Tuesday, September 1, 2009

My Definition of "Underinsured"

Some last week, I was listening to yet another Punditocracy Round Table when I heard something that truly pissed me off. One journalist, giddy over the healthcare fight (one can afford to be giddy when one isn't in the least bit affected by such trifling matters), tittered:

"Sixty-eight percent of all bankruptcies last year were due to medical costs. Eighty percent of those already had medical insurance. They were underinsured."

Yes, those numbers are really disturbing and tragic. But what really got me was that term: "underinsured." It's a term we often hear casually bandied about--so much so we really don't even contemplate what the word actually means. But who are these "underinsured" people?

Now, health insurers aren't the only ones who use this term. Other insurers use it, too. For example, 10 years ago, I was driving down the street and was suddenly hit by a woman who didn't see me and turned left right into my car. There was no contesting that it was the woman's fault. No one argued that point. However, she had State Farm, and we had Geico. State Farm argued that they didn't want to spend the $2,800 to fix the car. They wanted to total it and give us $3,500. "Why complain?" you may ask. "You got a new car out of the deal." No, I got a new car payment out of the deal. I argued, "Why should I have to buy a new car because somebody hit me?" Neither Geico nor State Farm saw it my way. They both agreed that I was "underinsured" and had to take the check.

My boy, Nameless, often talks about how Hurricane Katrina home owners were further victimized by home insurers. Apparently, a whole bunch of insurance holders discovered that they were indeed not covered by their insurance. They learned that they, too, were underinsured. No, they had flood insurance for their homes. However, apparently, it wasn't the flood that damaged their homes. It was the wind. They weren't covered for that.

How insurance companies get away with such fuckery is still beyond me. After all, home and car owners work hard and pay their premiums to guard against such catastrophes. In most states, they are actually forced to own their insurance. Yet, insurers can find some fine print to renege on their end of the bargain.

In most other industries this would be considered fraud. Imagine, you're paying your mortgage for decades and just when you're about to pay it off, the bank says: "But, Mr. Campbell, you bought a single-family residence. Remember when your brother and his family moved in for a couple months when he was unemployed. Well, that was a violation of your mortgage. We'll have to foreclose." Or think of paying your car note every month and then getting your Volvo repossessed because your car was built for city use and you took it out on the highway.

Those companies would automatically be shut down, folks would get sued, bastards would be thrown in jail. Yet, you can be underinsured because of wind damage?

Now, in a bald, naked, purely capitalist sense, you can understand where insurance companies are coming from. After all, they can only make money if they don't pay out claims. You pay out your insurance in case the rare instance of a car accident or friggin' hurricane comes along. Insurers make money hand-over-fist because these things generally don't happen. Car accidents do happen fairly frequently, but they're generally pretty cheap for your insurer. But hurricanes, floods, fires. You can make a mighty fine dime receiving money for that rarity. And if you can actually deny people payment for when it actually does happen.

But what about health insurance? Health problems are not rare at all. As much as we hate to admit it, sooner or later, we will all be using the health care system at some point in our lives. Either something horrific and tragic will happen to you (car wreck, etc.) where you'll be draining the system when you're young. Or you'll grow old and degenerate and spend the last two months of your life in a hospital ward. Knowing that, how can health insurers even make a dime?

Why ... by denying care and costs, of course. After all, a lot of "health-saving treatments" can run into six figures. Knowing that every ... single ... one of their customers will one day garner such costs, they couldn't possibly make a profit if they paid all those bills out. Now could they?

So, when we're talking about health insurance customers, the people who accounted for roughly 50 percent of the bankruptcies last year, who exactly are the "underinsured"?

Though the insurers, those on the Right, Tea Baggers, and those who just don't want to think about this debate won't admit it, the "underinsured" are all of us. They are people who work and either through their employers or on their own pay their insurance premiums and co-pays every month. They can be like Shannon in Bethesda with their Cadillac plans or they can have catastrophic coverage like yours truly. But one thing they have in common is some kind of serious medical issue--whether it be illness or accident. The other thing they have in common is that their insurer stopped paying.

But, with terms like "underinsured," the insurer puts the onus on the victim/customer. "Oh, your Cadillac's warranty ran out." "We would've covered your accident, but you didn't buy the Getting-Crushed-by-the-Vending-Machine-While-Having-Lunch-in-the-Break-Room-while-Talking-to-Your-Boss-and-Four-Other-Co-Workers-One-of-Whom-Is-Named-Sally coverage. Sorry."

Those bankrupted with their "Cadillac" plans discovered that they weren't allowed to get the tinted windows. Or rather, there was some procedure or other that the insurers decided, in retrospect, they weren't going to cover.

With their catastrophic insurance, they found out, after paying out the wazoo every time they even think about going to a doctor, that their catastrophe was just too catastrophic to be covered by their insurer. Even though their insurance was supposed to pay only for such disasters, they found their bills re-itemized endlessly until they found themselves paying the lion's share of their "insured" care.

All of these people scream, "But what happened to my Cadillac?" "But I don't even work with a Sally?" while their insurers shrug oh-so-helplessly, saying, "Sorry, but you took your city car out on the highway. You were underinsured."

As I said, in any other business, these insurers would be sued for fraud. Bastards would be arrested. But the insurers of all our fates don't have to worry about such trifling matters. They not only game the system. They own the system. They throw millions at our politicians. They have them cowering any time they even think about reforming the industry. Did you see how quickly single-payer was thrown off the table, shuffled off to the back room, gang-raped by our pols, and left for dead? You see how quickly Obama was willing to give the same treatment to the public option? Have you noticed how rabidly they've gotten the demographic most affected by these medical-care bankruptcies, the white working class, out there at those town hall meetings, frothing at the mouths, waving their American flags, and screaming that Obama is a Nazi?

Most importantly, see how we all accept the term, "underinsured," without a moment's pause?

"Fuck" and "cunt" are considered too profane to be included in any serious public discourse. We would simply go berserk if any politician, pundit, podunk hick uttered them in a public speech. If you ask me, "underinsured" is far more profane than either of those words could possibly be and should be expunged from any speech concerning the health care debate.


jadedj said...

An excellent case for taking the profit out of health care...period. Screw the insurance industry. I am for nationalization of heath care, and treat it as if it were in the same category as police, or fire, or any other public service. Who the hell cares if the insurance industry goes under. They should go under. They contribute NOTHING to our betterment. Nothing.

Excellent post. Keep gnawing at them.

Paula said...

One of our nephews and his wife just had a baby. She had a terrible pregnancy and the baby was born very early but now, at 2 months, is doing well. So far, their bill is up to $750,000...'nuff said about underinsurance. Whoever has enough insurance for that?

They don't really know what will happen, in terms of their insurance. They have insurance, but both the mother and baby may have reached their lifetime cap.

Can you imagine starting out your life uninsurable at any price?

Keep up the good work, Bill.

boukman70 said...

Thanks, yall. My God, Paula. That story's just absolutely horrific!