Tag Archive for insurance

Waiting and hoping for a miracle

Kelly and me in the Green Room of the Ed Shultz Show on MSNBC.

I have hoped for miracles before. Sometimes I’ve been disappointed, like when I could do nothing for my son as I watched him get sicker and sicker.

Then there’s my friend, Kelly Cuvar, who has had a rare form of cancer for 13 years. Pretty much everything about her is a miracle. Knowing her has made me believe miracles are possible.

Kelly has never been in remission. She is from Ohio (from John Boehner’s district, of all places), but she lives in New York, where she is able to get care for her disease.

But, she says, worrying about health care has caused her more angst than her cancer. What if she loses Medicaid? What if she had to find care on her own for some reason? What if the Supreme Court overturns the Affordable Care Act and Paul Ryan gets his way on Medicaid and Medicare?

Kelly and I don’t talk as often as I would like — we tend to keep up on Facebook and via e-mails these days. She’s pretty upbeat most days. Often, she’s downright irreverent. She has a right to be.

Kelly has said time and again that dealing with our broken health care system is more difficult than dealing with cancer. In most other countries, she wouldn’t have to worry about whether she would be thrown to the curb. In most other countries, she would get care. Period, end of discussion.

In the US, however, she never knows whether the doctor she’s seeing will stop accepting Medicaid, forcing her to find another doctor who will. Her well-being depends on which way the political, and lately, judicial, winds will blow.

Every decision she makes about her life revolves around her health care. It determines whether she’ll marry (she can’t now), where she’ll live, whether she can work (she can’t) … Just about every decision most of us make without thinking, Kelly has to make with an eye to whether it will affect her health care. Worrying about her care causes her more distress than her illness, Kelly says.

Kelly and I were fellow travelers along the road to getting the Affordable Care Act passed. We met in Washington, DC, when we both went there for rallies and lobbying. I carried my picture of Mike; Kelly carried her cane. We realized very quickly that we share a similar twisted sense of humor and the guts to speak truth to power.

When the ACA passed, Kelly and I were on the phone to each other, laughing and crying.

Sure, the law didn’t give us everything we wanted, but it was a start and we vowed to continue working to improve the system. We had won a battle, but there would be more and we knew it then. We would work for a public option, for the ability to buy into Medicare. Someday, insurance companies will have competition and people will be able to gain access to the care they need.

We didn’t believe we might have to start from scratch, though, and if the Supreme Court overturns the law, we’re back to Square One.

Kelly has cancer and I’ll turn 60 later this year. Neither of us has unlimited time. But neither of us is willing to give up, either.

No matter what the Supreme Court decides, Kelly and I will keep advocating for access to quality care for all Americans. Getting sick shouldn’t mean having to choose between bankruptcy and death.

If the ACA is upheld, Kelly will be able to buy insurance in 2014, as will others who have had cancer, diabetes, high blood pressure, depression, acne … all the things the free market has used to deny insurance coverage to people. We will be able to go to the doctor with the assurance that our needs will be met.

Some 20 million people will remain uninsured, however, and Kelly and I will continue to fight for improvements to the system. We may get tired because she’s sick and I’m old, but we won’t quit. I assure you, we’re in this for the whole race.

It may take a miracle, but Kelly and I have seen miracles; we believe in them.

 

 

The myth of government dysfunction

By my friend and former colleague Matt Davies.

As a Supreme Court announcement on the Affordable Care Act nears, the volume on the rhetoric is rising almost to the pitch it was before President Obama signed the bill into law. House Speaker John Boehner is promising to eviscerate the law if it is upheld so that President Obama won’t be able to boast about success during the coming election season. GOP nominee Mitt Romney is denying he had anything to do with the Massachusetts plan on which the federal law is based. He now says he would work to repeal the ACA.

So, what about the good of the American people? Is our current “system” really worth defending? Are we really OK with more than 45,000 unnecessary deaths a year and hundreds of thousands of bankruptcies because of massive medical bills?

Big Insurance is fighting anything that will pinch its profits, and the GOP spin machine is talking about how the ACA will remove all control of their health care from people, and how the system will drown in an avalanche of paperwork.

But over here on the left with the ghost of Ted Kennedy, we’re talking about how to expand coverage, possibly to single-payer.

Here’s a little truth for you: Medicare spends 97 percent of its funds on direct services; health insurance companies are whining about having to spend 80 percent of the money they take in from customers on care. Why? Because of executive pay and bonuses, lobbying, advertising, marketing.

Here’s another uncomfortable fact for the right: Since 1970, the number of physicians has less than doubled, while administrators’ jobs have grown by about 3,200 percent, according to figures from the U.S. Bureau of Labor statistics. Those administrators work for insurance companies and for doctors’ offices, mainly because doctors need so much help coping with the different forms, codes and requirements of each insurance company. In the US, we spend more than $700 per person on health care administration than they do in Canada, which has a national system.

About 31 percent of everything we spend on health care goes to this administrative mess, and the worst of it comes from the private sector. Under an improved Medicaid-for-all system, bills would go to one place; forms and codes would be universal instead of having a different set for each of dozens of companies.

If everyone has the same coverage, there will be no tricks to deny people coverage, such as denying a claim for a colonoscopy because it was done in a doctor’s office instead of a free-standing clinic.

Doctors and patients can make decisions based on the needs of the patient, not on what the insurance company will or will not pay for. The bureaucrats who interfere with doctor-patient decisions work for the insurance companies, not the people.

A nurse complained to me a couple years ago that she was on the telephone with a Medicare representative for almost two hours as they tried to come up with a code that would pay for what the patient needed.

I told her a private insurance company would have denied the care and hung up, and she agreed that likely would have been the case. The bureaucrats in the government might be somewhat burned out, but they aren’t eligible for a bonus just for denying you care.

We could save somewhere between 45,000 and 101,000 lives every year because we all would have access to appropriate health care, not to mention the money saved by managing chronic illnesses so they don’t become crisis care.

Insurance companies are spending billions to avoid letting everyone have access to care because there’s no money in it for them.

We are the only one of the so-called wealthy nations that does not see health care as a basic human right.

No matter what the Supreme Court decides in June, we all need to demand a better solution — one that puts people before corporate profits.

 

Numbers don’t lie

One of the things Republicans like to say when they argue that we can’t afford health care for everyone is, “Numbers don’t lie.”

Well, here’s a number for you: Official estimates by the US Census Bureau say that 49.9 million Americans now are uninsured, an incerase of about a million people from a year ago.

Statistics say that translates to about 5,000 more premature deaths every year, bringing the likely total to about 50,000 Americans.

“That’s one plane crash every day,” says Dr. Margaret Flowers of Physicians for a National Health Plan. “It’s the equivelent of another 9/11 every month.”

Most people are unaware of these numbers because they rely on the corporate media for information, Flowers says, and I agree with her. Instead of getting the truth, we get distractions and misrepresentations leading most Americans to believe we can’t afford health care for everyone.

For example, in Monday’s debate, Wolf Blitzer’s “hypothetical” man chose not to pay $200 a month for insurance. I don’t know anyone whose insurance costs are that low unless they have huge deductibles — $10,000 and more — and co-pays. Almost two-thirds of Americans don’t even have $1,000 to lay out for an emergency at any given time, so I don’t imagine our “hypothetical” man is being cavalier in making his decision.

“The number of young people who can afford insurance and choose not to get it is very, very small,” Flowers said. “If you have these huge deductibles and co-pays, you’re going to go bankrupt if you get sick. So of you’re going to go bankrupt anyway, why shell out hundreds of dollars every month to a big corporation?”

So, Wolf Blitzer’s example is misleading to begin with, although you won’t get that information on CNN.

The money we’re spending on wars and the money we’re not taking in from the wealthiest Americans and corporations would more than pay for Medicare for every American. Instead, we tell people we can’t afford it and 50,000 people die every year — one every 11 minutes.

“It seems to me that’s morally reprehensible,” Flowers said.

So, here are a few of the true numbers you probably don’t know:

  • TheCensus Bureau says 55.3 percent of Americans were covered by employment-based plans in 2010, down from 56.1 percent in 2009. It was the eleventh consecutive year of decline, from 64.2 percent in 2000.
  • In Massachusetts, whose 2006 health reform is supposed to be the model for the Affordable Care Act, 370,000 people were uninsured in 2010, representing 5.6 percent of the population, a jump from 4.3 percent who were uninsured in 2009.
  • Some states saw more than a 3-percentage-point to 5-percentage-point increase in their uninsured rate (Idaho, Louisiana, Mississippi, Montana and South Carolina). In terms of absolute numbers, Louisiana had the largest increase in the number of uninsured, 240,700, followed by New York (177,700) and South Carolina (173,300).
  • Among various population groups, the greatest loss of coverage was among working-age adults ages 35 to 64, people with incomes below $49,999, and people with disabilities.
  • Latinos continue to  face uninsurance disproportionately (30.7 percent), compared with blacks (20.8 percent), Asians (18.1 percent) and non-Latino whites (11.7 percent).
  • About 7.3 million children remain uninsured. Young people ages 19 to 25 had a drop of 1.6 percentage points in their uninsurance rate, a figure likely linked to the federal health law’s provision that allows dependent children to be covered under a parent’s health plan up to age 26.

I suggest you print this out and show it around. It’s what corporate America doesn’t want people to know.

The ‘hypothetical’ young man

My very un-hypothetical son, Mike, who died because he didn't have insurance.

I didn’t watch the GOP debate, but before I went to bed Monday night, I checked the headlines.

There it was: video of people cheering, “Yeah!” at the prospect of letting a “hypothetical” young man die rather than care for him. No one, not the candidates, not the moderator, not anyone in the audience reprimands them.

There is nothing hypothetical about it. About 45,000 people die every year — one every 12 minutes — because they don’t have insurance. The vast majority of them do not CHOOSE to be uninsured; they either can’t afford the premiums, or like my son, the insurance companies won’t sell to them.

My son had a birth defect, which is a pre-existing condition. It left him vulnerable to cancer, so he needed colonoscopies every year. He couldn’t get them, though, because he didn’t have insurance and he didn’t have the money to pay cash-up-front for them.

So, here is how it went for my not-hypothetical 30-year-old son:

First, he gets stomach pains. Eventually, they get bad enough so he decides to go into debt to see a doctor, who informs him he can’t have the medical tests he needs because he’s uninsured and he can’t pay the full cost, in cash, up front. The doctor writes in his medical record, “Patient needs a colonoscopy but can’t afford it,” and bills the patient for the appointment.

A week or so later, the patient goes to the Emergency Room, where he’s told it’s persistent gastroenteritis. Still no colonoscopy. The patient is unable to move his bowels and wonders why it would be diagnosed as gastroenteritis. He is billed for the ER visit.

A little more time goes by and the patient is still suffering, so he goes back to the ER.  This time the doctor says he has an ulcer and gives him an antibiotic. He is billed for the ER visit and the medicine.

Still a few more days and by now the patient has lost 30 pounds and is still in pain, still unable to move his bowels. His family is frantic with worry, but no one has enough money to pay cash up front for the colonoscopy. He goes back to the ER and is told he probably has diverticulitis. He is given a strong laxitive and sent home. He is billed for the ER visit and the medication.

The next week, the original doctor agrees to do a colonoscopy and bill the patient, who will be allowed to pay over several months. The patient is sent home without hearing any results. What he doesn’t know is that the doctor didn’t even finish the procedure because the colon was completely blocked. He never told the patient.

Three weeks later, the patient is down to 112 pounds. He is 6 feet tall. He is vomiting fecal matter and his kidneys are shut down. He is hours from death. The doctor realizes he probably could get in trouble for neglecting the patient so badly, so the patient is admitted to the hospital, where it takes five days to stabilize him.

By now, the patient’s cancer is Stage 3. It has spread. A charity pays the hospital, the doctors and the pharmaceutical company for chemo and radiation, so he at least gets treatment.

But six months later, the patient again is in pain and vomits up everything he eats.

This time, the doctors take a wait-and-see attitude, even though they know the radiation has caused another blockage. The patient drops to 104 pounds and family members threaten to take the story to the media as his doctors refuse to feed him intreavenously. They finally agree to feed him and a few days later, he is wheeled into surgery again.

The pathology lab finds “a few viable cells,” and the patient is told he will die. The doctors don’t bother to come talk to him about further treatment, even though he is on the oncology floor for another week. They don’t bother to treat a life-threatening infection in his incision.

The family searches and finds a doctor who will consult with the patient for about $400; as soon as he sees the patient, he knows he has to adopt him to give him any possibility of even short-term survival.

There’s more chemo — the patient has to leave his wife so the giant pharmaceuticals will get paid for his meds through Medicaid. The patient has no income because he has yet to be approved for disability, as though someone with his medical records might be scamming the system.

His family and friends gather round to support him, both financially and emotionally, but he was neglected too long, and he dies on April 1, 2009. His first disability check comes nine days later.

The doctors got paid by the charity; the pharmaceutical companies made hundreds of thousands of dollars from his chemotherapy. But the patient spent three years in horrible pain and in abject poverty. He was treated as though he wasn’t worth saving until he was adopted by a doctor with a heart, although by then it was too late.

His family still grieves, and always will. His friends still tell stories about his amazing courage, his gigantic heart and his decidedly off-kilter sense of humor.

He was not a bum; he was never lazy.

He was my son, and he didn’t deserve to be left to die.

For those whe cheer the thought of his death, I just want you to know I would never wish the same thing on you or anyone you love.

We made a difference

Health care advocates from across North Carolina filled the gallery this morning when the NC House Health and Human Services Committee met to consider House Bill 115, a bill that would hand over the control of the state’s health insurance exchange to the insurance companies and their allies.

They had a bit of the deer-in-the-headlights look as they saw the gallery filled to overflowing. There wasn’t even any standing room.

As of late last week, the plan was to push H115 through to the House Insurance Committee, which is chaired by Rep. Jerry Dockham, the insurance broker who introduced it.

But we advocates got the word out about the bill, despite the reluctance of most of the state’s media to pay any attention to it, and filled the gallery. Without saying a word, we let them know the word is out and we will fight them on this.

The bill that was supposed to create the health exchange was being drafted by a diverse panel of experts including health care providers, advocates, consumers, physicans and more. The group was put together by the NC Institute of Medicine, and it met several times to turn a suggested federal bill into a framework that would work for the protection and benefit of people of North Carolina.

But the insurance companies wanted control. They wanted to be able to “pre-authorize the expensive diagnostic tests that drive up health care costs.”  Sounds reasonable enough, right?

Wrong. Last year, they forced my husband to wait two days for a nuclear stress test after a bad EKG, very nearly killing him.

They wanted to be able to “offer consumers a wide variety of plans from which to choose.”

Like the catostrophic plan a friend of mine chose with a $10,000 deductible. When she developed breast cancer, she was told her chemotherapy wouldn’t be covered because it was outpatient.

What they want is to be able to confuse people into buying something that covers little more than the insurance company’s butt.

Then they asked for a voting seat on the board of directors, and nearly everyone at the meeting said it would be a clear conflict of interest. A couple weeks later, H115 appeared, before the Institute of Medicine panel could finish its work, giving seven of the 11 seats to insurance companies, brokers and their allies, all of whom opposed reform.

This morning, committee chair, Rep. Bill Current (R-Gastonia), said he didn’t even know “why we’re bothering with this since Obamacare is unconstitutional anyway.”

Insurance Commissioner Wayne Goodwin told him it’s a good idea “just in case,” because if the Affordable Care Act isn’t unconstitutional, and North Carolina doesn’t have an exchange, the federal government would operate the exchange. Then he went on to make some proposals from what the IOM panel has worked on:

  • A seven-member board composed of people with technical expertise and no financial interest in the exchange. The board would be complemented by five advisory committees that would include insurance companies and consumers.
  • Compliance with open records and open meeting laws, something H115 lacks.

The committee decided to meet again to discuss the insurance exchange in two weeks, which gives advocates two more weeks to get the word out that health reform in North Carolina is in danger of being subverted by big business and big greed.

If we don’t stop the takeover here in North Carolina, other states will follow suit. If we do stop it, big insurance will be on notice that we’re watching and we intend to put a stop to their efforts.

Let me introduce myself

Publisher’s note:

AWOP is pleased to introduce our newest contributor, Leslie Boyd. A fierce advocate of health care for all and I am super excited to have her join us!

*************

I’m Leslie Boyd. As a newspaper reporter for more than a quarter century, I saw and told the stories of real people in real situations who were being held down by systems that worked against them.

In 1983, it was Jeannie Alkema, a woman in Passaic County, NJ, with debilitating multiple sclerosis who was being cared for in her home. Her 12-year-old son suffered nightmares of his mother being put in a nursing home and him being placed in foster care. It was less expensive to care for Jeannie in her home than in a nursing home, but one day she called me in a panic and said the Department of Social Services was going to cut off her home care. Her son’s nightmare was about to become reality.

I called the DSS director and told him I was working on a front-page story about the mess( which I was, if she was going to be sent to a nursing home)  and he knew nothing about it. A few minutes later, though, he called me back and said it had been a computer glitch and Jeannie and her son would continue to get services at home.

My father, also a newspaper reporter, loved when he was able to right a wrong, to help people caught up in systems that were harming them.

I called what I did – writing about social justice issues by telling the stories of real people – advocacy journalism.

In 1992, I started writing about the health care crisis when a woman I knew told me she would be in debt for the rest of her life because she had thyroid cancer and had to pay for her treatments out-of-pocket. President Clinton had just been elected and was promising to help the then-16 million uninsured get access to quality health care.

His efforts were defeated by the health care industry, which didn’t want any controls in place.

Then, at the end of 2005, my son, Mike Danforth, got sick. He had a birth defect that left him very vulnerable to colon cancer. That being a pre-existing condition meant Mike couldn’t get insurance at any price, so he couldn’t get the colonoscopies he needed. The gastroenterologist wouldn’t even let Mike pay over time – he insisted on having the full price up front.

Mike and his wife, Janet, were students. They didn’t have $2,500 or more to pay, so Mike didn’t get his colonoscopies, and in December of 2005, he got sick. He couldn’t keep food down and he had abdominal pain. Still, he couldn’t get a colonoscopy. His doctor wrote in Mike’s medical record that Mike needed a colonoscopy but couldn’t afford it and then suggested Mike should get financial counseling.

Mike went to the emergency room several times and was given laxatives, pain killers and antibiotics, but he continued to get worse.

The doctor finally agreed to do a colonoscopy, but he never told Mike the results: “couldn’t finish procedure; next time use (pediatrics) scope.”

Mike’s colon was blocked. His life was in danger and his doctor just sent him home.

The next time Mike saw the doctor, a couple weeks later, he was vomiting fecal matter and his organs were shutting down. Mike, who was 6 feet tall, weighed just 112 pounds. He was admitted to Memorial Health Center Hospital in Savannah.

It took doctors five days to stabilize Mike so he could have surgery. By then his cancer was stage 3; it had spread to 11 of 13 lymph nodes.

Mike got chemo and radiation through a charity in Savannah, where he lived and was neglected, but the radiation caused a new blockage. This time his doctors let him get down to 104 pounds before they did anything, and the only reason they did was because we were going to take it the media.

The pathology report found “a few viable cells,” and they just gave up. No one from oncology ever even came to talk to him, and his doctor failed to treat a life-threatening infection in his surgical incision.

Fortunately for Mike, his life was extended when I got him a consultation with Dr. Herbert Hurwitz at Duke University Medical Center. He took one look at Mike, and knowing Mike would be dead in a few weeks if he was sent back to Savannah, Dr. Hurwitz “adopted” him.

Mike still needed Medicaid for his chemo, though, and he and Janet had to split so he could get it. He applied for disability but was turned down twice. He was finally approved in March 2008, but he died at age 33 on April 1, 2008, nine days before his first check came.

We used the bulk payment to pay off the debt we incurred supporting Mike for three years while he waited for disability.

In July 2009, I left the newspaper to do real advocacy. I founded Life o’ Mike as a 501(c)(3) nonprofit so I can stand up for what’s right and try to help people get the care they need. I tell Mike’s story and the stories of others who are suffering because Americans don’t think health care should be a basic human right.

Americans desperately need to be told the truth, but Big Insurance – and Big Media – prefer to keep people in the dark; that’s where they operate best – in the dark.

It’s up to progressives – liberals – to stand up and tell the truth and to work for social justice – living wages, safe, affordable homes, health care, education, consumer safety, food safety and more.

We have our work cut out for us.

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