Yeah, same old story. My technique since I'm retired, is sit at the computer, checking out websites, and use as much of their time as possible. I know it doesn't matter, but at least I get some satisfaction.

Ms. Poole describes perfectly the predatory function of the capitalist "health-insurance" scam -- the for-profit death-panels from which (thanks to Barack the Betrayer and the ReplicRats) -- there is no longer any rational hope of escape.

What we have instead, cleverly disguised as "health care," is a system of socioeconomic cleansing without death camps -- already a documented 40,000 women, children and men knowingly killed every year by denial of insurance and insurance claims.

Factor in the impending destruction of Social Security, Medicare and Medicaid, the number of slain will skyrocket. It's the new paradigm of capitalist governance in the United States: extermination for anyone who is elderly, disabled, chronically unemployed or otherwise deemed no longer profitable -- that is, no longer exploitable for profit.

But none dare call it genocide...much less admit it's an ultimate revelation of what capitalism is really about.

I can't argue with any of this, just point out that government insurance is not necessarily any better. She can try her counseling with Medicaid.

Speaking of Kafka.......he had a day job. After graduating University, the only job he ever held was as a lawyer for the Worker's Compensation Board on Prague.

I am constantly amazed by people who froth at the mouth at the thought of a government bureacrat standing between them and their doctor, but don't mind it a bit when it is an insurance company bureaucrat in that same spot.

@kilgoretrout--true, the public and private sectors can be equally bad at delivering health care. And both can do a much better job, too. The state's Uniform Health Plan has been generally great to work with in my experience and from what I hear from colleagues; so has Premera/BlueCross. Today, I think the most challenging thing for providers and consumers is the sheer variety and unpredictability of what to expect from one's plan, and the sense that there's not really a functioning floor in place, a minimal standard one can expect. When the problem is a government program, at least we have the right to complain to our elected officials. But when corporations can get away with mugging people, then that just makes it harder for other corporations to hold to a higher standard, and still offer competitive rates.

The run around and the stall are intentional. The insurance companies make a fortune on the interest earned everyday a claim is in processing. Even for the most legitimate claims that will eventually be paid, for everyday the insurance company can hold off actually processing the payment to your doctor or the lab, hospital or pharmacy or whoever, they invest and make millions. It is in their financial interest to delay, delay, delay. They do it intentionally. Another example of the perverse incentives in our so-called health care system.

I think coolpapa has identified the problem but balked at offering the obvious explanation. Worship of the "private sector" has become a religious belief unrelated to, and in defiance of, any basis in fact. Corporate brainwashing and supportive right-wing ranting have duped Americans into believing that private services are always superior to public ones. This conviction bears no relationship to reality, and being an article of faith, none is required. Another head-scratcher is that millions of patriotic Americans raise not a peep of protest against the useless expenditure of hundreds of billions of tax dollars on unnecessary wars and armaments. But they scream bloody murder over shouldering a comparatively puny tax burden to pay for the roads they themselves drive on and the schools their children attend.

This is nothing less than mass insanity. As a psychotherapist, Ms Poole might want to focus her considerable literary talents on this social pathology as well.

In case anyone is thinking that the Canadian single payer system would have provided superior coverage here, let me mention that psychotherapy isn't covered by the British Columbia plan, although psychiatry is. I have had a few small problems with my health insurance regarding extended claims (e.g.
physio, dental) but nothing like Ms Poole describes. Regarding medical care covered by the province, the doctor submits the claim to a government agency,
the Medical Services Association, which only accepts claims from registered doctors. That system seems to work very well, especially for the patient who never has to deal with a private insurer.

The last speeding ticket I got instructed me to mail my payment to an address with a four digit zip code. Public agencies can be maddening, too, Carol.

I'm in my 70's and had been, fortunately, something of a virgin regarding medical care, when I had an accident at an "event" three years ago. I was covered by both Medicare and special "event insurance" provided by a private insurer. The medical treatment (involving surgery and rehab) lasted about six months. The Medicare claims were handled fairly quickly and you could even go on-line to your personal Medicare record to check the status of various claims. The private insurer instructed me to have all invoices and statements sent to me. I was to make and keep copies, then forward the billings to them. What followed was often a dance as described in this piece. Most disturbing to me was that after four-plus months or so, some service providers would threaten to send MY account to collections. I didn't need an additional layer of games to play, so I would pay the invoice, then forward it to the private insurer for reimbursement. One provider waited TWO YEARS for payment before sending me a warning.

This is a great story, but it's anti-bureaucratic rather than anti–private insurance. While there may be many things that would improve under a single-payer system, I can't imagine that navigating the bureaucratic maze will be one of them.

When I was in Germany and had German health insurance, the insurance company gave me a card with my name on it and a magnetic strip on the back. When I went to the doctor's office, I swiped it at the receptionist's desk. That's all I ever had to do.

I never had to sign anything.
I never had to review a bill.
I never had to review a claims statement.
I never had to pay a deductible.
I never had to pay a copay.
I never had to pay coinsurance.
I never had to be a bill.
I never had to wait on hold.
I never had to pay for a non-covered procedure.
And I never had trouble getting a doctor's appointment or procedure.

Incidentally, the German health care system has univeral coverage, integrating a public option (what I had) and private insurance plans.

I would also like to point out that the costs of this amazing health care system have not cost Germany any ability to, say, weather the recession and BAIL OUT THE NATION OF GREECE ALMOST SINGLE-HANDEDLY.

In fact, German health care has been stable at 10% of GDP for several years (cf. the U.S. 15% of GDP and rising).

I'm just really not sure what people who are against the whole public option thing THINK the health insurance system in this country *should* be like, but I know I wish time and time again it were like Germany's.

Smacgry, doesn't that also mean you had no idea how much any of your care actually cost?

I can't imagine how that, multiplied by 300 million, would end up leading to lower healthcare costs. But, as you say, Germany seems to be managing it. Do you know how?

In the civilized world, health care is a human right, available to all regardless of socioeconomic status.In the United States, it is a privilege based entirely on wealth.

@Benjamin--thanks! But I disagree, partly, with your conclusion. What I experienced with this particular insurer (and have had similar experiences with one or two others) is worse than bureaucracy, it's borderline criminality. Many insurance companies behave much, much more responsibly than this. As for how a single-payer system would be, a lot would depend on the specifics of its implementation. I think studying well-functioning systems and imitating them would be a great idea, and a much better basis for deciding our national health-care system's future than the current fragmented, ideology-driven fear-based debate. Where's a petition I can sign to get that ball rolling?

Mr Lukoff:
For an account of the German system, and others, see:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Dewams, thanks for the link.

Loren, your dichotomy is flawed if you're dividing the world into civilized and the U.S., as far as healthcare access goes. Think about which other countries you are tossing into the "uncivilized" bucket.

Carol, I see what you're saying. I am glad we have a relatively strong insurance commissioner in this state. Complaints in that direction are probably in order? And yes, implementation specifics are key. I fear that we won't know about them until it's too late, however.....

Benjamin, it is simple math. The overhead of our private sector insurance system is %17. For comparison, Medicare overhead is %5. This is just one source of private sector waste. Look here for a nice comparison, brought to you by Mitt Romney, of all people!

http://masscare.org/health-care-costs/overhead-costs-of-health-care/

Carol, nice article.

There is a technical term for what you experienced--breakage. This strategy was probably developed at the Harvard Business School. Here is the wiki entry:

http://en.wikipedia.org/wiki/Breakage

It was originally developed for the gift card/rebate industry. There is even software to maximize breakage (make forms difficult to fill out, require box tops, on and on...) on rebate programs.

The private sector health care industry has adopted this practice to maximize profits, as you detail in your article.

@Andy--thank you for enlightening me as to the term for this. "Breakage" seems like a very apt word here. Especially when you consider that people are running into these issues in much more difficult situations than either my client or I face in this case. Psychotherapy is relatively easy to pay for out of pocket, if one has to. But when people are seriously ill, in need of surgery, etc., it just seems wrong that they have to spend time and energy fighting off this kind of strategy to deny them care and coverage.

Great article. I really enjoy Ms. Poole's writing and the civil debates that occur in the Crosscut comments section generally.

Three points:

(1)-For Ms. Poole and apropos single-payer: when Bill Clinton was president and Hillary Clinton was writing the 1993-94 health-care reform proposal, her main single-payer model was reportedly the Group Health Cooperative. Cheryl Scott, then Group Health's chief executive officer, was often said to be the most influential person among Hillary Clinton's group of advisers. Too bad the Clinton measure was almost certainly designed to fail – something Ms. Scott could not possibly have known – the betrayal implicit in its predestined failure confirmed by the fact both Clintons later reaped obscenely fat rewards from the for-profit insurance magnates. (Disclosure: I joined Group Health and also became a voting member of the co-op when I was 32 years old. Though I was in excellent health at the time, my membership was – and remains – a political statement in support of socialized medicine. Now enrolled in Group Health's Medicare program, I attest unequivocally to the superiority of its patient-care. Likewise the single-payer model itself, which I also experienced as an Army enlistee during active duty c. 1959-1962.)

(2)-In response to Ms. Poole apropos for-profit insurance (and capitalism in general): Ms. Poole says what she experienced “with this particular insurer” and similarly suffered at the hands of “one or two others” is “worse than bureaucracy, it's borderline criminality.” Then she adds, “(m)any insurance companies behave much, much more responsibly than this.” Alas, she equivocates. Capitalism's practice of murder by abandonment is immeasurably worse than “borderline criminality”; it is in fact genocide – the methodical extermination of any of us (elderly, disabled, chronically impoverished) who are deemed “unprofitable”: that is, no longer exploitable for profit. Meanwhile the for-profit insurers (and the capitalists in general) are only as beneficent as they are forced to be. However the hideous truth might be disguised, the essence of capitalism is infinite greed redefined as maximum virtue – Ayn Rand's reversal of every extant principle of human morality. But we cannot rationally blame Ms. Poole for equivocation; she has no choice. It is a matter of survival. Her dependence on for-profit insurers (and capitalism in general) leaves her vulnerable to blacklisting, which means she is compelled to sing the praises of at least some of her de facto masters. As Ms. Poole so correctly observes, “(w)hen the problem is a government program, at least we have the right to complain to our elected officials.”

(3)-For Mr. Lukoff apropos "dichotomy...flawed": I made two related statements. First I said, “in the civilized world” (which most assuredly is not the entire world), “health care is a human right.” This is unarguable: a realistic definition of human rights that includes all the pivotal socioeconomic factors – full employment, health care, education, public transport etc. – is the primary characteristic of what we label “civilization.” Next I noted the ugly truth that health care in the United States is a privilege of wealth – not a human right. This too is unarguable; it is proven not just by the rhetoric of the health-care debate but by the bottom-line reality the U.S. health care system knowingly murders at least 40,000 women, children and men each year by denying us the kind of medical services the civilized world acknowledges as basic human rights. My implication – that the U.S. is therefore NOT a civilized country – is deliberate; we are in fact not just the most barbarically misinformed, under-educated people in the industrial world, we are also – especially as proven by our rapidly declining life-expectancy – by far the most oppressed.

@Mr. Lukoff:

You are right. I had no idea how much my medical services in Germany cost, but by all objective measures German health care costs less on a national basis to deliver, with better results than American health care. Various factors play into this:

* Everyone has to have insurance ("individual mandate"), so most everyone pays into the system, who can. Germany is a very pro-insurance culture, incidentally, so Germans instinctively understand how having everyone participating in the system lowers the costs for all. Americans culturally do not seem to get this principle.

* The vast majority of German insurance plans are through nonprofit entities (90%). This lowers costs dramatically by removing profits from the equation.

* The poor get subsidized or free health care so that they can participate fully in the system and de-burden emergency rooms and other extraordinarily expensive modes of care. The poor also can get treatment for chronic conditions, also reducing the public cost of managing conditions like diabetes, heart disease, etc.

* German doctors get their medical education for free (all university education is free), so they don't have to pay back student loans, so they don't have to negotiate fees as high as do American doctors. German doctors' salaries are thus also quie a bit lower than American doctors' salaries as well.

* The nonprofit plans that 90% of Germans have are remunerated in part per enrollee, not based on the number of medical procedures they allow or deny. Thus, plans compete with each other to attract more enrollees, not by reducing expenditures.

* Pricing on medical services is done at the national level. Healthy capitalist competition exists in the German system, but it's the plans competing for enrollees, not maximizing profits. (There are more-expensive, for-profit insurance plans, but only the super-rich are allowed to buy insurance from them.)

I might also point out that someone who is sick is not, and maybe should not have to be, interested in the cost of their medical care. A sick person simply wants the most efficacious, practical treatment to get better or manage a chronic condition and get back to living a full life. I think Americans get overly focused on our a la carte mentality to medical care; culturally, I think Germans focus more on quality of life. They are lucky to be freer to do so - and they do so for about 33% less of GDP than we do.