Tag Archives: universal healthcare

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?

When You Get Beyond the Abstract

23 Jun

Pete at BS explains in this comment and this comment exactly what’s wrong with America’s health care system. Not with the quality of our care, but in the way we pay for it and access it.

62% of American bankruptcies are due to health care costs
. We have first world care and a third world way of paying for it.