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Health care in the U.S. – stop bickering and fix it

By pams
Sunday, July 19, 2009 20:08 EDT
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UPDATE: People have pointed me to this DKos diary, where it appears Holmes was not diagnosed with a brain tumor, but a cyst, and she has repeatedly appeared on TV claiming the tumor story. While that’s not particularly surprising, that even underscores the bottom line is her story proves we need reform because she had to put a second mortgage on her home, borrow from friends and her husband took a second job to be able to afford the $100k U.S. surgery.


Q of the day: do you have a health care horror story to share? Was it denial of service or meds by your insurance, or hospital bureaucracy, or something even more onerous, like poor quality care?

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I have to agree with this assertion over at Eschaton — “The reality is if you get real sick, no matter if you’re insured or not, you’re probably financially fucked.” The partisan bickering over how much it is going to cost is ludicrous — the cost is just one part of the problem, the fact that we have so many people uninsured and worse, under-insured, is the reality of too many Americans and to get everyone adequate care will likely cost trillions.

Those of us who do have decent insurance, are rightfully concerned that government mucking around in the system and playing politics with something that should be a right — equal access to GOOD medical care for all — is going to end up a big mess.

I’m not going to debate the merits of one plan or another here; I’m just looking at health care as a “frequent flyer” consumer with pre-existing conditions who sees doctors and specialists several times a year, and has adequate insurance that still has left me with long waits to see a specialist (3 months is not unheard of), and dealt with substandard care.

In our current system nearly everyone has horror stories about waiting for insurance to approve the most basic common sense things — like one extra day in the hospital after a c-section, or trying to get a medication not yet in generic form that you and your doctor know works and the insurance company insists on a different generic substitute or you pay outright. The number and type of what I call “drive-by” surgeries, where they kick you to the curb a couple of hours after you’ve been opened up on the table is astonishing — they wanted to do that for my gall bladder surgery and I begged to stay overnight because I’ve had complications after ambulatory surgery before that landed me back in the ER the next day. Thankfully it was approved, because I was right — I developed a fever and had serious difficulties that I wouldn’t have been able to manage at home.

But what if the insurance company had said no. That happens all the time. It happened to me several years ago, I wasn’t able to stay overnight and went into the drive-through surgery; I developed a serious staph infection. It required a second surgery a couple of weeks later. Oh, and I had to pay a lot out of pocket for that second surgery even though I wasn’t responsible for the need for it, even with insurance. A little time and attention would have saved everyone a lot of grief.

And prescription insurance — well big pharma makes us all pay for the price controls in other countries. I totaled up medications I take each month to see what they would cost if I didn’t have insurance — over $900/month! That’s insane. John’s story is no better, and again, he has insurance.

I didn’t know what my good plan covered until I got asthma as a result of my allergies. Now I know that my asthma drugs cost a whopping $471 a month. That’s $5,652 a year. After Blue Cross’ paltry share, that leaves me with $4,152 a year in asthma drugs (not counting any other prescriptions I may have to take for other unrelated problems that may arise). My insurance costs me nearly $420 a month. That’s another $5,040 a year. And the premium goes up around 25% a year. Imagine how much it’s going to be in ten years when I’m 55. And the joke, Blue Cross will still only give me $1500 in prescription drug coverage ten years from now – that’s the way their policy works. I got $1500 when I started 12 years ago with them, and I’ll have $1500 in ten years.

The problem here — and I’m calling out all of the elected officials on the Hill — is that while they are bickering about numbers (it will be huge no matter what we end up with I want all of them to answer one question: do they believe every person in the country is entitled to the same health care choices and offerings as Congress? If not, why not?

It’s too expensive” is not a legitimate answer.

That answer is loaded with the difficult truth underlying the debate — a lot of people determining the fate of our health care system believe there should be a tiered level of care — that some people are deserving of A+ quality care with all the options available, and some are not, and should be satisfied with something less, or fewer options because they poor or underinsured. If this is the case, state it now.

If Congress is satisfied with their current care, why not price out that model to cover everyone, and work the numbers. Obviously Dear Leader didn’t put a price tag on his war adventures and we’re still running up an endless tab that produced death and destruction that Congress keeps funding.

The high cost of health care is also due to doctors and hospitals covering their butts with extra unnecessary tests to avoid lawsuits, emergency rooms flooded with people who have no insurance and cannot pay, so the cost is passed on to those who can. Big pharma counts on us to boost the profits they cannot extract from countries with price controls; doctors have to carry high liability insurance because we’re such a litigious society…the list goes on and on.

Employer group policy deductibles keep rising each year, or services are reduced because the employer cannot afford to underwrite the costs to hold the line on premiums. No one should have their health care plan tied to their employment. It has to be portable and stable. COBRA, intended to provide portability of a policy for those who leave a job, is often too expensive.

And remember, if your plan is tied to your employment and you’re have pre-existing conditions, you better find a large company with a big group policy and never leave that job, since small businesses are more likely to have crappier policies or heinously high premiums — or offer no insurance at all.

The whole system is broken — except when it’s not and works just fine for a good number of people.

Why is it so difficult to put that level of priority setting on health care? Maybe I’m missing something. So back to the debate — since any solution — public/private/co-op will be a huge, expensive endeavor — what is the baseline of quality services that everyone should receive? Ability to pay should not matter, because we already know we have millions of unemployed people without the ability to pay right now. We have a system where only the well-insured and wealthy are able to get expedited or specialized care.
The real underlying problem here in all of this — and I think it’s tied to the general capitalist, class-based mindset in this country — that there’s a basic assumption that the health of some Americans is worth more than others. And I’m not just talking about the super-wealthy, it goes for the “aspirational set” as well. You know, the Rush listener, the Base, the blue-collar social conservatives who dream of the wealth and upward mobility that the Republicans sell them — until those titans of industry shut the plants down or move them overseas, and leave Joe Lunchbucket high and dry with an empty wallet, no health insurance and a family to feed. Only then does the reality set in.

Because of that there will always be a feeling out there it’s essential for any reform to include a way to “get a leg up” in terms of access and services that preserves the best care for the class-based or luck-based (you have a good job with great health plan benefits) privileged, leaving anyone who doesn’t getting cost-restricted, access-restricted services.

Let’s take a look at an ad (R) you might be seeing on your TV right now.

The commercials running down here in NC are outlandishly slanted and misleading, particularly one from a group called Patients United Now. The ad, “Survivor,” features a Canadian woman, Shona Holmes, who had a brain tumor, telling her story about her health care nightmare. She had to come to the U.S. to receive first-class care because the six-month wait to see a specialist in her country would have cost her life.

Her story is true. She’s right in one respect – we do have first-class health care here — if you have enough money you can buy any health services you need. She might be able to cross over to the U.S, but some people living here, even with insurance, can’t afford jack.

What you didn’t see in that ad is what she and her friends and family had to do to make that U.S. medical care happen. Holmes testified at a Health Reform Hearing before the Energy and Commerce Committee and you can see why Patients United Now didn’t add this bit of business:

My family and I decided to contact the Mayo Clinic in Arizona. We got an appointment immediately and I flew alone to Phoenix, 2,000 miles from my home outside of Toronto. Within a week, the doctors at the Mayo Clinic diagnosed me with a brain tumor, pressing on my optic chiasm causing the rapid vision loss. I had to have it removed within six weeks or my vision would continue to deteriorate and I would lose my sight. This was the tip of the iceberg of treatment that I would need to seek; however, it was the most crucial.

Three weeks after my diagnosis and unable to expedite the surgery in Canada, my husband bumped up hours in a second job, took out a second mortgage on our home, borrowed from family and friends, and rallied all of our financial resources so we could cover the $100,000 worth of expenses for my surgery and we flew back to Arizona so the doctors at the Mayo Clinic could remove my tumor. Ironically at that time a second surgery was strongly recommended by the Mayo clinic.

I required a second surgery to remove my adrenal glad. I returned to Canada and got back in line. I am here to report that surgery was done in Canada, but three years later. I will never know the amount of irreversible tissue damage that such wait times have caused. I will never get back the time, money, and life I dedicated to the fight to get the basic treatment that I was not only promised by my government, but was ordered by my government. I will never forget the experience of treatment in a facility suffering so badly from government funding shortages in staff and resources that even a pillow case on my bed was not to be found.

I know that the American health care system is not perfect, but again, I credit the system for saving my life. It is because of the choices available here in this country that I was able to receive the immediate care I needed. We as Canadians have one insurance company – the government. No option. Can’t choose another company, can’t supplement with after-tax dollars to purchase extra care. We can purchase health insurance for our pets, but not our children.

In Canada, I have very few rights as a patient. Patients there have to fight for the very basic services and care, much less any kind of specialized care. I am here today not only to tell you my own story but also to ask you, as leaders of this great country, not to destroy American health care but to keep in place the options that all Americans have for acquiring health care. Where would we Canadians go if the American health care system becomes like Canada’s?

She told CNN:
“That’s the stuff that I find so tragic — having dinner with my friends and I know how much money I owe them,” Holmes says, tears streaming down her face.
Now tell me, how many Americans could say the same thing about our own system? What she had to go through to pull together $100K shouldn’t have to be done either!

No one said the Canadian system is perfect; particularly in cases where specialists are needed, everyone should have timely access for serious deadly conditions. However, in this country, people who are underinsured or uninsured can be bankrupted by treatment for illnesses or injuries much less severe than Shona Holmes’s brain tumor. That’s the problem — the commercial doesn’t show who’s left out of the current U.S. system and who is cut off from the services they need.

From my POV, given our dog-eat-dog mentality here in the U.S., it’s hard to imagine a public/private/co-op system emerging that will 1) hold down costs, and 2) provide first-class care in a timely manner to everyone that compares to the best private insurance out there now or what someone with deep pockets can buy. Polls show Americans want a universal health care that is comprehensive — but no one wants to pay for it. We can’t have it both ways, and Congress knows that. To the layperson out there all of the parties out there have a lot to lose and nothing to gain in an overhaul that is drenched in partisan politics.

 
 
 
 
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