their way out of a paper bag,” as Phillips put it--for fear of offending their corporate donors. The performance of so-called ‘Blue dogs' and so-called GOP ‘moderates' in the Senate, in the current health care debate, fits the pattern. And while Senate opposition to a public option is losing credibility, the delaying tactics have had effect; as other writers have pointed out, every day or week of congressional delay profits the insurance industry. Fortunately congressional leaders are at least moving to undo the anti-trust exemption enjoyed by insurance carriers.

Even with a public option, we will still have work to do. For future reference:

Bad-faith practices in insurance include denying claims without reasonable justification, requiring duplicative information, refusing to provide coverage, unjustified policy cancellations and retaliatory rate increases. Several bad-faith practices involve the claims department — misrepresentations about claims handling, failing to handle claims promptly, and systematically delaying settlement.

On insurance bad faith, there are two areas of consensus among industry critics, defenders and observers:

1) First, it is impossible to gauge the full extent of bad-faith insurance practices because hard data on the national level are lacking;

2) Second, whatever the extent, the problem could be ameliorated by good administrative processes in the companies—i.e. good claims handling. This broad consensus emerges among policyholder attorneys, insurance company spokespersons, and industry observers, not only about health coverage but also about other insurance with an impact on health, including disability, long-term care, and medical benefits under automobile insurance.

When every man on the street or female head of household knows that choosing to file a claim may mean getting a premium increase, the continuing lack of exact information on insurance bad practices comes to seem rather expedient. This is not rocket science; if claims processing is the locus of widespread problems, then claims handling needs some attention, some enforced standard of good practice.

Note: The extent to which corporate media outlets have gone along with the industry, the GOP, and a succession of compliant administrations on this issue can hardly be overstated. Firsthand experience: In fall 2007 I spent a month to six weeks working on an article about health insurance abuses and lacks for a glossy health magazine, working closely with the editor—interviewing numerous individuals in person or by phone, checking out applicable law, researching articles in refereed journals, etc. At the last possible pre-publication minute and after a couple of rewrites, the article was deep-sixed by a hands-off publisher I had not previously seen in the picture. The editor later left, and the magazine has ceased printing.

(This article expands on earlier writing including posts at http://www.margieburns.com.)

Authors Website: www.margieburns.com

Authors Bio:
Freelance journalist in metro DC area.