There is some serious evil being done in this country, every day, by the cold-blooded, soulless, heartless, profit-margin-obsessed monsters we call “health” insurance companies:

One February morning, a courier arrived at the front desk of Bayonne Medical Center, trying to get to a patient’s bedside. His mission: to deliver a letter from New Jersey’s dominant health insurer warning that the patient would face a huge hospital bill if he did not leave right away.

Hospital security guards stopped the courier — and 13 others who came soon after — before they reached patients’ rooms. But then came the faxes and, after that, the letters mailed to patients’ doctors and homes. Told that her health plan would not pay for her to stay in the hospital, a 35-year-old social worker named Lisa with a severe lung infection was so unnerved that, tethered to an IV pole dripping antibiotics into her arm, she began to pack her gym bag before a staff member coaxed her back into bed.

The hardball tactics being used to pry patients from their sickbeds illustrate the colliding financial interests that pervade U.S. health care. It is a tug of war over where patients are treated, who decides how much care they receive and — fundamentally — which parts of the health-care industry gain or lose when people become ill.

The battle playing out in Bayonne has particular relevance as Congress tries to rewrite the rules that govern health care nationwide — with hospitals, insurers, doctors and other stakeholders descending on Capitol Hill to angle for advantage. The bills before the House and the Senate would shift the system’s balance of power that has evolved over decades — a balance at the core of the dispute here.

Yet the fight over hospital patients in this working-class enclave also hints at the limits of what federal health-care changes would accomplish; none of the bills would legislate away the specific business practices that have escalated into a full-scale brawl between the city’s only hospital and New Jersey’s largest health insurer, Horizon Blue Cross Blue Shield. Lawsuits are flying in both directions, each side accusing the other of fraud, greed and underhanded behavior that harms consumers and increases medical costs. Bayonne accuses Horizon of harassing patients and not paying its bills. Horizon accuses Bayonne of price-gouging and interfering with its health plans.

Such a sharp clash of self-interests is evidence that President Obama may have been naive in suggesting early on that health care’s stakeholders are now willing to set aside rivalries that have thwarted previous attempts at reform, said Uwe E. Reinhardt, a health economist at Princeton University who led a state commission on New Jersey’s shaky hospital finances. “It’s no different from Iraq with all the different tribes. . . . ‘How does it affect the money flow to my interest group?’ ” he said. “They are all sitting in the woods with their machine guns, waiting to shoot.”

In such a tense climate, Bayonne has become virtually the only hospital in the country that has withdrawn in protest from the “provider networks” of every major insurer, abandoning a tradeoff that has become a staple of the health-care system: Hospitals agree to be paid lower rates in exchange for knowing that insurers will steer patients to their beds. Bayonne is not, however, the only hospital at odds with Horizon. Four others have pulled out Horizon’s network or are close to leaving.

The incentives in this equation are all very simple. Rake in hundreds of billions of dollars from employers in premiums and then deny as much coverage as you can manage (or scare the shit out of the sick, vulnerable and dying people you’re supposed to be covering) without being indicted for capital murder.

I’m really starting to ponder the merits of single payer.

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  1. Chunzilla says:

    I think there is great confusion about what "Single Payer" is. I remember Obama supported this option as best for our country, but didn't think it had realistic chances of passing in congress, so what we're seeing now is hopefully reform that's better but far from best. Our newspaper carried a good description of SINGLE PAYER: "Single payer is a way of achieving universal health care. It is a health insurance system under which one agency, the government, pays all medical bills. As opposed to the multi-payer, private insurance system we have in the U.S. It is financed by taxes, which replace premiums. MEDICAL CARE PROVIDERS REMAIN PRIVATE.

    "Because single payer eliminates the profits of the insurance companies, and greatly reduces administrative expense due to its simplicity, it saves enough to cover all the uninsured, for the same amount of money. Single payer also breaks the connection between health insurance and employment, resulting in much greater security."

  2. schu says:

    The insurance companies define the term death panel.

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