In the 15 years I have been a nurse, I have known only one case of where
someone actually asked for their own medical records.       So, though
the irony was not intended, our health records are truly considered none
of our business....... by the 'HEALTH' corporations.     As usual,
liberal commentary barely even begins to touch on the true nature of the
'health crises' in the US (and throughout the world.)     Still, this
commentary captures the incredible imperviousness of the corporate
bureaucracy, as it delivers its PRODUCT.

PRODUCT?      What am I, just a commie cynic?      No.     This is how
the BIZ defines itself.     The hospital I am currently working at,  is
engaged in a campaign to make its workers more attentive of 'customer
satisfaction'.    That's right...  the patient is a CUSTOMER!        And
we do want CUSTOMER satisfaction (without ever actually delivering a
workable PRODUCT), don't we?

We don't have a Bob Barker directing SALES, but we do have a Mark......   

WRITE MARK, 'CUSTOMERS' are advised to send their letters..... and then
us workers  learn about how really rewarding it  is to have satisfied
CUSTOMERS!

Typical writings to MARK are......

'I was in our ER, and never was I treated so well as I was by Dr.
Pendejo and even down to the maid, Juanita.     She was wonderful when I
vomited all over the floor.  In my time of need, she assured me that it
was no trouble cleaning it up, though I was so embarrassed..... y
blah-blah-blah an so on.......'

Let the CUSTOMER actually try to see his/her own records!!!  and then we
learn a little about how eager the corporate hacks are to satisfy
CUSTOMER expectations.     And we all really want to see our own medical
records, don't we?     Why?    It's because we all know that they are
writing a bunch of crap and lies as they pretend to deliver treatment
that never gets delivered as it should.

Below, the PUBLIC CITIZEN's in-depth reporting on 'the health care
crisis'.

Tony Abdo

_________________________________
Your Health Records:
None of Our Business, And None of Theirs, Either
by Alan B. Morrison and Sidney M. Wolfe
 
A not-so-funny thing happened when our employer, Public Citizen, began
to investigate whether to renew its existing health insurance policies
or shift to other carriers. We asked our insurance broker to obtain bids
from our current plans (an HMO and Blue Cross) and from others that
might be interested in a group with about 90 employees.

What disturbed us weren't so much the prices -- we're used to annual
sticker shock -- but the questionnaires that we received from several of
the new bidders. They wanted to know more than how many employees we
had, how many dependents, and of what ages; they required detailed
personal medical histories on everyone who would be covered.

Here's the opening salvo of one questionnaire: "Please answer the
following questions to the best of your knowledge. How many of your
employees or dependents are pregnant? Give due dates and explain any
complications." The next item asks how many covered persons are
"disabled," without distinguishing which of the term's several legal and
medical definitions it means. It goes on to ask whether anyone has been
hospitalized within the past 12 months "or expects to be hospitalized in
the next 12 months." Unsurprisingly for a group our size, the answer is
yes; so we are then asked to "state reason(s) for hospitalization," with
several lines left to fill in the details.

Those questions are intrusive enough, but it gets worse. Question 4 asks
the employer to go back 36 months and find out whether anyone has been
diagnosed with any of 14 categories of ailments.

Along with such diseases as cancer and diabetes, the insurance company
wants to know about highly personal matters such as alcohol/drug abuse,
infertility, immune system disorders (such as AIDS), and any
psychological diseases or disorders.

Again, these are not just yes or no questions; employers are asked to
provide information about when each diagnosis was made, what the
prognosis is and what treatment the patient is receiving. And to be sure
that nothing has been missed, the last question asks whether anyone has
"incurred medical claims in excess of $5,000 over the last 12 months"
and requires details. It apparently doesn't matter whether those claims
were ever paid.

For the Public Citizen officer who would have to sign this form,
answering most of the questions would be easy: "I have no idea, because
only our insurance carriers have all that data, and I don't think they
would give it to us even if we asked." But more important from our
perspective, we don't think that any employer should have access to that
kind of highly private information because it could be used, legally or
not, to the disadvantage of the employee who is forced to provide it.

Therefore, we at Public Citizen decided as a matter of policy that, even
if we could get the information, we would not ask for it since it is
really none of our business, even though it could directly affect the
cost of our health insurance program, which is our business. Indeed, as
we subsequently learned, although some carriers did not insist that we
fill out this kind of form before quoting us a price, almost all of them
had a policy such as that reflected in the form's last line: "Rates
contingent upon review and acceptance of medical information."

In the end, we kept the same carriers, albeit with a few changes and a
price increase that was less than we had originally been told. In all
likelihood, the small increase was because our carriers already had the
answers to the questions on the form, as well as much more information
about our employees and their dependents, from which they were able to
decide how likely they were to make a profit at a given level of
premiums. We felt good because we had not cooperated with the massive
invasions of privacy that these forms demanded, but that was only
because our cooperation was not needed.
The whole episode was particularly distressing because Public Citizen is
a well-known consumer advocacy organization that might be expected to
resist this kind of personal interrogation. Surely insurance companies
are at least as invasive when dealing with other employers, who may be
less concerned about protecting the medical records of their employees.

This episode clearly illustrates how the business of medical insurance
in America works today. The theory behind group health insurance is that
it is supposed to spread risks and costs so that the healthy subsidize
the sick. That is a fair trade-off since most of us at one time or
another will need some sort of expensive medical treatment. The use of
these forms, however, makes clear that insurance companies are doing
their best not to sell insurance, but to sell prepaid services to people
who are unlikely to need much medical treatment or, at worst, who will
only need fairly predictable and inexpensive services. As a result,
these companies are no longer in the business of spreading risk, but of
avoiding risk.
If this trend continues, it will become even more difficult for anyone
to obtain reasonably priced, moderately comprehensive health coverage.
Even if insurance companies were prohibited from asking for such private
information before they signed up a group, there is nothing to stop them
from "dumping" a group afterward if its medical costs go too high.
Indeed, health insurers already are dumping patients if, after too many
of them actually need medical care, they are deemed "unprofitable" as a
group. That's what happened to 100,000 people in North Carolina, South
Carolina and Georgia who subscribed to Mid-South Health Plan, a
subsidiary of Trigon, a large managed-care company. Trigon announced in
October 1999 that, because of "an unexpected increase in medical costs,"
it would close Mid-South. Trigon says it gave its former customers six
months to find other coverage; but for any of those whose illnesses made
them unprofitable in the first place, this was probably quite difficult.

As the old saying goes, "there ought to be a law," but passing one that
will work is easier said than done. Congress has already tried to deal
with a narrow aspect of the problem of refusing insurance to people with
preexisting conditions, but the experiment has been largely
unsuccessful. In 1996, in response to complaints that insurance
companies were refusing to insure people who had potentially expensive
conditions (such as AIDS, but also including pregnancy), Congress
enacted a law that prevents outright discrimination by providers of
group health insurance. The law also forbids charging higher rates for
the sick than for the healthy. But the law expressly allows the insurer
to raise the rates of the group as a whole. This doesn't end the
discrimination; it simply shifts the cost to a somewhat larger group --
but not the entire community, let alone the entire population of a state
or region. And for individuals who are not part of a group, the law
assures that they can purchase medical insurance, but gives them no
protection against having to pay outrageous amounts for it.

Another option for Congress would be to establish a whole regime to
control health care prices -- which would include new rules and
regulations for insurance companies, hospitals, doctors, companies that
sell products and services to them. If it did, of course, there would
have to be a significant, costly government enforcement and regulatory
program to see that companies complied, not to mention the internal
costs for each company to be sure that it didn't violate these
inevitably complex laws. If such a system were put in place, we could
pretend that the free market was still at work, but it would be unlike
any free market ever seen in this country.

Moreover, there is no guarantee that the new laws would do anything more
than eliminate the very worst abuses, while insurance companies would
still find a way to serve mainly the well and the well-off.

Of course, if we had a system under which there was no shopping around
for insurance coverage, and in which the health care providers treated
whoever came in the door and were paid accordingly, the problem of group
dumping would disappear.

There is such a system, found in almost all developed countries in one
form or another. It's called national health insurance. But the gods of
conventional wisdom in this country have removed it from the list of
options for discussion.

However, if you believe that group dumping -- and other similar flaws in
our current system -- should not be allowed to continue, don't be so
quick to dismiss a single-payer system, like Medicare, unless you have
something else that will do the job as well.

Alan Morrison is director of the Public Citizen Litigation Group. Sidney
Wolfe is director of the Public Citizen Health Research Group.

© 2001 The Washington Post Company