Why We Must Have Health Care Reform

The pending health care reforms have three primary goals. One of them is to stop health insurance companies from canceling (“rescinding”) policies issued to customers who turn out to require health care. It’s a part of the effort to stop the denial of coverage for so-called “pre-existing conditions.”

WC finds it incredible that folks are still denying that health insurers don’t do this; that health insurers don’t lie, cheat and steal in an effort to keep sick people – i.e., people who might have claims – off their rolls.

As just one example, the State of California’s Department of Managed Health Care (“DMHC”) performed an audit of 90 randomly selected rescissions by Anthem Blue Cross, to determine if any of the rescissions was inappropriate. The result? All 90 cases audited – each and every one of the randomly selected cases – was improperly rescinded. The result was a consent decree in which Anthem Blue Cross agreed to reinstate all of the 1,773 rescinded policies. And to allow increased scrutiny of any future rescissions. And to pay a $10 million fine. And, in an even more telling concession of guilt, to allow the dozens of civil cases against Anthem to go forward. Why would Anthem intentionally, even fraudulently, cancel its customers policies? To make more money, of course. The business of insurers is to not pay claims.

Perhaps even more egregious is the story reported by Murray Waas of Reuters involving Jerome Mitchell. Most of the record in the case is under seal, but enough is public to make clear that Fortis Health, now known as Assurant, intentionally created an untraceable, unreviewable system to locate and cancel high risk customers, on flimsy, non-existent and even invented excuses. And Assurant’s General Counsel advised Assurant not to keep minutes of the meetings of the committee that reviewed these cancellations. There’s only one reason for that kind of advice, of course. The South Carolina Supreme Court in September 2009 affirmed a jury verdict against Assurant. Supreme Court Chief Justice Jean Hoefer Toal, writing the decision for a unanimous court, was harshly critical of Assurant, holding, “There is ample evidence in the record to support a finding that the harm Mitchell suffered was a result of intentional deceit.” The South Carolina Supreme Court reduced the punitive damage award from $15 million to $10 million, but did so because U.S. Supreme Court precedent required it to do so.

Paul Krugman is one of the few commentators to recognize the problem and to set health care reform in the context of the problem:

Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies.

If you think you can trust the health insurance industry, think again. The president of Assurant had the unmitigated gall to testify before Congress that you just can’t trust the patients to tell the truth. If you think Congress’s remedy goes too far, think again. This is the last best chance this decade to start to fix a badly broken health care system. Don’t believe the lies; the simple fact is you can’t trust much of anything the health care insurance industry says.

Oath of Fealty, by Elizabeth Moon

Twenty-two years ago, Elizabeth Moon wrote Sheepfarmer’s Daughter (Deed of Paksenarrion, Book 1), which began the story of Paksenarrion Dorthansdotter, who ran away from a forced marriage to become a mercenary solider. Paks’ tale continued in Divided Allegiance (The Deed of Paksenarrion, Book 2) and concluded in Oath of Gold (The Deed of Paksenarrion, Book 3). The entire trilogy was later published as a single volume, The Deed of Paksenarrion: A Novel. The end of the trilogy was very well done, especially for a first novel, but it left any number of loose ends. Paks’ “Deed” had left entire countries in disarray.

Moon returned to Paks’ world with two prequels, but both were pretty dark. They have never been as popular as “Deed.” And, besides, they offered only the barest hints of what happened in Paks’ time after the events of “Deed.”

Now, at last, with Oath of Fealty, Moon has returned to the world and time of Paksenarrion. While we have had to wait a very long time to hear the rest of the story, the good news is that Ms. Moon’s formidable plotting and writing skills have improved over the years. “Fealty” is a page turner, even more than “Oath of Gold” was. We follow events across the Eight Kingdoms and even into Aarenis as the impact of Paks’ actions spread across her world. The story picks up the evening of Duke Phelan’s arrival in Lyonya – the last scene in “Deed” – and follows the very different consequences for the Duke’s captains, Dorrin and Arcolin, for the Crown Prince of Tsaia and other major and minor characters from “Deed.” Paks herself appears, but she is a relatively minor character in “Fealty,” important but not the focus of the story. Despite the lapse of 22 years, the characters and events are consistent; too often, in late-arriving sequels, there are annoying inconsistencies and contradictions. Not here.

According to Moon’s blog, this is the first of a projected trilogy. Certainly some of the characters are left in peril at the end of “Fealty,” and there are important plot threads left unresolved. But this is a complete novel, just as the books in the first trilogy were. It is also an immensely satisfying read. Dorrin, in particular, is well-written and has moments that the 22-year younger Moon probably could not have written.

Bravo, Ms. Moon. Exceptionally well done. While Moon has written “Fealty” so it can be read without having read “Deed,” I suggest that “Fealty” will be much more satisfying if you read “Deed” first.

My very highest recommendation. I very much look forward to the next book.