When They Say the Market is Efficient

They mean efficient at profiteering, I guess. The President vetoed SCHIP because he doesn’t want kids sneaking into the big tent of government health insurance. And he also doesn’t want his pals in the private sector having their horns pulled in, as an earlier iteration of SCHIP expansion proposed. No siree, the corporate way is the American way. Against this background, the New York Times serves up its first blockbuster of this week. I hope it gets as much play as last week’s torture story. It’s right up there.

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.

The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.

$700,000 in fines on 11 companies? Hey, that’s like fining you a nickel for speeding. Wouldn’t you be sorry?

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.

The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.

Excuse me. $700,000 would be more like fining you a nickel for DWI and slamming into a car holding grandma and grandpa.

But federal officials point with pride to their efforts to police the Medicare market, and they say that competition among private plans has been a boon to beneficiaries, offering more choices at lower cost than anyone expected.

“The Medicare drug benefit is saving seniors an average of $1,200 a year,” said Michael O. Leavitt, the secretary of health and human services.

Gee, thanks, Mike. But what about saving seniors their lives?


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