I write all day at work. Lucky! you might say. And yeah, it’s the kind of work I’m good at. But it’s not that simple.

You see, I work for a health insurance company, and my job is to write correspondence, all day long, letting doctors and hospitals know why we’re not paying them for treatment–or not paying them as much as they thought we would be.

There are all kinds of reasons for why a medical provider might not get paid. They didn’t jump through the hoops of getting the treatment authorized. They did not sign a contract with us. Our medical experts have reviewed the treatment and deemed it to be experimental.

I can take some slight comfort in the fact that most of the time, when the insurance coverage is denied, the provider is required to write the charges off–so they are not allowed to bill the denied amount to the patient. Still, I’m sure the extra costs are passed on in one form or another.

Why am I telling you all this? Well, just to let you know that I am, in fact, what Sarah Palin and the Tea Party warned you about back when they were screaming about Obamacare. I am the bureaucrat who stands between you and your health care.

Of course, Republicans are strangely silent about people like me. Apparently, the fact that I’m getting paid for my health care denials by a private corporation rather than the government makes them more acceptable. On their end, medical providers have to create entire departments to deal with insurance billing and authorization rules, time and money which isn’t being spent on treating patients. Once again, though, the same conservatives who abhor extra government regulations are very capable of turning a blind eye to those same regulations when they are created in the name of private profit.

The truth is, health care costs will need to be controlled, no matter what the system in place. If we ever do have a single payer system, it will be funded with taxpayer money, and that taxpayer money should be treated with respect. We will still have to determine that the treatment being prescribed is reasonable, and that providers aren’t recommending unnecessary procedures (and by the way, providers trying to charge patients for fraudulent or ineffective treatment is something which happens frequently in our for-profit health care system). Republicans try to paint a scary picture of a single payer system in which you will be restricted from getting the care you want, whereas they claim that in a privatized health care system you have the freedom to choose any doctor and treatment you like. That is simply not true. Sure, you are free to choose any service you like–if you can pay the sky-high uninsured costs for it, which the vast majority of people can’t. You need health insurance to help pay for your care, and when you have insurance, the insurance company restricts what care you can get.

Of course, in our system the very wealthy do have the freedom to pursue whatever kind of medical treatment they want–and travel to get it wherever they like–and these are really the only people the conservatives in Congress care about, anyway.

My fundamental point is that single payer health care is nothing to be scared of. Your health care options are not going to be any more restricted than they are now, and you will be able to get treated for your illness or injury without having to go bankrupt in the process. Not a bad idea at all.

Take it from a health insurance bureaucrat.

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This blog post dedication goes out to a very special presidential candidate…and the way he’s changed my life.

As some of you may know, I work in the health insurance industry, for a local company which shall remain nameless.  Yes, it feels paradoxical to be working in that field when I’m a supporter of a single payer system, but that’s life for ya.  Working in insurance may seem like the most boring career path ever–I’m like Kafka without the brilliant novels–but over the years, I’ve enjoyed my job and found some good friends among my co-workers.  It’s been a nice stable paycheck, and I was hoping to keep working there for years to come.

And now the company I work for is imploding.  Why?  Well, there are multiple factors, but a major one stands out.

When insurance companies agreed to join the Obamacare exchange, the government promised them payments from something called a risk corridor program.  This was meant to compensate them for the fact that they would be taking on a large number of new customers who had been uninsured for a long time, and thus would be very sick and would need costly treatment.  This turned out to be true, and costs for the industry have been even higher than expected.  If anything, this is evidence for just how broken our healthcare system was previous to the Affordable Care Act.  All these newly insured Americans are now finally receiving care for medical conditions they were often forced to neglect because they couldn’t afford to have them treated.

I certainly do not expect sympathy for insurance companies in this scenario.  However, the risk corridor payments were supposed to make the transition to Obamacare smoother and keep the health care infrastructure from falling to pieces.  Supposed to.  But only 13% of the risk corridor money which was promised has been paid out.  And it’s all because of that one very special guy.  Yep, Marco Rubio.  Marco cut most of the risk corridor money out of the budget, and he’s very proud of it.  He brags about being the only conservative who has truly succeeded in damaging Obamacare.  Because it’s so much more important to stick it to the President than to allow Americans access to health care…

So now, insurance companies across the country are going out of business, employees are facing layoffs–and the truly frustrating thing is that Obamacare is getting the blame.  I’m hearing it myself around my own workplace.  It’s easy to think that it’s Obama’s fault, if you haven’t heard all the facts.  Rubio knew what he was doing.

Okay, so saying that I’m not voting for Marco for President is a bit of an empty threat–it’s not like I was going to vote for him before.  Still, I’m definitely never voting for him now. Not for dogcatcher.  I’d gladly vote for Bernie over him.  A shoe could be running against him and I would vote for the shoe.  Call it a personal grudge.

Say it with me, everyone:  elections have consequences.  Think there’s no difference between the candidates?  Think it’s not worth your time to vote?  Nope, nope, nope.  My future, and the future of almost 2,000 other workers, hangs in the balance right now because of the actions of one man.  Vote like the quality of your life depends on it… because it does!!!

So what is the Republican party going to do to discredit Donald Trump?

They’re going to have to do something–they can’t allow him to be the nominee. In fact, that’s what I keep hearing: “Reince Priebus is going to do something.” But what? I’m racking my brains and, for the life of me, can’t come up with what that will be. So far, Trump has been saying offensive thing after offensive thing, and still going up in the polls. He attacks Latino immigrants–up in the polls. He attacks a Fox News host–up, up, up.

Since a lot of Trump’s appeal stems from his outsider cred, it might be possible for his opponents to undermine him if they can somehow portray him as an insider–a moderate or on the side of the Democrats. But right now, that doesn’t seem to be working either. He came right out and said he likes single payer health care at the debates. He’s fine with Planned Parenthood. His fans don’t care.

So what will the Republicans do? As we speculated, my mother came up with an elegant solution. “If it gets too close to the convention and he’s still the frontrunner, they’ll just shoot him.” I wonder if they could get away with that? They could always claim they mistook his hair for a lion….

On the other side, the Democrats are stuck with a similar dilemma. I’m sure they’ll want to get rid of Bernie Sanders. Perhaps they can do so by making the argument that he would be unelectable in the national contest. But that argument is getting harder to make as Bernie rises in the polls and Hillary continues to sink into her e-mail scandal. What happens if Hillary is too wounded to go on and Bernie sticks around?

I’ve got enough cynical faith in our country’s political machine to believe that we will, in the end, get the designated mainstream nominees we were meant to have in the first place. But the plotline of how we arrive there could be very interesting indeed to follow…stay tuned!

July 4th seems like a good time for an optimistic post. I’ve been experiencing the implementation of the Affordable Care Act (“Obamacare”) first hand, as I work in the health care industry, and here’s a little update about how that’s been going….

The start of this year was complete insanity, as the insurance company I work for scrambled to deal with a steep increase in business. And no, the fact that we weren’t *quite* as prepared as we should be was not the government’s fault… Thankfully, things have stabilized now and my days are no longer crazy and overwhelming. However, we still have a lot more customers and a lot more work, so there is still overtime available. And this, of course, means fatter paychecks for me. Sheesh, thanks a lot, Obama! 😉

At home, my mother finally has health insurance, after years of going without. Now it’s just a matter of talking her into going for a check-up…but that’s not an issue of cost anymore, just her dislike of going to the doctor!

So far, the effects of the Affordable Care Act on my life and the lives of my loved ones have been positive. Could things have been better? Sure. A friend of mine recently received some very bad news about her health, and this has been a blow to all of us who know and care about her. The one silver lining? She is very grateful that she made the decision to move to Canada shortly before she was diagnosed with her illness. In her Facebook posts, she almost always mentions how thankful she is to be part of the Canadian health care system. She has more than enough to deal with right now, but at least she doesn’t have to worry about going into debt or not being able to afford her treatment. And that’s a relief.

So yes, single payer would be even better. But, since that doesn’t seem like a realistic option in the States anytime soon, I’ll take the health care reform we’ve had over nothing. Here’s to our beautiful country reaching even higher in the years to come. And remember, you don’t have to believe the anti-ACA propaganda–Happy Independence Day!

Okay, here is one of those situations which makes me question if our health care system is really the “best in the world”.  The Wall Street Journal reports today that UnitedHealth announced a 5.5% rise in its profits, higher than expected.  This is reported as very good news for the economy, as UnitedHealth is the first medical insurance company to reveal its profits this quarter, and is a good indicator of how other insurance companies are doing.

The reason UnitedHealth’s profits are higher than expected?  Due to the recession, people have been avoiding hospitals and doctors in order to save money.

This right there is a problem.  We have a system in which patients and insurance companies are on opposing sides.  Patients have to use as few services as possible if the insurance company is to make a profit.  The criticism we always hear of a government-run system is that it would deny people services, but it sure seems to me like the private insurance company would also want to find ways to deny its customers services, otherwise, where is the profit?  This, of course, is why we need Medicare–the elderly get sick too often to be profitable.  The article states that as the economy gradually improves, the use of medical services is expected to pick up again–but will that not be bad news for the insurance industry, and thus bad news for a large sector of our economy?  This sounds like a lose-lose situation.

Granted, there are inefficiences and abuses in the health care system, and the population of our country could stand to lead a healthier lifestyle, which would cut down on health care costs.  But the thing about medical care is, it’s not always a choice.  Sometimes you simply need to be able to use it.  And if people are foregoing preventive care which could avoid more serious problems later so that they can save money, the results of that cannot possibly be good.

Naturally, the irony of all this is that the Affordable Care Act does not scrap the private insurance industry.  Rather, it expands the customer base for it.  So this blog is by no means meant to sing the praises of recent health care reform.  It is just meant to express yet again the serious doubts I have about our current system.  If there is any way to read the above news about UnitedHealth and take away something positive from it, I would love to hear it.

 

Yes, to all of the people mourning the Supreme Court decision today:  it’s true, your liberty has died.  As someone who grew up under a universal health care system, I can tell you that it’s just complete tyranny.  They forced you to go to the hospital!  They forced you to take an ambulance!  Even if you weren’t sick!

Actually, no such thing happened, of course.  When we lived in Holland, we went to the doctor and got the same treatment for our problems as we do here, except that over there, we didn’t have to worry about the financial aspect of the situation.  The people we know in Europe who get a serious illness only have to stress about the illness, which is bad enough in itself.  They don’t also have to stress about going bankrupt.

Anyway, I’m pretty sure I’ve already mentioned all this in previous blogs, but it bears repeating, since people continue to tell fables about how in a single payer system, you will no longer have “freedom” when it comes to your health care.  The only loss of freedom which I will freely acknowledge happens under a single payer system is that you may end up paying higher taxes.  Speaking of which, I’m thinking of taking the train to the library tomorrow–yet more terrible impositions from my local government which I will have to suffer under.

On a small added note, I’m so glad I was wrong about how this decision went today.  For once, my pessimism was proven incorrect.  But I’m still feeling pessimistic about the election in Nov…hope I’m just as wrong about that one!

Okay, so that Plan B I had in case everything went to hell?  I hate to be a pessimist *again*, but it seems to have flown out the window and bounced out the door.  At least one aspect of it.

I was hoping that if we truly went to Hades in a conservative handbasket, I would be able to focus on local political action.  Specifically, I had imagined that if the Affordable Care Act was struck down by the Supremes, there would be ways for progressive activists to make universal health care happen here in Oregon.  We’re a liberal state, so it didn’t seem like a stretch.  Or I could finally give in to my mother’s nagging and move East, to Vermont or Massachusetts, one of the states that had a good health care system already in place.

Now I’m hearing from various places that if the individual mandate is rejected by the court, this will automatically make the individual mandate in these state programs unconstitutional as well, and it will mean that most of these plans will come to an end.  I’m hearing this from fellow liberals, not conservatives.

Is this true?  I really hope it isn’t.  If it is, there’s nowhere left to go.  Every place in America, even the places which would like to have universal coverage, will be stuck with the abuses of the status quo system.

There’s always the option of going overseas:  plenty of countries which not only have universal health care, but take it for granted and don’t have to deal with huge political fights about it.  But as I’ve said before, I just don’t see myself leaving this country.  I have too many friendships, people I care about—I have roots here now.  I’ve grown to love this place.

So, Plan C—if things are going down in flames and there’s not much I can do about it, I’m going to sit back and enjoy the bread and circuses, and the good company.  If we’re headed in the direction I think we are, and I end up living in the slums, at least I’ll be with my friends!