www.timesleader.com News Sports Weather Obituaries Features Business People Opinion Video Contact Us Classifieds

Writer defends insurance firms

There is no question that health care in our country is flawed and remedies need to be sought. I support calls for an expanded public option to serve the poor, eradicating pre-existing condition exclusions, significantly limiting members’ out-of-pocket expenses and many of the other legislative reform initiatives that have been suggested.

However, the recent demonizing of the private health insurance industry is initiating rhetoric that is untrue, irresponsible and unfortunate.

I understand the president and his supporters need to push his agenda for reform and the need for dialogue to accomplish this is critical. However, when the dialogue turns into falsehoods that defame the characters of hundreds of thousands of caring, hardworking Americans, a defense is warranted.

I, as most Americans, have been served by for-profit health insurance companies most of my life. Currently, I am served as a pancreatic cancer fighter who has had the full support of my health insurance company since my battle began. Also, I have and continue to serve on behalf of a private health insurance company as an associate. It’s with this insight and experience that I can add perspective on how my colleagues and I go about our jobs each and every day.

We go to our jobs with the mission of serving our members’ best interests at heart and as priority one. I am responsible for making hundreds of decisions every day that determine the payment of claims. I tell you that never once over the years that I have served in this capacity have I experienced a direct order from management, or been subjected to a company policy, that initiates denial of coverage to a member’s claim based on the margin of profit their situation stands to make or lose the company.

Now, I don’t dispute that instances like this have occurred over the past 70-plus year existence of our system of health administration. However, as with all things human, there are mistakes made, egregious and unacceptable acts committed and flaws. But the overwhelming rancor about health insurance companies regarding their employees’ daily actions is appalling.

The associates at these companies go about their business in a caring, concerned and professional manner. Whether they’re answering a member’s call regarding coverage, processing a member’s claim for payment or working together with our elected leaders to help change the face of reform, they are doing so knowing the members they work on behalf of are mothers, fathers, sisters, brothers, and neighbors in our nation’s communities. These employees genuinely care about the people they serve.

It has been said that the private insurance industry has become all business and no heart. I can say with 100 percent confidence, from first-hand experience, that this is not the case.

Two countries, two ways of life

In 1973 while in the Navy I was in an incident in which the Russians shot over the bow of our ship.

Years later I made friends with a Russian immigrant who was also in the military. One day I asked him what the difference was between Russia and America.

He said: In Russia if you want to fall down drunk in the middle of the road, nobody cares. If you want to smoke your brains out, nobody cares. If you want chickens in your backyard or a junk car, nobody cares. Put addition on your house, nobody cares. But in Russia, you can’t say anything. In America you can say anything you want, but you can’t do nothing.

Well, I can’t comment on Russia, but I can say for sure that after 55 years of living in the United States, I have seen a lot of things changing. Every year it’s harder and harder to be in business: more laws, more government agencies, more enforcement officials, more taxes, more rules, bigger and bigger jails, etc.

Now I don’t want to comment on who is right or who is wrong, but I sometimes think that things were better when they were worse.

Where have profits from casinos gone?

In 2008, property owners were thankful that they received an “exclusion” of an extra “deduction” on their school taxes, due to the percentage of profits generated by the state’s casinos.

But in 2009, with more casinos generating profits, property owners noticed less of an “exclusion” in their school tax notices.

So, why is there less school tax exclusion in the 2009 notices? Have any of these “profits” been diverted?

Use VA system for health care

There has been considerable discussion about revamping health care in the United States and implementing a national health care plan.

Because health insurance has been provided to so many employees as a fringe benefit, most people showed little or no concern about the escalating cost of health care and health insurance until recently. They didn’t have to be concerned; somebody else was paying the bill.

As the cost of health care went up and the government started to cap the amounts paid for welfare recipients, cost shifting on a major scale occurred. Employers that were paying for this employee benefit saw their monthly insurance premiums escalate year after year at double-digit rates.

The cost of health care in the United States is killing this country and forcing more companies to move their operations overseas. No longer can companies provide a fringe benefit that eats up 20 cents out of every dollar. And, creating a national health care plan that gives tax dollars to the same insurance companies, hospitals, doctors and health-related businesses that have created this financial affliction will only exacerbate the problem.

Expansion of existing methodologies to millions of uninsured will not work and cannot be supported through substantial increases in taxes, especially with an aging population that already has been told reductions in Social Security payments might be required to keep the program operational. The money isn’t there and will not be there to support it. Any new program that would give millions of new customers to the same gatekeepers that shifted costs and allowed the private sector of health care to escalate to a point of being as detrimental as it is beneficial should not be considered.

Given the aforementioned, I still believe there is a way to provide a national health care program at a reasonable cost. The feds should consider a program that operates through the existing Veterans Affairs hospital system. With more than 700 VA hospitals and clinics strategically located throughout the United States, the foundation for a national plan already is in place.

That system has all the bidding, specifications and facilities in place. Even its pay scale for employees is structured and in place. The top of this scale is considerably lower than salaries in the private sector.

It becomes clear that a system developed within the military structure would cost substantially less than anything in the for-profit sector.

Although many of the 700-plus VA and military hospitals are in need of upgrade and repair, renovations could be accomplished to support national health care at a cost many Americans would find much more palatable than any plan being discussed in Washington that would continue to line the same pockets.

W-B is truly city to be appreciated

As a recent King’s College alumnus who is enjoying a fresh new perspective on life in metropolitan Washington, D.C, I truly can’t thank the campus community enough for preparing my peers and me for a wonderful future ahead.

When I enrolled at King’s in 2005 many people thought Wilkes-Barre was merely an “armpit.” Mayor Leighton’s “I Believe” campaign was initially met with confusion, disappointment and sneers. When I graduated, that mood was beginning to visibly change, with people now enjoying the relocated and renovated Rodano’s, Bart & Urby’s, the theater, Café Toscana, the new riverfront park, Blue Chip Gourmet, Barnes & Noble, Starbuck’s, Dunkin’ Donuts, Arts YOUniverse, Hardware Bar, Third Fridays, and many other newer downtown venues.

There was a growing interest among people with whom I talked about living downtown as well, so hopefully the developers of the long-anticipated Hotel Sterling, Murray Complex and Empire Silk Mill projects will finalize their plans. If so, it will bring hundreds of new residents to center city and this increased foot traffic will further enhance the city’s impending revival.

Despite what some of the naysayers might allege, Wilkes-Barre is blessed to have schools such as King’s and Wilkes University, and I hope King’s in particular continues to gentrify the blighted, transitional and often dangerous neighborhood bordered by North Street, Union Street, North Main Street and North Washington Street.

The demolition of four blighted homes along North Street (one was even the site of a murder during my tenure at King’s) is a great start.

Wilkes-Barre has come a long way in just a few years, and I might even be back someday to live downtown and open my own business.

From afar, though, I continue to be amazed and disconcerted by the chronic pessimism, negativity and whining exuded by many Wilkes-Barre residents. Outside observers can readily identify that the past several years are heralding in the Diamond City’s largest and potentially most successful redevelopment initiatives since the aftermath of the 1972 Tropical Storm Agnes flood.

Wilkes-Barre is a compact, walkable and historical urban oasis and is well-poised to capitalize upon these features when fuel prices inevitably spike once again and people look to shorten their present Back Mountain, Mountain Top or Greater Pittston commutes.

While I didn’t fully appreciate the beauty of Wilkes-Barre’s urban design at the time, I most certainly do now. Would it be a terrible hardship for more people in the “Valley with a Heart” to look at the glass half full on occasion instead of just saying, “This city’s always been a hopeless mess and always will be”?

If cities such as Bethlehem, Providence and Hartford can be undergoing successful renaissances after many years of steep decline, then why can’t Wilkes-Barre? A city that doesn’t believe in itself is a city whose future is sorely diminished.

Send us your opinion

Letters to the editor must include the writer’s name, address and daytime phone number for verification. Letters should be no more than 250 words. We reserve the right to edit and limit writers to one published letter every 30 days.

• E-mail: mailbag@timesleader.com

• Fax: 570-829-5537

• Mail: Mail Bag, The Times Leader, 15 N. Main St., Wilkes-Barre, PA 1871 1

The Weekender Go Lackawanna Timesleader The Dallas Post Tunkhannock Times Impressions Media The Abington Journal Hazelton Times Five Mountain Times El Mensajero Pittston Sunday Dispatch Creative Circle Media Image Map