Tuesday, October 27, 2009

Health insurance fairy tale

Once upon a time, in a kingdom far away, there lived a happy little group of people in a nice little village in a lovely setting.

(Photo Source: Flickr, Donna Cymek)

These people worked together in the community, each performing some role.  Some people were particularly skilled in one thing, other people possessed another set of skills.  They each earned a decent income working in this community and paid sums of money each month (let's call them premiums) into an account from which members of the community would draw in time of need, medically speaking.

One group was assigned to manage this account.  Over time, they saw that there was generally money left over, which they would pocket.  They liked having not just a salary for managing the account, but also having high profit margins.  Let's, just for the sake of convenience, call this group who manages these premiums for the health maintenance of the happy community: Aetna.

Aetna did a good job for many years; the people in the community were well-cared for and as long as they paid their premiums, had reasonably low expenses for the medical benefits they needed

The community was happy and prospered.

One day, Aetna found out that some people in the community were talking about having a central representative body govern over this health care account.  Aetna became angry.  On top of that, Aetna hadn't pocketed much money the last year.  In fact, they had to pay out more than was paid in (for the first time).  If you were to total all the years they made a profit it would balance out in their favor, but that's not how Aetna saw it.

(Photo Source:  Berlin 07: Angry Fish At The KaDeWe.)

So, angry Aetna decided, due to both concerns, to raise premiums on the community, making each member of the group pay significantly more for the health care account and benefits.  At the same time, they also decided to establish new rules and limitations on what the people of the community could do with the money from this account and how much they could take out.

The people of this once happy community were not pleased by these changes and asked Aetna to reconsider.  Aetna gave a few minor concessions, just to shut the people up, and continued on its merry way, pocketing large profits and rendering fewer services.

Did Aetna know that these actions served only to make people more serious about forming some sort of representative body to govern over the health care account?  Perhaps Aetna didn't really care: get as much money as possible as long as possible.

Meanwhile, some members of the once happy community were hit with hard times financially.  They cut corners and worked hard just to make ends meet.  The higher health care costs and lower benefits provided by Aetna really make things tough for these citizens.  For whatever reason, they had health issues that made them very much in need of medical care and medications  As it became harder and harder for these people to pay their medical bills, they became even more marginalized.  not only did they have medical conditions that affected their day to day lives, but now they were paying enormous sums just for what had once been considered standard care, rendering them now unable to live their lives as "normal" people.  Those people graced by good health went along their merry way; the people with health conditions scrimped and saved and struggled to make ends meet.  They knew of course, that some people who didn't happen to live in the community had no access to any health account whatsoever (not even under severe conditions) so they felt badly  about bemoaning their own state of affairs.

Aetna cared little for the people external to the community without health care or even those in the community who had medical conditions.  They apparently just felt that as long as they could stay profitable, they would continue to play the game, raising the stakes everywhere they could so that they milked the community as long as possible.

The End.

(Photo Source: Standard Rights Managed (RM) BE037954,  Illustrated Political Cartoon: Corporate Greed as Octopus Original caption: 6/27/1882 - Corporate greed octopus gobbles up freight for Great Railroad while unemployed handlers look on. Cartoon 1882. IMAGE: © Bettmann/CORBIS)

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