HEALTH CARE/Joan Retsinas

Robber Barons Enter Health Care

The 19th century Robber Barons who built the nation’s infrastructure on the backs of workers were reverse Robin Hoods: they took from the poor to enrich the rich. Inspired by them, the moguls behind Monopoly-the-game created a tiny icon, Rich Uncle Pennybags. As any 10-year-old knows, Monopoly (both the game and the business model) rewards ruthless acquisition, matched by ruthless destruction of competitors’ portfolios. Greed has inspired players, long before today’s hedge fund geniuses were born.

In this season of greed, it is time to award the Uncle Pennybags Prize in health care, given to people who amass riches by squelching their customers.

Ordinarily the insurance companies would win: avaricious methods, like exclusions for pre-existing conditions, low “ceilings” on benefits, high profit margins, limited coverage for most every malady, have netted mega-returns, at the expense of enrollees. But now that the Affordable Care Act has nixed the more egregious methods, the insurance companies are out of the running. The field, though, is full.

Second runner-up: the physicians, nurses and therapists who consider Medicare an open trough. A recent “fraud sweep” charged 107 people, many well-paid clinicians, with bilking Medicare of $452 million in false claims. (A September sweep charged 91 people with bilking $295 million.) The scams are ho-hum: billing for care not provided, billing for non-existent patients, overbilling. Stepped-up enforcement, thanks to provisions in the Affordable Care Act, swept up these contenders. But, since the scams are so time-worn, the malefactors don’t win.

First runner-up: Philip Morris. (“Philip Morris focuses on the global market,” Farah Stockman, Boston Globe, April 24, 2012). Since 1965 when the Surgeon General declared smoking unhealthy, the company has battled the government over restrictions on advertising, sales to minors, warnings on cigarette packages -– and lost. To discourage smoking as much as to raise revenue, states raised taxes. To add insult to injury, states successfully sued Big Tobacco. By now most public places in the United States, including restaurants, ban smoking. The occasional “designated smoking spots” are generally out-of-the-way. Only 19% of Americans smoke. Even though Philip Morris lobbyists have raised high the banner of “personal choice,” the Marlboro Man is passé.

So Philip Morris looked overseas, to the millions of people, many teenagers, not yet hooked. Why not hook them with glitzy advertising, sports promotions, and cheap pleasure? In places where people die from malaria, typhoid, AIDS, diarrhea, even polio, surely heart disease and cancer are low on the list of health-worries. Besides, people enjoy smoking. And people yearning for freedom should at least be free to smoke. In Uruguay, Australia, and Norway, when governments tried to block cigarette sales, Philip Morris went to court to block those edicts. Smoking, not surprisingly, is on the rise outside the United States. And when Philip Morris looks to China, the company does not see restrictions on basic freedoms, but sees the freedom to smoke. Whatever the market for American goods overseas, the market for cigarettes is robust. Uncle Pennybags would praise the company’s entrepreneurial zeal.

Grand Winner: Accretive Health. Accretive collects on medical bills. As Monopoly players know, you can’t win if you can’t collect. Accretive has collected, literally as well as figuratively, on the backs of putative dead-beats. (“Minnesota AG blasts Fairview’s former medical debt-collection firm for aggressive tactics,” by Christopher Snowbeck, St. Paul Pioneer Press, April 25)

Accretive’s client: hospitals. Hospitals can sink in red ink, as uncollected, seemingly uncollectible, bills mount. Telephone calls, letters, even personal visits, often don’t work. People hang up, tear up the letter, ignore the doorbell. Fairview in Minnesota hired Accretive to beef up collections, and Accretive wielded its magic. Why not dun the patient when he is in the hospital? Accretive established bill-collection quotas for hospital personnel, it urged staff to harass patients in the emergency room (in violation of a statute designed to prevent hospitals from “dumping” emergency room patients, before admission), it was gearing up to zero in on pregnant women counting contractions in the obstetrical wards. Accretive did not prevail. Physicians objected, the press weighed in, the hospital ended its contract with Accretive, and the Minnesota attorney general stepped into the fray. But for gutsiness – the kind that replicates the spirit of the robber barons, Accretive wins the Uncle Pennybags prize.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, June 15, 2012