Will the California legislature destroy Aetna insurance? Probably. It’s in the works.
Opinion by Consumer Advocate Tim Bolen
SB 840 (Senate Bill 840), a proposal to destroy ALL health insurance providers within California, and replace them with a State run system has already passed the California Senate with a vote of 25 to 15. The measure is headed for the California House where it will come up for a vote in November of this year.
Shocked? I’m not.
The health insurance industry brought this on themselves. Frankly, they deserve to get shut down. They are a pall on America. They, in a macrocosm, represent EVERYTHING wrong with health care in the US. The US, according to the World Health Organization (WHO) ranks seventy-second (72) in health care, with countries like Morocco, Costa Rica, Nicaragua, etc., rating higher in quality. But, of course, the US ranks #1 (Number one) in health care costs.
Did you get that? Seventy-second in ranking – number one in costs…
California has a population of about 34 million people – almost 12% of the total US population. A successful action here to destroy the health insurance industry will reverberate nationwide. “Me to” legislation, across America, will look like a domino layout played to a predicted end.
Good.
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The important point to consider here is that the California Senate could have chosen to simply rein in the health insurance industry – but chose, instead, to destroy it completely.
Why? A lot of very good reasons.
Regular readers of my newsletter will remember my criticisms of the health insurance industry. I’ve talked about some horrible things the health insurance industry has done to America. Apparently, the California legislature agrees with my analysis. Shortly, I’ll give you some of the reasons I’m sure my friends in the California Senate are looking at – but first, let’s look at what authoritative writer Peter Barry Chowka says about the SB840 plan. In his analytical article “Medicine, Inc. Moves To Further Restrict Privacy and Health Care Options As A Mandatory, Single Payer, Universal Health Care Plan Nears Passage in California Part One”. Chowka says:
B840 – Socialist Medicine Comes to California
Now, in the year 2005, in what may be the greatest single threat to the autonomy and freedom of millions of Americans to control their own health care decision making, California, the nation’s largest and arguably most politically and culturally influential state, is moving ahead to create a state-run system of government health care, effectively ending and criminalizing the system of privately financed health care that has been in effect in the United States since the country was founded.
The vehicle for this change is SB840, the California Health Insurance Reliability Act (CHIRA), a bill in the California state legislature that would establish a single payer system, outlaw private insurance, and set up a huge bureaucracy to decide how medicine is practiced in the state right down to the level of individual doctors and all other licensed health care providers. The head of this unprecedented program would be a partisan political position elected by the public to an eight year term. Strongly supported by the California Democrat party, SB840 has already passed the California Senate by a vote of 25-15 and is set to be voted on in the California Assembly after the November 2005 elections.
Health care has been moving towards a complete government takeover since the onset of Medicare and Medicaid at the federal level in the mid-1960s. SB840 would put all of health care for all Californians in a new state-controlled bureaucracy, with the costs for expanded care – including all medical treatments, prescription drugs, and even dental and vision care (eyeglasses) for everyone in the state including millions of illegal aliens – paid for by a new tax on all state residents.
Despite the enormous importance of this legislation in a state with 34 million residents that spends over $200 billion a year on health care, there has been hardly any national, and relatively little state, reporting by the news media on the subject. An exception is “A prescription for scarcity,” an opinion column in the Orange County Register on September 11, 2005 by John R. Graham which critiqued SB840.
“Under SB840,” Graham writes, “it will be illegal to buy health insurance that competes against that offered by the state agency. Nor will privately operated hospitals have the right to compete to serve patients. SB840 gives the state immediate control over hospitals’ operating budgets and control over capital budgets in the near future. Hospitals will need to seek approval from the state for operating budgets every three years based on estimates of procedures it will do. SB840 envisions a state health insurance agency that will sweep out all Californians from other programs. Even Medicare patients will be pulled out of the federal program, which allows a role for private insurers, and into the new state monopoly. While a provider may theoretically opt out of the system, he cannot bill extra. Technically, the [Sheila] Kuehl [Democrat Senator from Santa Monica who authored SB840] system would not limit coverage of any particular condition or procedure. But total spending will be limited to a certain share of the state GDP. When that limit is approached or breached, it is inevitable that services will be cut back. If a doctor thinks that his services are worth more than the fee determined by the state, he cannot ask the patient to pay the difference. In any case, the ability of providers to opt out is limited by reality. The state will tax all Californians to fund the system, and outlaw private insurance.”
Obviously, as you can tell from the tone of his writing, Chowka doesn’t think SB840 is the answer. Read his whole well-written article, and you’ll get an even bigger picture of the problem, and other issues surrounding the problem. Further into his discussion he makes an important point:
“The single payer, socialist medical system in Canada is often cited as an effective model for change by proponents of California’s SB840, similar attempts to “reform” national health care, and so on. But as Rep. Ken Lindell, a first-term Republican legislator in Maine, has written: “The Canadian model may be cheaper than ours, but only because it relies on rationing to contain costs. It fails miserably is in delivering quality care when it’s critically needed. The joke in Canada is that there is a 12-month waiting list for maternity wards.”
I tend to agree with Chowka’s analysis, but I’m looking at one other factor – and that’s the fact that this proposal, SB840, is far better than the current system. In other words, even from my Conservative Republican view, a“socialized medicine” system is better than the abuse we have now – by leaps and bounds. Keep in mind, too, that “drugs” in Canada, cost about 1/5th what they cost in the US.
Why would the California Legislature Take Such Radical Action?…
I’ll give you six good reasons – and I’m sure the legislature has been besieged by many more than that.
(1) “Five Minute Medicine” was born the day health care was institutionalized by health insurance companies.
What’s “Five Minute Medicine?” Anyone with a “Health Plan” knows the answer to that question. It’s where a person feels they need to see a “doctor” about something so they call the phone number of the HMO, get an appointment for a month-and-a-half in the future, wait an hour-and-a-half in the waiting room on appointment day, twenty minutes (nearly naked) in the examining room, to see a doctor for all of five minutes during which he/she listens to the patient for (maybe) two minutes – and takes the next three minutes to write three new prescriptions so the patient can go stand in line at the pharmacy.
(2) Then the patient finds out that their prescription “co-pay” equals fifty percent more than the total cost for the whole prescription was before “Big Pharma” was allowed, in 1999, by the FDA, to advertise directly to the consumer. Prescription pricing in the US is a scam.
(3) The Health Insurance Industry is trying to “regulate” medicine. They, themselves, have become an ungainly, and stupid, bureaucracy. They are long past the period where they were of benefit to the American people. They are now one of the biggest impediments to good health care in America. To them, medicine should fit into nice little boxes which they can use to make actuarial tables. The fact that different health professions, and different health professionals within those professions, would use different approaches to the same health problem (and expect to be paid), to them, and their thinking, is a “bad” thing.
To the health insurance industry, medicine is simple. In their computer, used by all of their employees, they already have, written in a little box, the “treatment” for each health condition, and what it will cost, and what they will pay. Something “new” will throw the whole company, if not the whole health insurance industry, into a tizzy.
(4) What results from the above (3) is that “medicine” succumbs to “Sutton’s Law.” Washington watcher Maury Silverman has been telling his friends in the US Congress about that situation. He points out that Willy Sutton, the famous 1930s bank robber, when asked why he robbed banks, replied “because that’s where the money is…”
With “Sutton’s Law” in place, doctors can only perform those things for which they can be reimbursed “because that’s where the money is…”
(5) Worse, is that there is clear evidence that the health insurers are abusing the health professional licensing system State-by-State. They use, and abuse, their “health fraud” investigator’s personal relationships with State and Federal agencies to “prosecute” health professionals through Administrative hearings designed to take professional licenses away from those professionals who dare to argue about payment for services. This problem is reaching crisis proportion.
In Wisconsin a few years ago, fourteen of sixteen professionals accused by the Department of Regulation & Licensing, were initiated by health insurance companies who simply did not want to pay claims. Those professionals, and a large Statewide support group, have initiated, and are testifying in front of, a Wisconsin legislative investigation of their own.
One of the worst examples of this abuse I’ve ever heard of happened, in Wisconsin, to Pain Management specialist Stuart Suster MD. His case is a horror story of abuse. You can read about his case by clicking here.
(6) Worse yet, are the accusations leveled at Aetna insurance in the “Cavitat v. Aetna” case. In that action Aetna is accused of making its health care decisions based on the opinions of members of a known crackpot organization – the courtroom discredited “quackbusters.” Aetna seems to be so worried about this case they are trying to get records of the case sealed from the public. Cavitat, I think, whose legal team is headed up by famous civil rights attorney Walter Gerash, wants to get this case in front of a jury ASAP.
Now, Walter Gerash, had as his mentor one Melvin Belli. Nationally, Gerash is on par with F. Lee Bailey, Johnny Cochran, Jerry Spense, or Robert Shapiro. Gerash, in the Courtroom, is a modern day William Jennings Bryan, an orator who, syndicated columnist Alan Prendergast says:
“He lurks in the bad dreams of hungry prosecutors and hidebound judges, a caped avenger in bolo tie and maroon beret. The cameras catch him exiting the courtroom in the eye of the media whirlwind, a feisty bantamweight with a large voice–a voice so thunderous when raised in outrage that one frazzled judge felt compelled to note for the record that defense counsel was bellowing. But if you’re in trouble with the Man, there’s no sweeter sound than when he stands before the bench and introduces himself:
“Walter Gerash for the defense, your honor.”
So, in review – Will the California legislature destroy Aetna insurance? Probably. Aetna, and the other insurers, have brought this action by the California legislature, led by our friend Senator Sheila Kuehl (Kuehl and the Gang) on themselves. I don’t see any better solutions on the horizon. So, let’s GO with this one.
Stay tuned…
Tim Bolen – Consumer Advocate