Saturday, October 24, 2009

The sequel: Evil insurance company repents

Never underestimate the power of a determined family, the press, the internet, and an outraged public. Guardian Life has changed its policy and apologized to the Pearl family. Ian Pearl will continue to receive the home care he needs. Read more about the repentant insurer at CNN or at the Washington Times, the newspaper that broke the story last week.

When I first commented on the Times story, I argued that the insurer was simply doing what for-profit insurers must do. I wrote, "What is evil is this: that we Americans allow our health-care system to be financed by industries that exist to make a profit. No other rich capitalist nation does this."

After hearing from Matthew Pearl, Ian's brother, I realized that Guardian Life had gone beyond the necessary evils of for-profit health care. I then wrote: "I now understand that the Guardian Life Insurance Company grossly misbehaved, even by the lax standards of the health insurance industry, and should not be excused for any reason."

However, Guardian Life's repentance does not get insurance companies off the hook, nor does it excuse the inherent evils in a health-care system based on profit. Insurers will continue to deny coverage where it is most needed. Most families will be unable to challenge insurers with the skill and tenacity of the Pearls. The cost of insurance will continue to rise, along with the number of uninsured...
  • unless Republicans stop whining and start crafting serious solutions.
  • unless Democrats stop bickering and start agreeing on a proposal with teeth.
  • unless everyone in Congress has the guts to forget about all those meals and junkets and campaign finance contributions lavished on them by the health-care industry, and votes for what is right and good and necessary.
You can contact your U.S. Representative here and your U.S. Senators here.

Monday, October 19, 2009

I was wrong. The insurance company was evil.

I was wrong. Last Wednesday I posted "An evil insurance company?" I argued that the villain in an obvious case of injustice--a denial of service to spinal muscular atrophy sufferer Ian Pearl--is not the insurance company, but the U.S. health-care system itself.

I still believe that the for-profit U.S. health-care system is a villain in Mr. Pearl's case (and in many other cases), because such injustices happen with regularity when health care is made a source of profit. However, I now understand that the Guardian Life Insurance Company grossly misbehaved, even by the lax standards of the health insurance industry, and should not be excused for any reason. The article I cited pointed out their misdeeds, and I should have paid more attention. The company's malfeasance became much clearer to me when Mr. Pearl's brother sent me this comment. It is attached to my original post, but I'm also including it here so that more people will see it.
Matthew Pearl said...

Ian is my brother. Thank you for including a link to the story. I'd like to explain, though, why the story is far more shocking than your post recognizes. This actually is unprecedented. Insurance companies are not allowed to identify an individual who is sick or disabled and drop him or her in order to increase their profit. That would be discrimination and illegal. So Guardian, instead, dropped the entire "plan design" for everyone who had it, doing an end-around the law. Not only that, our lawsuit uncovered documents--now public, now published in the article you link to--showing the executives planning a "hit list" of which individuals to target based on how much their health care costs. We're talking people with serious illnesses and diseases. They referred to my brother Ian and those like him as the "dogs" of the group they had to "get rid of" and "train wrecks." This was not the beginning. They had sent private investigators for years to try to find that my dad's business was not a real one, or some other basis of cancellation--which of course they didn't. They did this to the other "dogs," too: people who are paralyzed, have MS, cancer and other critical diseases. The truth? They thought Ian would die a long time ago. So did the doctors. So instead they pulled this. And in contrast to what you generously assume, they were still profiting in their small business division--big profits. At the time of this plan withdrawal, Guardian CEO Dennis J. Manning boasted that it had capital of $4.3 billion, net income of $437 million, and record shareholder dividends.

They're either an insurance company or they're not.

For those who want to help do something about this, please check the Facebook group I just started (click here).

Thank you again, LaVonne, for sharing the story.
You're welcome, Matthew. I have joined your Facebook group ("Help Ian Pearl show insurers he is not a dog") and encourage readers to join too. Guardian Life needs to be held accountable, and people thinking about health-care reform need to be aware of how low some companies will stoop.

Here's the big question: do all for-profit insurance companies behave as miserably as Guardian Life did?

In a just-posted article, "I am not a dog," Ian Pearls tells his story. He says:
I know firsthand that America's health care system has the capacity to provide incomparable, life-saving care. But I am living proof that insurance-company "death squads" meeting behind closed doors routinely make life-sustaining benefits vanish.

Several months ago former insurance executive Wendell Potter began speaking out about how one of America's largest insurance companies, Cigna, treats its clients. After interviewing Potter, Bill Moyers said:
Looking back over his long career, Potter sees an industry corrupted by Wall Street expectations and greed. According to Potter, insurers have every incentive to deny coverage — every dollar they don't pay out to a claim is a dollar they can add to their profits, and Wall Street investors demand they pay out less every year. Under these conditions, Potter says, "You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations."
Click here to read Moyers' article, see the interview, or link to Potter's congressional testimony.

Clearly the big health-care insurers don't want any meaningful reforms. Click here to read about how Edward Hanway, Cigna's CEO, is trying to "use his corporate connections to orchestrate the defeat of real health care reform."

It may indeed be that Cigna and Guardian Life and lot of other for-profit insurance companies are simply doing what business has to do in order to reward its executives and stockholders. I was wrong to say that such callous behavior is not evil, and I apologize. It is evil whenever an individual, or a company, or an entire health-care system puts profits above human beings. Come on, America. We can do better than this.

Thursday, October 15, 2009

The public option

This week as Congress tries to cobble together a health-care plan out of the five in circulation, I'm thinking again about T.R. Reid's excellent book The Healing of America. In August I linked to some of Reid's articles here, and in September I previewed his book here. Today The Christian Century posted my actual review of the book here, and I hope you'll read the review and then go buy or borrow the book. It offers a wide range of possibilities that just might work in the United States--at least, they are working quite well elsewhere.

Meanwhile, this is the week to contact your member of Congress. After reading Reid, I think the best system for America would be to keep private insurers but require them to be not-for-profit. That's not going to happen, though, so I'm convinced that the second-best system would include a public option to ensure that everyone has basic health-care coverage at a reasonable cost.

If you too are in favor of a public option, click here and consider signing Howard Dean's petition, to be presented to Congress Monday, October 19. Congressional Republican leader John Boehner has said he doesn't know anyone outside Congress who is in favor of the public option. Let's introduce ourselves.

Wednesday, October 14, 2009

An evil insurance company?

A friend sent me a link to a Washington Times article, "Insurer ends health program rather than pay out big." The subject line of my friend's e-mail was "Evil insurance company." I disagree.

It's a sad story. Ian Pearl, 37-year-old brother of novelist Matthew Pearl, "has Type II spinal muscular atrophy - which often kills victims in infancy. He grew to adulthood only to suffer respiratory arrest at 19. He has required a tracheal tube ever since." His insurance company, Guardian Life, is "legally barred from discriminating against individuals who submit large claims. So "the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl's."

Mr. Pearl's care costs $1 million a year. Without it, he will probably die.

Why don't I think the insurance company is evil? Because a for-profit company has to watch its bottom line. It is responsible to its shareholders. It exists in order to make money. If it doesn't, it will fail; and if it fails, even more people will be uninsured.

What is evil is this: that we Americans allow our health-care system to be financed by industries that exist to make a profit. No other rich capitalist nation does this.

Many developed nations finance their health-care systems through private insurance companies. The difference is this: everywhere else, basic health insurance is required by law to be not-for-profit.

Our legislators are trying to reform health care without reforming the evil that is at the heart of our system. Until the profit motive is removed from basic health-care insurance, we will continue to read stories like Mr. Pearl's.

Monday, October 12, 2009

Adam Smith meets the rich young ruler

For more than sixty years American presidents have tried to reform our health-care system, to no avail. In the same time period, all other developed nations have set up systems that insure all their citizens, that spend less per capita than we do, and that have better outcomes in almost all categories. Why are American still lagging behind?

Ethicist Daniel Callahan diagnoses our problem in the most recent issue of Commonweal magazine and comes to this conclusion: we suffer from “the absence in this country of a solid common-good tradition.”

In his thoughtful article "America' Blind Spot: Health Care & the Common Good," Callahan points out that the absence of a common-good tradition is not ideologically based—it is felt at all points on the political spectrum. “In their opposition to liberal reform efforts,” Callahan writes, “conservatives invoke freedom, choice, and competition as their leading values. Liberals—and the Obama administration in particular—have no agreed-upon set of countervailing values.”

Instead of the common good, says Callahan, liberals have appealed to rights, obligations, and justice—fine concepts, but without much curb appeal. Conservatives invoke radical individualism, even though one of their heroes, Adam Smith,
believed that markets could not flourish without a strong underlying moral culture. Smith believed that such a culture is animated by empathy and fellow-feeling, by our ability to understand our common bond as human beings and to recognize the needs of others.

And all of us argue about the bottom line.

Sunday’s Gospel reading was about a man who asked Jesus what he needed to do to inherit eternal life. Jesus told him to sell his possessions and give them to the poor. “At that statement his face fell, and he went away sad, for he had many possessions” (Mark 10:22).

I confess: I don’t want the poor to take any more of my possessions. I pay taxes. I give to charities. In the wake of the recession, our income has taken a serious hit, and a tax increase would hurt. I would much rather offer the poor someone else’s possessions. Why not help them, as many European countries do, by restricting doctors’ income and insurers’ profits?

Strangely, my cardiologist’s office doesn’t want to lose any of its possessions either. A recent mailing urges patients to oppose health-care reform and Medicare changes, warning that their lives may be endangered if cardiologists are prevented from making big bucks from overusing expensive diagnostic equipment (this is not, of course, how they phrase it).

Oddly enough, insurance companies would like to hang on to their possessions too (though almost everybody in America thinks that Aetna’s CEO probably doesn’t need every cent of the more than $24 million he made in 2008). No wonder they are doing their best to scare us into keeping the present system.

Without a shared belief in the common good, who among us will go first? Or will we do nothing, hang on to our possessions, and go away sad, leaving health care unreformed and the poor uncared for?

Here is how Callahan concludes his fine analysis:
Suffering, disease, and death are our common lot. They ought to be dealt with as our common problem. It is a shame that the kind of empathy and mutual support that Adam Smith understood to be a requirement of morality have not, in our culture, been extended to health care—extended to one another in the recognition that we all have bodies that go awry and fail. Instead we are offered a consumer model, a national Walmart of medical choice where we are all sharp-eyed purchasers getting the best possible deal for ourselves. A construal of the common good as the freedom of consumers to get what they want, indifferent to the fate of others, is a cheap substitute for the real thing.

Callahan expertly diagnoses our problem, but he does not offer a solution. National revival comes to mind, but America already has a much higher percentage of church-going Christians than the countries that take care of all their poor and suffering. Maybe we won’t really care about the common good until more of us Americans experience poverty and suffering first hand.

Friday, October 2, 2009

Review: Travel as a Political Act

Rick Steves was a teenager when he first traveled overseas. Visiting a park in Norway with his parents, he had an epiphany:
Right there, my 14-year-old egocentric worldview took a huge hit. I thought, "Wow, those parents love their kids as much as my parents love me. This planet is home to billions of equally lovable children of God." I've carried that understanding with me in my travels ever since.

Now famous for his travelogues on public television, his guided tours of Europe, and his guidebook collections including the constantly updated Europe Through the Back Door, Steves is somewhat less well known for his devout Lutheran faith and his devotion to liberalizing America's drug laws. All of these interests coalesce in his new book, Travel as a Political Act.

Steves's message is simple: Go to other countries. Listen to the people who live there. Learn other ways of seeing and doing that you might not have considered before. Some of these ways are better than the ones we're used to. Some could help us make our country a better place.
America is a great and innovative nation that the world understandably looks to for leadership [he writes]. But other nations have some pretty good ideas, too. By learning from our travels and bringing these ideas home, we can make our nation even stronger. As a nation of immigrants whose very origin is based on the power of diversity ("out of many, one"), this should come naturally to us ... and be celebrated.

The book consists of eight essays drawing on his travels not only in Western Europe but also in the Balkans, Turkey, North Africa, Central America, and Iran (click here to watch his hour-long presentation on "the most fascinating and surprising land I've ever visited"). One thread unites the chapters: Steves's plea to us Americans to open our minds, ears, and hearts to people of other cultures and to learn to see things from their perspective. "Growing up in the U.S.," he writes, "I was told over and over how smart, generous, and free we were. Travel has taught me that the vast majority of humanity is raised with a different view of America."

I'm not a world traveler like Rick Steves but, beginning right after my sixteenth birthday, I've gone to school in France and worked in the U.K. and visited most of the Western European countries as well as Turkey, Syria, Lebanon, Israel, Taiwan, and Thailand. I've never, ever been treated rudely because I'm an American, but I've been startled to catch glimpses of what some non-Americans think of the American way of life.

I've watched anti-American banners parading down the street at a Swiss May Day parade, seen British TV political adverts warning that the opposition party might instigate a health-care policy as dreadful as America's, listened to an entire sermon in an English country church lambasting American evangelical religion, and heard German conservative evangelical politicians express disbelief and fury at the actions of George W. Bush. To me, Rick Steves's observations about how people of other nations view us ring true.

Rather than dominating other nations, Steves believes, we should listen to them and learn from them. A self-avowed capitalist (he runs a business, after all), he nevertheless sees value in some of Europe's social programs and is horrified by what U.S. businesses have done to Central America. An unapologetic Christian, he is comfortable with secular Islamic--not Islamist--governments. Appalled by Iranian totalitarianism, he still finds common ground with people he meets and even explains why the omnipresent "Death to America" posters may not be quite as menacing as they seem. And he thinks Europe's ways of curbing drug use are much, much smarter than America's.

As the title indicates, Travel as a Political Act has a strong political slant, but it is also full of human interest stories and quirky factoids about other cultures (did you know that on October 24, less than three weeks from today, the average American will have worked as many hours as the average Western European works in an entire year?). Color photos on nearly every page add to the book's appeal. Steves hopes to appeal to people of all political persuasions, though I suspect he is preaching largely to the left-leaning, well-traveled choir.

One reviewer at wrote Steves off as just another liberal from the Northwest who is clueless about how the rest of America thinks (she doesn't say if she has traveled outside the U.S.). It seems to me that Steves knows a lot about how Americans think--and he is terrified, because too many of our views are not based on reality or understanding. Only to the extent that we know how others think--those "billions of equally lovable children of God"--will we Americans be able to add to the world's peace, prosperity, and freedom.