The greatest threat to the health of Americans today may be their insurance companies. It may take many years for the pendulum to swing back. In June 1998, a State Farm claims adjuster was shown on national television, in a report about State Farm's settlements with California earthquake victims, saying, "Properly paying claims is the exception, not the norm." Please remember when you sign up for insurance that "good hands" and "good neighbors" are Madison-Avenue advertising terms and don't have a thing to do with the reality of "cost cutting," "rationed care," "profits" and the "bottom line."

HMO's may work in several ways. Your doctor may sign up to care for 50,000 covered insured patients annually for a flat fee, say $40,000 per year for the whole lot. (Yes, that's 50,000 people on a particular plan like some of Humana's.) That's 80 cents per person. What if most or many patients show up? With an overhead exceeding $200/hr for many doctors a doctor may go broke seeing them all in a traditional fashion, especially if most need a treatment of some kind. You can bet that doctor isn't going to want to do anything complicated or time-consuming for a patient, if it can be avoided. Since skin cancer does not usually return for several years following a failed treatment, it is clear that freezing, scraping and applying a cream will be high on the list of treatments an HMO doctor may use. Other HMO's work a little differently, something like PPO's, where the doctors are paid as much as 50 % less than even the numbers in the 1998 table in the subsection Skin-cancer Treatment Costs and Hidden Factors. The benefit for the doctor is that he/she gets a ready steady stream of patients. The trap for the unwary doctor is that often managed-care companies change prices with little notice, deliberately "lose," destroy or reject that doctor's claims. Your doctor's billing department can literally grind to a halt waiting for an insurance-company clerk with no medical education to decide whether a patient needed the biopsy or skin-cancer treatment given. These are deliberate "hoops" or "tricks" developed by the businessmen, lawyers and accountants at the insurance companies to restrict your access to better care that would cost them more MONEY. The less money insurance companies spend on patients, the more money they can keep as profits. One patient of the website author who was a managed care executive said it was common practice to hire the smartest people and put them in the division that brings in the premium money and put the most challenged people in the division that pays the money out to doctors and hospitals and train them that their first reflex is to reject.

Ever wonder why the company you work for signed up with the HMO that won't pay for the good blood-pressure medicine your last insurance company paid for? Many times the reason lies with the executives of your company who may have been given cash, insurance-company stock, sets of golf clubs, Lear Jet trips (possibly Gulfstream, GS-5, since Lear is the cheapest type of business jet) or exotic vacations. In addition, your execs may have been given a low-ball figure by the insurance company to sweeten the deal. Insurance companies know that they will make so much money taking the premiums your company pays that they can afford to sway your execs with some of the same treats that insurance company officials themselves have enjoyed for so long at the expense of people's health.

If these insurance-company tactics seem hard to overcome, consider the following: The federal government, Congress and the President passed a little known (to you) guideline in a federal law called ERISA. The ERISA guideline makes it virtually impossible to sue any of these (mis)managed-care companies for harm to you resulting from their cost-cutting policies.

Take this case in point: A California newborn was told to see an eye specialist. Her HMO balked, delayed and tried to put off the specialist visit. The baby is now permanently blind. Eye specialists who finally saw the baby stated that the HMO's delay was definitely the certain cause of the baby's permanent blindness. The HMO even admitted it! But the parents and baby could not sue the HMO because of the federal government's ERISA guideline. Politicians wrote this part of ERISA to help the insurance companies who, in turn, supported their political campaigns with company stock and cash. HMO's would go broke if a fraction of the true potential lawsuits ever got going over some of the harm they have caused.

The insurance companies seem to always have some spokesperson, preferably a spokeswoman for proper motherly "spin," comment on a case like this, saying that such occurrences are "few and far between" and that managed care has improved the quality of American health. The author believes that for every one of these "few and far between" cases seen on TV, there are thousands more happening every day. If many or all of these cases were to be shown on TV, they would become old news and boring very quickly. Insurance companies know this. They also know that time will wash cases (crimes) like this from the average American's memory, especially if they change the names of their plans or companies frequently enough to confuse a tired public. Additionally, insurance companies are big advertisers on television. The threat of lost revenue for television networks may well affect the network's decisions on whether to air adverse news stories. See Dealing with Insurance Companies Over Skin Cancer.