Insurers don't pay for anyone (except themselves)

Let’s cut through the nonsense being talked about health care. It doesn’t matter what party you support, it doesn’t matter if you never vote, it doesn’t matter if you’re fit as a fiddle or have chronic problems, if you are reading this you are human.

With any bio-mechanical machine, there are maintenance issues, there are breakdown issues and there are medication issues. And the way the health-care system deals with these issues is paper pushing and fiscal planning for those who stand to profit.

Health insurance is really health accident insurance. There is no keep-healthy insurance in America. That is up to you. Like your car insurance, basic coverage is there to insure the other guy on the road in case of an accident (third party insurance) or, if you have enough money, insure you against your damages. What, who, pays for basic health accident insurance? You do with your taxes, the ridiculous New York state taxes (local and state) for all that Medicaid coverage for people who have no self-insurance.

So, if you want to understand insurance in America, you have to start with this concept: Everyone in America is already covered for catastrophic illness by Medicaid. Alright, it’s not really good coverage, but then neither is the cheapest car insurance (which, by the way, relies on medical costs being covered by the state). So we already have socialized medicine (we just don’t want to admit it).

For all my staunch anti-social program friends out there, remember that VA insurance and Medicaid/Medicare coverage you benefit from comes from the general public good, the social dollar pool, so stop pretending social programs are evil on the one hand and taking benefits with the other.

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The second thing to realize is that insurance companies cover the rest of the cost through premiums. And they calculate premium cost based on a profit margin over what they have to pay out.

As long as they make 10 percent over their outlay, they do not give one fig what healthcare costs are. In fact, they have a built-in incentive for higher health care costs (as long as they don’t kill the goose that lays the golden egg) because higher costs mean more profits. And, as we all know, if they can, they don’t pay. Pure gravy.

Each year they meet with the Association of Trial Lawyers to fix the prices for insurance payouts for everything from medical malpractice to injury (loss of a finger, that sort of thing). These are agreed sums below which the trial lawyers won’t or should not sue and above which they won’t pay (without being forced to, in court, after many, many years).

And they meet with the hospital groups to fix basic medical procedure payment. So, if the claim is more than they have price-fixed as an industry (that is, as a trust as defined by Teddy Roosevelt), they don’t pay.

Sharon Hospital has 78 beds. Sharon Hospital has a Blue Cross adjuster just for Sharon Hospital. The Blue Cross adjuster drives a Cadillac and makes twice what the young emergency doctor does. Their adjuster has better benefits. The hospital doctor studied eight years, the adjuster two. Who is the more valuable to you, the patient?

You want medical insurance, fill out the form provided. And there it is, in the fine print, “Have you ever been refused medical insurance coverage?â€�  This means the following: You are uninsurable, end of discussion. They don’t pay.

And if you had never been refused coverage, there are those questions on existing conditions. This means the following: Your pre-existing conditions are not covered. They don’t pay.

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Now let’s assume you passed the basic tests and got medical coverage. Don’t get sick. Please. When you do, your coverage goes up, dramatically. Of course, they say they never increase premiums based on your one-year claims… but after 35 years of paying these fees, that is not my experience. They don’t pay without getting it all back.

I had emergency back surgery in New York after a doctor misdiagnosed an MRI and that year our premiums went up 20 percent, surprise, surprise, and have risen every year since, of course.

So, even if you are never sick, never claim, you pay for medical coverage, either private or simply for Medicaid and Medicare. And if you get really sick you pay and can pay more evermore. And if you are chronically ill or have a pre-existing condition you cannot change insurers because your primary ailment will never be covered.

And if you ever filled in a medical insurance form and were refused for any reason (it could be something as simple as a current pregnancy), then you join the “uninsurable.� You are a bad risk. They don’t pay.

To sum it up, you pay for medical coverage through your taxes. A trust-bust-able, heavy lobbying force, doesn’t pay – but they control and set medical reimbursement prices, not the government, not your doctor. They do, a fully independent business acting in collusion as a trust. They simply don’t pay, unless they have a profit clearly mapped out, already colluded with lawyers, price-fixed with hospitals (themselves running a mark-up business profile) and supported by all the politicians in Congress with their hands out. Them they pay.

Now watch your Congressman or woman argue the American Health System Reform; what a sham. I wish reform would happen, but I fear it won’t because we, the public are the real stooges here, we’ll believe the lies on insurance paid TV ads, we’ll let Congressmen and women tell us Obama is in too much of a hurry (tell that to the 40 million Americans with no coverage except Medicaid — your taxpayer dollar down the drain), and, most of all, the insurance guys who prefer not to pay as a rule will make sure they keep the system they want and currently run – the  system that reaps them so much profit.

What are a few lobbyists’ back-handers to Congress to keep their control? What are a few million on spurious TV ads? What are a few million to Rush to make him scream socialism yet again, or have a few “centrist� Democrats telling the President to slow down while they kill public interest? Their money train is a risk, not health care; their trust might be broken up. For them the money and power risks are great. For all of us, our lives are at stake. I say to heck with all of them, I vote for us.

Peter Riva lived in Amenia Union before he relocated to New Mexico.