An Open Letter to a Healthcare Insurance Provider

Subject: Agent/Marketing Position Announcement

Dear Sir or Madam:

In the fall of 2009 I graduated from a nationally accredited university with a degree in business administration; my major is management.

I am very interested in the healthcare industry and believe The Patient Protection and Affordable Care Act (HR 3590) is a step forward in providing quality healthcare insurance for all Americans. The provisions in Title II of HR 3590, concerning minimum essential coverage for nearly all Americans by 2014, provide a huge opportunity for healthcare corporations. Personally, I would like to see vertical integration in the healthcare industry to give consumers a “bigger bang for their buck.” However, the characterization of healthcare as a commodity is in no sense correct.

Until we embrace social citizenship we will continue to stumble as a society in providing adequate healthcare to all our people (Fraser and Gordon). Please understand that I am not advocating socialized medicine. I believe social citizenship, as it involves healthcare, concerns many stakeholders: the pharmaceutical and medical suppliers must value compassionate care over monitory profit, potential doctors and nurses must be given financial help to allow them to reach their career goals without incurring enormous debt, healthcare providers should work toward horizontal integration to lower unit costs and provide patients more options and higher-quality care, the general public needs to become more aware of health and wellness opportunities and practice healthier lifestyles, food distributors need to provide more outlets that supply healthy food to intercity markets, restaurants (especially fast-food establishments) should provide healthy food options on their menus, and healthcare insurers should adopt the provisions of HR 3590—even before these requirements are mandated by law. Some of the conditions of HR 3590 that relate to healthcare insurance are as follows:

  • No lifetime or annual limits
  • Prohibition on rescissions
  • Coverage of preventable health services
  • Development and utilization of uniform explanation of coverage documents and standardized definitions
  • Prohibition of preexisting condition exclusions or other discrimination based on health status
  • Fair healthcare insurance premiums
  • Guaranteed availability and renewability of coverage
  • Prohibition against discrimination of individual participants and beneficiaries based on health status
  • Comprehensive healthcare insurance coverage
  • Prohibition on excessive waiting periods

If your organization embraces these values I would be very interested in talking with you. Healthcare insurance providers have a tremendous strategic opportunity. Title I of HR 3590 discuses “consumer choices and insurance competition through health benefit exchanges.” Firms that quickly embrace the provisions of HR 3590 will create brand recognition and will have a strategic opportunity as healthcare exchanges become available. Section 1312 states:

The Secretary [of the U.S. Department of Health and Human Services] shall establish procedures under which a State may allow agents or brokers—(1) to enroll individuals in any qualified health plans in the individual or small group market as soon as the plan is offered through an Exchange in the State; and (2) to assist individuals in applying for premium tax credits and cost-sharing reductions for plans sold through an Exchange.

In the very near future the role of healthcare insurance representatives and marketers will change greatly. I believe this is a very promising career path but the underlying motive for following such a career must be to provide more people access to affordable, compassionate healthcare. Any insurance provider that supports these values and helps their employees to champion these core beliefs should do well in the coming years.

Already, Section 1421 of HR 3590 offers small businesses tax credits of up to 50% if they provide their employees with healthcare insurance. By 2014 there will be a surge in demand for healthcare insurance as it becomes mandatory. Forward-looking healthcare insurance providers will have ready to use plans in place to meet the huge new demand when small businesses and individuals start using the new healthcare insurance exchanges.

The healthcare industry is not only the foundation of our economy but also the bedrock of our society. The requirements in Title II of HR 3590 improve access to Medicaid, enhance support of children’s health insurance programs, and provide many other measures that improve access to quality healthcare. Yet, it is unlikely we can achieve the renaissance in compassionate care that is at the core of HR 3590 unless there is a corresponding change in healthcare values throughout our culture. Jami Rubin, a healthcare investment researcher said, “[e]conomic cycles have minimal effects on the drug industry. Illness is not affected by economic factors, and drug companies tend to do well regardless of the state of the global economy” (38). Many would disagree with Rubin’s conclusions. During the Great Depression the combination of unemployment, underemployment, and reduced pay debilitated the standard of living of most Americans. Undoubtedly, these forms of deprivation did not lead to good health. Homelessness became widespread and many people did without heat or utilities. Migratory workers were poorly fed and many lacked shelter. Malnutrition became commonplace, and starvation befell many. Family disruption and loss of self-respect plagued the unemployed; many remained out of work for years. The grim situation also forced many to leave behind their standards of dignity. Begging, thievery, and prostitution became the way to get by for a large number of Americans. Those who were fortunate enough to keep their jobs faced unbearable working conditions, which led to chronic anxiety and constant stress. All these factors escalated the risk of physical and mental illness during the Great Depression (Kusmer; Markowitz). Recent times have reminded us of what happened in the 1930s. In the Great Recession many laid-off workers have lost their healthcare coverage, their homes, and their standard of dignity.

It is understandable that research, motivated by competition, is extremely important in bringing to market new, innovative pharmaceuticals, healthcare devices, and therapies. Unfortunately, some firms seem to have lost all understanding of the ethical implications of healthcare. Quick profits trump long-term sustainability and result in the public losing confidence in the American healthcare system. Compassionate healthcare delivery is left out of the equation. For example, recently AstraZeneca was fined $520 million for attempting to market its anti-psychotic drug Seroquel to doctors that treat health problems unrelated to what the drug was designed to be used for (Sutton).

Competition is important for pharmaceutical companies, healthcare insurance corporations, and healthcare providers. But should the underlying, essential goal of compassionate healthcare be sidelined in favor of quick monetary rewards? Perhaps more could be achieved if the healthcare industry were consolidated. Many investors would benefit if healthcare conglomerates became solid, long-term investments; instead of speculative, haphazard adventures. If this were the case perhaps a more stable industry would better support economic growth and innovative, worthwhile research. Moreover, the industry could become a source of stability during recessions and economic downturns; not just for investors but for Americans of every socioeconomic stripe.

I am sure you agree that, as a letter of introduction, my correspondence is unconventional. My goal is to give you a sense of my understanding and commitment to healthcare reform. If you honestly believe your organization is taking, or will soon take a leadership role to embody the principles of HR 3590 in your corporate culture, I would be very interested in talking with you.

Very Sincerely,

Leslie Charles Coover


Fraser, Nancy and Linda Gordon. “Contract versus Charity: Why Is There No Social Citizenship in the United States?” Socialist Review 22 (1992): 45-47.

Rubin, Jami. “Pharmaceutical Industry Dynamics.” Industry Analysis: The Health Care Industry. Ed. James Balog. Washington, DC: Association for Investment Management and Research, 1993: 38 (quotation), 38-50.

Kusmer, Kenneth. Down and Out, on the Road: The Homeless in American History. New York: Oxford University Press, 2002: 193-220.

Markowitz, Gerald and David Rosner, eds. “Slaves of the Depression.” Workers’ Letters about Life on the Job. Ithaca: Cornell University Press, 1987.

Sutton, Stephanie. “AstraZeneca fined $520 million for off-label marketing.” .

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