Friday, June 26, 2009


By : Mr. Marcus H. Lovejoy, M.B.A., B.S., Fund Manager, Coordinated Care Systems LLC (a Delaware Limited Liability Company); Trained Statistician; Cost Control Analyst; Certified, Standard & Poor’s Profitability 100 Association; Philanthropist.

People wonder why our health care system has problems. I’ll tell you why: Too many sick insured motherfuckers sucking up trillions of investor dollars.

It’s a disaster. You have these 32-year-old insured people who get chronic diseases. They live ten, twenty years before finally succumbing. Every day during that time, they require incessant care, medication, hospitalization, therapy, treatment, surgery, assessment, rehabilitation. Do you have any idea how much this shit costs? It costs $20,000 to remove a fucking wart in a 30-second procedure. Imagine how much it costs to care for some ailing asshole who needs constant sunctioning, recurrent surgery, ICU care and ventilator treatment for years on end. Let me tell you: Caring for sumbitches like that would break an African country’s national treasury in less than two weeks.

So what do we do? To be perfectly honest, I really don’t know. All I know is that insured sick motherfuckers really ruin my day. I run a major health insurance fund. Our company provides top-notch care to paying customers. But we assume that most people won’t require constant care for years on end. We assume that they’ll need some surgery once or twice per lifetime, not every goddamned week. We assume that they will get better, then live healthy lives during which they can pay premiums. Most people do. They pay their premiums, go to the hospital once or twice in their lifetimes, then die. Look, death might be traumatic on the family. But for me it’s a relief: It means the asshole won’t need any more bank-breaking care at the fund’s expense.

We do what we can to cut really sick people off before they drain the fund into non-profitability. Our company employs hundreds of lawyers to do two main things: (1) Draft policies that restrict coverage; and (2) Find ways to deny coverage to everyone who faces an expensive illness. As concerns the first matter, our lawyers write 100-page contracts that give the appearance that insured people will get the care they need. But upon closer inspection, they contain thousands of exclusions and exceptions that provide the company a way to bail out when care gets a little too pricy. For example, we might cover eye injuries, but not corneal injuries. Or we might cover leg injuries, but not “injuries involving the leg” as that term is defined in a later section. Additionally, we include clauses that limit our liability for certain covered care at a certain dollar amount. This means we can call off a hopeless show before it gets out of hand, like the guy who needed a $15,000,000 brain surgery. We only covered $1,000,000. He had to agree to pay the remaining $14,000,000 or forget about the brain surgery.

Hey, I have a fund to run. I don’t have time to worry about a tumor on some fucker’s brain. I’ve got a Board of Directors to answer to. Yeah, yeah, yeah, you say I’m a mean-spirited prick who doesn’t care about people. Well let me tell you something: This business is not about care. It’s about dollars, bee-otch. And I don’t make dollars when some lucky moron pays $54.99 a month and gets fully covered for a $15,000,000 surgery. Sure, I’ll let that happen: IN HELL. And I’m not afraid to say it: I’d rather keep my job than put my ass on the line for some kid with leukemia.

As concerns the second matter, our lawyers know how to fight people who claim coverage for expensive illnesses. When it looks like someone has a minor illness—like a cold or something—we don’t fight it. A doctor visit here or there won’t affect our returns. But when it looks like someone just came down with Parkinson’s or—worse—a woman just had a difficult pregnancy, we scramble for ways to back out. We scour medical histories and applications for inconsistencies and pre-existing conditions. We look for lies in statements. We send out investigators. We look for anything that lets us invoke an exclusion. Basically, when an insured woman is writhing in labor for 20+ hours with a premie, we start sounding alarms. We know the bill will be enormous. Do you know how much it costs to keep a premature peanut alive in a neonatal ICU? It’s in the tens of millions. Then I say: “Fuck her if she thinks we’re gonna cover this shit.” Guess what? We never do. We have our ways; and you’ll never know what they are. You just get the denial letter that says: “We regret to inform you that, pursuant to your policy…(no coverage) blah blah blah.”

So yeah, I have a stressful job. I have a lot on my mind. I have people to answer to. They want to see quarterly growth, not loss. This fucking recession isn’t helping things, either. Now I have to worry about insureds complaining about their jobs and reduced pay. In a way, I’m glad they don’t pay their premiums, because that means we can just strike them off the rolls; and that’s one less potential multi-million dollar Parkinson’s sufferer to worry about. On the other hand, we need lots of people paying premiums to keep the company afloat. The key to success in the health insurance business is twofold. First, you need to keep a healthy premium flow coming in at all times. Second, you need to make sure you don’t pay out more in benefits than you gain in premiums. Obviously, lots of customers mean lots of premiums. That is good. But when lots of customers get expensive diseases, it can erase all your gains in a heartbeat. Basically, it’s a balancing act: Keep the premiums coming in without paying out too much in benefits.

That’s where I come in. I scrutinize benefit payouts. I have charts. I have reminder programs. I have manuals. I have employees who keep me informed about each and every last insured bastard who might come down with a rare blood disorder. I take Tums® for ulcers. I have anxiety. I am edgy because I never know when I’m going to get another bad phone call from the Senior Claims Reviewer: “Some guy needs a full intestinal transplant.” When I get calls like that, my heart sinks. “Fuck. There goes another $10,000,000. What the hell am I going to say to the Board?” Then I call the lawyers and tell them to start checking payment records and medical histories. Most of the time, we find good news that lets us deny coverage, or at least really cut it down.

But sometimes we don’t. Those are bad days. Then I need to call up the Chairman and tell him why we just authorized $10,000,000 to some schmo who paid only $100 a month for basic hospital coverage. “I’m so sorry about this…” I say. Then comes the screaming interruption: “Lovejoy, you dumb ass! Do you know what this is going to do to our numbers for May?!? You incompetent little fuck, etc., etc.” Then I glance around the office and try not to have a heart attack. All because of some heartless, selfish man who decided to get intestinal cancer on my watch.

My job isn’t all doom and gloom. I have won awards at industry dinners. Health Insurers’ Insider® magazine even called me a “scrupulous professional fund manager; one of the best in the biz” in their 2006 “Health Industry All-Stars” issue. I take comfort in the fact that my company is a major American business that employs over 5,000 people from coast to coast. I also take pride in the fact that we provide competitive coverage in the private health insurance market that helps people lead healthy, productive lives. My work earns me a great salary. I have a beautiful home and two great kids. Private health insurance did this for me. There are some moments in which I am truly grateful for my job. And I wouldn’t have it if America didn’t trust private enterprise to handle health.

Still, most of my life is a battle. I live my days worrying about whether some lucky insured will hit the care jackpot and get a lifetime of free medical treatment after paying a measly monthly premium. I will say it now and forever: I hate high-priced insureds. They make my life miserable and they hurt my company. Kids are the worst. When some kid gets cancer, you’re looking at decades of high-dollar care at clinics, sanitoriums, hospitals, rehab centers and university laboratories. Then there’s surgery, therapy and all the fucking doctor visits. Then you’ve got specialty examinations, referrals, CAT scans, diagnostics, blood tests and every imaginable MRI test. This shit adds up like a bar tab from hell. Chronically sick kids are the bane of my existence. They cost billions of dollars to keep alive. And for what? So they can weakly breathe through a tube while sobbing relatives crowd around the bed and miss work? What is the fucking point? I wish these expensive little shit-sprouts would just hurry up and die. They are costing way too much, and no one is happy about the situation. I mean, for Christ’s sake, the kid ain’t getting better. He’s just going to keep wasting away until he finally croaks. Why make me pay billions of dollars to prolong the inevitable? You selfish cocksucking assholes. AAAAAAAHHHHHHHH! I just want to pull my hair out when I think about it. And to think that the company is slipping down the Fortune 100 list because of these greedy dying kids…it’s just a disgrace.

I am in the health care management business. It’s not easy. It’s stressful. It’s agonizing. It’s difficult. When you deal with other peoples’ money, life is tough. And I deal with billions of investor dollars every day. Investors don’t want excuses. They want profits. That’s where the anxiety comes in: How am I supposed to generate a profit when people get sick for years and don’t die? Do they realize how uneconomical that is? No, they don’t. Sick people sit around and expect care while our investors grimly foot the bill and wait for them to kick off.

As a health fund administrator, I think about people differently. I have no personal stake in people’s lives. I don’t care about their pain, dreams, hopes, emotions, fears and aspirations. I just want to know whether they represent a company liability. If they do, they force me to make tongue-tied explanations to the Board. If they don’t, God bless them, because they bring in profits. The Board likes profits. It doesn’t like liabilities. You figure it out. Die, you sick fucks. You’ll make my life so much easier when you stop racking up those monster medical bills.

So here’s what I really feel. I confess that I don’t like sick children, sick old people, women who experience pregnancy complications, people who require unanticipated surgery, people who require long-term hospitalizations and anyone who costs more to keep alive than to let die. Here’s my message to all of you: You are selfish, lucky money-grubbers. You make my job difficult. And you can all go to hell.

Having said all this, if you are in the market for affordable, reliable health insurance, call your local Coordinated Care Systems agent. Because it’s your health—and you matter™.

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