"Death Panels" and the Public Option

You want death panels? Here's your death panels. They're already here and the people defending the healthcare status quo are defending them. The Institute for Public Accuracy (IPA), an organization that counters right wing think tanks, comes out with a press release spelling out just who's killing patients -- hint: it's not commies in the gummint.

More than one out of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

IPA looks only at California in the report, but it seems a pretty safe assumption that this is true for other states as well. In all, the Nurses Association found that California insurers had denied 47.7 million claims between 2002 and 2009, which means that 22% of all claims were denied.

"With all the dishonest claims made by some politicians about alleged 'death panels' in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation's biggest and wealthiest insurance companies simply because they don't want to pay for it," the report's authors write. "The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about. Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice."

That's not good news. Although, you'd assume that if a public option denied fewer claims, it would become more competitive and force other insurers to adapt or die. But that doesn't seem to be the case in California. A look at the top six insurers shows some variation in denial of claims:

* PacifiCare -- 39.6 percent
* Cigna -- 32.7 percent
* HealthNet -- 30 percent
* Kaiser Permanente -- 28.3 percent
* Blue Cross -- 27.9 percent
* Aetna -- 6.4 percent

Yay for Aetna, huh? They seem to be the exception to the rule. But one company's better performance on this issue hasn't forced better performance from others. I suppose there are other factors involved in choosing healthcare providers -- not the least of which is not really having any other choice through your employer.

If workers had a choice and they saw these numbers, Aetna would really have a leg up on the competition. That's competition and that's a free market. What we have now is "you take what you get." If insurers actually had to compete on anything other than cost (which, let's face it, is pretty much the only factor an employer has any incentive to consider), those other insurers would be changing right now.

What a public option would do would be to allow government to set a measure of what constitutes decent insurance -- to draw a baseline. If insurers had to compete with good healthcare coverage, we'd get good coverage.

Until then, we'll be dealing with insurance companies who decide whether your health is worth their money.