Insurer ends health program rather than pay out big

Source: Washington Times

Ian Pearl has fought for his life every day of his 37 years. Confined to a wheelchair and hooked to a breathing tube, the muscular dystrophy victim refuses to give up.
But his insurance company already has.

Legally barred from discriminating against individuals who submit large claims, the New York-based insurer simply canceled lines of coverage altogether in entire states to avoid paying high-cost claims like Mr. Pearl’s. In an e-mail, one Guardian Life Insurance Co. executive called high-cost patients such as Mr. Pearl “dogs” that the company could “get rid of''

Guardian, a 150-year-old mutual company, reported profits of $437 million last year, a 50 percent increase over $292 million in 2007. It paid dividends of $723 million to policyholders and had $4.3 billion in capital reserves, according to its annual report. The company’s investment income totaled $1.5 billion that year, a small increase from the year earlier.

Read more: http://washingtontimes.com/news/2009/oct/14/ny-insurance-company-tries-to-rid-itself-of-high-c/

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I'm surprised this story came out of the washington times

What I'm hoping will happen, though we find clouds in every silver lining, is what happened with this story. I read the entire Washington Times once, only once. That was torture. Praise of Bush for Iraq, misplaced 'patriotism' and more. It made FAUX Snooze look like Keith Olbermann. To have THEM clearly report a story that demonizes insurers such as this is groundbreaking. I won't get my hopes up we'll see this happen often, or even again, but there is a salient point. The farther right-wing you go, the more 'nut-job' you are to some. But let's face it, the more sociopathic one is. Totally self interest. How much does what I do revolve around how it benefits me (or my family)? How do I vote, what news channel do I watch, etc.. You can tell from that, easily.

There's a quote from a Style Council (Paul Weller) song: "With Everything To Lose". It says: 'the only thing they understand is a wall against their backs'. The right wing does not care until it affects them. But the growing premiums, and the projected continued growth of those is 'winning them over' to our ideas. Not to our side, they will never be there, that involves too much empathy. But there will be a point when they simply can't afford the plan they have now. Or they get shocked it doesn't cover what they thought it did. Oh, believe me! The self-interested will come running for govt. help then, only to find out the stuff they carried signs against isn't there, unless they are 65, or incredibly poor. I can just imagine how pathetic they will look then.

Buying insurance across state lines, 'tort reform', and the bullshit non-reform ideas the right wing has 'offered' won't do a damned thing to help them when they find themselves in that mess. Only a true public option, or better, single-payer universal, can help them then. They can change party affiliation, shit, they can get an abortion during a gay-marriage, it won't matter. They define knee-jerk. It will be too late then. The idea of prevention, of helping others that COULD be you, that just don't happen to be at that moment, these are 'self-centered' enough for them you'd think. That's where the Becks and Limbaughs of the world spin them in the wrong direction. Both of those ideas are totally in line with what the Christ many of them pretend to follow wanted.

I'm a Christian and I'm constantly reminding them that Matthew 25:40 is most definitive of Christ's liberalism. "Sell all you have and give it to the poor" is yet another quote (don't have the number for that one handy). That's income-redistribution (socialism)! But they'd rather create a Conservapedia to make up lies justify their reasons. There's no limit to what they'll do to ignore other's needs, give a bit to charity and hide behind some Christian-shield-justification. Until it hurts them directly, until they could really use what we've been demanding, it won't matter. That's why there is no 'compromise' in many cases. Sure, make the bi-partisan effort. Let the public see you tried. But get out from behind that ruse, and get real universal health care, for all!

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this pigs and wins a fortune. Anyone who thinks we don't need a public option or better yet single payer should read this story.

if someone sues these idiots, they will run off to the press complaining about tort law suits and how these cases has burdened their company ...

Edit: Tried to insert sarcasm but removed it because of the seriousness of the message.

In all fairness, knowing how often quotes get mangled or misinterpreted in reporting, I would say that it is very possible the person was referring to these high-payout policies as dogs, rather than calling the people themselves dogs.

You want to make an excuse for them, fine. You must own stock.

And, there's no doubt in my mind that these companies would consider people dogs.

:sarcasm: as well as :puke: and :mad:

I wish Obama would explain what purpose this particular gang of crooks serves.

I'm not making an excuse for them... please read my message #91 here which explains my perspective about separating "real" arguments from ones that become diluting distractions.

re: "You must own stock"

Considering the status of my retirement fund over the last year, I imagine I'd have been much better off if I did! But your comment is distressing as an example of the way that so many people here attack people and their motives rather than address issues or simply accept that even we on the same side can have slightly different perspectives from one another. I don't know why people have to reply to calm, reasoned "alternate" comments with accusations of a hidden agenda (freeper, puma, stockholder, whatever).

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And you know that.

You're right, of course that's the important part. I was just replying to the person who focussed on the dog comment. The real issue is exactly what you say it is, not the distraction of some exec's comment that may be the red meat some people jump on.

It's bad enough that insurance is for-profit... it will be worse if the government mandates everyone get for-profit insurance, which is why a public option is a must.

Though honestly, I have to wonder if even a public option would cover the level of care this person was getting. There will have to be limits even to a public option. So I'm not sure that would have been the solution to the problem of this case. It's possible that one of the roles for private companies will be to provide supplemental insurance to cover these more extraordinary possibilities.

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We are too noble and rational to take advantage of the irrational and disgusting language used by others?

We are too good to allow some corporate executives to be blamed for reducing people to policies and then saying terrible things about those people by referring to them as their policies?

Do you often feel an urge to defend that which should not be defended?

re: "We are too noble and rational to take advantage of the irrational and disgusting language used by others?"

I try to be, yes. I prefer to fight people on honest grounds when possible. There are enough good reasons to be against this guy without resorting to putting words in his mouth. And if you fight them on the real stuff, it takes away their opportunity to argue back against you on the insignificant stuff. If you start to argue with someone around something he *can* defend as a misinterpretation, you've lost the opportunity to score your point against what was really indefensible.

they called these guys Dogs.

And hey, that was "Dead Peasants Insurance" -- so maybe they were calling the policies Dead Peasants. Yeah, that must be it.

:crazy:

To the insurance companies, the people ARE the policies and the policies ARE the people.

I'd go a step further and suggest that they don't treat their raw material (people) any better than a mining company treats its raw material (gold). They process the raw material the same as any other for-profit company, and sub-standard raw material is treated as such.

..............IT'S LEGAL!! That is why they need to be covered under anti-trust and be HEAVILY regulated. We are going to get some kind of "weak" bill probably w/o a public option, the least WE THE PEOPLE should get out of this (other than the shaft) is strong regulation.

…inadequate. May I humbly suggest a term like "filthy psychopathic vermin."

:toast:

The line of coverage is there for a reason. And that's the insurer's fault, and I'm sure by the end of the whole kerfuffle, Mr. Pearl (if he wishes) could very easily own Guardian Life Insurance Co.

and why mandatory insurance should never be required.
Not to mention why we need severe insurance reform.
I fear it is too too late for all that, however.
And even if the poor bastard sues, they can and will out wait him.

Both in scope and in regulation. Else the chronically ill be forever confined to the state in which they made their first claim.

"there's Guardian Life Insurance Company of America."


The company's
mantra at their site.

http://www.hoovers.com/guardian-life/--ID__40192--/free-co-factsheet.xhtml

Guardian my ass. :grr:

and when they use us up, they move on to the next body. They literally suck the life out of our sick Americans, and then spit out the bones.

and blue dogs think we can negotiate with these people??

These insurance companies should be treated like a cancer.
They should be completely removed and all measures should be taken to ensure that they cant regain power again.
you can't negotiate and make deals with cancer.

They are bought and paid for.

to you in a lawsuit ...

insurance companies decide not to honor their contract ... crickets ...

They make their income from the suffering of other people. The income they receive from the suffering of average people is not enough for these greedy jerks, they have to take home even more money by keeping the money they should be paying out to the most needy of all

Its a racket and the rich and well connected get $$$$$$

The poor get squat.

The blue dogs lips massage the private parts of corp execs, in exchange for being bought and paid for-- like Baucus

Thus, there are no stockholders. The policy-holders own the company. THat is why I would like to see the everyday people like you and me who own this company rise up and demand proper treatment.

I meant corporations in general

Sorry you misunderstood.

life due to recission. Aren't you overwhelmed by the compassion?

:sarcasm:

These stories infuriate me. :mad: :grr:

:nuke:

and take action. Good for WashTimes.

I thought at mutual companies the policy holders are also the "owners", kind of like a credit union. Of course, maybe I am totally wrong about that?

and remember receiving one dividend.

such companies as this one 'deserve to make profit'. Those are his words. Deserve. As if it were another one of Obama's religious dogmas, they deserve it. Lt Choi deserves to be fired, the Insurance companies deserve to profit hugely off of vile practices that would be called fraud by people of honor.

Politicians (~98% would be my guess) only obey their corporate masters.

"Not on the table" must be a code phrase that politicians and corporations use whenever they actually mean "who gives a damn what the peasants want".

All my Canadian friends are totally sickened by your health situation. Every time we have to go to a doctor or visit a hospital we tell one another how grateful we are and how fortunate we are to have "free" health care. And good health care too.

I feel sad about Americans and their corrupt politicians. No way should anyone make a profit out of suffering and sickness!!!!

We're not going to fix it in a few months... or even a few years.

$723 million dollars in shareholder dividends annually are on the table for just this one insurance company.

That's nearly three-quarters of a billion dollars for one insurance company.

Collectively, the health insurance industry surely is a multi-billion, if not trillion dollar industry.

The government is not going to destroy such a large, profitable chunk of its economy.

But Guardian and their ilk, mutual or otherwise, can all go away. Too many complicated laws in ERISA and HIPAA, but none protected Mr. Pearl.

Mr. Pearl's case is an LTC nightmare. A colleague of mine pointed out the illusion of the middle class. Just enough purchasing power to buy a new car or HDTV every so many years, a mortgage nearly 50% of income, and other trivialities to keep up with the Joneses or the Goldmans' or the Sachs'. In the end, you lose the home you worked all your life to pay for. As the middle class enters retirement, having had little means to save millions for the most expensive kind of care similar to what Mr. Pearl needs, the prospect of losing a home looms real.

I hope the health care system we end up with truly focuses on preventative care. I hope political and religious views no longer hamper the research and implementation of cures. The wish list goes on and on. The Single payer system we are fighting for must include these considerations and many more.

They're freakin' demons!

it's like having a "we need reform" story on Faux "News" - not logical. They're supposed to have their head in the sand.

This one must have slipped by Moon's key minions.

Mr. Jones said

Are you delusional?

this example should prove the fallacy of that. The companies will simply stop offering entire lines of coverage. And individual state governments can't be 24-hour-a-day watchdogs on every sneaky trick these greedy bass turds will pull.

As I've posted elsewhere, this happens with all insurance, including auto, life etc. The states frequently have to threaten these companies that if they drop one type of coverage, they won't be allowed to sell any other type within the state.

Congress must mandate that decent coverage is provided & protected, PARTICULARLY if they're going to mandate that we purchase insurance. And the only thing that will afford actual competition to keep costs down is a STRONG public option - not some weeny tidbit to shut us up & get Conservative votes.

..........My home insurance this year increased from 425 yr to 650 yr. No claims, no nothing on my part, I didn't even call these fuckers. NEVER in the 7 yrs I have been with them have filed a claim or as much as made a phone call, nothing, nada. And my reward, bend over. It's not just the healthcare (insurance) companies, it's all the "money making machines", banks, insurance, investments etc. They are there to make money for the already rich, and to fuck the poor/middle class.

An easy, quick solution to end the predatory nature of health insurance. If you are healthy. Drop your insurance. Boycott.

Or. Start a national, non-profit, health-insurance company. Call it Public Option Inc. lol.

Make two plans. Call one "The Republican Plan" and charge double, cover less. It'll be extremely popular in some states.

Since it is a mutual company, it is people like you and I who own them. Why don't they attempt to organize and prevent this from happening?

for them. This majority usually doesn't pay attention to their policies unless something catastrophic happens, so as long as the "dividend" return seems normal they will put up with the rise in premiums "to cover costs" and a decrease in the more unusual services that are "too costly to continue covering", because they're not going to get MS or some other seriously debilitating long term condition; they're just going to get a condition that popping half a dozen over-priced to the consumer pill and seeing a doctor for maintenance on a semi-annual basis (and perhaps a couple yearly lab workups)with perhaps only one or two expensive events. Procedures and costs that are not usually expensive, because the insurance company negotiates the price down to a quarter or less of the costs someone walking in would pay, and they still get their 10 - 40% deductible from the patient up front to help defray the cost.

The average family pays over $9K a year in health insurance premiums, with an average $500 per family member deductible, not counting co-pays, medicine, and medical equipment. This doesn't include the dental and vision costs. The insurance companies usually only outlay $2K a year providing actual medical service (including the negotiated prescriptions) for the average family, and the policies probably only incur another $2K in administrative and other overhead costs to the insurance company...
So on average, your $9K a year out of your paycheck or out of pocket in premiums for you and your relatively healthy family only actually pay for around $4K in services and other costs. The rest is profit...
True, the 10% of the other policy holders who are actually sick, injured or have expensive chronic conditions are probably using some of that profit, but I doubt that is more than about $2500 of your $9K, spread out across the other 90% of reasonably healthy policy holders.
Hmmmm.....I think loan sharks might just get less profit from their services that insurance companies do...

Haele

I would still like to see a grassroots movement to educate people on their rights in a mutual company. The vast majority of people want these types of changes. Sadly, with most everything in this country, is that it is so damn hard to educate and motivate people (especially when it does not impact them).

we let the wall street banks off the hook when there was a once-in-a-century chance to finally get them in line, and the same goddamned thing is about to happen with the insurance companies, which should ALL be broken up...

once upon a time this country and its people used to fight soulless monopolies and robber barons...now we defends them nonstop with soft media coverage and slanted legislation....

just stomach turning....hurl...

But it won't for some, I know that.

I guess they dont have to pay any new claims .. but have to pay up old ones

Just asking

clearly they have a greater right to profit than this man has a right to live.

So I think we should take away the right to live of the health care insurer model. Sentence them to financial death and let's get that public option started.

Consider it triggered.

It's time.

The Corporate elite has decided to throw the health insurance pigs under the bus.

:grr:

Their practice of cherry picking healthy people to take premiums for care that will not be needed is a drain on our nation's health care resource dollars. That profit for doing nothing could be used to pay for actual health services.

They're in business to MAKE MONEY. Period.

And to their way of thinking, they were losing money on Mr. Pearl. So they screwed him over, along with everyone in his state. That seems to be OK with them. Deplorable.

...for the complete dismantling of the private health insurance system, I have not heard it.

Firstly, private insurers and their lobbies will make the argument that the free market will punish Guardian and that other insurers will pick up Mr. Pearl. That's a crock. If the premiums paid are less than the outlay, there is no financially sound reason for any for-profit insurer to cover the health care needs brought on by Mr. Pearl's condition. If they DO offer a policy to Mr. Pearl, it will follow this model and be hyperexpensive to make his policy profitable. More than likely, though, he'll be declared uninsurable.

Secondly, the idea that it isn't Mr. Pearl's case specifically, but rather all cases which require ongoing or expensive treatments, which represent red ink that the insurance companies don't wish to support puts the nail in the coffin of for-profit health insurance. Why? Because the policy is SUPPOSED to pay out. That's what insurance is. Something is covered under the policy? Pay it out. Rather than do this, they've canceled coverage for ENTIRE SWATHS OF CHRONIC OR LONG-TERM CARE to avoid paying out. They are NOT insurers in any relevant definition of that word. Therefore, they should NOT be insuring.

If the private health insurance industry wants to play on this field, they should NOT be able to take their ball and go home to avoid taking a loss. But it isn't even about that. The fact is that insuring a car or a home is based on a high measure of personal control. If I am a bad driver, I can expect higher insurance rates. This seems fair, and although it would be an extreme inconvenience, I'd still be able to live my life if I was dropped from my policy. Driving a car is not a right, but a privilege. If I own a home, which is also not a right, I have it within my power to protect my investment as well, and if I fail to do so, I can also expect an increase in rates. Fair enough.

The fact is that if LIVING is a right (it is), then reasonable access to the tools to go on living is also a right. This means health care. Under the current system, my rights are NOT being protected from undue hardship, and it is the GOVERNMENT'S job to protect those rights. I don't care if the government wants to farm out the work to private industry (ok, not true, I do), but the responsibility is THEIRS. If their "contractors" aren't getting the job done, then it is THEY who must find another route.

... only unborn babies have the right to live. Everyone else is SOL, especially if they're Democrats.

They have also made the argument that health care is not a constitutional right. You just made it clear, that health care is a right, BY EXTENSION, of the right to live. While not explicitly stated in the constitution, is not explicitly excluded either. The 9th: The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

The right to live is an unalienable and natural right, protected by the 9th. And by the absence of a PO or single payer, our rights are NOT being protected.

because of a contract, but this company simply gets to cancel contracts it doesn't like because they cost it money?

Got it.

Pad the pockets of the wealthy, fuck regular folks.

I always thought my grandparents were just disagreeable towards banks, insurance companies, lawyers, and the government. More and more, I see where they simply saw things as they are....

I have my auto insurance through a company in Minnesota but I live in Georgia. In order to sell auto insurance in Georgia the insurance company must be licensed to sell insurance in Georgia.

So simply saying you can go out of state to purchase health insurance means nothing. I certainly wouldn't want Georgia to not require every health insurance company doing business in Georgia to be licensed here. I would still want there to be a licensing requirement.

As a result unless the "other" insurance companies, i.e. those not currently insuring residents in Georgia, go through the process of becoming licensed in Georgia, there is no "purchasing out of state".

Why do I want them to be licensed in Georgia? Well although I find Georgia government from the worthless Governor to the do-nothing General Assembly on down political pols in the pockets of business, at least I have some recourse through the ballot box. If the insurance commissioner is grossly negligent I can seek to have him/her voted out of office.

If the insurance company were not required to be licensed here but only say in Minnesota, the company could do whatever they wanted to Georgia residents without any recourse.

And as for tort reform, I am appalled at some of the sensational awards being meted out in some exceptional cases. But by and large what the Repukes want to do is cap awards at something like $250K nation-wide. That would be cover for the malpractice insurance companies and doctors, nurses, etc. alike. When you are engaged in a business that involves the care of a patient's life, you have to take the job seriously and if you are negligent you need to try to make the plaintiff whole. Let's say a husband of 35 with a wife and two children dies as a result of negligence. Further let's say the husband made an annual income of $75K a year. We are saying that $250K will provide for the family until they can adjust (what if the wife was a stay at home Mom and as a result lacks current job market skills?) and compensate them for the loss of a husband and father to the children? It is a giveaway to be reckless. Just as the current bonus structures on Wall Street compensate for extreme risk taking without any down side.

In the name of competition and fairness, allowing things like multi-state co-ops (?) to avoid state oversight, patient and consumer protection, and any state-mandated coverage provisions. With the low-cost "public" option competing in part through reduced coverage, the others would likely request the same right; not to worry, that provision is already discretely tucked away in the proposed bills or will be soon. Remember credit card reform.

I'm not a religious man. I don't believe that hell exists, at least not in an otherworldly sense (war, poverty, disease, chronic suffering, cruelty are what I consider hell). However, if that other hell does exist -- the biblical, spiritual, otherworldly one -- (and articles like this, about these "health" insurance PIGS, make me hope that I am wrong in my nonbelief), the best seats in the house are reserved for these fucking demons. It is simply unbelievable that we as a nation have been cowed into this system, and that so many still can't even admit that we have a problem. It is a crisis of decency.

from these guys, they'll clean up their act! :puke:

(choice of word intentional) to follow the guy's dad and make sure he was really working in New York. The guy was commuting to New York from Florida just to keep this g-dd-mn insurance. So they followed him with private DICKS to see if they could find an excuse to drop him, thereby consigning Ian to his death. :grr: :banghead: :nuke:

Yeah, no one knows that it's coming up the next week, but for God's sake... This disgusts me to no end.

Can they possibly interview this poor individual? Jesus...

ahead of any reform legislation that disallows some of their behavior. We may end up with single payer anyway.

... that most, if not ALL, the big names within the corporation (the decision-makers, ie the mischief-makers) show up every Sunday morning at right-wing xtian churches and give the "family values" line of guff the loudest lip-service of anyone.

I say find these people, publish their names and religious affiliation and contact the religious organizations and ask how they balance this VERY non-family values sort of behavior with the hypocrites that sit in the pews.

Lots of names!

http://www.guardianlife.com/company_info/who_we_are.html

... need to find an angry mob on their doorstep one morning.

Let's smash those corporate ivory towers to pieces!

Congress needs to regulate insurance, not coddle it. We don't negotiate with terrorists.

We should just end private insurance and become a civilized nation like the rest of the world.

... they are well within their rights to cancel lines of coverage and they are well within their rights to call anyone a dog or a shitbag or whatever. It's slimy and despicable but it's legal.

And it is only the first example of what is going to start happening with the insurance companies. More companies will follow suit and the lawsuits will mostly be dismissed.

The solution is not in private companies but in the government either through thorough and stringent regulation of private insurers (and none of this interstate selling shit) or through a government option for anyone who wants it. Single payer would take care of this problem, but that ain't happening in America - we lack the will.

They'd not been in the news during this health insurance debate, I thought they were maybe a bit better than the rest, who the f*ck was i kidding.
:mad: :banghead:

Then we'd have to have single payer.

eom

What do we owe the insurance industry anyway?
Do we exist to accomodate THEIR need to generate profit?
Or do they exist to SERVE OUR NEEDS?

Clearly they're NOT serving our needs.
The market-based for-profit health care model HAS FAILED us.

SINGLE PAYER NOW
MEDICARE FOR ALL

Hey, all you freepers talking about "death panels". Here's one for you. They consider other human beings to be dogs to be gotten rid of.

How the hell can anyone support these damned insurance companies? :grr:

Oops, I just heard Keith say it's a million dollars. That's like a Wall St. bonus for an exec, isn't it? Or maybe a small percentage of the exec's annual compensation.

There are no words.....:puke:

:grr: