15 February 2007

Single-payers in the lions' den

The Colorado Health Underwriters Association is hosting the national association in Denver this June. It’s tradition to wow guests with a tourist delight, and the Colorado group decided to take conventioneers on a train that travels up into the Rockies. So they were disappointed to learn that their convention meets a week before the train begins running.

They went to management in hopes the outfit would open up a week early.

No go — although for $35,000 the train company would run the train for that day.

Now where would a little state insurance group come up with that kind of money?

Wait! These guys are part of the second fattest industry in the United States — and before Iraq nudged the oil industry up into number one, they were tops. $35,000 is chump change to this crowd — and sure enough, Humana and Assurant came through with the cash. What a sweetheart deal, wouldn’t you say?

The association’s state president brought that happy news to the Southern Colorado chapter at an “education fair” in Colorado Springs last week.

The Springs has been called the evangelical Vatican for all the right-wing religious groups based there, beginning with Focus on the Family. It’s also home to the Air Force Academy and Fort Carson Army Post — home to the 3rd BCT, 43rd ASG, 3rd ACR, 5th Armored Brigade, 13th Air Support Operations Squadron, and the 10th Special Forces Group. Lots of these guys fall in love with the landscape, the tawny plains running up against the abrupt wall of the Rockies, and have raised their families here.

All in all, it’s become a misplaced piece of Virginia or South Carolina.

And yet Southern Colorado’s underwriters are strangely captivated by the idea of single-payer. Dr. Cory Carroll, another single-payer proponent, spoke to them last year with a fairly hair-raising reception. Evidently he softened them up — either that or their innately Southern manners took over this year in the presence of Health Care for All Colorado’s president and grande dame, Dr. Elinor Christiansen. Audience members may not have believed some of what she told them, but they were mostly polite.

I tagged along to see what kind of questions this crowd would have — and because I had some trepidation about Dr. Christiansen entering this kind of lions’ den. That was even though Eldon VanDerWege, an HCAC member armed with an MBA and a good powerpoint presentation, was already accompanying her.

I shouldn’t have worried.

Dr. Christiansen was born in Beijing, China, the second child of an engineer father and physician mother. She has a ready and gracious smile, but it comes with the sense that she’s also tough and smart.

She reminds me of another amazing woman physician of great courage and stamina: Dr. Cecilia Wood, who runs a clinic for disabled children on the island of Mindanao in the Philippines, a place that the State Department advises Americans stay away from because of terrorism.

Dr. Christiansen also has a remarkable life story: She remembers the Japanese occupation of Beijing, including the day when a Japanese officer casually leaned out from his rickshaw, traveling next to that of the Christiansen children on their way to school. The Japanese soldier lopped off the head of a Chinese man as he passed by.

She worked in inner-city Denver with mothers and children before taking over the University of Denver’s healthcare plan for students — a kind of mini-single-payer plan. Dr. Christiansen is only nominally retired. She works long hours as Health Care for All Colorado’s president.

The underwriters began with business. Their local president spoke unabashedly about the need to give money to Colorado legislators to “financially influence” them.

Working with a local television station’s health fairs would bring “a lot of positive political capital...”

I noted my squeamishness at this bald acknowledgement of the how-to of manipulation — as I expect their lobbyist did as well.

Sure enough, he put the matter back into accepted terms. Money buys access, that’s all.

There was an urgency here in this Marriot banquet room — these women and men (they’re mostly women) need that access. After all, the lobbyist said, there has already been a Republican legislator beating Democrats to the punch in talking up the idea of an insurance “connector.”

“We need to sit down with them and explain why that’s not the best way to go,” he said.

A “connector” does sound ominous, doesn’t it? Kind of Schwarzeneggerian “I’ll be back.” For the underwriters, the word is threatening because it refers to the Commonwealth Connector in Massachusetts, which helps people buy “affordable health coverage” if they don’t have it — in order to conform to that state’s new mandate that everyone have insurance. The Connector offers subsidized insurance to people up to 300 percent of the Federal Poverty Level, and it “connects” small businesses and other individuals to insurance products.

One would think that insurance underwriters would be in favor of a mandate to buy health insurance, but in fact “the Connector” is a government program taking over these people’s jobs — helping people find affordable health insurance.

Which must be an increasingly frustrating job for the percentage of underwriters living in the reality-based community. Has most of the reality-based contingent already left?

As the crowd sitting at round tables on the floor of the small banquet room listened, representatives from Humana, Kaiser, Assurant, Blue Cross and a dozen other HMOs and insurance providers waited on a circular walkway around the room for the breaks that would allow them to explain their “products” to the underwriters. Think about that. There are hundreds of insurance products. Underwriters, to do their job well, have to learn all the arcane loopholes and fine print of as many as possible, in order to give their clients a true choice. It’s a goal that must have actually become impossible years ago, especially for anyone selling to the middle class. But good luck, eh?

The lobbyist also told the group that 5,000 to 6,000 people make their living selling insurance in Colorado, but only 500 belong to the association.

That number came up again when a senior analyst from Colorado’s Department of Insurance talked to the group about consumer complaints against their industry.

Michael Gilles said that his department had recovered $726,000 for consumers in just the past month, and that the figure would be $7 million to $10 million by year’s end.

“We’d like to think that the private sector model fixes problems, but it does not work that way,” he lectured, reminding the group about the Golden Rule.

He said that “cost-effective” products often result in reduced benefits that consumers don’t understand.

“We get the call from someone who says, ‘my agent said that this policy would do everything my current policy does but costs less,’” said Gilles.

“We look at it, and it’s actually dramatically different — not just a little different.”

Gilles said his office doesn’t have problems with association members. The guilty parties were found amidst the other 5,000 agents.

Then it was Eldon’s turn to present his powerpoint slides, which emphasize the lack of cost-effectiveness in our system.

A woman at our table with a “New York Casualty and Life” nametag so audibly and positively responded to his presentation that I worried for her standing with her fellow agents.

Afterwards, one of the questions — accusations, actually — was about waiting for surgery in Great Britain. It’s interesting how waits in Canada and Great Britain symbolize those system’s shortcomings. And it’s interesting that we supporters of single-payer healthcare find ourselves feeling so defensive about those systems — which we all know aren’t perfect. Can humans create a perfect system?

The charge was that Tony Blair was exhorting Britain to improve from its current average of a six-month wait for hip replacements to the European Union standard of three months.

Eldon responded that his sister had to wait a year for a replacement hip — in the United States. Oh.

Eldon also made the point that if his investment broker took 33 percent of his investments — as administration eats up 33 percent of our healthcare dollars — we wouldn’t invest.

Even this audience agreed to that.

Coming up: Dr. Christiansen, Linda Gorman of the Independence Institute, and Rob Rush of Memorial Hospital debate single-payer.

No comments: