Same Old, Same Old . . . .

Will health insurers proclaim that they cooperate with health reform, while they take aggressive measures to  avoid risk?  Will they play these games?

1. Devise drug formularies which provide limited access to expensive medications required for lifesaving treatment of serious diseases?
2. Provide a disincentive tier copayment system for drugs which makes them unaffordable for persons with serious diseases (genetic and acquired) requiring expensive new drugs?
3. Provide no or very limited network access (or high copayments) for consultation or follow up with expert physicians and facilities for patients with rare diseases which are expensive to treat?
4. Redline areas which traditionally have higher-than average claims costs?
5. Shift patient utilization and serious sickness risks to physicians or physician groups who are not financially equipped to shoulder these risks?
6. Provide low payment to physicians in certain specialties and geographic areas to discourage physicians from attracting high-cost, high-risk patients?
7. Adopt the 85% rule which means that if 85% of the patients do not complain, or on survey say that they are satisfied with the plan, that is sufficient? (Such a plan may discourage sick high-users who are in the 15% of the dissatisfied group.)
8. Deny benefits retroactively (i.e., an out of the area claim for a traveling patient who reasonably considered the condition to be an emergency)?
9. Use marketing measurements of "quality" rather than disease outcome measurements?
10. Discourage utilization by providing telephone roadblocks to patients and physicians obtaining authorization for care?