Editor's Notes

Mr. Incredible is this great superhero, but liability lawsuits force him to retire and he winds up as a claims clerk in an insurance company
|
(0)

Tredmond@sfbg.com

All the great sci-fi and comic book movies have some sort of larger social metaphor. Robocop, one of my all-time favorites, was really about the privatization of public resources. Our hero gets mangled in a firefight because Detroit turned its police department over to Omni Consumer Products Corp., which cut staffing to boost the bottom line and there's no backup available.

So when I was editing this week's cover package on the battle over health insurance, I couldn't help thinking about The Incredibles. See, Mr. Incredible is this great superhero, but liability lawsuits force him to retire and he winds up as a claims clerk in an insurance company, where he sits around all day stamping "denied" on health insurance claims. Then he gets in trouble for quietly telling customers how they can appeal.

I've always imagined that real health insurance offices look exactly like that. People sit around all day and get paid to make sure that other people don't get health care. And if they deny enough claims, they get a nice bonus. If they approve too many claims or help the poor customers appeal, they get fired.

The thing is, the bonus part is true. Many insurance companies pay their staff based on how much they have done to keep costs down — that is, to make sure expensive medical treatments are denied. I've been through this. The medical insurance won't pay for the anesthesia my son needs for complicated oral surgery because the procedure happens in a dental office. The dental insurance won't pay because the drugs are administered by an anesthesiologist, who is a doctor, not a dentist. Someone is smiling in both the medical and dental insurance offices; they just saved $1,000. Bonus on the way.

Sound familiar? I bet you've been through it too.

This is why the only way health insurance is going to get better is if the profit is taken out of it. And why it's absolutely nuts that the insurance industry is still considered part of the solution.

The city budget didn't come out well. The cops, the mayor's press office, the mayor's 311 call center, the places where there is still a lot of bloat, saw no real cuts. Public health and human services, which have already been cut to the bone, got hacked even more. And there is no concrete plan to even try to raise new revenue this fall.

There are some lessons here, and let me start with an obvious one. The final deal went down with two people — Sups. John Avalos and David Chiu, both new to the board — in the room with the mayor's staff. Same thing in Sacramento — five people cut the deal. There's got to be a better way. *