View Full Version : Liberal health care lies #1,345,987 & 1,345,988 and more!

Constitutionally Speaking
10-08-2009, 08:34 AM
The left has spent considerable time demonizing private industry and driving them either out of the country or out of business entirely (then of course they blame Republicans for losses of jobs). In the past it was the steel industry, the textile industry, the mining industry, the auto industry etc (the list of lost industries due to liberal harassment is too long to list). The medical insurance industry is just their current victim.
They look to government as the solution to every possible issue that they perceive as being unfair or wrong - ignoring the fact that the un-fairest and most egregious perpetrator of wrongdoings is the government itself.
Currently they are demonizing private insurers by exaggerating instances of claims denial and foisting the "victims" into the public spotlight.
The AMA - a very visible SUPPORTER of the President's health insurance goals has been front and center recently. The President has gone out of its way to point to their support and trying to imply that because the AMA supports his plans, most doctors do also. President Obama even went so far as to bring a group of doctors to the White House for a photo-op that "proved" doctors supported his plan.
Now it turns out that the AMA goofed up and did not delay their annual report on how the insurance industry has performed.
You see, it shows that the government sponsored MODEL of efficiency and virtue they want to FORCE on the rest of us, is the WORST of the major insurers when it comes to denying coverage! In fact, it denies nearly TRIPLE the percent of claims that the oft-cited evil private company, United Health Care. Additionally, it's denial rate is 76% HIGHER than the average for the top private insurers.

Here is their report:

http://www.ama-assn.org/ama1/pub/upload/mm/368/2008-nhirc-report-card.pdf (page 5)



The Left wants us to believe that PRIVATE industry is evil and the Government is the benevolent player in this game, yet if the left had their way, using the estimated total number of insurance claims figure of 15,000,000 and comparing the Medicare rejection rate to United Health Care's rate, this would mean that 1,027,500 claims would be rejected instead of only 402,000!!! Now THAT is an impressive change Liberals!!! Some REAL change you apparently believe in.
Now, of course the left wing blogs are furiously trying to discredit this report by cherry picking data from one or two states and only from partial years and using data from illegitimate sources (the Daily KOS is one of these blogs). They forget that the AMA has SUPPORTED Obama's efforts and that this report comes out year after year and EVERY year it shows the same basic thing - Medicare is the WORST of the major insurers when it comes to denying claims.
The other lie is that doctors support this change. A recent survey that found:

"Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted


45% of doctors would consider QUITTING if Obamacare is adopted!!!!
Now liberals, tell me again there won't be serious shortages in health services!!
All of this to cover virtually no additional people (the Democrat plan with the HIGHEST estimated coverage would cover fewer than 95% of all people) yet would inevitably destroy an industry that performs FAR better than the models the Democrats are trying to copy.

10-08-2009, 10:03 AM
Wow...excellent post.

Constitutionally Speaking
10-08-2009, 11:19 AM
Wow...excellent post.

Just fighting the liberal liars.

Constitutionally Speaking
10-08-2009, 12:03 PM
I think I am going to sticky this and invite all to post the lies that the left is trying to pass off as fact.

10-08-2009, 02:16 PM
Great Post....I am stealing it to post on other forums and spread it around the internet....

Constitutionally Speaking
10-08-2009, 08:02 PM
Great Post....I am stealing it to post on other forums and spread it around the internet....

PLEASE do that. But link back here. It is part of an article I am writing for potential publishing.

12-01-2009, 07:31 AM
Great post, I am also going to post elsewhere and link it back here.

12-04-2009, 01:02 AM
In anyone tracking far-right spin?:(

12-04-2009, 01:11 AM
In anyone tracking far-right spin?:(

We don't spin! Pay attention Hazle!

01-22-2010, 02:37 PM
I found the above article concerning these denial stats. But this guy dives deeper into the details and finds that only .69% of medicare selectively denies claims compared to 1.18% for private companies.

He sums it up by saying: "As you can see, the summary numbers being used to discredit the notion of a public option are far from a damnation of the government's ability to administrate health care. If fact, an analysis of the raw data helps show that Medicare actually practices far less selective exemptions than the private insurance industry does. And really, selective exemptions are the primary villain in this story, not denials rates. And the granddaddy of all selective exemptions is rescission."

You can read the details at the link provided. Complicated stuff. Only starts to clear things up. I'm still digesting the details and still a bit confused.

Constitutionally Speaking
01-23-2010, 06:23 PM
Could you fix your link? I would be interested in seeing it


01-23-2010, 06:29 PM
Great Post....I am stealing it to post on other forums and spread it around the internet....

Me, too!

01-23-2010, 07:22 PM
Twisting Medical Claim Denial Numbers 10/09/2009

Somebody forgot to read this
Opponents of a government administrated health care option have a new talking point: The government run Medicare program denies more claims than private insurance companies do.

This talking point stems from an article written by Patrick Tuohey over at biggovernment.com. In Tuohey's article, he uses data from an AMA survey that found Medicare denies 6.85% of the medical claims while the combined rate of denial for the private insurance industry is 3.89%1. Obviously the argument attempting to be made is, "If the government administrated Medicare program denies 2% more claims than private insurance, how can proponents of a government administrated health insurance option justify their support of it?"

Fortunately, support is not at all difficult to justify. It starts by looking closer at the numbers which support the claim.

First and quickly, the most simple point. The Medicare numbers represent only patients 65 and older, while the numbers for the private insurance companies represent every patient age. Anybody who has an elementary understanding of statistics knows that if data is generated from two different sample demographics, that data cannot be equally compared. Therefore, any argument formulated from this data shouldn't be taken seriously.

So, I guess we're done. We could easily just forget about this poorly reasoned argument until those making it are able to compare Medicare to private insurance data limited to patients 65 and older.

That's no fun. Let's continue our analysis of this argument under the false assumption that data it's based on is logically comparable.

However, we shouldn't stop at the summarized data biggoverment.com used. We need to look deeper into the report then they did. We need to look at the raw data used to create the summerized data biggovernment.com improperly referenced. And we should probably use the most recent data available which would be the 2009 report, not the 2008 report.

If we do look at the newer data and analyze it further, we'll begin see a different, albeit similar picture.

The first thing to note is that the combined rate of denial for the private insurance industry for 2009 is 2.79%2, lower than their 2008 number 3.89%. Similarly, the 2009 number for Medicare's claim denial rate is 4.00%, also smaller than their 2008 number 6.85%. The ratio of the difference between these numbers remains relatively constant for Medicare vs. the private health insurance industry from 2008 and 2009, so it's safe to assume that ration of our second metric will also remain consistant - the reasons why the claims were rejected. The reasons for claim denial give us a much better idea as to what's going on in the health insurance industry than just looking at the percentage of denials.

We'll start with Medicare. The raw data tells us that only 17.4% of their rejections were classified as, "non-covered services because this is not deemed a 'medical necessity' by the payer." The rest of the reasons for rejections were things like,
Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor (28.9%)
Patient/Insured health identification number and name do not match. (10.0%)
claim/service lacks information which is needed for adjudication. (9.1%)
If we take the 17.4% of Medicare's claim denial deemed 'not medical essential' and apply that to the 4.00% of total rejected claims, only 0.69%3 of Medicare claim denials were selective exemptions.

Let's compare that to the rejection reasons given by the private insurance industry. Here are the most common rejection reason given by the private insurance industry:
Deductible Amount (you need to pay more before we do)
These are non-covered services because this is a pre-existing condition (unless we've covered you since birth, you're SOL)
Precertification/authorization/notification absent (you need to tell us before you are in a catastropic accident)
Expenses incurred prior to coverage. (sounds a lot like pre-existing conditins)
Procedure/treatment has not been deemed 'proven to be effective' by the payer (because we're not just paper pushers, we're doctors)
You'll find none of these selective exemptions listed by Medicare in the AMA report. These are exclusive to private insurance and their never-ending quest to find new way to deny payment to their customers. On average, these selective exemptions used by the private insurance industry account for 42.47%4 of the claims they deny. Take that number and apply it to their average of 2.79% of claims denied and we can conclude that these private insurance companies selectively deny 1.18%5 of their claims. Compare this to the 0.69% we calculated for Medicare.

But while the above are common, by far the most common reason for rejection given by the six private insurance companies in this report is, "Expenses incurred after coverage terminated". In fact, this is the number 1 reason for 4 of the 6 private companies (Aetna, Coventry, Humana and UHC).

So, what does "Expenses incurred after coverage terminated" mean? There are one of two possibilities and both involve Rescission - the act of canceling a customers policy after they submit a claim.

If this denial reason code represents the percentage of customers an insurance company rescinded, then the six private insurance companies rescission rates average out to 30.45% of their denied claims. If this is true, then on average the private insurance industry cancels 0.84%6 of their customer's policies in a given year. This figure seems high based on the numbers the industry has previously admitted to, so let's examine the other option...

The other possibility is that "Expenses incurred after coverage terminated" doesn't cover rescission. What this means is that the totals in the report don't include the customers who were simply dropped, i.e., an insurance company can't deny a claim to somebody who isn't a customer. Put simply, it would be like a supermarket tracking the food you didn't buy. If this is the case, then the private health insurance numbers in the report are too low.

As you can see, the summary numbers being used to discredit the notion of a public option are far from a damnation of the government's ability to administrate health care. If fact, an analysis of the raw data helps show that Medicare actually practices far less selective exemptions than the private insurance industry does. And really, selective exemptions are the primary villain in this story, not denials rates. And the granddaddy of all selective exemptions is rescission.

Dealing with a denied claim is not a pleasant experience, but dealing with rescission means your life has just changed forever. If you're a victim of rescission, you not only won't receive the care you need, you no longer have insurance. Considering rescission mainly occurs when the patient is confronting catastrophic circumstances, rescission often means death. And it happens much more than you probably know.

The clearest and most damning explanation of how common rescission actually is was done by tauntermedia. Using the comments made by the private health insurance CEO Don Hamm that, "Rescission is rare. It affects less than one-half of one percent of people we cover", tauntermedia concluded:

Half of the insured population uses virtually no health care at all. The 80th percentile uses only $3,000 (2002 dollars, adjust a bit up for today). You have to hit the 95th percentile to get anywhere interesting, and even there you have only $11,487 in costs. It’s the 99th percentile, the people with over $35,000 of medical costs, who represent fully 22% of the entire nation’s medical costs. These people have chronic, expensive conditions. They are, to use a technical term, sick.

If the top 5% is the absolute largest population for whom rescission would make sense [because the cost of care over time might substantially exceed premiums], the probability of having your policy canceled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.
Got that? If you're unfortunate enough to be stricken with a disease that your health insurance company knows will eventually cost them $35,000 of more, you have a 50% chance of losing your coverage. If the rescission rate is actually 0.84% as we've calculated and rescissions are limited to the most expensive 1% of claims then for every 20 claims over $35,000 that come in, the private insurance industry are paying for only 3.

No comparison of Medicare denial percentages will ever top the atrocity of that repulsive fact.

1 2008 Averages: (6.80 + 4.62 + 3.44 + 2.88 + 3.88 + 2.90 + 2.68)/7=3.89%
2 2009 Averages: (2.02 + 2.03 + 3.99 + 2.56 + 1.81 + 4.34)/6=2.79%
3 4.00*.174 = .69
4 ([Aetna](24+15.5+6.4)+ [Anthem(16.6+9.6+3.6)+ [Cigna](0)+ [Coventry](61)+ [Humana](35.7+8.0+6.7)+ [UHC](52.4+7+4.6+3.7))/6 = 42.47
5 2.79*.4247=1.18
6 2.79*.3045=.84