The Insurance Industry And You

30 Jul


The debate surrounding “health care reform” in 2009 has been disingenuous, riddled with anecdotal bullshit, straight up lies, and is being treated as a political football more than the lynchpin to the financial health of this country.  Each day that passes, I become more cynical about our ability to do ANYTHING in this country for the right reasons.

Republican leaders like John Thune, John Boehner, Newt Gingrich, Orrin Hatch, and Eric Cantor have appeared on numerous talk shows and panel discussions citing studies from a “non-partisan” think tank which show that a public healthcare option would result in 103 Million Americans losing their insurance.  Of course, none of the dopey “liberal journalists” who host those shows did any research on the veracity of their claim or the connections of the think tank.  They just let the Republicans spout off the numbers without any critical analysis.  Welcome to TV news in 2009.

Along came The Washington Post with a story identifying a few interesting factors to frame the claims from The Lewin Group and the Republicans.

More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician’s group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the “usual and customary” doctor fees that insurers use to determine how much they will reimburse consumers for out-of-networkcare.

Next up,  Rachel Maddow did some digging and had this to say about the Republican cited “non-partisan thinktank“.


Yes, the Lewin Group is “non-partisan” if by “non-partisan” you mean wholly funded, subsidized and managed by United Healthcare, the second largest private insurance group in America.

The Lewin Group is an Ingenix company.  Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world’s best-in-class health care information technology capabilities

As mentioned in the WaPo story and the Maddow segment, Ingenix and United Healthcare were at the center of an investigation by NY Attorney General Andrew Cuomo.

Cuomo’s investigation concerned allegations that the Ingenix database intentionally skewed “usual and customary” rates downward through faulty data collection, poor pooling procedures, and the lack of audits.  That means many consumers were forced to pay more than they should have.  The investigation found the rate of underpayment by insurers ranged from ten to twenty-eight percent for various medical services across the state.  The Attorney General found that having a health insurer determine the “usual and customary” rate – a large portion of which the insurer then reimburses – creates an incentive for the insurer to manipulate the rate downward.

While the actions taken by Cuomo were necessary to reform a system which intentionally defrauded patients and doctors, Republicans and Libertarians will no doubt claim it was just New York and big government getting between you and your Doctor and “meddling in the free market”.

The fact that Ingenix and The Lewin Group are cited as policy experts and/or non-partisan in any debate after Cuomo’s investigation and settlement defies the bounds of logic.

Wouldn’t it be nice to have an honest discussion about the costs and benefits of public healthcare policy without disingeuous talking points and intentional fraud?

16 Responses to “The Insurance Industry And You”

  1. Brian Castner July 30, 2009 at 4:58 pm #

    When I read your first sentence, I assumed you were talking about the Democrats . . .

    All that you write is interesting and I’m sure correct. R’s have thier “think tanks” and Dems’s have theirs. Its a useful tactic so you have a group providing you numbers that you already agree with.

    I hate to ask, but what’s the point though? The R’s are all sound and fury. The Dems have filibuster-proof majorities – if they want to pass a bill, they will. Gingrich and Boehner can say Government Healthcare will cut your baby’s heart out – it doesn’t matter. The reason healthcare is a CF right now is Blue-Dogs vs. Liberals, both of the Dem variety. Focus your sunlight in that direction.

    Rachel Maddow is indicative of a politically-worrying trend among Dems (if you are a Dem). They are so used to being the oppostion, they don’t know how to lead. Why devote air time to knocking down R’s. THEY DON’T MATTER. Just pass your bills, or the American people will wonder what you’ve been up to while you’re in charge.

  2. Jeff July 30, 2009 at 5:41 pm #


    It’s so interesting that you find the Republicans lying and disingenuous but not the Dems. That makes you, my friend part of the disingenuous media.

    My thought is that it will be impossible to have an intelligent discussion and a real fix to the healthcare issues with the system we have. Dems and Republicans are both more interested in politics and getting money and votes than doing the right thing. Neither is capable of creating a smart system that works.

    The Dems have their “independent” think tanks who spout stats that serve their purposes. To say the Republicans are the only ones is completely disingenuous in itself.

    There is no discussion about cost, no discussion about who’s going to pay for it, nothing. It’s the Dems pushing through their idealized version of healthcare while taking care of their own needs.

    Lets talk facts, not hyperbole and drama. You can always find a few people who are great poster children for anything. Bad healthcare or good, whatever the issue. What matters are the real facts. Stories about people who’ve been screwed by insurance companies mean nothing. If there are enough that there’s an identifiable problem, sure you deal with it. A heartrending story in the news or from a pol’s mouth is meaningless.

    All I have heard from anyone including our esteemed President is meaningless BS. Let’s talk real numbers, real solutions and make it fair and right for everyone. What is being pushed through is an absolute partisan mess which I feel will hurt the overall healthcare in this country and bring with it unimaginable costs and the accompanying tax increases.

    I don’t think our politicians and the system they work within can create a bill that will work and not mortgage our future in hopes that somehow we’ll be able to pay for it.

    I agree, there is a healthcare issue in this country. Know what though? If I were to become sick, I sure am glad I’m in America under this system than elsewhere with inferior healthcare, technology and waiting lists.

  3. Mike In WNY July 30, 2009 at 5:49 pm #

    The disingenuous studies from the partisan think tanks are anathema to an intelligent discussion, however, the government has not brought any proposals to the table which will not make health care worse.

  4. Chris Smith July 31, 2009 at 12:47 am #

    All that you write is interesting and I’m sure correct. R’s have thier “think tanks” and Dems’s have theirs. Its a useful tactic so you have a group providing you numbers that you already agree with.

    There is a difference between academic think tanks on the left and industry specific think tanks on the right, and it’s not a small one. The most prominent and influential liberal think tank is the Center for American Progress. Organized by John Podesta and funded by wealthy liberals, but not advocating positions that would directly benefit those liberals. Whereas the American Enterprise Institute is funded by defense contractors and oil companies and the output of those think tanks, shockingly, is to advance policies that directly benefit defense contractors and oil companies. Same as The Lewin Group, funded by healthcare companies to shockingly advance policy studies which demonstrate just how vital, valuable and important those healthcare companies are. When issue papers from AEI or Lewin are put forward as non-partisan studies, it’s disingenuous and straight up lying. They ARE partisan by their very nature and it’s a shitty tactic.

    I hate to ask, but what’s the point though? The R’s are all sound and fury. The Dems have filibuster-proof majorities – if they want to pass a bill, they will. Gingrich and Boehner can say Government Healthcare will cut your baby’s heart out – it doesn’t matter. The reason healthcare is a CF right now is Blue-Dogs vs. Liberals, both of the Dem variety. Focus your sunlight in that direction.

    Blue Dogs are scared of their constituencies who are influenced by constant media featuring studies from the likes of The Lewin Group and the CPR group who put out bullshit TV commercials linked in the original article. The sound and fury from the right is EXACTLY why healthcare reform is stalled. The people believe bullshit studies and are scared into thinking bureaucrats are going to pull the plug on their Nana. It also doesn’t help that healthcare lobbyists are spending through the nose to bring Democrats over to their side of the debate, which is a totally different issue.

    Rachel Maddow is indicative of a politically-worrying trend among Dems (if you are a Dem). They are so used to being the oppostion, they don’t know how to lead. Why devote air time to knocking down R’s. THEY DON’T MATTER. Just pass your bills, or the American people will wonder what you’ve been up to while you’re in charge.

    Rachel Maddow is a vocal critic of this Administration and points out frequently that he is capitulating to the right and not leading from the front. I’d agree with you (and her) that this President is weak. If I knew I was going to get third-way triangulation, compromising on everything and an outsourced political agenda, I’d have voted for Hillary. He had all the political capital in the world and he blew it when he compromised on his stimulus bill and included $350BN in tax breaks to get Republican votes. He should have made it a $1TN bill and 100% spending. Then, it would have been effective. Now, it’s a slow distribution system which is having a mediocre effect on the economy and the tax cuts won’t show benefit for years, if at all. Now, the Republicans can claim the stimulus didn’t work, even thought they are the ones who made it ineffective.

    See Matt Taibbi’s article at True Slant on this issue.

  5. Christopher Smith July 31, 2009 at 12:57 am #

    The solution to our problems is Clean Money/Clean Elections. Until you remove the influence of money and lobbyists on our policy discussions, we’ll never formulate sensible solutions.

    When you have a few minutes in your busy day, watch this video.

  6. Jeff July 31, 2009 at 8:07 am #

    I couldn’t agree more. The system is broken and unfortunately those who have the power to fix it, are the ones that have to vote to change it. Kind of a pathetic catch 22 isn’t it?

  7. Brian Castner July 31, 2009 at 10:20 am #

    @ Chris – there is obviously a big difference between The Center for American Progress and your Lewin Group (that I had never heard of before your post). But those aren’t the two you should be comparing. I happen to think the leading progressive/Dem think tank is the Brookings Institution, and they are fine. I don’t mind the AEI or the Heritage Foundation, personally, and I think they are comparable to the CAP. But don’t compare apples to oranges – the Dems have plenty of corporate echo-chamber think tanks – you just aren’t choosing to mention them. How about The Third Way, The Hamilton Project, or the Economic Policy Insitutite. They are just as “shitty,” just funded by corporations and groups that support Dem causes. If you don’t see that, lay off the kool-aid for a while til you come back to your senses.

    And if the Blue-Dogs have no balls, blame your own party, not the lobbies on both sides. The average voter in Arkansas or Missouri is not learning about healthcare from the Lewin Group. They barely know a fight is going on, much less understand it. The Blue Dogs are the ones watching the commercials – tell them to get over it.

    You should have known Obama wasn’t the savior when people like David Brooks were praising him for his ability to see all sides of an issue, and there was a new group created called Obamicans. Maybe it turns out having no leadership experience does make you a bad leader. Not that I hope for that – I’d hate to have another lame duck president for 3.5 years.

  8. Ethan July 31, 2009 at 10:27 am #

    @Chris: can I get an “Amen, brother!” on that one.

    The Big O blew it by trying to “compromise” with a bunch of embittered losers who’s only goal in seeking “bipartisanship” was to trash Obama and run out his political capital, which they’re doing. Hey, Obama, get a pair. And note to Rham: do what you’re there to do and start whipping.

    “We are by far the wealthiest nation on earth, but we rank 38th in life expectancy, below Cuba. In the key index of infant mortality, we badly trail other nations that have national healthcare: We have 6.26 deaths per live births, compared to Canada’s 5.04, Britain’s 4.85, Germany’s 3.99 and France’s 3.33. Although we spend far more money on our healthcare than any other country, whether the expenditure is measured as a percentage of GDP or per capita, a staggering 45 million Americans were uninsured in 2007, 15 percent of the population. By all key measures, our healthcare is inferior to those of other industrialized countries.” Gary Kamiya

  9. Alan Bedenko July 31, 2009 at 10:48 am #

    Blaming the think tanks is a cop out. Whether they’re partisan or not, whether they’re whores or earnest non-profits, by their very nature advocate, agitate, and lobby.

    That’s not the problem. The real problem is the horrific state of journalism in this country, and I’m talking most specifically about cable news but to a lesser degree all mainstream news in every medium. Instead of taking the information and conclusions from the think tanks and whatnot and actually looking into their accuracy and veracity and reporting what the truth is, the media take the easy way out and regurgitate what each side has to say about an issue and then leaves it at that.

    Somewhere along the way journalistic objectivity went from being on the side of truth to merely presenting both sides to any given story, regardless of accuracy, in the name of “balance”. Well, fuck balance. But that takes work, and newsrooms are understaffed with underpaid people.

    That’s before we even get to whether Fox is a shill for the RNC or MSNBC is a shill for the Illiterati or whatever. Because cable news is so hard-up to fill 24 hours with reasonably interesting information, they cock it all up with screaming matches and stenography. So, the people who consume that news generally get misinformed, and this then misinforms the debate and we have what we’ve got now with health care.

    Anyhow, I agree that Obama has been milquetoasty on the health care issue, and he should come out guns a-blazing and obliterate the misinformation that’s spreading out there among the earnest but ill-informed.

    Hey, look! A press release!

  10. Brian Castner July 31, 2009 at 11:17 am #

    @Alan – when was the golden age of American journalism, when news stories were truly reported and facts exposed. I’ve decided that is one of our Great American Myths, that the newspaper industry used to be more than a shill for one side or the other. Certainly the rags of the turn of the last century don’t count, but back in the 1930’s, 40’s and 50’s, it was no better. I was in the Mighty 8th Air Force Museum in Georgia last week, and they had a bunch of news paper headlines. Here was one from VJ Day: “Japs Quit: Defeated Japs Bow Heads Meekly in Surrender, Realize our Superior American Bombs Will Destroy Their Very Way of Life.” Fair and unbiased.

    • Alan Bedenko July 31, 2009 at 11:48 am #

      Brian, most of the big papers still tend to report factually and critically when needed. NY Times, LA Times, WaPo. They stray from time to time, but the reporting is generally excellent and objective. Back in the pre-CNN days, when you got your news from Cronkite, Chancellor, and/or Brinkley, stories were reported with accuracy and beyond typical sound bite nonsense.

      One only needs to look to the BBC World News broadcast to see how TV journalism is supposed to look.

  11. Chris Smith July 31, 2009 at 1:57 pm #


    I am a victim of too many tabs open and closed the tab in which I just posted a lengthy rebuttal to your comment.

    I’ll have you know, good sir, that it was sternly worded and ultimately would have proven you wrong in every respect and resulted in my emergence as victor in this conversation. You have been duly scolded in the ether of the Internets. I have neither the time nor inclination to retype all that I just lost. Just know this…

    I win, you lose.

    Hugs and Kisses,

  12. Brian Castner July 31, 2009 at 3:49 pm #

    @ Alan: I was mistaken by singling out newspapers – I should have said “media in general.” Because while I agree those papers that you mention generalyy do a good job, the cable news have taken the place of the muckrakers.

    @ Chris: You are a better man than I, because when I lose a post to the Humors and Ethers, I can’t let it go, and retype the whole thing. I even try to use the same words in the same order. I can’t help it – its not a good thing.

    But as long as you won the argument, that’s the important thing.

  13. Chris Smith July 31, 2009 at 4:13 pm #

    @Brian, I’m glad you can accept defeat without empirical evidence. Kudos to you. We shall fight another day!

  14. Brian Castner July 31, 2009 at 5:07 pm #

    @ Chris: I was doing my best lib-Dem impression – easily cowed at the first sign of trouble.

  15. Steve S August 6, 2009 at 9:36 pm #

    Here is something that has not been reported yet. Ingenix was started by, among others, a Minnesota business woman named Lois Quam. Lois Quam is married to former Minnesota State Legislature and current Minnesota Governor candidate, Matt Entenza. And if you were wondering, he is a Democratic candidate (in MN, it is referred to as DFL). Lois’ relationship with United Health and Ingenix have made the couple millionaires many times over. He has vowed to spend as much money as it takes to win the nomination. So, he is spending millions earned by trying to deny millions of American’s health care to win the DFL nomination for governor. What a sad, sad story. Untold!

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