Then explain why they offer me coverage at rates 4-5X my peers if they offer me a rate at all. Explain to me why when I buy this outrageously expensive coverage they deny me coverage of everything under the sun saying it is part of my congenital birth defect that they don’t cover. Explain to me how pneumonia can be declared to be not covered because I have that extra chromosome? Explain to me how an appendectomy can be denied because of the same reasons? Explain to me how they can deny me everything, charge me four times as much, when I can pay out of pocket less than $1000 for my ‘pre-existing’ condition. They deny me everything based on this condition, yet the condition itself pales in comparison to the normal every day things they have denied me time and time again.
They are unjust, they are unfair, they treat me horribly, and I have no legal recourse, I know, I tried.
Let’s look at this with a little objectivity. Insurance companies are companies. They are publicly held and are supposed to make money, right? (If you own stock in one or are in a union-sponsored retirement plan or hold shares in a mutal fund, as part of an IRA, you should answer the above “yes”)
As an example, I looked at the company Aetna. They are one of the big health insurance companies that you complain about. During the 4th quarter of 2007, they brought in 7.144 billion in revenue and had net earnings of 448.4 million. That works out to a 6.2% profit. That is reasonable, if not, in fact, a bit low. You will, of course, counter my discussion with a mention of the fact that the outrageous executive salaries are part of their operating expenses. Well, I looked. (In public companies, executive compensation is a matter of public record). Their CEO, Ronald Williams, made $1.7 million salary and a total compensation of $7.732M. That works out to be a little more than $0.50 for each of the 15 million subscribers of Aetna. In fact, if you took a look at the combined compensation of ALL of the executive suite, you’d find that they earned about $15 million last year. In other words, about a dollar per subscriber goes to pay for the entire executive suite. So if the ENTIRE executive suite at Aetna decided to take a vow of poverty and do what they do for free, transferring the savings to the subscribers, you’d pay about a dollar less a year for your Aetna insurance policy. So it’s not that the stockholders are making too much money (6.2% profit) or that the Executive Suite salaries are too high (a dollar a year per subscriber)…there has got to be another reason for you to be in the insurance situation you’re in.
But why is your insurance so high and why do they deny so much? A complete discussion is WAY beyond the scope of what can be discussed on this board (and all the particulars are not in my personal area of expertise), but, in general, the way it works is that if you work for a large company, that company negotiates a package for its employees with an insurer. The insurance company is going to make money off the deal (but not an outrageous amount…as shown above). The insurance company anticipate what they believe the total amount of medical bills they will have to pay out for the health care of all the members of that group, their internal costs, and then assign rates based upon that anticipated cost. The rules of what is and is not covered is pretty much an industry standard…but your company may have certain restrictions on what they will pay the insurance company to provide (for example, if you work for a company that has a Catholic ethos, they may not pay for abortions or for artificial birth control…if the state laws allow those provisions, that is). If you work for yourself or for a small company, there is a far smaller pool to balance out the anticipated costs.* That could explain why your rates are higher. In addition, if you have employer-provided insurance, your employer will likely pay between 1/2 to 2/3 of the cost of that insurance. If you have to self-insure, you have to bear all of those costs yourself.
*Note: there are some states that have insurance regulations creating a pool of self-insureds…which would affect all of the members of that group.
As to the denied charges, here’s what I’d consider: You (or your company) signed a contract with your insurance company. (If you have employer-provided insurance, then you subscribed) Exclusions were part of that contract. For example, page 16 of
Aetna’s individual insurance brochure states that if you have certain medical conditions, you will have to pay more for your rates or they might not agree to insure you. They also say that they won’t cover pre-existing conditions for the first 12 months of coverage (unless you already had health insurance). Bottom line is if you signed a contract and they went against the terms and conditions of the contract, they did wrong. If you signed a contract and didn’t read/ understand the terms and conditions, that doesn’t make them evil. That means you made a very foolish decision.
Would socialized healthcare be good for your situation? Likely it might seem better than what you have right now. But, I would suggest that you should consider the quality of health care in socialized medicine countries prior to becoming an advocate for it. You would find that you wouldn’t like the end result…not just for you, but for everybody. But if it seems like a good idea, feel free to move to Canada or Britain.
In fact, it would probably be a good idea to round up all the healthy people and make them indentured servants. Certainly, they are fit enough to do the bulk of the work for everyone else. There is no reason that someone who is not healthy should have to endanger their lives by moving and/or lifting anything. Get them all free electric scooters.
I think it is about time this be treated as anything else on an equal basis.