The US House of Representatives is scheduled to vote on one of the many required, but in this case crucial, steps to beginning an overhaul of the chaotic situation of American health care. By all accounts the vote is close, which is really pathetic. What is being proposed in the US is a baby step in absolute terms, although it is huge in terms relative to the historically backwards and reactionary character medical care in the US. I hope it passes, since not passing it would leave tens of millions without insurance of any kind and most of the rest of us insecure about the coverage we have. Well, not all of us. I’m over 65 so I have the benefit of a government single-payer system (called Medicare in the US). That makes me luckier than others, at least as far as health coverage is concerned, although my late mother had it right when she declared, in one of her few less than highly dignified utterances, “Getting old sucks.”
The proposed “reforms” are welcome but still badly flawed by leaving everyone else at the mercy of private health insurers. So at this critical juncture (at this point I don’t know how it will come out), it’s time to remind ourselves who these folks are that drive the health care bus in the US:
In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural South Carolina, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance.
Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that. (Murray Waas, Reuters)
So this kid hired an attorney, went to court, and had a jury award him $15 million (reduced to $10 million by the judge). Another case of a jury beguiled by a slick plaintiff’s attorney? Not according to the trial judge and the South Carolina Supreme Court judges who heard the case on appeal:
Previously undisclosed records from Mitchell’s case reveal that Fortis had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators.
“There was evidence that Fortis’ general counsel insisted years ago that members of the rescission committee not record the identity of the persons present and involved in the process of making a decision to rescind a Fortis health insurance policy,” [Trial Judge Michael G.] Nettles wrote.
Elsewhere in his order, Nettles noted that there were no “minutes of actions, votes, or any business conducted during the rescission committee’s meeting.”
The South Carolina Supreme Court, in upholding the jury’s verdict in the case in a unanimous 5-0 opinion, said that it agreed with the lower court’s finding that Fortis destroyed records to hide the corporation’s misconduct. Supreme Court Chief Justice Jean Hoefer Toal wrote: “The lack of written rescission policies, the lack of information available regarding appealing rights or procedures, the separate policies for rescission documents” as well as the “omission” of other records regarding the decision to revoke Mitchell’s insurance, constituted “evidence that Fortis tried to conceal the actions it took in rescinding his policy.”
In affirming the trial verdict and Nettles’ order, Toal was as harsh in her criticism of the company as Judge Nettles had been. “We find ample support in the record that Fortis’ conduct was reprehensible,” she wrote. “Fortis demonstrated an indifference to Mitchell’s life and a reckless disregard to his health and safety.”
Mitchell’s rescission was officially performed by an insurance company committee, charged with considering the validity of the grounds for such drastic action. It turns out, however, this committee was just a sham rubber stamp for the actions of clerks and underwriters at lower levels. In the session where Mitchell’s insurance was canceled, a session where there were no minutes, notes, instructions or rules or even the barest written record, 40 cases were handled in less than two hours. That’s less than 3 minute per case, assuming there was no chit chat or time between cases. Pretty quick for matters of life and death and certainly too quick to see if the recommended action were based on verified or even plausible information.
In Mitchell’s case there was no attempt to verify a single scrap of information (involving a questionable date) despite abundant evidence in the record it was erroneous and not plausible. Even the underwriter had he doubts.
Were it not for the efforts of a tenacious social worker, Mary Wiggins, who worked with an agency servicing HIV patients, Mitchell would have been allowed to die and the evidence buried. Remember this case when people complain about being at the mercy of government bureaucrats. With private health insurance you are at the mercy of clerks and low level underwriters whose livelihood, is contingent on their employer’s main objective, to save (and therefore, make) money:
“In addition to these acts toward (Mitchell) there was evidence that Fortis has for some time been making recommendations for rescission, and acting on those recommendations, without good-faith investigation conducted fairly and objectively … Fortis pre-programed its computer to recognize the billing codes for expensive health conditions, which triggers an automatic fraud investigation by its “Cost Containment” division whenever such a code is recognized.”
A federal investigator who has reviewed Assurant’s remaining records says that they showed that once a person with HIV was targeted with a fraud investigation, the company made a greater effort than usual to cancel the person’s insurance. Policies and medical records were scrutinized to a greater extent than others being scrutinized, he said.
We won’t have real health care reform in the US until we are released from the clutches of these blood suckers. That won’t happen today, either way, but we can hope that it’s on the way. I hope I live to see it.