Academic journal article
By Maher, John N.
Journal of Law and Health , Vol. 25, No. 1
I. INTRODUCTION II. SKY-ROCKETING COST, LOSS OF COVERAGE, & BANKRUPTCY A. Extremely High and Rising Costs Overall B. Rising Insurance Premiums, Deductibles, and Out-of-Pocket Expenses C. Rising Costs Hurt the Economy D. Personal Financial Ruin III. HEALTH CARE FINANCING IN THE UNITED STATES A. Signing the Affordable Care Act B. Government Health Care Financing Programs C. Privately-Funded Medical Coverage D. The Underinsured & The Uninsured E. Financing Friction F. Corporate Interests Protected Through Public Relations Tactics G. Unsavory & Apparently Unlawful Public Relations Tactics H. The Challenges A head IV. INSURANCE COMPANY RISK REDUCTION AND RISK AVOIDANCE TACTICS A. Dropping Beneficiaries Who Get Sick B. Padding Profit Through Coverage Denial C. Dr. Linda Peeno 's Testimony Before the House of Representatives V. WIN-AT-ALL-COSTS PUBLIC RELATIONS TACTICS A. What Is Public Relations? B. Misleading Public Relations Tactics C. Specious Third-Party Front Groups D. Contrived Self-Serving Studies E. The Result of the Public Relations Gamesmanship VI. POTENTIAL SOLUTIONS A. Congressional Hearings to Build a Record B. State-Based Licensing of Public Relations Professionals C. There Must Be Disclosure D. Existing Laws VII. CONCLUSION
"IT IS A FACT THAT HEALTHY NATIONS ARE WEALTHY NATIONS. ... "(1)
Excerpt-1: ... This is the fatal flaw. Many of those charged to fund medical care are incentivized, by corporate and fiscal law, to find ways to deny coverage. This enticement has led each of the larger private health insurance companies to implement various morally unsettling, but often licit ways to deny payment based on technicalities and fine print. So doing positions the company to maintain a medical loss ratio in keeping with shareholder and investor expectations, not to mention mammoth executive compensation linked to stock performance. Meanwhile, somewhere else in America, a patient goes untreated even though the technology and the medical resources may be available. Attending physicians are embarrassed, even frustrated or outraged. The patient feels the despair of abandonment. The anxiety and pain family and friends already feel is worsened by the idea that their loved one has been devalued by an anonymous, aloof, and apparently disinterested medical director ensconced in a distant office building overlooking the green fields of Connecticut. Given the importance Americans place on individual rights, freedom, and the inherent value of each life, one would think that those charged to fund medical care would be incentivized by benevolence and good will rather than the bottom line, especially when those in need of care are at their most vulnerable in body and spirit. (2) Excerpt--2: The time is now to clearly identify the extent of these two material problems: the elevation of profit over the financing of care on the one hand, and unchecked corporate duplicity guised as legitimate public relations on the other hand. Solutions must contemplate recalibration of the payment system so that those responsible for payment are motivated to fund medically necessary care rather than deny payment to increase profits. Solutions must equally embrace measures to require public relations firms to disclose the identity of their clients and certify the good faith basis of public claims so that debate about significant issues such as the health of America's citizens is free from disguise and unseemly manipulation. A problem identified is a problem half solved. (3) Until these two problems are taken up, each remains poised to produce high-stakes problems in the future. (4)
The purpose of this Article is two-fold: first, to highlight two problems which threaten the effectiveness of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), (5) and second, to invite civic and governmental dialogue to implement solutions to those problems. …