Throw the Bums Out

Ok, I've had it, and in fact, I think we all have.

A couple of weeks ago, I received my new premium bill from Anthem Blue Cross Health Insurance. I've been a policy holder for over 25 years. The annual premium for my wife, Marilyn, and myself, is increasing 35%, from $20,184 to $27,336 , while the reimbursement rates for provider doctors and hospitals continues to decline rapidly. Frankly, I've never seen anything like this, it is unconscionable.

I am a doctor in Los Angeles, own my own medical practice and have for over 40 years. I'm in the unique position of also seeing the very same abusive treatment from Anthem Blue Cross doled out to my patients: endless increases in premiums based on greed and avarice and decreases in reimbursement. Over many of the years I've been in practice, I've watched reimbursement for services stay equal or slightly above the increasing costs of living. But over the last 5 to 10 years, I have seen a spiral of decreasing reimbursement to the point that most of my colleagues are no longer taking any insurance. After all, there has to be a point when increasing overhead and decreasing reimbursement reaches a point of no return. The same is true of my patients. In essence, we are paying more and getting less. In addition, many claims submitted to Anthem Blue Cross involve numerous, exhausting follow up calls and emails to fight for proper reimbursement. Anthem no longer functions as a quality care insurer, but rather specializes in passing paper back and forth telling us our care as prescribed by our doctors is often "not medically necessary." Horror stories from my patients telling me they fought Anthem Blue for 2 years for a $36.00 reimbursement is not uncommon.

If you think as a doctor, I am immune to their abuse, think again. I recently was diagnosed with a small cancerous growth in my kidney, and had to undergo a surgical procedure to remove it. Many years ago I had a knee replacement. Since these are both now characterized as pre-existing conditions, I don't have any choice but to maintain my contract with Anthem. No other insurance provider will accept me due to my medical history, until I'm eligible for Medicare.

Health insurance companies can charge whatever they want as long as at least 70% of the money goes to patient care. This is state law here in California. In addition, my new contract states, "Anthem Blue Cross will usually adjust rates every 12 months; however, we may adjust more frequently in accordance with the terms of your health benefit plan." Basically, this means, there is no end in sight for how high the increases can go. As if this isn't bad enough, WellPoint, Anthem's parent company, has made billions of dollars in profits, a $2,700,000,000 profit alone just in the last quarter of 2009. This is on the backs of all of us who can't afford to be without health insurance or forfeit our wellness. This is shameful, disgraceful and immoral.

California is currently so poorly run and backlogged with consumer complaints, legislators and regulators have only recently begun to challenge Anthem Blue Cross. My calls to California Insurance Commissioner Steve Poizner (all three of them) have not been returned by him, although I did hear from one of his deputies -- nice guy, inconclusive conversation. Funny, I was brought up to believe that our government is here to protect us, not increase the wealth of investors. Now it seems, we have to help them out of this mess.

Accidents, diseases and ill health can kill you. Doctors, hospitals and other care givers are trying to keep you healthy, treat you if needed, prevent major diseases and comfort you in the last months days and hours of you life. I have spent my entire professional life dedicated to healing people, that is my job and my passion. However, I am no longer willing to have Anthem Blue Cross trade my health and yours for gross profits to fatten the paychecks of executives and investors.

Anthem Blue Cross is supposed to encourage doctors to treat cancer. However, I believe they, and others like them, are the newest form of cancer, infecting all of us and sucking the life out of us until such time as we decide to let them know their business model is broken.

So what did I decide to do? Take action. I picked up the phone and called the LA Times medical editor, Duke Helfond, who wrote a front page story about Anthem Blue Cross' abusive premium increases. As a result of that story, I received literally hundreds of phone calls from colleagues, patients and community members telling me they are ready to join the fight. And it hasn't stopped there. I was interviewed by CNN for Wolf Blitzer's Situation Room. Now, Congressman Waxman has called for investigative hearings in Congress looking into abusive increases by Anthem Blue in California, as has Congressman Bart Stupak of Michigan. California Insurance Commissioner Poizner called for a freeze on the most recent rate increases; Anthem has agreed to a two month freeze. California Attorney General Jerry Brown is also calling for investigations. President Obama told reporters in Washington after the LA Times article appeared that Anthem's rate hikes highlighted the need for healthcare reform. "If we don't act, this is just a preview of coming attractions," Obama said. "Premiums will continue to rise for folks with insurance; millions more will lose their coverage altogether; our deficits will continue to grow larger. And we have an obligation -- both parties -- to tackle this issue in a serious way." President Obama will hold his important Health Summit next week, and in his letter inviting congressional leaders to the meeting, he indicated that his legislative proposal would "put a stop to insurance company abuses, extend coverage to millions of Americans, get control of skyrocketing premiums and out-of-pocket costs and reduce the deficit.

And interestingly enough, Anthem Blue's parent company WellPoint, today canceled their investor meeting scheduled for next week to "prepare for the Congressional hearings on Feb 24th." WellPoint CEO Angela Braly has been called to testify and explain the rate increases in California to a subcommittee on the House Committee on Energy and Commerce, while executives from Anthem Blue in California have been called to testify Tuesday before California's Assembly Health Committee.

This is just a start, we need to keep the momentum going and I need your help.

If we want change, we must demand it.

Join me in establishing a grass roots campaign and together, we can affect change by collectively shaming the insurance companies to decrease premiums or legislators and elected officials to force the bums out of California. Send me your suggestions for the name of our group, and think about this: now that there is a freeze on premiums from Anthem Blue Cross for two months, I will save $1200.00 that can stay in my pocket. If there are 800,000 individual policy holders in California who can save an average of $400 per month during this time, that represents $320,000,000. There's power in that monetary figure and if we join forces, we can influence where our premium dollars go. Medicare is able to provide appropriate care to millions of people with a 4% cost. In other words 96% of Medicare goes right back to the people. That's people power.

If you are interested in joining me fight this abuse, let me know. Your comments are important to me. How has your contract with Anthem Blue Cross affected your life and family? Come on California, let's show the nation we know how to fight health insurance abuses and rip-off. We won't tolerate insurance company greed on the backs of our good health and ability to work. Join me, and truly make a difference -- THROW THE BUMS OUT!