McCarthy Follows Party Line on Health Care

Why is Rep. Kevin McCarthy smiling? Because as a congressman, he has government sponsored health insurance.

On June 18, 2009, I received a letter from my health insurance company. It's not a letter someone with a chronic medical condition wants to receive,

"We reviewed your request to obtain Copaxone Kit under your plan. As we informed your doctor, we are unable to approve your request for the following reason, coverage is proved where therapy can preserve function and provide the patient benefit in performing activities of daily living. The information provided by your prescriber indicates that your use of this medication does not meet this requirement for coverage."

The letter, a portion of which was quoted above, was one part of a drama that started on June 18, 2009, when the company that manages perscriptions for the state of California refused to refill my perscription for Copaxone. An unkown and unnamed insurance company bureaucrat refused to refill a perscription for a medication that I need and gave me no reason except that my doctor did not answer their questions correctly. I was also told I had TWO HOURS!!! to call my doctor, get him to call the insurance company and then answer their question correctly (I asked what questions) but the operator refused to say. If I didn't get that done by the end of the business day, I would have to appeal the insurer's decision.

Needless to say, I was angry and in turmoil. I wrote about my concerns on my Facebook page."Having to argue with my insurance company regarding refill of medication. Told I had little more than 2 hours to get my to doctor to call their pharmicist for "prior authorization." This happens, but it is very vexing. Single payer health care I'm for it!" By the end of the week, my doctor called the insurance company, answered their bullshit questions correctly and got my perscription refilled.

But, I am still angry about because for five days my health was hostage to the whim of a FACELESS, NAMELESS, INSURANCE COMPANY BUREAUCRAT, whose job is to deny claims for no apparent reason. I discovered there is a reason, but first I'd like to talk about health care reform, Congressman Kevin McCarthy's stance on health care reform, and the fact that insurance companies are using "recission" to deny claims to policy holders who make the mistake of getting sick.

The 24/7 news outlets have been giving a great deal of coverage to health care reform and the bizarre reactions of certain segments of the American population. A lot of news coverage has been given to one of the more bizarre segments of the bizzarre population, the people who are protesting by participating in town hall mobs. Many of these people are so afraid that President Obama is the re-incarnation of Adolf Hitler, that they have no problem using Hitlerian tactics to disrupt important civic discussion on health when they are held by Democrats or moderate Republicans (Do they still exist?).

Do moderate Republicans still exist? I guess so, I mean supposedly Kern County Republican Kevin McCarthy is a moderate Republican. In the past, that description used to be given to men like Dwight Eisenhower or Abraham Lincoln. Unfortunately, I am beginning to believe that Rep. McCarthy is starting to flirt with the dark side of the Republican party. I have on occasion seen in on National Television basking in the dolorous glow of House Minority Leader John Boehner's fake tan. He is also beginning to quote the inane policy pronouncements of Minority Whip Eric Cantor on his congressional web site.

I mention Rep. McCarthy because on Thursday Aug. 6, 2009, I made the mistake of spending 15 minutes listening to Rep. McCarthy, R-Bakersfield conduct a "telephone town hall" on health care. It was sad to hear him reguritate the Republican talking points on health care, Government health care bad, Nancy Pelosi bad and so-on. He didn't actually lie, but he misrepresented the truth. If I had wanted that kind of crap, I would have watched Fox News. If you want to know the depth of Congressman McCarthy's views on health care you can visit his web site. It is the usual stuff, of letting the market set prices and give everyone, especially the rich a tax cut, and curbing ambulance chasers who are hounding well-heeled quacks out of the medical profession,

We must ensure that the quality of American health care received by our patients remains the best in the world. Doctors, not Washington bureaucrats, should make decisions about your health. Market-based solutions serve our families' freedom to choose their best health care option at an affordable price. Common-sense tax relief and lawsuit abuse reform can help work towards the goal that all Americans should be able to afford their own health care plan that meets their own unique needs.

It's the typical Republican health care boiler plate. Some of it might even be worthwhile. One interesting thing is the fact is that no one is talking about insurance companies issuing policies and then refusing to pay legitimate claims. Author Peter Gosselin in an interview on PBS' Tavis Smiley on June 24, 2008, had this to say about a woman named Deborah Potter who made the mistake of getting sick.

And then Deborah Potter gets diagnosed with multiple sclerosis, and she couldn't collect on the very policy that she'd been selling to people. The company simply denied her claims and denied them for three and a half years, and it took this insurance insider three and a half years, the hiring of a lawyer, and an "L.A. Times" reporter writing a long story about it to get her benefits turned on.

Tavis: What do you make of that?

Gosselin: Well, the moral I draw from it, I try to step back from these stories of individual people and try to draw the broader moral. Her benefits in the case of that policy are governed by a single federal law. All of our benefits that we get from our employers are governed by a single federal law. It's called ERISA, and ERISA was meant by its authors, its congressional authors, to protect employee benefits. And we know that because it says so right in the preamble of the law.

But over the last generation, the Supreme Court and increasingly conservative federal appeals courts have rendered a series of decisions that have basically flipped the law on its head, making it easier for employers, for insurance companies, and for benefit administrators to deny people like Deborah Potter her benefits.

Deborah Potter was denied benefits due to an insurance company practice called "recissions." According to Gosselin in his book Highwire recissions are a method where, "insurers sold policies, collected premiums, and even sometimes paid small claims. But instead of carefully of carefully scrutinizing an applicant in advance, the insurer would wait until a policyholder filed a big claim, then sometimes cancel the policy and refuse to pay."


The result, according to Gosselin is that "It is hard to overstate how using recission except in the rarest of instances turns the very logic of insurance on its head." It's a great business, sell policies, collect premimums and then when the bills arrive stiff the poor schmuck who bought the policy in the first place. Bernie Madoff should have run an insurance company he'd be a free man today.

How good a business is it? McClatchy commentator Joe Galloway give us a glimpse in an Aug. 7, 2009, editorial on the McClatchy web site,

It's because those same corporations have, in just one decade, driven their profits and overhead (hiring those lobbyists and buying those congressional critters and building their fleets of private jets) from 5 percent to nearly 20 percent. In other words, the corporate bite has gone from 5 cents of every dollar paid in premiums to 20 cents of every premium dollar. It's good old unregulated American greed of the same stripe that drove this country into its current economic meltdown. Wall Street loves these guys.

The key question of the health care debate is simple, do we continue the status quo, or do we try to develop something better? No system will be perfect and there may be cost increases and rationing of care. Employer sponsored health insurance is going the way of the defined benefit pension. According to Peter Gosselin, insurance companies can not be trusted to provided a fair and reliable private option. Insurers will also refuse to allow all-Americans into a health insurance risk groups. Whether we like it or not the government may have to step in,

"Insurers cannot be counted on to assemble those groups on their own; the financial incentives to take the healthy and avoid the sick are simply too great. If employers are no longer to play the role they have traditionally played of assembling these groups, there is only one alternative--government. Unwelcome as many Americans may find the idea of goverment playing a bigger role in health care--and as much as we may object on philosophical and other grounds--we must not fool ourselves into believing there is some simple alternative."

Congressman McCarthy and many Republicans and some Democrats are asking you to trust them and oppose President Obama's efforts to achieve health care reform. If you like the status quo, do nothing. Oh, and do not get sick. Because if you get sick you will probably receive a letter refusing to pay for treatments you thought your insurance company would cover. I received such a letter, have you? If you haven't received such a letter, can trust the Republicans to carry out adequate health care reform?

I don't.

Capitano Tedeschi

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Photo of Congressman Kevin McCarthy source: http://kevinmccarthy.house.gov/showpage.asp?ID=62

Source for quotations from Peter Gosselin, High wire : the precarious financial lives of American families. Peter Gosselin. NY : Basic Books, c2008.

McCarthy Follows Party Line On Health Care, copyright Aug 11, 2009 by Jamie Jacks.