Showing posts with label Universal Health Care. Show all posts
Showing posts with label Universal Health Care. Show all posts
Thursday, October 9, 2014
Should we provide health care for all? Does this woman deserve it?
Should we have a single payer system?
Sunday, October 14, 2012
A Possibly Fatal Mistake
A Possibly Fatal Mistake
Daniel Stolle
By NICHOLAS D. KRISTOF
New York Times
October 12, 2012
MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.
Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.
We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.
Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).
By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.
Well, not that I remember. I don’t want to discredit his youth.
Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.
If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.
I’ll let Scott take over the narrative:
It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.
I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.
As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.
In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.
Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”
I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)
The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.
A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.
I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”... •
Daniel Stolle
By NICHOLAS D. KRISTOF
New York Times
October 12, 2012
MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.
Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.
We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.
Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).
By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.
Well, not that I remember. I don’t want to discredit his youth.
Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.
If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.
I’ll let Scott take over the narrative:
It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.
I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.
As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.
In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.
Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”
I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)
The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.
A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.
I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”... •
Sunday, September 23, 2012
Consumers have "no meaningful information about the quality of care," but the same can't be said for Leslie Michelson
Why do consumers have "no meaningful information about the quality of care"? Because businesses are the ones buying the insurance, not the patients. And insurers have no stake in long-term results.
September 21, 2012
Leslie Michelson: Doctor to the 1% (and Maybe Someday to You)
By JOSEPH RAGO
Wall Street Journal
The rich are different than you and me. Not only—yes, yes—do they have more money, but they've also heard of, and many have hired, Leslie Michelson.
...So the health-care delivery system, to the extent it qualifies as a system, "has no quality control, no integration, no coordination." Doctors "tend to operate in an independent and isolated way, and even specialists who've been treating the same patient for years and years typically never, ever speak to one another."
Private Health is designed to backfill these gaps whenever one of its patients has a medical emergency or complex condition, say, a traumatic brain injury or newly diagnosed cancer. A personal-care team parachutes in, led by a clinician employed by the company, and compiles a brief on the patient. They centralize and digitize the patient's medical records, usually dog-eared paper piles that can run to thousands of pages. Research scientists immerse themselves in the latest findings and treatment regimens for the particular condition involved.
Tests are double-checked—biopsy tissues are sent to an outside pathologist, MRIs to another radiologist. For an era of targeted therapies, Private Health runs a full battery of molecular diagnostics "to sequence the entire three billion base pairs of somebody's DNA in a couple of hours," Mr. Michelson marvels.
The goal is to ensure an accurate diagnosis and lay out all the treatment options. Private Health functions as a kind of running, independent second opinion. It operates in the twilight zone where there isn't a "best practice" for when and how to treat, but a continuum of risks and benefits that vary from patient to patient.
The clinician helps locate the right experts, Mr. Michelson says, and then works to "fuse together all these multiple specialists in a single team with a single objective." There are "no redos, no lost scans, no ambling around going from specialist to specialist, trying to figure out what's going on." The most frequent reaction is: "This is how medicine was always supposed to be practiced."
The idea for Private Health came to Mr. Michelson when he was running the Prostate Cancer Foundation, the multibillion-dollar philanthropy Michael Milken set up in 1993. Prostate cancer is a common disease but treatment isn't straightforward. Surgeons end up recommending surgery, radiation specialists radiation, still others "watchful waiting," etc.
Mr. Michelson says people started asking him for advice, which led to the prototype for Private Health. Eventually he decided to improve his process across more diseases and help more people.
One irony is that for all its white-glove extras (a research department, genetic profiling), a lot of what Private Health does are core functions that patients would value and providers or insurers ought to be doing but rarely do (case management, using computers). Why is that?
Cost is part of it. "It's too expensive for us to do it for everybody right now," Mr. Michelson says. Another part, he thinks, is that "the incentives are attenuated because of the structure of insurance," namely, job-based coverage.
Since businesses are the customers, not the individuals who change jobs every three years on average, insurers "act rationally" and don't invest in services with "short-term costs and long-term payback." Mr. Michelson thinks the better option is for businesses to convert to cash vouchers so their workers can buy portable policies. Right now, there is "no meaningful information about the quality of care, virtually no information about price, and no sensitivity to price," but that would change if the insurance industry built "an enduring relationship with consumers," he says.
"I understand that it is woven into the fabric of our society that employers can and should continue to pay for health insurance for their employees," Mr. Michelson declares. "But why, circa 2012, should HR departments be selecting and administering one or two or three plans for a thousand or a hundred thousand workers and their dependents? You don't need a Ph.D. in economics to understand that you will guarantee suboptimization."
September 21, 2012
Leslie Michelson: Doctor to the 1% (and Maybe Someday to You)
By JOSEPH RAGO
Wall Street Journal
The rich are different than you and me. Not only—yes, yes—do they have more money, but they've also heard of, and many have hired, Leslie Michelson.
...So the health-care delivery system, to the extent it qualifies as a system, "has no quality control, no integration, no coordination." Doctors "tend to operate in an independent and isolated way, and even specialists who've been treating the same patient for years and years typically never, ever speak to one another."
Private Health is designed to backfill these gaps whenever one of its patients has a medical emergency or complex condition, say, a traumatic brain injury or newly diagnosed cancer. A personal-care team parachutes in, led by a clinician employed by the company, and compiles a brief on the patient. They centralize and digitize the patient's medical records, usually dog-eared paper piles that can run to thousands of pages. Research scientists immerse themselves in the latest findings and treatment regimens for the particular condition involved.
Tests are double-checked—biopsy tissues are sent to an outside pathologist, MRIs to another radiologist. For an era of targeted therapies, Private Health runs a full battery of molecular diagnostics "to sequence the entire three billion base pairs of somebody's DNA in a couple of hours," Mr. Michelson marvels.
The goal is to ensure an accurate diagnosis and lay out all the treatment options. Private Health functions as a kind of running, independent second opinion. It operates in the twilight zone where there isn't a "best practice" for when and how to treat, but a continuum of risks and benefits that vary from patient to patient.
The clinician helps locate the right experts, Mr. Michelson says, and then works to "fuse together all these multiple specialists in a single team with a single objective." There are "no redos, no lost scans, no ambling around going from specialist to specialist, trying to figure out what's going on." The most frequent reaction is: "This is how medicine was always supposed to be practiced."
The idea for Private Health came to Mr. Michelson when he was running the Prostate Cancer Foundation, the multibillion-dollar philanthropy Michael Milken set up in 1993. Prostate cancer is a common disease but treatment isn't straightforward. Surgeons end up recommending surgery, radiation specialists radiation, still others "watchful waiting," etc.
Mr. Michelson says people started asking him for advice, which led to the prototype for Private Health. Eventually he decided to improve his process across more diseases and help more people.
One irony is that for all its white-glove extras (a research department, genetic profiling), a lot of what Private Health does are core functions that patients would value and providers or insurers ought to be doing but rarely do (case management, using computers). Why is that?
Cost is part of it. "It's too expensive for us to do it for everybody right now," Mr. Michelson says. Another part, he thinks, is that "the incentives are attenuated because of the structure of insurance," namely, job-based coverage.
Since businesses are the customers, not the individuals who change jobs every three years on average, insurers "act rationally" and don't invest in services with "short-term costs and long-term payback." Mr. Michelson thinks the better option is for businesses to convert to cash vouchers so their workers can buy portable policies. Right now, there is "no meaningful information about the quality of care, virtually no information about price, and no sensitivity to price," but that would change if the insurance industry built "an enduring relationship with consumers," he says.
"I understand that it is woven into the fabric of our society that employers can and should continue to pay for health insurance for their employees," Mr. Michelson declares. "But why, circa 2012, should HR departments be selecting and administering one or two or three plans for a thousand or a hundred thousand workers and their dependents? You don't need a Ph.D. in economics to understand that you will guarantee suboptimization."
Tuesday, July 10, 2012
Taking A Risk To Secure Health Insurance
Taking A Risk To Secure Health Insurance
By Randy Dotinga
KaiserHealthNews.org
Henry J. Kaiser Family Foundation
JUN 12, 2012
When it comes to medicine, I usually do as I'm told.
Take a pill? Sure. Blood test? Absolutely. Surgery? If you think so, doc.
But I've been acting against medical advice since January, and I'll keep on ignoring it until July. Let me explain.
Last January, I cancelled my existing, very expensive individual coverage through California's state-run high risk plan and became insurance-free to gain eligibility for the federal alternative.
That means that if I get a cancer diagnosis tomorrow, I'll end up with huge medical bills. I did this because I want to take advantage of the federal government's efforts to help people like me who have pre-existing conditions and no access to a group plan.
Those two words -- pre-existing condition -- explain why I find myself in this circumstance.
Back in 1996, when I was 27, my heart started to beat funny. The diagnosis was lone atrial fibrillation, a kind of irregular heartbeat that appeared for no apparent reason and, in my case, couldn't be fixed. Even getting "cardioverted" didn't help.
A daily beta blocker keeps my heart from pumping too fast, and my risk of any complications is low. Even so, no one will insure me on the individual market.
And since I'm single and self-employed as a freelance writer, I don't have access to guaranteed group coverage, except for a plan for artists and writers that would cost me at least $31,226 a year.
That's why, for the last few years, I have made do with the state's high-risk insurance plan. California, where I live, is one of 35 states that offer health insurance to people with pre-existing conditions who otherwise wouldn't be able to get individual coverage.
But for me, access to California's high-risk plan is expensive -- the PPO plan would cost me $748 a month this year, close to $9,000 a year -- and the coverage is thin. The annual spending limit is just $75,000, hardly enough to cover a major health crisis. And the lifetime benefit limit is a paltry $750,000.
As a result of the 2010 federal health law, I now have another possibility: The federal high-risk plan would cost me just $265 a month -- $3,180 a year -- and offers unlimited annual and lifetime benefits.
That sounds like a great deal cost-wise, and the lack of coverage limits is much better for me in the long run if I get diagnosed with an expensive disease. But there's a rub: I'm not eligible for the federal plan unless I go six months without any coverage at all. That's just what I decided to do. To me, the prospect of affordable and unlimited coverage -- at least from July 2012-December 2013 -- is worth the risk of going without coverage for the allotted time.
"You're responding in an understandable way," said Harold Pollack, a University of Chicago professor who studies health care. "Any program that requires people to be actively uninsured creates a very paradoxical and painful set of incentives and encourages people to do what you're doing."
But I'm taking a major risk by going without insurance for so long. This would be the absolute wrong time to get hit by the proverbial bus. Or, as happened a few weeks ago, hear a dermatologist ask "Have you had that looked at?" while I lounge at a hotel pool. (Don't worry. I'd previously had it looked at, and it's nothing to worry about.)
My decision to go coverage-free did not go over well up in Sacramento when I mentioned it to staffers at the California Managed Risk Medical Insurance Board, which oversees the state and federal high-risk plans here.
A spokeswoman told me that the agency wouldn't cooperate with me on this story if I planned to embolden other people to make the same decision. Janette Casillas, the agency's executive director, put it this way: going without insurance in order to get insurance "is not something that we would encourage."
The federal government could change everything by getting rid of that six-months-without-coverage rule. But if it did, it would need to find another way to limit coverage for high-risk patients so it doesn't cost more than the budgeted amount, Pollack said. "They'd have to have some other rationing requirement that would also create problems, since it's such a small program for such a huge need," he said. "Almost every deficit of this program comes down to the fact that Congress has not appropriated enough money to meet the need that is there."
Even if I do land in the federal high-risk plan as of July 1 -- if space is available -- it's not a long-term fix for me or anyone else. The good news, for me at least: In 2014, the federal health law is scheduled to take full effect, including provisions that protect consumers who have pre-existing conditions from being denied coverage. The high-risk pool coverage won't be needed anymore.
Thursday, June 28, 2012
Supreme Court upholds Obama’s health-care law
Supreme Court upholds Obama’s health-care law
By Robert Barnes
June 28, 2012
Washington Post
Chief Justice John G. Roberts Jr. on Thursday joined the liberal wing of the Supreme Court to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure health insurance is permissible under Congress’s taxing authority.
Even as it upheld that central component of the Patient Protection and Affordable Care Act, however, the court modified another key provision of the law, ruling that the federal government cannot withdraw existing Medicaid funding from states that decide not to participate in a broad expansion of Medicaid eligibility.
The court’s historic compromise, which will affect the health-care choices of millions of Americans, amounts to a major victory for the White House less than five months before the November elections, although the Medicaid decision sets new limits on the power of the national government.
President Obama welcomed the ruling, which he called “a victory for people all over this country whose lives will be more secure.” He said the decision would allow the health-care law to offer millions of currently uninsured Americans “an array of quality, affordable health-insurance plans to choose from” starting in 2014.
“Today the Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance,” Obama said in televised speech at the White House. He said he knew that this individual mandate “wouldn’t be politically popular” and that the debate over the law “has been divisive.” But he said the law was “good for the country” and “good for the American people.”
“The highest court in the land has now spoken,” Obama said. “We will continue to implement this law. And we’ll work together to improve on it where we can. But what we won’t do, what the country can’t afford to do, is refight the political battles of two years ago or go back to the way things were. With today’s announcement, it’s time for us to move forward.”
Illustrating the divided nature of the ruling, Justice Anthony M. Kennedy, representing the court’s most consistent conservatives, read a scathing dissent, while Justice Ruth Bader Ginsburg, representing the liberals, issued a separate opinion supporting Roberts but differing with him on key aspects of the case...
By Robert Barnes
June 28, 2012
Washington Post
Chief Justice John G. Roberts Jr. on Thursday joined the liberal wing of the Supreme Court to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure health insurance is permissible under Congress’s taxing authority.
Even as it upheld that central component of the Patient Protection and Affordable Care Act, however, the court modified another key provision of the law, ruling that the federal government cannot withdraw existing Medicaid funding from states that decide not to participate in a broad expansion of Medicaid eligibility.
The court’s historic compromise, which will affect the health-care choices of millions of Americans, amounts to a major victory for the White House less than five months before the November elections, although the Medicaid decision sets new limits on the power of the national government.
President Obama welcomed the ruling, which he called “a victory for people all over this country whose lives will be more secure.” He said the decision would allow the health-care law to offer millions of currently uninsured Americans “an array of quality, affordable health-insurance plans to choose from” starting in 2014.
“Today the Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance,” Obama said in televised speech at the White House. He said he knew that this individual mandate “wouldn’t be politically popular” and that the debate over the law “has been divisive.” But he said the law was “good for the country” and “good for the American people.”
“The highest court in the land has now spoken,” Obama said. “We will continue to implement this law. And we’ll work together to improve on it where we can. But what we won’t do, what the country can’t afford to do, is refight the political battles of two years ago or go back to the way things were. With today’s announcement, it’s time for us to move forward.”
Illustrating the divided nature of the ruling, Justice Anthony M. Kennedy, representing the court’s most consistent conservatives, read a scathing dissent, while Justice Ruth Bader Ginsburg, representing the liberals, issued a separate opinion supporting Roberts but differing with him on key aspects of the case...
Sunday, April 29, 2012
Obama healthcare reforms lead to $1.3 billion in insurance rebates
Obama healthcare reforms lead to $1.3 billion in insurance rebates
By Noam N. Levey
April 26, 2012
U.S. consumers and businesses will receive an estimated $1.3 billion in rebates from insurance companies this year, according to a new study quantifying a key early benefit of the healthcare law that President Obama signed in 2010.
That will translate into anywhere from a few dollars to more than $150 for some 15 million consumers nationwide, the new report by the nonprofit Kaiser Family Foundation found.
Obama’s healthcare law requires insurers to spend a minimum portion of customers’ premiums on medical care, a provision championed by consumer groups concerned that companies were hiking premiums to pay for executive salaries, shareholder dividends and other expenses unrelated to their customers’ care.
Starting last year, if insurers did not meet these targets – known as medical loss ratios – they had to pay rebates this year to people enrolled in their plans.
The Kaiser study, which analyzed rate documents filed with state regulators nationwide, found 486 health plans nationwide that will be required to pay rebates, with the largest number in the so-called individual market serving people who do not get health coverage through work.
Nearly a third of all consumers in this market, which is widely seen as the most trouble-plagued in the country, will be eligible for a rebate.
Approximately a quarter of consumers in the small group insurance market and less than a fifth of consumers in the large group market qualified for rebates.
The study also found wide variation in states, with insurers selling individual health plans in some states such as Alaska, Maryland and Pennsylvania required to provide average rebates of around $300. In Hawaii and Maine, by contrast, no insurers in the individual market will have to provide rebates.
Data was not available for California because HMOs in the state are not subject to the same reporting requirements...
Sunday, November 6, 2011
National Toothache: U.S.’s Fifth World Health Care
National Toothache: U.S.’s Fifth World Health Care
by Grady Miller
Canyon News
Nov 6, 2011
HOLLYWOOD—According to a recent Kaiser Family Foundation poll, fully one-third of Americans are skipping dental care because of the high cost. As the Times reported this week, doctors are seeing people who haven’t visited a dentist since Clinton was president, and they are enduring toothaches for years.
I know the dental neglect score, because I toughed out a painful abscessed molar for much of a decade. When the good Dr. Fundaminsky extracted it, I felt sudden relief and also learned about the grave dangers posed by infected teeth: it’s not just the pain. Because all the blood flows through the gums on its voyage throughout the body, infected teeth can lead to organ damage and even death, when left untreated.
Hearing of those poor who have deprived themselves of medical care, I recall my own long healing process when my eyes slowly opened and I overcame a deeply ingrained aversion to seeking the proper care — an insane aversion reinforced by the grin-and-bear-it brand of American stoicism, a usually admirable trait that is in the medical context deplorable. In fact, as someone who suffered M.A.S. (Medical Avoidance Syndrome - my coinage), I believe it poses a major public health problem.
From 1992 to 2001, I resided in a Third World country and during that time I discovered how deprived I had been, handicapped by my American notions of health care and a peculiarly American dread of going to the doctor. While in my new country of residence, Mexico, I was insured by I.M.S.S. (the Mexican Social Security Institute), even as a foreigner. As an American, I didn’t have the foggiest concept of what this meant or know how to take advantage of this benefit until it was too late for my molar, so indoctrinated had I been by the United States’ dysfunctional health care system.
In Mexico, the government-run system of health care and hospitals, established in 1943 under President Avila Camacho, is open to most Mexican workers and other individuals who pay a yearly fee (around $100) based on a full-time minimum wage. A good six years passed before I knew enough to get some antibiotics from I.M.S.S. to alleviate an ear infection.
For me, the real mind-opener was simply living for the first time in a country where medical care is widely available without costing an arm and two legs, a country where the dictates of common medical sense reigned. I lived in a country where alarmed friends and co-workers would urge a visit to the doctor when symptoms of a dermatological malady had conspicuously crossed the line of my stoic American tolerance for an ailment without seeing a doctor. (It turned out to be shingles.) In Mexico, my whole fearful outlook toward medicine changed: if I had a complaint or just plain curiosity about a change observed in my body, for $20 or $30, I could do something about it. At the end of such visits, I would usually be granted a generous dose of the great cure-all, the peace of mind that comes from knowledge.
An underclass of many, far too many, Americans have been infected with the pernicious idea of monetized health care. The land of plenty has spawned a destructive culture of self-sacrifice. We shun the dentist because it may be costly and the toothache will eventually subside. Likewise, a host of other medical issues and routine check-ups are postponed for a payday that never comes for the unemployed and the working poor. An embarrassing number of Americans steel themselves to ignore the body’s warning signs and deny themselves necessary care. With the recession, the trend is even more prevalent. Another Kaiser Family Foundation survey last year revealed that one in three Americans reported problems in paying medical bills, and almost half reported somebody in their family skipping pills and postponing medical treatment because of the cost. Hey, you wouldn’t put off an oil change on your car, would you? It is a pathetic commentary on our culture that we take better care of our cars than our bodies.
As for my infected molar, let me be truthful. I avoided the dentist for years in both Mexico and California. In addition to having the Scottish allergy to untoward expenses, I share the common human trait of dreading and hating the dentist. My dumb.
by Grady Miller
Canyon News
Nov 6, 2011
HOLLYWOOD—According to a recent Kaiser Family Foundation poll, fully one-third of Americans are skipping dental care because of the high cost. As the Times reported this week, doctors are seeing people who haven’t visited a dentist since Clinton was president, and they are enduring toothaches for years.
I know the dental neglect score, because I toughed out a painful abscessed molar for much of a decade. When the good Dr. Fundaminsky extracted it, I felt sudden relief and also learned about the grave dangers posed by infected teeth: it’s not just the pain. Because all the blood flows through the gums on its voyage throughout the body, infected teeth can lead to organ damage and even death, when left untreated.
Hearing of those poor who have deprived themselves of medical care, I recall my own long healing process when my eyes slowly opened and I overcame a deeply ingrained aversion to seeking the proper care — an insane aversion reinforced by the grin-and-bear-it brand of American stoicism, a usually admirable trait that is in the medical context deplorable. In fact, as someone who suffered M.A.S. (Medical Avoidance Syndrome - my coinage), I believe it poses a major public health problem.
From 1992 to 2001, I resided in a Third World country and during that time I discovered how deprived I had been, handicapped by my American notions of health care and a peculiarly American dread of going to the doctor. While in my new country of residence, Mexico, I was insured by I.M.S.S. (the Mexican Social Security Institute), even as a foreigner. As an American, I didn’t have the foggiest concept of what this meant or know how to take advantage of this benefit until it was too late for my molar, so indoctrinated had I been by the United States’ dysfunctional health care system.
In Mexico, the government-run system of health care and hospitals, established in 1943 under President Avila Camacho, is open to most Mexican workers and other individuals who pay a yearly fee (around $100) based on a full-time minimum wage. A good six years passed before I knew enough to get some antibiotics from I.M.S.S. to alleviate an ear infection.
For me, the real mind-opener was simply living for the first time in a country where medical care is widely available without costing an arm and two legs, a country where the dictates of common medical sense reigned. I lived in a country where alarmed friends and co-workers would urge a visit to the doctor when symptoms of a dermatological malady had conspicuously crossed the line of my stoic American tolerance for an ailment without seeing a doctor. (It turned out to be shingles.) In Mexico, my whole fearful outlook toward medicine changed: if I had a complaint or just plain curiosity about a change observed in my body, for $20 or $30, I could do something about it. At the end of such visits, I would usually be granted a generous dose of the great cure-all, the peace of mind that comes from knowledge.
An underclass of many, far too many, Americans have been infected with the pernicious idea of monetized health care. The land of plenty has spawned a destructive culture of self-sacrifice. We shun the dentist because it may be costly and the toothache will eventually subside. Likewise, a host of other medical issues and routine check-ups are postponed for a payday that never comes for the unemployed and the working poor. An embarrassing number of Americans steel themselves to ignore the body’s warning signs and deny themselves necessary care. With the recession, the trend is even more prevalent. Another Kaiser Family Foundation survey last year revealed that one in three Americans reported problems in paying medical bills, and almost half reported somebody in their family skipping pills and postponing medical treatment because of the cost. Hey, you wouldn’t put off an oil change on your car, would you? It is a pathetic commentary on our culture that we take better care of our cars than our bodies.
As for my infected molar, let me be truthful. I avoided the dentist for years in both Mexico and California. In addition to having the Scottish allergy to untoward expenses, I share the common human trait of dreading and hating the dentist. My dumb.
Wednesday, October 19, 2011
Kaiser Permanente sues patient who didn't pay $10,000 for Kaiser's failure to diagnose
Kaiser said – we don’t know what’s wrong with you – now give us our money.”...He thought he could win in court because they never did anything for him and he was continuing to get sicker...Kaiser said he owed them about $10,000 for all the tests, CAT scans, MRIs. The bills kept piling up. He couldn’t pay it.
Adara believes that if we had a single payer national health insurance system, her father might still be alive.
October 19, 2011
Adara Scarlet, Suicide and Single Payer
by RUSSELL MOKHIBER
Counterpunch.org
...[Martin] Goldstein graduated from the University of Louisville School of Law. He was a member of the Colorado Bar. But he found out that he didn’t like practicing law – so he did odd jobs – as a stock broker, taxi driver, and dispatcher.
When he lost his jobs as a dispatcher, he lost his health insurance.
But he had this amazing ability to count cards at the Blackjack table...
And he made on average $200 a day.
“He had an amazing memory,” Adara says. “He was a walking talking encyclopedia. He taught me how to count cards when I was ten years old. He could beat the system and he did.”
Adara says that it’s a myth that counting cards at a casino is illegal...
“Back then, there was a $5 betting minimum and maximum per hand. If you were to do this today, he would be much more prosperous. Now you can bet up to $100 per hand. Back then, it was just strictly five dollar ante.”
“And he played blackjack. He was clearing $1000 a week. The rent on the house was $1195 a month. He never seemed to have a problem with the grocery shopping. And buying clothes for me and my sister.”
He was able to pay the bills – including $600 a month to Kaiser Permanente for health insurance for himself and the girls.
Then Goldstein started getting sick – and running up medical bills.
“He was having a whole bunch of medical problems,” Adara says. “They never figured out what was wrong with him. We never found out.”
The illness started in about 2000 or 2001...
What were the symptoms?
“Legs swollen,” Adara says. “Calves were so swollen they were bigger than his thighs.”
“And he couldn’t eat. He couldn’t keep food down.”
“His circulation was all screwed up, so he was always cold.”
“Kaiser bounced him around to a whole bunch of specialists. But nobody could figure out what was wrong with him – they pretty much gave up after a certain point.”
“Kaiser said – we don’t know what’s wrong with you – now give us our money.”
“But he said he was not going to pay them. He thought he could win in court because they never did anything for him and he was continuing to get sicker. He lost a whole bunch of weight. He was overweight most of his life. He actually got pretty skinny toward the end.”
“He got fed up with Kaiser. He paid all of this money into the system. Not only the premiums, but the co pays. He said – I’m not going to pay this bill – you haven’t figured out what is wrong with me.”
“I assume they wouldn’t cover him anymore, or he just refused to give them any more money.”
“Kaiser said he owed them about $10,000 for all the tests, CAT scans, MRIs. The bills kept piling up. He couldn’t pay it.”
“It was something around $10,000. He couldn’t pay it. He refused to pay it.”
“Kaiser sued him. He went to court and fought them. But Kaiser won the lawsuit.”
“But he didn’t pay. He couldn’t pay.”
“They put bill collectors on it. He was in debt to them. He had bill collectors calling him.”
“Kaiser Permanent is a horrible horrible company,” Adara says.
In early April 2003, Marty Goldstein was eating a bowl of chili in the kitchen. And he said to Adara that he was going to kill himself.
“It was the most casual thing,” Adara said. “He said – I want to talk to you about something. I don’t want you to tell your sister because she is kind of emotional. I don’t want her to get bent out of shape. But I’m sure you’ll understand.”
“And he said – I’ve decided that I have lived my life, it’s time to go, I’m going to stick around for one more birthday.”
“His birthday was April 30.”
“My birthday is May 11.”
“He was 53 that year. I was 18.”
“My response was to freak out and tell my sister, which was exactly what he asked me not to do.”
“He was sitting there eating a bowl of chili while he was talking about it. He was just blowing on the chili, eating the chili, like it was nothing.”
“I went down and told my sister – Dad is talking about killing himself.”
Did he say how he was going to do it?
“No he didn’t. He just said – it was time to bow out. It was so casual.”
“He said that he had lived his life. He said all he had done was get himself into debt. And there was no way he would be able to pay Kaiser. He said – what do I have in my future other than bankrupting my family?”
“He suffered from depression. I’m sure if we had a better mental health care system, he wouldn’t have thought this was the only way out.”
“When I told my sister, she panicked. We went upstairs and cornered my dad and said – you have every reason to live. That kind of thing.”
“He acted like we convinced him. After we were at it for a while, he said – you are absolutely right, I don’t know what I was thinking. I was just talking crazy talk. And he never brought it up again.”
That was April 2003.
Did he say anything after that date?
“Never. He never brought it up again.”
But less than a year later – on February 4, 2004 – Marty Goldstein killed himself.
How did he kill himself?
“He shot himself in the head. I got a call from my aunt. It was the cops who called her. He had left a note. He called 911 first. He said – I’m about to kill myself. Please collect my body so my daughters don’t find it. He left a short note for the emergency people. He said – here are the keys to the house for my daughters. He even said what day the trash pick up was. He said – please don’t let my daughters find my body here.”
Did he leave a note for you?
“Yes, a long note in a sealed envelope. It was a 22-page hand written letter.”
“He said when bill collectors come around, they can come and collect my TV, bed, everything like that. I have a small life insurance policy that will pay collectors off at about 75 cents on the dollar.”
“I guess he must have been about $40,000 debt in total, because it was a $30,000 life insurance policy. The life insurance company of course managed to screw us – we didn’t get that.”
“He had actually gotten life insurance with a company that covered suicide. God knows where he found that. It was some place out of Texas. He had done that specifically in the early 1990s.”
“He had this policy for years. Maybe he had suicide on the back of his mind.”
An aunt told Adara that her father’s bills wouldn’t pass on to the family.
“But collectors called me and my sister anyway. They tried to trick us into thinking that we owed it. I’m really glad my aunt told me – you don’t owe anybody any money. Don’t let anyone talk you into thinking that you do. My sister and I just hung up on them. And finally after about a year, they quit calling.”
Adara believes that if we had a single payer national health insurance system, her father might still be alive.
“He was really depressed and he considered suicide as a possibility. But I don’t think he would have done it. The Kaiser Permanente bills were on his mind. He didn’t want to burden his family with bills.”
“My dad’s main killer was depression. And no health insurance. If had been able to pay those bills, he would have stuck it out.”...
Adara believes that if we had a single payer national health insurance system, her father might still be alive.
October 19, 2011
Adara Scarlet, Suicide and Single Payer
by RUSSELL MOKHIBER
Counterpunch.org
...[Martin] Goldstein graduated from the University of Louisville School of Law. He was a member of the Colorado Bar. But he found out that he didn’t like practicing law – so he did odd jobs – as a stock broker, taxi driver, and dispatcher.
When he lost his jobs as a dispatcher, he lost his health insurance.
But he had this amazing ability to count cards at the Blackjack table...
And he made on average $200 a day.
“He had an amazing memory,” Adara says. “He was a walking talking encyclopedia. He taught me how to count cards when I was ten years old. He could beat the system and he did.”
Adara says that it’s a myth that counting cards at a casino is illegal...
“Back then, there was a $5 betting minimum and maximum per hand. If you were to do this today, he would be much more prosperous. Now you can bet up to $100 per hand. Back then, it was just strictly five dollar ante.”
“And he played blackjack. He was clearing $1000 a week. The rent on the house was $1195 a month. He never seemed to have a problem with the grocery shopping. And buying clothes for me and my sister.”
He was able to pay the bills – including $600 a month to Kaiser Permanente for health insurance for himself and the girls.
Then Goldstein started getting sick – and running up medical bills.
“He was having a whole bunch of medical problems,” Adara says. “They never figured out what was wrong with him. We never found out.”
The illness started in about 2000 or 2001...
What were the symptoms?
“Legs swollen,” Adara says. “Calves were so swollen they were bigger than his thighs.”
“And he couldn’t eat. He couldn’t keep food down.”
“His circulation was all screwed up, so he was always cold.”
“Kaiser bounced him around to a whole bunch of specialists. But nobody could figure out what was wrong with him – they pretty much gave up after a certain point.”
“Kaiser said – we don’t know what’s wrong with you – now give us our money.”
“But he said he was not going to pay them. He thought he could win in court because they never did anything for him and he was continuing to get sicker. He lost a whole bunch of weight. He was overweight most of his life. He actually got pretty skinny toward the end.”
“He got fed up with Kaiser. He paid all of this money into the system. Not only the premiums, but the co pays. He said – I’m not going to pay this bill – you haven’t figured out what is wrong with me.”
“I assume they wouldn’t cover him anymore, or he just refused to give them any more money.”
“Kaiser said he owed them about $10,000 for all the tests, CAT scans, MRIs. The bills kept piling up. He couldn’t pay it.”
“It was something around $10,000. He couldn’t pay it. He refused to pay it.”
“Kaiser sued him. He went to court and fought them. But Kaiser won the lawsuit.”
“But he didn’t pay. He couldn’t pay.”
“They put bill collectors on it. He was in debt to them. He had bill collectors calling him.”
“Kaiser Permanent is a horrible horrible company,” Adara says.
In early April 2003, Marty Goldstein was eating a bowl of chili in the kitchen. And he said to Adara that he was going to kill himself.
“It was the most casual thing,” Adara said. “He said – I want to talk to you about something. I don’t want you to tell your sister because she is kind of emotional. I don’t want her to get bent out of shape. But I’m sure you’ll understand.”
“And he said – I’ve decided that I have lived my life, it’s time to go, I’m going to stick around for one more birthday.”
“His birthday was April 30.”
“My birthday is May 11.”
“He was 53 that year. I was 18.”
“My response was to freak out and tell my sister, which was exactly what he asked me not to do.”
“He was sitting there eating a bowl of chili while he was talking about it. He was just blowing on the chili, eating the chili, like it was nothing.”
“I went down and told my sister – Dad is talking about killing himself.”
Did he say how he was going to do it?
“No he didn’t. He just said – it was time to bow out. It was so casual.”
“He said that he had lived his life. He said all he had done was get himself into debt. And there was no way he would be able to pay Kaiser. He said – what do I have in my future other than bankrupting my family?”
“He suffered from depression. I’m sure if we had a better mental health care system, he wouldn’t have thought this was the only way out.”
“When I told my sister, she panicked. We went upstairs and cornered my dad and said – you have every reason to live. That kind of thing.”
“He acted like we convinced him. After we were at it for a while, he said – you are absolutely right, I don’t know what I was thinking. I was just talking crazy talk. And he never brought it up again.”
That was April 2003.
Did he say anything after that date?
“Never. He never brought it up again.”
But less than a year later – on February 4, 2004 – Marty Goldstein killed himself.
How did he kill himself?
“He shot himself in the head. I got a call from my aunt. It was the cops who called her. He had left a note. He called 911 first. He said – I’m about to kill myself. Please collect my body so my daughters don’t find it. He left a short note for the emergency people. He said – here are the keys to the house for my daughters. He even said what day the trash pick up was. He said – please don’t let my daughters find my body here.”
Did he leave a note for you?
“Yes, a long note in a sealed envelope. It was a 22-page hand written letter.”
“He said when bill collectors come around, they can come and collect my TV, bed, everything like that. I have a small life insurance policy that will pay collectors off at about 75 cents on the dollar.”
“I guess he must have been about $40,000 debt in total, because it was a $30,000 life insurance policy. The life insurance company of course managed to screw us – we didn’t get that.”
“He had actually gotten life insurance with a company that covered suicide. God knows where he found that. It was some place out of Texas. He had done that specifically in the early 1990s.”
“He had this policy for years. Maybe he had suicide on the back of his mind.”
An aunt told Adara that her father’s bills wouldn’t pass on to the family.
“But collectors called me and my sister anyway. They tried to trick us into thinking that we owed it. I’m really glad my aunt told me – you don’t owe anybody any money. Don’t let anyone talk you into thinking that you do. My sister and I just hung up on them. And finally after about a year, they quit calling.”
Adara believes that if we had a single payer national health insurance system, her father might still be alive.
“He was really depressed and he considered suicide as a possibility. But I don’t think he would have done it. The Kaiser Permanente bills were on his mind. He didn’t want to burden his family with bills.”
“My dad’s main killer was depression. And no health insurance. If had been able to pay those bills, he would have stuck it out.”...
Friday, October 7, 2011
Insurers Banking their Cash
Insurers Banking their Cash
By The Palm Beach Post
Sept. 30, 2011
Critics of the Affordable Care Act pounced last week on the news that health care premiums went up 9 percent this year. According to the Kaiser Family Foundation, the average family health plan in the U.S. now costs $15,073.
What the critics didn't say was that the year before President Obama signed the law, the cost of an average family policy rose 5 percent. That same year, 2009, the five largest U.S. health insurance companies earned a record $12.2 billion - as 2.7 million Americans lost their private health coverage in the worst year for the economy since the Depression.
This year, some insurers reported double-digit profit increases during the second quarter, and expect to exceed expectations for the year. One reason may be that fewer consumers are seeking medical care in the still-weak economy.
Some of the Affordable Care Act's key portions - the individual mandate, the marketplace-like exchanges - came from Republicans two decades ago. Gov. Scott and other current Republicans who want the health care law repealed say premiums will go down if insurers can compete by selling policies across state lines. Most insurers, however, already have licenses in multiple states. Blue Cross and Blue Shield of Florida recently gave its mental health policies for Florida residents to a Kansas-based company in which it has part ownership.
Objective analysts attribute only about 1 or 2 percentage points in premium increases to the new law's mandates, notably those that require insurers to provide preventive services at no out-of-pocket costs and add adult children to their parents' policies. Those are good changes.
Some analysts believe that insurers are charging more to hedge their bets for when the economy improves and more people seek treatment, and that companies are banking cash before next year, when the law requires them to justify increases. In this case, the health care law is more the target than the problem.
- Rhonda Swan,
for The Palm Beach Post Editorial Board
By The Palm Beach Post
Sept. 30, 2011
Critics of the Affordable Care Act pounced last week on the news that health care premiums went up 9 percent this year. According to the Kaiser Family Foundation, the average family health plan in the U.S. now costs $15,073.
What the critics didn't say was that the year before President Obama signed the law, the cost of an average family policy rose 5 percent. That same year, 2009, the five largest U.S. health insurance companies earned a record $12.2 billion - as 2.7 million Americans lost their private health coverage in the worst year for the economy since the Depression.
This year, some insurers reported double-digit profit increases during the second quarter, and expect to exceed expectations for the year. One reason may be that fewer consumers are seeking medical care in the still-weak economy.
Some of the Affordable Care Act's key portions - the individual mandate, the marketplace-like exchanges - came from Republicans two decades ago. Gov. Scott and other current Republicans who want the health care law repealed say premiums will go down if insurers can compete by selling policies across state lines. Most insurers, however, already have licenses in multiple states. Blue Cross and Blue Shield of Florida recently gave its mental health policies for Florida residents to a Kansas-based company in which it has part ownership.
Objective analysts attribute only about 1 or 2 percentage points in premium increases to the new law's mandates, notably those that require insurers to provide preventive services at no out-of-pocket costs and add adult children to their parents' policies. Those are good changes.
Some analysts believe that insurers are charging more to hedge their bets for when the economy improves and more people seek treatment, and that companies are banking cash before next year, when the law requires them to justify increases. In this case, the health care law is more the target than the problem.
- Rhonda Swan,
for The Palm Beach Post Editorial Board
Friday, August 12, 2011
Bladder cancer advocacy network
Bladder cancer advocacy network
June 5, 2011
Hard choices
By ludovic
June 5, 2011
In Newly diagnosed
Shared with the public
I'm 86 years old and in
general good health. I had a
TURP on April 23, tumor
removed from a thin-walled
diverticulum on the right side
of bladder. Biopsy at the time
revealed I also have
adinocarcinoma. I am
preparing to undergo
segemental cystocopy to
remove the diverticulum and
adjacent bladder wall where
tumors are located.
I chose this procedure over a
radical cystoscopy because
quality of life is important. If
successful, I will still be able to
pee normally, (albeit more
frequently).
The question posed by my
surgeon: "If I find it not
possible to complete the
partial, do you prefer I
continue on to do a radical or
do I close you up?"
Hypotetically, knowing what
you now know and you were
86, what would you answer?
BTW, were I to elect for a
radical, which urinary
diversion would you
recommend?
...By ludovic
July 3, 2011
Thank you to all who offered
opinions and advice based on
your own experiences. They
were, of course, of
tremendous value in electing
the course for me to follow.
Firstly, I have to express my
thanks to and admiration of
the skills in both diagnosis
and surgery of Dr. HUATHIN
KHAW , the specialist who has
taken care of my uroligical
needs for about 17 years at
Kaiser Permanente in San
Diego.
Secondly, I have to attest to
his humility and empathy by
reporting that he readily
organized an appointment
with another urological
specialist for a second opinion
before deciding on the final
course of action.
Thirdly, based on his finding
that the adino tumors
appeared to be located only
in and close to the
diverticulum and his
assessment of the area
available to him to excise
them and still leave adequate
tissue for stitching and
reclosing the bladder, we
agreed to go with a
diverticulectomy and partial
cystectomy.
The surgery, held on June 18,
lasted for 5 hours and
resulted in his removing the
diverticulum plus a
happily-small 10% of my
bladder. Subsequent path
results showed tumors gone
and margins clear of cancer,
as were the nearby lymph
nodes.
For the time being, I am
cancer-free and suffering a
diminishing amount of
discomfort following removal
of a drain tube and catheter,
and the slow healing (I'll be 87
later this month) of the
incisions.
I've noted, with increasing
thankfulness for my own good
fortune, the anguishing
choices some sufferers have
had to make in respect of the
cost of the treatment they
require. As a member of the
Kaiser Permamente Senior
Advantage program, the only
contribution I have been asked
to make is a $200 per night
hospital charge. My surgery
and the subsequent
state-of-the-art nursing help,
plus all needed supplies and
follow-up visits for device
removal, etc. have been at no
charge. For those who may
not qualify for such a
program, I can only say that I
am totally amazed that any
right-thinking US citizen,
except those who own shares
in healthcare insurance
companies, would vote
against a political party that
advocates free healthcare for
all paid for from general
taxation.
June 5, 2011
Hard choices
By ludovic
June 5, 2011
In Newly diagnosed
Shared with the public
I'm 86 years old and in
general good health. I had a
TURP on April 23, tumor
removed from a thin-walled
diverticulum on the right side
of bladder. Biopsy at the time
revealed I also have
adinocarcinoma. I am
preparing to undergo
segemental cystocopy to
remove the diverticulum and
adjacent bladder wall where
tumors are located.
I chose this procedure over a
radical cystoscopy because
quality of life is important. If
successful, I will still be able to
pee normally, (albeit more
frequently).
The question posed by my
surgeon: "If I find it not
possible to complete the
partial, do you prefer I
continue on to do a radical or
do I close you up?"
Hypotetically, knowing what
you now know and you were
86, what would you answer?
BTW, were I to elect for a
radical, which urinary
diversion would you
recommend?
...By ludovic
July 3, 2011
Thank you to all who offered
opinions and advice based on
your own experiences. They
were, of course, of
tremendous value in electing
the course for me to follow.
Firstly, I have to express my
thanks to and admiration of
the skills in both diagnosis
and surgery of Dr. HUATHIN
KHAW , the specialist who has
taken care of my uroligical
needs for about 17 years at
Kaiser Permanente in San
Diego.
Secondly, I have to attest to
his humility and empathy by
reporting that he readily
organized an appointment
with another urological
specialist for a second opinion
before deciding on the final
course of action.
Thirdly, based on his finding
that the adino tumors
appeared to be located only
in and close to the
diverticulum and his
assessment of the area
available to him to excise
them and still leave adequate
tissue for stitching and
reclosing the bladder, we
agreed to go with a
diverticulectomy and partial
cystectomy.
The surgery, held on June 18,
lasted for 5 hours and
resulted in his removing the
diverticulum plus a
happily-small 10% of my
bladder. Subsequent path
results showed tumors gone
and margins clear of cancer,
as were the nearby lymph
nodes.
For the time being, I am
cancer-free and suffering a
diminishing amount of
discomfort following removal
of a drain tube and catheter,
and the slow healing (I'll be 87
later this month) of the
incisions.
I've noted, with increasing
thankfulness for my own good
fortune, the anguishing
choices some sufferers have
had to make in respect of the
cost of the treatment they
require. As a member of the
Kaiser Permamente Senior
Advantage program, the only
contribution I have been asked
to make is a $200 per night
hospital charge. My surgery
and the subsequent
state-of-the-art nursing help,
plus all needed supplies and
follow-up visits for device
removal, etc. have been at no
charge. For those who may
not qualify for such a
program, I can only say that I
am totally amazed that any
right-thinking US citizen,
except those who own shares
in healthcare insurance
companies, would vote
against a political party that
advocates free healthcare for
all paid for from general
taxation.
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
The way I see it, Americans shouldn't have to die or be physically damaged simply because they don't have healthcare. Also, they shouldn't end up financially devastated by illness or injury.
This means we all have to chip in to provide health care for all. Having everyone buy health insurance is one way of doing this. But if this isn't possible, then the only solution I can see is a single-payer system.
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
By Associated Press
August 12, 2011
ATLANTA — A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.
The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional...
This means we all have to chip in to provide health care for all. Having everyone buy health insurance is one way of doing this. But if this isn't possible, then the only solution I can see is a single-payer system.
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
By Associated Press
August 12, 2011
ATLANTA — A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.
The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional...
Saturday, April 16, 2011
A long way to go on health reform
A long way to go on health reform
By Umang Malhotra
San Diego Union-Tribune
April 15, 2011
The American health care system has been leaking like an old car for decades. Congress, in the search for a universal solution, is using a piecemeal or duct tape approach to stop the leaks. Our lawmakers bemoan the expense, while using the most cost-ineffective solution.
The system is undeniably broken. By reputable measurements, America ranks first in obesity, 27th in life expectancy, 37th in infant mortality and 54th in access to health care (tied with Fiji). CIA World Factbook figures are even worse. Despite the U.S. spending twice what the next affluent country spends per person, all international comparisons show that America lies near the bottom on health care. According to AARP data, it also lags far behind other countries in long-term care for seniors. Nearly 50 million people in the U.S. are uninsured; millions are underinsured, and more than half the personal bankruptcies – over 1 million a year – are caused by medical bills, something unheard of elsewhere.
America is the only affluent nation unable to provide universal health care for its residents – astonishing for the richest country in the world.
The reason is a money-driven system – riddled with interest groups selfishly fighting to protect their own constituencies. With the cost of health care rising at more than twice the rate of inflation, it is already a huge problem for businesses and governments. If it continues, it will be disastrous.
The health care bill signed by President Barack Obama is neither universal nor is it likely to ever be cost-effective. It is nearly 2,700 pages, and with the addition of all the enabling regulations, becomes a minefield open to interpretations in the hands of insurance companies and lawyers – a bureaucratic nightmare. The cost of premiums and payments from your pockets will keep on rising.
Sadly, many legislators turn the issue into an ideological controversy, rather than a search for common good. They bury their heads in a sand of partisanship, power and hypocrisy; accepting government health care plans for their families while denying the same to the rest of the population.
Other issues, uniquely American, are lobbying by insurance and drug companies, and the involvement of vast armies of lawyers. The same drug costs much more in America than in other countries, while frivolous malpractice lawsuits escalate the costly practice of defensive medicine...
By Umang Malhotra
San Diego Union-Tribune
April 15, 2011
The American health care system has been leaking like an old car for decades. Congress, in the search for a universal solution, is using a piecemeal or duct tape approach to stop the leaks. Our lawmakers bemoan the expense, while using the most cost-ineffective solution.
The system is undeniably broken. By reputable measurements, America ranks first in obesity, 27th in life expectancy, 37th in infant mortality and 54th in access to health care (tied with Fiji). CIA World Factbook figures are even worse. Despite the U.S. spending twice what the next affluent country spends per person, all international comparisons show that America lies near the bottom on health care. According to AARP data, it also lags far behind other countries in long-term care for seniors. Nearly 50 million people in the U.S. are uninsured; millions are underinsured, and more than half the personal bankruptcies – over 1 million a year – are caused by medical bills, something unheard of elsewhere.
America is the only affluent nation unable to provide universal health care for its residents – astonishing for the richest country in the world.
The reason is a money-driven system – riddled with interest groups selfishly fighting to protect their own constituencies. With the cost of health care rising at more than twice the rate of inflation, it is already a huge problem for businesses and governments. If it continues, it will be disastrous.
The health care bill signed by President Barack Obama is neither universal nor is it likely to ever be cost-effective. It is nearly 2,700 pages, and with the addition of all the enabling regulations, becomes a minefield open to interpretations in the hands of insurance companies and lawyers – a bureaucratic nightmare. The cost of premiums and payments from your pockets will keep on rising.
Sadly, many legislators turn the issue into an ideological controversy, rather than a search for common good. They bury their heads in a sand of partisanship, power and hypocrisy; accepting government health care plans for their families while denying the same to the rest of the population.
Other issues, uniquely American, are lobbying by insurance and drug companies, and the involvement of vast armies of lawyers. The same drug costs much more in America than in other countries, while frivolous malpractice lawsuits escalate the costly practice of defensive medicine...
Saturday, February 12, 2011
Issa Watch: Holding the Oversight Chairman Accountable
Friday, February 11, 2011
Meeting Rena
by Rick Jacobs
Issa Watch
...Rena and her son were also both recently diagnosed long-term health problems. Their Congressman’s response was voting to allow their insurance provider to deny them coverage for these “pre-existing” conditions. Facing a spike in her health insurance costs, a choice between her own medication and medicine for her son, and the even the prospect of losing her coverage altogether, Rena decided to contact her Congressman.
Not for the first time, Rena called Issa's office asking to meet with him. Instead of getting a meeting, she was told that she won't ever get one.
Instead of meeting with Rena, Issa did make time for folks who shelled out $125 a pop to attend a Vista Chamber of Commerce event at the posh Shadowridge Country Club Friday night. While Issa was inside vowing to champion the cause of the DC Lobbyists he’s asked to help drive his committee’s agenda, Rena was outside for hours in the chilly night— hoping for just a few seconds to speak to her Congressman.
Tragically, Rena’s experience mirrors that of a growing number of Americans for whom the concept of a truly “Representative” government is almost always out of reach. A few weeks ago, Rena’s Congressman, Rep. Darrell Issa, sent letters to more than 150 corporate lobbyists who aren’t in his district to ask what he could do to make their lives a little easier. But Rena—one of the small business owners who create nearly two-thirds of the new jobs in this country and one of the 331,000 CA 49 residents with pre-existing conditions who are directly impacted by the new healthcare law -- couldn’t even get a meeting...
Meeting Rena
by Rick Jacobs
Issa Watch
...Rena and her son were also both recently diagnosed long-term health problems. Their Congressman’s response was voting to allow their insurance provider to deny them coverage for these “pre-existing” conditions. Facing a spike in her health insurance costs, a choice between her own medication and medicine for her son, and the even the prospect of losing her coverage altogether, Rena decided to contact her Congressman.
Not for the first time, Rena called Issa's office asking to meet with him. Instead of getting a meeting, she was told that she won't ever get one.
Instead of meeting with Rena, Issa did make time for folks who shelled out $125 a pop to attend a Vista Chamber of Commerce event at the posh Shadowridge Country Club Friday night. While Issa was inside vowing to champion the cause of the DC Lobbyists he’s asked to help drive his committee’s agenda, Rena was outside for hours in the chilly night— hoping for just a few seconds to speak to her Congressman.
Tragically, Rena’s experience mirrors that of a growing number of Americans for whom the concept of a truly “Representative” government is almost always out of reach. A few weeks ago, Rena’s Congressman, Rep. Darrell Issa, sent letters to more than 150 corporate lobbyists who aren’t in his district to ask what he could do to make their lives a little easier. But Rena—one of the small business owners who create nearly two-thirds of the new jobs in this country and one of the 331,000 CA 49 residents with pre-existing conditions who are directly impacted by the new healthcare law -- couldn’t even get a meeting...
Monday, February 8, 2010
Obama says he won't give up on Melanie Shouse's dream of health care reform
Obama says he won't give up on Melanie Shouse's dream of health care reform
By Michael Sorkin
ST. LOUIS POST-DISPATCH
02/06/2010
Melanie Shouse believed Barack Obama could reform health care, and the St. Louis activist worked hard to help get him to the White House.
She died last Saturday from breast cancer while battling her insurance company to pay for her chemotherapy treatment.
On Thursday night, President Obama cited her case in promising to continue working for health care legislation.
In a speech, Obama spoke of Shouse's death and her obituary in the Post-Dispatch.
"How can I say to her ... 'We're giving up'?" Obama said....
Shouse, 41, of Overland, died after a 41/2-year battle with breast cancer.
Her obituary reported that she waited months to go to a doctor after she began to feel sick in 2005. She explained that she could only afford so-called "catastrophic" health insurance — a policy that required her to pay out $5,000 in deductibles before the insurance kicked in.
Shouse spent the last years of her life advocating that consumers "take on the Big Insurance Monopoly and liberate American families from the slavery of skyrocketing insurance premiums and canceled coverage, which leave millions of us in a state of perpetual fear and insecurity."...
By Michael Sorkin
ST. LOUIS POST-DISPATCH
02/06/2010
Melanie Shouse believed Barack Obama could reform health care, and the St. Louis activist worked hard to help get him to the White House.
She died last Saturday from breast cancer while battling her insurance company to pay for her chemotherapy treatment.
On Thursday night, President Obama cited her case in promising to continue working for health care legislation.
In a speech, Obama spoke of Shouse's death and her obituary in the Post-Dispatch.
"How can I say to her ... 'We're giving up'?" Obama said....
Shouse, 41, of Overland, died after a 41/2-year battle with breast cancer.
Her obituary reported that she waited months to go to a doctor after she began to feel sick in 2005. She explained that she could only afford so-called "catastrophic" health insurance — a policy that required her to pay out $5,000 in deductibles before the insurance kicked in.
Shouse spent the last years of her life advocating that consumers "take on the Big Insurance Monopoly and liberate American families from the slavery of skyrocketing insurance premiums and canceled coverage, which leave millions of us in a state of perpetual fear and insecurity."...
Obama official 'very disturbed' by Anthem Blue Cross rate hikes
UPDATE: DEMOCRATS ACHIEVE A SMALL STEP TOWARD HEALTH CARE REFORM
Anthem Blue Cross backpedals on raising rates
Anthem to delay insurance rate hike amid criticism
By LINDA A. JOHNSON (AP)
Feb. 13, 2010
Health insurer Anthem Blue Cross will postpone its much-criticized plan to raise rates for some California residents who buy insurance on their own, after reaching a deal Saturday with state regulators.
Anthem's planned rate hike, which the state estimates would affect about 700,000 customers, averaged 25 percent and would have been as high as 39 percent for some.
Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company's complex and detailed plan filing, including data on the medical costs it expects to incur...
In this Feb. 4, 2010 file photo, Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington. washingtonpost.com
Blue Cross is obviously feeling very powerful. I imagine it will spend the new revenues on campaign ads to defeat universal health care. Hmmm. I'm trying to think of a more arrogant and smug act of contempt for the people who pour their hard-earned money into Blue Cross.
Obama official 'very disturbed' by Anthem Blue Cross rate hikes
By Duke Helfand
LA Times
February 9, 2010
California insurance regulators asked Anthem Blue Cross to delay controversial rate increases of as much as 39% for individual policies, hikes that have triggered widespread criticism from subscribers and brokers -- and now from the federal government.
In a rare step, the Obama administration called on California's largest for-profit insurer to justify its rate hikes, saying the increases were alarming at a time when subscribers face skyrocketing healthcare costs...
HHS secretary asks insurer to justify rate hike
By SHAYA TAYEFE MOHAJER
The Associated Press
February 8, 2010
LOS ANGELES -- The Obama administration on Monday asked California's largest for-profit health insurer to justify plans to hike customers' premiums by as much as 39 percent, a move that could affect some 800,000 people.
In a letter to the president of Anthem Blue Cross, Health and Human Services Secretary Kathleen Sebelius said she was disturbed to learn of the planned increases, calling them "extraordinary."...
WellPoint sees profit grow eightfold in fourth quarter
The Los Angeles Times, January 28, 2010
CA Health Insurance Companies Pay Fine for Rescinding Health ...
21 Jan 2010 by admin
The recent legal ruling is a result of a lawsuit against health giant Anthem Blue Cross of California. Prosecutors argued that Anthem violated state law by selling health plan members the promise of health insurance, but then later ... “ This puts new cops on the beat,” said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. “Lots of stuff in the standard operating practices of health plans is going to be affected ...
chocobaby.luv.ph/
Patient Sues Anthem Blue Cross Over Liver Transplant - Consumer ...
7 Oct 2009
Ephram Nehme was gravely ill when Anthem Blue Cross of California agreed to pay for a liver transplant his physician said he needed to survive. Then, his condition went downhill fast. The news from his doctor was bad. ... tremendously important issue because most people aren't savvy enough about how to work this system, and it is totally stacked against them," said Bryan Liang, director of the Institute of Health Law Studies at California Western Law School in San Diego. ...
Consumer Watchdog Updates
Anthem Blue Cross backpedals on raising rates
Anthem to delay insurance rate hike amid criticism
By LINDA A. JOHNSON (AP)
Feb. 13, 2010
Health insurer Anthem Blue Cross will postpone its much-criticized plan to raise rates for some California residents who buy insurance on their own, after reaching a deal Saturday with state regulators.
Anthem's planned rate hike, which the state estimates would affect about 700,000 customers, averaged 25 percent and would have been as high as 39 percent for some.
Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company's complex and detailed plan filing, including data on the medical costs it expects to incur...
In this Feb. 4, 2010 file photo, Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington. washingtonpost.com Blue Cross is obviously feeling very powerful. I imagine it will spend the new revenues on campaign ads to defeat universal health care. Hmmm. I'm trying to think of a more arrogant and smug act of contempt for the people who pour their hard-earned money into Blue Cross.
Obama official 'very disturbed' by Anthem Blue Cross rate hikes
By Duke Helfand
LA Times
February 9, 2010
California insurance regulators asked Anthem Blue Cross to delay controversial rate increases of as much as 39% for individual policies, hikes that have triggered widespread criticism from subscribers and brokers -- and now from the federal government.
In a rare step, the Obama administration called on California's largest for-profit insurer to justify its rate hikes, saying the increases were alarming at a time when subscribers face skyrocketing healthcare costs...
HHS secretary asks insurer to justify rate hike
By SHAYA TAYEFE MOHAJER
The Associated Press
February 8, 2010
LOS ANGELES -- The Obama administration on Monday asked California's largest for-profit health insurer to justify plans to hike customers' premiums by as much as 39 percent, a move that could affect some 800,000 people.
In a letter to the president of Anthem Blue Cross, Health and Human Services Secretary Kathleen Sebelius said she was disturbed to learn of the planned increases, calling them "extraordinary."...
WellPoint sees profit grow eightfold in fourth quarter
The Los Angeles Times, January 28, 2010
CA Health Insurance Companies Pay Fine for Rescinding Health ...
21 Jan 2010 by admin
The recent legal ruling is a result of a lawsuit against health giant Anthem Blue Cross of California. Prosecutors argued that Anthem violated state law by selling health plan members the promise of health insurance, but then later ... “ This puts new cops on the beat,” said Bryan Liang, director of the Institute of Health Law Studies at California Western School of Law in San Diego. “Lots of stuff in the standard operating practices of health plans is going to be affected ...
chocobaby.luv.ph/
Patient Sues Anthem Blue Cross Over Liver Transplant - Consumer ...
7 Oct 2009
Ephram Nehme was gravely ill when Anthem Blue Cross of California agreed to pay for a liver transplant his physician said he needed to survive. Then, his condition went downhill fast. The news from his doctor was bad. ... tremendously important issue because most people aren't savvy enough about how to work this system, and it is totally stacked against them," said Bryan Liang, director of the Institute of Health Law Studies at California Western Law School in San Diego. ...
Consumer Watchdog Updates
Wednesday, October 28, 2009
I'm a doctor. So sue me. No, really
The doctors' lobby says capping malpractice suits will make healthcare cheaper.
I'm an M.D. and I don't believe it
Salon.com
By Rahul K. Parikh, M.D.
Oct. 27, 2009
Flu season has come early and I'm writing far too many prescriptions for Tamiflu. I'm trying my best to adhere to the guidelines set by the Centers for Disease Control for who should get the drug (kids under 5 years of age, or kids who have a chronic illness like asthma or diabetes). But in more than a few instances, I've ignored the guidelines and given Tamiflu to perfectly healthy kids with no risk factors for influenza-related complications.
Part of the reason I'm writing so many extra prescriptions stems from stories about healthy people getting sick with H1N1 and ending up critically ill or dead. One of those stories aired recently on "60 Minutes" -- a healthy high school football player in Arkansas developed a fever after a game. He went to his doctor, who thought he had a garden variety flu and sent him home. Two days later, the boy collapsed and was airlifted to the nearest pediatric intensive care unit. He developed a bacterial pneumonia on top of his H1N1 flu, which led to severe damage to his lungs. He couldn't breathe on his own, so he remains in the ICU on a ventilator.
The H1N1 strain of influenza is no more lethal than any other strain of flu. Mortality is less than 1 percent. Nevertheless, by over-prescribing an expensive drug that has only marginal benefits, I'm unequivocally practicing what is known as defensive medicine. As in, the kind of medicine that protects doctors as much as patients.
Mine isn't an extreme example of defensive medicine. I'm a pediatrician. Obstetricians and emergency room doctors are sued at far higher rates, and would have more dramatic stories to share. But my motivations are the same as theirs: I'm afraid that if I don't do something, one of my patients may get sick or die, and I'll end up in court being asked why I didn't do everything I could have.
Defensive medicine is just one of the supposed systemic ills that doctors, doctors' lobbies and doctors' insurers invoke when they shill for what they call malpractice reform. Proponents of reform say that defensive medicine, frivolous lawsuits and high premiums are behind the surge in healthcare expenses. They insist that malpractice costs are forcing doctors to close their doors and depriving patients of care. Recently, three past presidents of the American Medical Association coauthored an opinion piece for the Wall Street Journal that bundled all of these arguments into an attack on the public option. Their piece attempted to shift the blame for America's healthcare crisis away from private insurers and onto a supposed scourge of ambulance chasers. "The nation needs comprehensive medical malpractice reform," they wrote. "It is the surest and quickest way to slow down the rising cost of healthcare."
Their refrain is familiar to anybody following the healthcare reform debate. The only problem is that it's not true. There's nothing "sure or quick" about changing medical liability laws that will improve healthcare or its costs. Defensive medicine adds very little to healthcare's price tag, and rising malpractice premiums have had very little impact on access to care.
Let's look at the numbers. First, based on the current rhetoric, it's easy to assume we have an epidemic of malpractice suits in America. We don't.
There are many statistics out there, and it's not always possible to make an apples to apples comparison between one study and another. Some surveys cover the nation, some cover one group of states, some cover another cluster, and results vary. But according to the Congressional Budget Office, nationally, between the mid-1990s to the mid-2000s, the frequency of malpractice suits per capita remained stable at about 15 claims per 100 physicians per year. Another report, from the National Center for State Courts, actually shows that the number of cases between 1996 and 2006 dropped 8 percent.
Quantcast
Although the payout per claim has increased, the Justice Department, in a 2007 report about medical malpractice -- in fact, the same report cited by the authors of the Wall Street Journal piece mentioned above -- provided an explanation quite different from an epidemic of lawsuits. "Growing healthcare costs and an increasing effort by many attorneys to litigate only those medical malpractice claims involving severe injuries or wrongful death claims may explain some of these increases," they wrote. Still, even with the rise in payouts, the Congressional Budget Office, using statistics from the government's Centers for Medicare and Medicaid Services, estimates that malpractice costs account for less than 2 percent of healthcare spending. Saving 2 percent of the over $2 trillion we spend on healthcare isn’t going to bend the cost curve.
Next is the question of frivolous lawsuits. Tort reformers push the notion that junk lawsuits dominate the legal system. The Wall Street Journal article cited above refers to studies that show that 80 percent of claims are settled without payment to the patient and that when a case does make it to trial, doctors win 89 percent of the cases.
But the private studies cited often involve small numbers of claims, or focus on a single hospital, insurer, specialty or type of injury, or were commissioned by interested parties, aka the malpractice insurers themselves. The 2007 Department of Justice study cited by the Journal trio covers only seven states, and nowhere does it mention the numbers 80 percent and 89 percent. Repeated attempts to contact and ask one of the authors of the WSJ story about the specific source of their data were unsuccessful. The DOJ report shows that in one state, Illinois, 88 percent of claims were closed without a payout. But for the other states it examined, the number was between 62 percent and 69 percent. Regarding the percentages of cases doctors win, a 2001 analysis by the Bureau of Justice Statistics, examining malpractice trends in the 75 most populous counties in the U.S., put that number closer to 70 percent.
In 2006, researchers from Harvard published a study in the New England Journal of Medicine that was designed to avoid the limits, and the biases, of prior research. What they found kills the notion of frivolous lawsuits. It suggests that most people who sue are suing for good reason.
Next page: Tort reformers neglect the fact that malpractice reform won't save one extra life
I'm an M.D. and I don't believe it
Salon.com
By Rahul K. Parikh, M.D.
Oct. 27, 2009
Flu season has come early and I'm writing far too many prescriptions for Tamiflu. I'm trying my best to adhere to the guidelines set by the Centers for Disease Control for who should get the drug (kids under 5 years of age, or kids who have a chronic illness like asthma or diabetes). But in more than a few instances, I've ignored the guidelines and given Tamiflu to perfectly healthy kids with no risk factors for influenza-related complications.
Part of the reason I'm writing so many extra prescriptions stems from stories about healthy people getting sick with H1N1 and ending up critically ill or dead. One of those stories aired recently on "60 Minutes" -- a healthy high school football player in Arkansas developed a fever after a game. He went to his doctor, who thought he had a garden variety flu and sent him home. Two days later, the boy collapsed and was airlifted to the nearest pediatric intensive care unit. He developed a bacterial pneumonia on top of his H1N1 flu, which led to severe damage to his lungs. He couldn't breathe on his own, so he remains in the ICU on a ventilator.
The H1N1 strain of influenza is no more lethal than any other strain of flu. Mortality is less than 1 percent. Nevertheless, by over-prescribing an expensive drug that has only marginal benefits, I'm unequivocally practicing what is known as defensive medicine. As in, the kind of medicine that protects doctors as much as patients.
Mine isn't an extreme example of defensive medicine. I'm a pediatrician. Obstetricians and emergency room doctors are sued at far higher rates, and would have more dramatic stories to share. But my motivations are the same as theirs: I'm afraid that if I don't do something, one of my patients may get sick or die, and I'll end up in court being asked why I didn't do everything I could have.
Defensive medicine is just one of the supposed systemic ills that doctors, doctors' lobbies and doctors' insurers invoke when they shill for what they call malpractice reform. Proponents of reform say that defensive medicine, frivolous lawsuits and high premiums are behind the surge in healthcare expenses. They insist that malpractice costs are forcing doctors to close their doors and depriving patients of care. Recently, three past presidents of the American Medical Association coauthored an opinion piece for the Wall Street Journal that bundled all of these arguments into an attack on the public option. Their piece attempted to shift the blame for America's healthcare crisis away from private insurers and onto a supposed scourge of ambulance chasers. "The nation needs comprehensive medical malpractice reform," they wrote. "It is the surest and quickest way to slow down the rising cost of healthcare."
Their refrain is familiar to anybody following the healthcare reform debate. The only problem is that it's not true. There's nothing "sure or quick" about changing medical liability laws that will improve healthcare or its costs. Defensive medicine adds very little to healthcare's price tag, and rising malpractice premiums have had very little impact on access to care.
Let's look at the numbers. First, based on the current rhetoric, it's easy to assume we have an epidemic of malpractice suits in America. We don't.
There are many statistics out there, and it's not always possible to make an apples to apples comparison between one study and another. Some surveys cover the nation, some cover one group of states, some cover another cluster, and results vary. But according to the Congressional Budget Office, nationally, between the mid-1990s to the mid-2000s, the frequency of malpractice suits per capita remained stable at about 15 claims per 100 physicians per year. Another report, from the National Center for State Courts, actually shows that the number of cases between 1996 and 2006 dropped 8 percent.
Quantcast
Although the payout per claim has increased, the Justice Department, in a 2007 report about medical malpractice -- in fact, the same report cited by the authors of the Wall Street Journal piece mentioned above -- provided an explanation quite different from an epidemic of lawsuits. "Growing healthcare costs and an increasing effort by many attorneys to litigate only those medical malpractice claims involving severe injuries or wrongful death claims may explain some of these increases," they wrote. Still, even with the rise in payouts, the Congressional Budget Office, using statistics from the government's Centers for Medicare and Medicaid Services, estimates that malpractice costs account for less than 2 percent of healthcare spending. Saving 2 percent of the over $2 trillion we spend on healthcare isn’t going to bend the cost curve.
Next is the question of frivolous lawsuits. Tort reformers push the notion that junk lawsuits dominate the legal system. The Wall Street Journal article cited above refers to studies that show that 80 percent of claims are settled without payment to the patient and that when a case does make it to trial, doctors win 89 percent of the cases.
But the private studies cited often involve small numbers of claims, or focus on a single hospital, insurer, specialty or type of injury, or were commissioned by interested parties, aka the malpractice insurers themselves. The 2007 Department of Justice study cited by the Journal trio covers only seven states, and nowhere does it mention the numbers 80 percent and 89 percent. Repeated attempts to contact and ask one of the authors of the WSJ story about the specific source of their data were unsuccessful. The DOJ report shows that in one state, Illinois, 88 percent of claims were closed without a payout. But for the other states it examined, the number was between 62 percent and 69 percent. Regarding the percentages of cases doctors win, a 2001 analysis by the Bureau of Justice Statistics, examining malpractice trends in the 75 most populous counties in the U.S., put that number closer to 70 percent.
In 2006, researchers from Harvard published a study in the New England Journal of Medicine that was designed to avoid the limits, and the biases, of prior research. What they found kills the notion of frivolous lawsuits. It suggests that most people who sue are suing for good reason.
Next page: Tort reformers neglect the fact that malpractice reform won't save one extra life
Monday, August 17, 2009
Obama attacks insurance companies for capping coverage and charging "outrageous fees"
http://www.reuters.com/article/healthNews/idUSTRE57D47P20090816?feedType=nl&feedName=ushealth1100
Sat Aug 15, 2009
By Jeff Mason and Matt Spetalnick
GRAND JUNCTION, Colorado (Reuters) - U.S. President Barack Obama reignited his criticism of health insurance companies on Saturday, promising reforms that would prevent firms from capping coverage or charging "outrageous" fees.
Traveling to a conservative area of Colorado, a western state that supported Obama in the 2008 election, the president continued his assault on companies that the White House has painted as being at the root of the country's healthcare woes while defending his proposals to fix the system.
"Insurance companies will no longer be able to ... place an arbitrary cap on the amount of coverage you can receive or charge outrageous out-of-pocket expenses on top of your premiums," Obama told the crowd of roughly 1,500 people.
"No one in America should go broke because they get sick," he said to loud applause.
Sat Aug 15, 2009
By Jeff Mason and Matt Spetalnick
GRAND JUNCTION, Colorado (Reuters) - U.S. President Barack Obama reignited his criticism of health insurance companies on Saturday, promising reforms that would prevent firms from capping coverage or charging "outrageous" fees.
Traveling to a conservative area of Colorado, a western state that supported Obama in the 2008 election, the president continued his assault on companies that the White House has painted as being at the root of the country's healthcare woes while defending his proposals to fix the system.
"Insurance companies will no longer be able to ... place an arbitrary cap on the amount of coverage you can receive or charge outrageous out-of-pocket expenses on top of your premiums," Obama told the crowd of roughly 1,500 people.
"No one in America should go broke because they get sick," he said to loud applause.
Tuesday, August 11, 2009
The "death panels" are already here
Is our current system "downright evil"?
The "death panels" are already here
Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
Salon.com
By Mike Madden
Aug. 11, 2009
The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.
It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.
That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."
Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.
Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty...
The "death panels" are already here
Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
Salon.com
By Mike Madden
Aug. 11, 2009
The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.
It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.
That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."
Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.
Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty...
Saturday, February 23, 2008
Universal Health Care cost 1.1% in Taiwan
Experts call for health cover in U.S., cite study
Wed Feb 20, 2008 8
HONG KONG (Reuters) -
Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.
In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".
"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.
Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.
However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.
"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.
"Every second middle-aged man is a smoker and every fourth is a chewer ... which could account for the large increases in lung and oral cancer in the lower socioeconomic groups and the relatively small reduction in health disparities."
Taiwan introduced universal health insurance in 1995, which extended insurance coverage from 57 percent of the population to everyone. Co-payments are required, however: 10 percent for inpatient and 20 percent for outpatient care, although these are waived for the very poor, veterans and indigenous groups.
National health expenditure rose modestly, from 5.1 percent of gross national product before 1995 to 6.2 percent in 2005.
Visits to the doctor and use of medication increased substantially after 1995, especially among the elderly and poor.
The most obvious positive correlation was life expectancy for men, which increased to 74.22 years from 71.83 years after universal health insurance.
There was a reduction in deaths from cardiovascular and infectious diseases, and from accidents, but deaths from cancer and diabetes rose.
(Reporting by Tan Ee Lyn; Editing by Alex Richardson)
http://www.reuters.com/article/healthNews/idUSSHA36232320080220?feedType=nl&feedName=ushealth1100
Wed Feb 20, 2008 8
HONG KONG (Reuters) -
Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.
In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".
"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.
Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.
However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.
"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.
"Every second middle-aged man is a smoker and every fourth is a chewer ... which could account for the large increases in lung and oral cancer in the lower socioeconomic groups and the relatively small reduction in health disparities."
Taiwan introduced universal health insurance in 1995, which extended insurance coverage from 57 percent of the population to everyone. Co-payments are required, however: 10 percent for inpatient and 20 percent for outpatient care, although these are waived for the very poor, veterans and indigenous groups.
National health expenditure rose modestly, from 5.1 percent of gross national product before 1995 to 6.2 percent in 2005.
Visits to the doctor and use of medication increased substantially after 1995, especially among the elderly and poor.
The most obvious positive correlation was life expectancy for men, which increased to 74.22 years from 71.83 years after universal health insurance.
There was a reduction in deaths from cardiovascular and infectious diseases, and from accidents, but deaths from cancer and diabetes rose.
(Reporting by Tan Ee Lyn; Editing by Alex Richardson)
http://www.reuters.com/article/healthNews/idUSSHA36232320080220?feedType=nl&feedName=ushealth1100
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