If you missed any of this, be sure to watch both videos in this post. It's definitely some of the most spontaneous and revealing television I've seen in a very long time. Keith Olbermann brought together Michael Moore and Wendell Potter in a segment about how the health insurance industry mobilized to smear both Moore and "Sicko" ahead of its release, fearing it would get traction and start a "grass roots uprising" for single payer health insurance.
It's not that it's a surprise. We all know this is the standard tactic. But what comes through on these videos is how truly angry and passionate Moore is about this effort to discredit work that he viewed as essential to the debate. If memory serves me, they did succeed at marginalizing it, at least to the extent that it was not as relevant to the general debate as death panels were to become.
Urologist Jack Cassell has a message for anyone who supports President Obama and health care reform: Find a new doctor. He posted a sign on his front door with the following message:
The sign reads: "If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."
As if it weren't enough to put out that particular flavor of welcome mat, there's also this little gem:
In his waiting room, Cassell also has provided his patients with photocopies of a health-care timeline produced by Republican leaders that outlines "major provisions" in the health-care package. The doctor put a sign above the stack of copies that reads: "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."
Beyond the obvious temper tantrum, I'm at a loss to understand exactly what his problem might be. It's not like he accepts patients from a myriad of insurers. According to his Doctor.com listing, the only insurance he accepts is CIGNA. Since he's a specialist and surgeon, I can only assume he's a little angry that he might get some new patients down the road as more people are able to get health insurance and seek medical treatment?
Oh, and in case you wondered, the answer is yes. He's a registered Republican, and his wife is running for local office. For all of his education, it seems he can't be bothered to read the actual provisions of the law, preferring the Frank Luntz abbreviated version instead.
No warm fuzzies for Dr. Cassell from Rep. Alan Grayson, either.
The outspoken Grayson described Cassell's sign as "ridiculous."
"I'm disgusted," he said. "Maybe he thinks the Hippocratic Oath says, ‘Do no good.' If this is the face of the right wing in America, it's the face of cruelty.... Why don't they change the name of the Republican Party to the Sore Loser Party?"
Seriously. I'll let the medical community sort out the ethics, but if I saw that sign on my doctor's door, I'd find a new doctor. Pissed-off urologists aren't my cup of tea.
Just got off another blogger conference call, this time with Howard Dean, former CIGNA exec Wendell Potter, and Mike Lux.
Dean announced the results of a DFA poll that is "really quite stunning," he said. (You can read the results here.) The Senate cloture vote is scheduled for 7:30 p.m. on Christmas Eve, he said.
Democracy for America's "No Option, No Mandate" campaign to contact Harry Reid clocked 7000 calls in four hours, too, he said.
Dr. Dean opened the call by saying "this bill has always been a giveaway to the insurance industry, but we were willing to compromise" to get the public option.
He recapped all the compromises we made: "We wanted single payer, but that was taken off the table early on. That was a mistake. We had to get to the place where we had health insurance for all Americans." But now, he said, there's no public option, and no Medicare option.
"You're forced to pay money to an insurance company or get fined $750 by your government, while 27% of your money goes to CEOs who are flying around in these private jets," he said.
He talked about the compromises made for pre-existing conditions, the most disturbing one the ability to charge you 300% more, merely for being older. "It's guaranteed issue, but if you’re making $65,000 a year for a family of four and you’re paying $20,000 for insurance, how is that reform?"
He said the real bad stuff in the Senate bill was
"hidden in the weeds, so you can’t find it."
Dr. Dean brushed aside the "Get a bill, any bill" mentality in Washington. "Any legislation passed will have a huge impact on American healthcare. If they can’t fix it, it shouldn’t pass."
Wendell Potter, former CIGNA executive and reform activist, said the insurance industry got "every single thing they wanted" in the Senate bill.
"There's no individual mandate, no public option. There's also three words, 'benefit design flexibility' in Senate bill – that means the freedom to design plans that will pass more and more of us into ranks of the underinsured - and charge up to 22% of income if someone gets sick," he said.
In Massachusetts, they have a 2 to 1 premium ratio, "and they're already having trouble finding affordable, adequate insurance. The industry wants to shift even more costs to individuals and families, having the government pay them half a trillion dollars. The Senate bill meets every one of their requirements," Potter said.
"They will continue to shift the cost burden to consumers and get around not using preexisting conditions by charging for certain factors like high cholesterol."
Dr. Dean pointed out the House bill "is the compromise, we didn’t think it was right to take the option of an employer-based system away if people liked it."
In Vermont, he said, you can't be charged more than double the lowest premium.
Dean listed some more of the insurance company wish list the Senate was so eager to fill. "Getting rid of the anti-trust provision. This contributes to the predatory effect of the insurance companies – they're essentially unregulated. We need to get the provision in, get them regulated.
Wendell Potter talked about something you often hear pushed from the Republican side: "Just let us sell across state lines and let the market decide." As he points out, insurers would go to the states with least regulation.
Paul Hogarth from Daily Kos asked them to address criticism that if the bill is killed, "there's no reform and we’re worse off, the momentum is gone."
"I don’t know that we’ll be worse off," Dr. Dean said. "We ought to strip down this bill and get rid of the mandate. It should have been done by reconciliation."
Former CIGNA executive Wendell Potter says one of the most important things we can do to reform health care is to control the medical loss ratio - something Al Franken, Jay Rockefeller and other senators are attempting to do:
Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.
This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.
Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.
Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.
The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.
Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American
patients and their doctors, according to the industry's trade group.
And they do this by finding every excuse in the book not to pay a claim, even if it means
canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging."
In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main
When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.
The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.
The Republican National Committee will no longer offer employees an insurance plan that covers abortion after POLITICO reported Thursday that the anti-abortion RNC's policy has covered the procedure since 1991.
"Money from our loyal donors should not be used for this purpose," Chairman Michael Steele said in a statement to POLITICO. "I don't know why this policy existed in the past, but it will not exist under my administration. Consider this issue settled."
Steele has told the committee's director of administration to opt out of coverage for elective abortion in the policy it uses from Cigna.
Federal Election Commission Records show the RNC purchases its insurance from Cigna, and two sales agents for the company said that the RNC’s policy covers elective abortion.
Until Thursday, the RNC’s plan had covered elective abortion – a procedure the party’s own platform calls “a fundamental assault on innocent human life.”
Informed of the coverage, RNC spokeswoman Gail Gitcho told POLITICO earlier Thursday that the policy pre-dates the tenure of current RNC Chairman Michael Steele.
“The current policy has been in effect since 1991, and we are taking steps to address the issue,” Gitcho said.
The RNC moved quickly Wednesday to assuage any concerns its members might have.
In a letter obtained by POLITICO, RNC Chief of Staff Ken McKay writes to the 168 committeemen and committeewomen across the country that Steele "takes this issue very seriously."
He writes that the RNC has been evaluating its health insurance policy and will continue to do so.
But they'll still be writing checks to CIGNA for that modified policy, and CIGNA is still offering abortion on its plans - which means their premium dollars are funding abortion, right? At least, according to the Stupak amendment.
Via Raw Story. Actor/comedian Andy Cobb once did ads for Blue Cross in Florida. And now CIGNA's Wendell Potter has someone to talk to:
Teaming with the liberal Brave New Films, a former Blue Cross pitchman is now pitching against Blue Cross.
Andy Cobb, who once tried to sell Floridians on a Blue Cross health insurance plan, says he's fed up with the industry.
"I was a spokesman for BlueCross and Blueshield of Florida," Cobb says. "Call me a spokesjerk. People who make money for buying things you don't need. And we're telling you lies."
"They, by which I mean I, make money by standing in the way of reform," Cobb says in the ad, which appears as a spoof of something like a freecreditreport.com ad. "It's time for change."
"That's why I'm calling on leaders from the spokesjerk industry," Cobb continues. "The freecreditreport.com guy. The Shamwow dude. And Senator Bill Nelson, recipient of big money from insurance companies -- to lead us. To walk away from their cash cows and tell American people the truth.
"And us spokesjerks, we'll be fine," Cobb adds. "There's plenty of room in entertainment for people who tried to sell you the worst product in American history. Private health insurance."
One of the things that you can never anticipate fully before becoming a parent is the absolute ferocity of the instinct to protect your child. It's innate, feral, and so deep that it can actually scare you. I am profoundly grateful every day that my children were born healthy, but I know that should my luck run out and one of my kids develop some sort of life-threatening illness, there is no stone I would leave unturned in my quest to save my child. There is no length I wouldn't go for my babies.
And if all those efforts were in vain, I don't know how I'd survive the loss of my child. I had a miscarriage some years back, and I carried that loss like a huge, gaping wound inside me for so long. And that was for a child with whom I never got a chance to know or develop a real bond.
Now imagine how Hilda Sarkisyan feels. The daughter she bore, raised and nurtured for seventeen years dies just hours before the insurance company she battled finally relented to give her daughter the liver transplant she needed. Can you imagine that grief, that anger at how unnecessary Nataline's death was? All the obstacles placed in their way by a for-profit insurance company in addition to just missing Nataline had to be paralyzing in its pain.
"You guys killed my daughter," the diminutive San Fernando Valley real estate agent declared at the lobby security desk. "I want an apology."
What she got was something quite different.
Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her "the finger."
Sarkisyan walked out, stunned and hurt.
"They showed me their true colors," she said. "Shame on them."
This woman has just gone through a pain I wouldn't wish on anyone--watching her child die needlessly--because CIGNA decided there wasn't enough of a cost-benefit to them to authorize a liver transplant. A for-profit insurance agency acted as a de facto death panel, opting to let this child die. Got that, GOP? There's the death panel you fear-monger. But they're not some hypothetical used to scare Grandma and Grandpa, they're REAL and some day, they may decide that you--or worse, your child--are not worth the cost of saving.
And don't be surprised if they show their heartlessness by heckling you and flipping you off when you walk in their doors to ask why.
And as if on cue, here comes Fox News, defending CIGNA:
Remember Nataline Sarkisyan? She was the 17-year-old who died because CIGNA wouldn't pay for her liver transplant. Said it was "experimental." And by the time public outrage forced them to backtrack, she was dead.
Now her parents are trying to change the law that forbids them from suing CIGNA for damages - because until they do, it's cheaper for insurers to let people die:
"It was the worst thing in life," Hilda Sarkisyan said in a recent interview.
Mark Geragos, the high-profile trial lawyer who helped the family make its pleas to Cigna while Nataline was alive, filed the wrongful death suit on the family's behalf last year.
"If you don't sue, you can't make changes," Hilda Sarkisyan said. "It's not about the money. It's about the principle. They are just going to keep denying people care if we don't stop them."
Cigna said the dismissal of the wrongful-death case in April showed that the court "agreed with our position that the Sarkisyans' claims regarding Cigna's decision making were without merit."
In fact, the court did not consider the merits of the family's wrongful-death claims. Instead, it decided those claims could not be heard.
Judge Feess cited rulings by the Supreme Court and others interpreting 1974's Employee Retirement Income Security Act, or ERISA, which governs employee retirement funds and benefit plans.
Under ERISA, the courts have said, the only monetary damages that beneficiaries of workplace health plans can sue for is the cost of the treatment of service in dispute.
The cost of mounting a lawsuit often far exceeds the cost of the treatment in question, patient lawyer Scott Glovsky said. As a result, few lawyers take them on. That has in effect shut the courthouse doors on most treatment coverage disputes involving workplace health plans, which are the source of medical insurance for 132 million workers and dependents.
"ERISA is a license to kill," Glovsky said. "The companies know that they can deny treatment with the sick or dead member having virtually no recourse."
Wendell Potter, a Cigna spokesman who quit after handling the publicity surrounding the Sarkisyan case, agreed.
"HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences," Potter said in a speech to the Civil Justice Foundation in San Francisco.
But, without these limits, an industry spokesman said suits against health insurers could be disastrous for consumers.
"It will bankrupt these plans, and employers would no longer be able to offer coverage," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.
Then maybe you should go ahead and pay for the procedures instead. It would be good for your image and you could save a lot of money!
With Congress considering a healthcare overhaul -- including a requirement that individuals buy health insurance -- Potter, the Sarkisyans and their supporters want lawmakers to undo the high court's 1987 ERISA ruling.
Santa Monica-based Consumer Watchdog sent a letter to key congressional leaders urging them to undo the ERISA ruling, and president Jamie Court said Nataline's case shows why such a move is crucial to any healthcare reform.
"If the insurer decides they don't want to pay for the treatment because they can save a lot of money, there is not a dime available in damages if the person dies or is injured," Court said. "It's cheaper to kill you. If you die, you can't go to court."
It's not the first time this aspect of ERISA has come under fire.
In 2001, the late Sen. Edward M. Kennedy led an unsuccessful effort to take away the protection for health insurers.
"Patients should have the right to hold their HMO accountable in court when its negligence causes the injury or death of a patient," Kennedy told Senate colleagues.
Amy Goodman interviews Stacie Ritter, whose twin daughters are being denied coverage by CIGNA for the followup care they need from the side-effects of cancer treatment:
STACIE RITTER: Hi. Thank you, Amy. Thanks for having me.
AMY GOODMAN: Hi, Stacie. Tell us your story.
STACIE RITTER: Well, it’s a rather long one, so I’ll try to make it as brief as I can.
Our issues with insurance companies have been going on now for quite a while. It didn’t start with CIGNA, though, until April Fool’s Day of 2008. That’s when my husband’s employer switched insurers to CIGNA, which, again, as far as healthcare is concerned, you don’t have a choice. When your employer switches insurers, you get what they give you. And unfortunately, we were given CIGNA.
My girls are cancer survivors. They had pituitary and hypothalamus gland damage as a result of chemo and total body radiation to treat their cancer as part of the stem cell transplant that they had when they were four years old. And a lot of times when a child has that issue, they end up on growth hormone. Many years later, once the oncologist notices a—like a plateau in their growth, which mine did back in 2005, so she referred us to an endocrinologist at Children’s Hospital in Philadelphia, and he monitored them. And they didn’t start growth hormone until 2007. So that was two years of monitoring to make sure, you know, that it wasn’t just a little lax in their growth and that it was really a damaged pituitary and hypothalamus.
And once they started the growth hormone under our previous insurer, which was Aetna, they did very, very well. And so, our doctors said, well, then, that’s—their positive response to the medication is proof that it was damaged, then, the hypothalamus and the pituitary gland. So that was great, so we’ll continue to do this until their bones start to fuse and they no longer need growth hormone.
But unfortunately, CIGNA does not feel the same way that our previous insurer and our world-renowned expert doctor felt. So they claim to have had two endocrinologists look at our case, and both of their endocrinologists deemed that my girls just suffer from idiopathic short stature, which means short stature of unknown origin. But quite to the contrary, we know the origin. We have lots of documentation and proof of the origin.
AMY GOODMAN: And that was—you say that was the radiation that they were exposed to to deal with their rare cancer.
STACIE RITTER: Yes. And chemotherapies, too, are very toxic, and also depends on the child’s age at the time, and even the sex has a lot to do with it. So, the younger the child, especially under five, which mine were—they were four at the time—and the sex—females tend to suffer more damage than males for some reason from the total body radiation. Not all children with cancer have these kind of late-term effects. It’s only children who have had radiation to the brain area, which mine did.
(I have been doing some work as a blogger fellow with Brave New Films on their Sick For Profit campaign. Visit us on Facebook.)
Today Brave New Films released their second installment in the Sick For Profit series, taking a look at the corrupt practices of CIGNA, denying care to their customers while their lead executives rake in millions and lead lavish lifestyles.
Meet Jo Joshua Godfrey. She had cancer without knowing for over a year.
"I would go to CIGNA and they would tell me I had bronchitis and give me medicine and send me home. No matter what medicine they gave me I wouldn't get better. Then the CIGNA Director called me up and she told me that there was nothing wrong with me at all. I called the doctor, and I came with my film and my CAT scan and he just put it in, it took exactly thirty seconds. He told me, 'You have cancer,' and he said the reason CIGNA did not want to give you your records is they've known right way back for years that you have cancer and they're not going to treat you."
CIGNA took in $19.1 billion dollars in revenue last year, with a $292 million dollar income. That doesn't include the salaries given to people like CEO Ed Hanway. He made a cool $12 million last year, and over the past five years he took in $120 million. Hanway has $28 million in unexcercised stock options. The company corporate jets, also not seen in profit statements, cost $68 million. This money is gained, as former communications director Wendell Potter says in this video, through denying claims and dumping the sick, enhancing the value of the company for Wall Street investors. The effect on people's lives, meanwhile, is tragic. Nataline Sarkysian, featured in the Americans United For Change advertisement, lost her life after CIGNA repeated denied her a liver transplant, despite the family having full coverage.
Meet Stephen Coddington, the wife of Marian, a stroke victim:
The case manager at the nursing home called me in and was really upset, and she said, "CIGNA is wanting to discontinue therapy with her. The doctors called and appeals were denied." It has been a day-in and day-out fight. Every talk that I've had with them, it's been, how can we wiggle off this hook.
This is the human cost for an insurance company's existence, for the record profits and supreme lifestyle of their executives. Welcome to the American health insurance industry. Instead of helping policyholders attain the health security they need for their families, big insurance companies get rich by denying coverage to patients. Now they're sending lobbyists to Washington, DC to twist the arms of lawmakers to oppose reform of the status quo. Why? Because the status quo pays.
CIGNA is not a special case in the insurance industry. It's perfectly normal and expected for a corporation to maximize profits. The difference with insurance is that the profit comes at the expense of your well-being, and frankly, all the regulations in the world won't substantively change that. The best way to fight back is through exposure, a juxtaposition of the human luxury paid for by human misery.
So help us shine this spotlight. CIGNA's advertising tagline is 'A Business of Caring.' We think they ought to come up with something more appropriate for their actual practices. If you come up with one, post it on our Facebook page. Here are some examples. We'll send the best over to CIGNA. In addition, Jo Joshua Godfrey will join SEIU Healthcare 775NW outside the CIGNA corporate offices in Seattle, Washington today as they demand quality and affordable health care for every American as a fundamental right and not a privilege.
And send this video to your friends. Everyone needs to know what's at stake in health care reform. This kind of denial of coverage can happen to anyone under the current system.