Health insurers' abuses

Health insurance companies are happy to claim that their profit margins are not as high as those of some other companies that sell consumer products. But in the case of the health insurance industry, other measures are far more pertinent.

The fiscal health of health insurance companies is not fairly measured by the standard of profit margins for products of consumer choice like plasma televisions and I-Phones, clothing labels and potato chips. Rather, health insurers are measured in terms of enormous customer volume and the captive necessity of paying highly expensive monthly premiums in state markets that are generally dominated by one or two near-monopoly companies. Under these circumstances, the companies' stunning total revenues more than compensate for the supposedly lower profit margin.

In fact, health insurance companies are enormously profitable in revenue volume. They rake in billions in revenue, yet they may cavalierly deny expensive treatments or cancel a patient's coverage when a critical condition arises. The chief issue with health insurers is fairness. Many make a lot of money by using random or cruel tactics simply to keep their earnings strong.

The abysmal absence of effective state and federal regulation is a large part of the problem. But more importantly, the ethics and business standards of insurance industry leaders is defective, harmful and by normal standards too often immoral.

For-profit, and even non-profit, insurance companies frequently engage in claim denial practices that test humane standards. It is common, for example, for insurers to back-track on a patient's prior history to find a way to claim that pertinent information on prior conditions was withheld and is grounds to deny coverage. And most states allow such practices.

Such heartless behavior can and does lead to unnecessary deaths and, often, medical-related bankruptcies. When the nation's largest for-profit insurance companies are paying annual executive compensation packages of $25 million or more, spending less than 75 percent of their earnings on health care benefits, amassing mind-boggling reserves, and spending far too much money on employees who are hired simply to deny or delay payments for fair claims, there is ample cause to demand industry reforms and to create alternatives to induce lower costs and improve treatment.

It's no secret that the health industry is regulated so lightly in most states that its behavior is often abusive to customers who must buy individual coverage, as opposed to group coverage through employers.

That's not to say that policies offered to employer groups are always comprehensive or fair. But group policies are far more likely to be more comprehensive and to be administered more fairly than are private individual policies.

With regard to private coverage, most states permit insurance companies to reject individuals for coverage on the basis of their health status, existing conditions, occupation, age or recreational activities. Insurers are allowed to group and charge customers on the basis of presumed health risks, creating multiple tiers and varying charges, and defeating the idea of spreading risk throughout the general population. They may define or change their standards for coverage as health conditions arise, and they may deny or cancel coverage years after a policy is purchased without an advance review by state authorities.

And though health insurance companies in most states virtually dictate reimbursement levels to physicians, hospitals and other health care providers, they typically find grounds for premium increases that run double or triple general inflation rates, if not far more. An example of the latter is occurring right now.

Health insurers around the country are raising premiums for small business this year by around 15 percent, according to a New York Times report on Sunday, apparently to mollify Wall Street traders as well as to increase earnings.

Health insurers' abusive practices must be restrained. A public insurance option under the pending insurance reform plan is critically important to that goal.