Letter: Health insurance companies ignoring the public trust
11 03 08 - 11:39
U.S. health care stands out as being the most costly and having so many uninsured. Failure can be traced to the insurance industry, which, for the most part, was given the very central responsibility of deciding who is eligible, treatment to be covered, premiums to charge and benefits to be paid. In satisfying their demand for profits, insurance companies ignore the public trust when they make up rules to deny individuals coverage and pay doctors unreasonably reduced amounts.
For many years a specialty company, solely owned by an insurance company and not accountable to any outside oversight, has routinely collected claims data from insurance companies. This database determines the “reasonable and customary” rates for reimbursing physicians. The New York state attorney general and the American Medical Association now accuse the companies involved of manipulating the data to arbitrarily reduce reimbursements.
Private insurance companies now market alternative Medicare programs. Their premiums cover administration and claim expenses, and provide a profit. In 2003, the General Accounting Office found major errors in over-billed premiums and underpaid benefits. When pressed to return $59 million to the beneficiaries or the Medicare trust fund, President Bush told the GAO that insurance companies are not required to return anything.
Under his administration, regular auditing was reduced significantly.
The insurance companies must not again be invited into the planning and administration of new health-care initiatives. They should not profit in processing medical claims. They may be large money contributors, but they disqualified themselves by their prior performance.
Kenneth Saum