Denial

 I don't remember offhand if I mentioned this in my previous post on the subject, but Sarah Palin's grotesque lie about "death panels" also contained a reference to a claim by conservative economist Thomas Sowell:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course.

 

Sowell is obviously an ignorant idiot. As you presumably know, government already paid for health care for the elderly and the disabled, as it still does today. The ACA did nothing to change this, on the contrary it extended medical insurance to people who didn’t already have it, including notably people who couldn’t get it because they were sick, i.e. had pre-existing conditions. Furthermore it required that insurance pay for services that previously, it often did not. 

 

Government health care does not "refuse to pay the cost," it is in fact the only way for old and poor people to get health care, and it does pay. Guess who doesn't? Private insurance companies. As Elizabeth Rosenthal reports in Kaiser Health News, "Denials of Health Insurance Claims Are Rising — And Getting Weirder." Private health insurance companies (not the government) are increasingly refusing to pay legitimate insurance claims in order to boost their profits. One way they are doing this is by using artificial "intelligence" to churn out denials.

 

[T]he increase in denials, and the often strange rationales offered, might be explained, in part, by a ProPublica investigation of Cigna — an insurance giant, with 170 million customers worldwide. ProPublica’s investigation, published in March, found that an automated system, called PXDX, allowed Cigna medical reviewers to sign off on 50 charts in 10 seconds, presumably without examining the patients’ records.

 

Here are some examples Rosenthal provides of bizarre denials.

• Dean Peterson of Los Angeles said he was “shocked” when payment was denied for a heart procedure to treat an arrhythmia, which had caused him to faint with a heart rate of 300 beats per minute. After all, he had the insurer’s preapproval for the expensive ($143,206) intervention. More confusing still, the denial letter said the claim had been rejected because he had “asked for coverage for injections into nerves in your spine” (he hadn’t) that were “not medically needed.” Months later, after dozens of calls and a patient advocate’s assistance, the situation is still not resolved.
• An insurer’s letter was sent directly to a newborn child denying coverage for his fourth day in a neonatal intensive care unit. “You are drinking from a bottle,” the denial notification said, and “you are breathing on your own.” If only the baby could read.
• Deirdre O’Reilly’s college-age son, suffering a life-threatening anaphylactic allergic reaction, was saved by epinephrine shots and steroids administered intravenously in a hospital emergency room. His mother, utterly relieved by that news, was less pleased to be informed by the family’s insurer that the treatment was “not medically necessary.”

HHS is supposed to be monitoring the insurance companies to make sure they aren't doing this, but it has been falling down on the job. " One insurer denied 49% of claims in 2021; another’s turndowns hit an astonishing 80% in 2020." 

 

We need universal, comprehensive, single payer national health care. We also need to stop giving tenure to incompetent fools.