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So I’m sitting here at home on a lazy Sunday. I check my e-mail and lookie here, I have an e-mail from "Vice-President Joe Biden" asking me to go check out the health care horror stories that the Obama Administration has gathered from around the country.
Now, I have my own horror story from a couple of years ago when I lost an argument with a can of cat food and had to take myself to the closest emergency room for stitches (on a Saturday morning). That little trip wound up costing me over $1,500 for the emergency room visit, stitches, emergency room doctor, and so on.
But this diary isn’t about me. It’s about the disconnect between the stories gathered and our supposed leaders in the Senate and Congress.
Here are just a few of the problems recounted in the stories;
1. My dad works for the government and I was covered by his Blue Cross Blue Shield insurance until I turned 23 and graduated from college. I tried to get individual coverage from Blue Cross Blue Shield without a lapse in my coverage. They denied fully covering me since I had a pre-existing condition. They would not even allow me the discounts that other insured parties enjoyed through the insurance agreements.
2. I am a single parent who was layed off from Bank of America in 2007. I was offered to stay on the company’s medical plan but the premium was over $1300 a month. So I opted for COBRA as it was $770 a month. After Cobra ran out, I was denied medical insurance for pre-existing conditions. I had paid medical premiums non-stop for 40 years and now I cannot get quality medical insurance.
3. She works 32 hours per week and does not have health coverage available. She works as a customer service person at a grocery store. Her husband works full time as a cook for a hospital. He makes less than ten dollars per hour. He is a professional chef by trade. He carries the family health care and pays one hundred dollar per week! Out of a fort- hour week at less than ten dollars, this is roughly one quarter of his income that leaves little to live on after taxes.
4. My insurance premium went up over 30% this year, I pay a very big deductable and the coverage has been reduced. I did not have any significant expenditures only routine testing and three visits this year to my primary care physician and one visit to a specialist. When I tried to get into a Tax Savings Plan I was told I would have to double my deductable and have a downgraded plan. The cost of insurance premiums for my wife and I will now be over 12% of my pretax income.
5. I am the Mayor of a rural town in Oklahoma. You probably wouldn’t be surprised at how many of us don’t have health insurance. Most here don’t believe that you are listening to them. I do. I don’t expect you to read this. My husband and I are in our late 40′s. It would cost us over $1,600 a month for insurance. We own a small business in SE Oklahoma.
This is just a small sample of five stories that the Obama Administration has received out of hundreds and thousands of such stories. There is a common thread. The insurance coverage or inability to purchase coverage or too expensive coverage are the most commonly stated problems. There are stories of how folks have been treated in Canada or England or France or Germany or Japan with some comparisons of what it would cost in the US but most of the stories are based on the costs and actions of insurance companies.
Maybe we can tie Max Baucus, and Kent Conrad and Ben Nelson and Joe Lieberman and all the other Senators and Representatives who are balking at having a Public Option in a Healthcare Reform Bill because the insurance companies might be hurt and not make as large a profit as they can get by squeezing individuals and refusing coverage. In today’s healthcare system in the US, it is the insurance companies that are hurting us and denying us healthcare for their profits.
Max Baucus, Joe Lieberman, Kent Conrad, Charles Grassley, Ben Nelson:
Do you understand that your insurance company buddies have created the problem?
Do you understand that your constituents want you to support us and not your insurance company campaign contributors?
Do you understand that the best path to fix these problems is taking the insurance companies out of the picture?
I don’t expect you to give up your gold plated health care. I just want you to understand that the same level of care that you receive should be available to ALL of us.
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And in the non-horror story column, I was in Paris, on my own, visiting the D’Orsay Museum. It has a revolving door, and I walked into it head first, smashed my glasses into my eyebrow, and was stunned and bleeding like a stuck pig. I managed to get back into the museum and showed the guard, who responded by getting me to the nurse’s office. She tried to fix it with a styptic pencil but it was too deep. So they sent me to an emergency room in an ambulance, accompanied by a fireman. By this time, I had recovered some French and my sense of humor, so I got on well with the fireman, who had an uncle in Madison WI.
We got to the hospital, the intake nurse wanted to be rude, but the fireman told her I was a good guy, so she relaxed. In about 45 minutes, I had been glued back together and handed a printout of symptoms of concussion. I was worried about how much this would cost. When I asked the doctor, he was offended.
Health care is a right in France, he told me. The bill was $0.
I used to work in a hospital.
Then a few years ago, I had to be taken to the ER, where they admitted me for a mini-stroke, a TIA. A doctor originally from Africa was very nice, and said I would need an MRI to see if there was any other damage, and I’d need to be on a drug like Plavix to thin the blood.
Then a doc I had worked with in the ER came in. He remembered that we both had teen sons the same age. When he discovered I was unemployed and no insurance, he said “You can just get a CT scan and take aspirin.”
The nurse told him I’d been taking aspirin for a year. I started crying and said I had taken care of people for years, and now I’m sick, what happens? I die? No one will help? She got the social services person and they started a Medicaid application.
The doctor from Africa was very apologetic. He was kind. They did find an old lesion with an MRI.
So I got care but what if I hadn’t been able to speak? Who will advocate for patients?
People should not feel disposable. That’s how I felt in that situation.
Yes, and thank you for this, but do you understand that no kind of public option that Obama will support — no kind of public option that will ever be passed even if the Conrads, Wydens, Baucuses, and Nelsons are all whipped into line — will do anything to, in your words [take] the insurance companies out of the picture”?
Obama has pledged as much. He acknowledges the “legitimacy” of preventing a public option from being able to compete “unfairly” against private insurers. Chuck Schumer, who parades as a champion of the public option, has, with the craven approval of the NY Times, proposed a watered down proposal for same that deliberately ties the public option’s hands behind its back. The draft tri-committee House legislation, which organizations like HCAN and way too many liberal commentators and bloggers have praised to the hilt, embodies Schumer’s basic structure.
We have this disjointed situation now, where HCAN and the DNC are compiling the same horror stories that single-payer advocates have been publicizing for years, and yet insist that the solution is a still-amorphous plan to make the private insurers “honest” rather than make them gone.
If all we can get this year is so compromised and insufficient a remedy, then we need to be loud and forthright about its inadequacies and declare that the insurance companies’ reprieve is temporary and far more than they deserve, and that if the experiment doesn’t show clear and significant signs of working, and soon, the next step is straight-up single payer.
As noted, the real controversy of Obamacare is not the public plan, it’s the private-insurance reprieve.
Then we use the statements and problems that Obama solicited from folks to force him to change his perspective.
He is the one presenting the fallacious argument that leaves the insurance companies in charge. If he (and the rest of the clown brigade in DeeCee) don’t want to fix the problem, then they shouldn’t be allowed to brag about accomplishing nothing if/when a “healthcare reform” passes.
For if the insurance companies are still heavily in the mix when all is complete, then the reform will be a FAIL.
It’s too late for that. The whole point of the public option, in particular, the whole point of the “exchange,” is to keep the insurance companies heavily in the mix. When right-wingers claim that the public option is just a Trojan horse for a transition to single payer, the response from Obama and from HCAN is, in essence, That’s a damn lie! rather than, You say ’single payer’ like it’s a bad thing.
This president and this congress will not produce a single-payer-ready public option. They’ve already promised not to.
margot, you just did. thank you.
amen.
it may even be the only path.
as ralphbon wrote:
The problem in Washington is that the politicians somehow think that we do not understand where health costs are coming from. The for-profit insurance system is now so far into its terminal, organized-crime phase that almost anyone without those sweet Congressional benefts knows all too well. I could provide a half-dozen stories like the following from within my immediate circle of acquaintances.
Recently, a close relative was diagnosed with breast cancer, did chemo, and had a lumpectomy. There were complications resulting in a dangerous clot, and the dear relative had to be on a long course of injectable blood thinners. Normally, these drugs have to be administered in a hospital, but the relative is herself a healthcare practitioner and more than qualified to self-administer. Her employer’s plan handbook explicitly covered this option. So I showed up to help pack her things while her discharge was being processed and while the insurance pre-approvals were being arranged by the physician’s assistant.
The drug was denied. The PA, the hospital’s patient advocate, the patient herself, and I all ended up on the phones. For about 5 hours. We were all shuttled from one ill-educated call-center staffer to another, each of which claimed nothing could be done, and then from one supevisor to another. I suspect many would have given up. Both the patient, the hospital advocate, and I all had some connection to the medical industry and knew enough to insist and hang on. Discharge did not happen. The patient stayed in another night. The weekend was coming up. I had to get back to work.
Finally, the next day, the patient got through to a 2nd-tier supervisor of some sort who initially tried the same line as her underlings. We again read her the relevant passages from the patient’s benefits handbook, but the supervisor claimed that there was nothing she could do. The dear relative then said that she was relieved, because this meant that she could get her doctor to admit her again and could stay in the hospital for the full 2 or 3 weeks of treatment. The rest would do her good. She described the comfortable surroundings (it was rather nice), and started to hang up. At that point, the supervisor “discovered” that the rejection was caused by the drug being erroneously listed in their database as “hospital-only”, and that any supervisor could override this and approve the treatment. Dang computers.
So I took the relative home and then went to her pharmacy to get the drugs–the PA had called ahead to be sure they were in stock and ready for pickup. No drug. The pharmacist said that the insurance would not approve it. I threw a cold icy fit. They checked again, twice. Denied.
Luckily, the PA had given the relative some samples for use that night. The next day, we started working the phones again and went through the same rigamarole. Even though we explained about the override, no one seemed to know about it. I got on the phone at that point, got very dramatic about the danger to the patient’s life, and announced that I had called her doctor and we were having her admitted. Suddenly the supervisor that knew about the override (oh, THAT override). She explained that the override just hadn’t taken when her colleague did it the day before–something with the computers. Right. But I just kept her on the line while the relative called the pharmacy and had them run the approval while we waited.
I concluded that the whole thing was an organized policy of delay intended to discourage claims or at least string them out for as long as possible. Perhaps the claim does not count against their boss’ bonus if approval slips into the next shift. Maybe they hoped to avoid paying for at least one day at $120 a day. I don’t know. But the bottom line is that the tactic cost the insurance carrier an extra day in the hospital on a specialist cancer ward, a charge that dwarfed any imaginable savings from the medication. Moreover, two highly compensated professionals–the PA and the hospital’s patient advocate–spent a lot of billable time on this, time that gets added on to everyone’s bills eventually.
The mere fact that both the hospital and the oncologist have these patient advocates is indicative of the source of runaway costs. I talked to the advocate at the hospital at length. She was a Licensed Nurse Practitioner (MD in all but name) who works exclusively on forcing insurance companies to live up to the letter of the policies they have sold. She showed real Crusader spirit, and I was glad to have her. But can this be efficient under anyone’s business model?
One final straw: after the surgery, the complications, and the radiation, my relative needed to take a relatively new type of drug to prevent recurrence. There were three different ones available, all with varying but significant side effects. All very pricey. NONE of them were in the insurer’s formulary. The plan handbook said that, in such cases, the drug would be covered. But the call-center staff and supervisors insisted that these drugs were in a special, high-cost category.
The relative was, by this point, taking no prisoners. She said she understood and asked to be transferrred from the drug pre-approval department to surgical pre-approval. Why they asked? She was going to schedule a bilateral radical mastectomy with reconstruction, since she couldn’t have the preventative treatment. Why take the risk? They approved all three drugs then and there–whichever she tried and tolerated best would be fine.
The relative is a hardcase beneath the ladylike exterior. And she is a professional that knows the healthcare racket from the inside. But how many less determined or less knowledgeable women die from willful insurance malpractice without anyone knowing? And how much are the carriers charging us for killing other peoples’ relatives and pocketing other people’s money?
P.S. The relative was coverd by one of the best plans offered by one of the two or three largest private heaqlth insurers.
single payer is the only thing that will work. we need money for creative advertising.
good for all of you! and as you say, many people don’t know how to be persistent in dealing with the insurance companies. or are already too sick!
omigosh, you rock for telling that story and esp. for prevailing!
I’m still reeling from receiving, just yesterday, the EOB for my daughter’s annual physical and immunizations. We have “very good” insurance and NONE of it was covered! None. And I was astonished at the cost of two of the shots. I feel stupid for not asking, but I figured all immunizations are in the same ballpark. Now I know.
Needless to say I have some phone calls to make.
that’s so true. My mother comes from the old school of the doctors and all medical professionals know best. I’m sure she’s not alone in that category.
Since I’ve been disabled for nearly 20 years (actually, thank god it happened then), I’ve often talked to doctors about a “patient advocacy” system as people still believe their doctors know all.
My particular genetic neurological disorder is virtually unknown. And many people have it and the docs miss it…esp since twice as many wimmin have it…so, it must be “hysterical”, right?
It makes total sense to me to have a group set up in which the members know alot about any given medical condition and can advise doctors who are too busy to re-educate themselves, even if they want to, about these “orphan” disorders/diseases.
Never happen.
There’s another part to the problem, too. People think that their care covers bills except for copays. Generally, it doesn’t. There is also “co-insurance”, a provision whereby insurance only covers a percentage of the total cost (80-85%).
Usually, this applies up to some total out-of-pocket expenditure on the subscriber’s part. Thereafter the insurance pays all. But this is not always the case. Wierd stuff can lie buried in the policy details.
A friend of mine with a supposedly very good insurance package had to have three back-to-back emergency surgeries at an unbelievable total cost. He didn’t know that his insurance had both a co-insurance provision and, apparently, a maximum benefit. He’s a relatively well-paid professional in a two-income household. Yet he had to sell his cars just to pay down part of what “good” insurance wouldn’t cover.
Thanks so much for your story and comments, which reiterate the point I keep making about how deceptive it is for Obama to talk about “keeping what you have if you like it,” as if a policy defines what one “has.”
Even with supposedly quality coverage, ultimately what you “have” is a relationship with a company with a fiduciary responsibility to seek out ways to withhold reimbursement. What you “have” is defined not only — not even primarily — by the letter of your policy but by the persistence of your advocacy. An exchange may mitigate this, but it’s not an enforcement or advocacy body.