Category: “Anecdote-Off”

Blue Shield to restore coverage for dropped Californians – Los Angeles Times

Blue Shield to restore coverage for dropped Californians – Los Angeles Times:

“In an attempt to settle investigations prompted by articles in The Times, the insurer agrees to reissue plans to almost 700 Californians and reimburse them for expenses that would have been covered.
By Lisa Girion [January 7, 2009 ]

“Blue Shield has agreed to reissue medical coverage to nearly 700 Californians whose policies were canceled after they got sick and to make changes in the way it handles insurance bought by individuals, officials said Tuesday.

“Blue Shield of California’s Life & Health Insurance Co. also agreed to reimburse consumers whose coverage was canceled for medical expenses they paid out of pocket.”
…
“Most of the state’s health insurers remain mired in litigation over the practice that has led to the cancellation of thousands of policies of sick patients, as well as financial losses for them, physicians and hospitals. In addition, Los Angeles City Atty. Rocky Delgadillo has sued Anthem Blue Cross, Blue Shield and Health Net, accusing all three of improperly dropping customers.”
…
“When the state’s charges were initially filed, Ross called them “grossly unfair.” Blue Shield and other insurers have maintained that state law allows them to review a patient’s old medical records after they get sick and rescind coverage if it finds something the policyholder failed to disclose on his application — whether intentionally or by mistake.

“Consumer advocates and lawyers have accused Blue Shield and other insurers of using purposefully confusing applications designed to trick people into making mistakes that can later be used against them and of failing to properly vet the applications before issuing coverage.”

God bless the American Businessman! Or woman. (Sorry, Loretta!)

Thomson Reuters Survey Finds Cancer Patients Forgoing Treatment

Thomson Reuters Survey Finds Cancer Patients Forgoing Treatment: “cancer treatment decisions of individuals.

Entitled “The Cost of Cancer,” the report aggregates survey responses from 1,767 adults currently being treated for cancer. It finds a clear link between patients’ annual income and their decisions to curb cancer treatments due to cost — even among patients with late-stage cancers.

The report notes that among the 569 survey respondents with late-stage cancer, 12.3 percent said they have passed up recommended treatment because it was too expensive. This figure varies dramatically by patient income level. Twenty-five percent of late-stage cancer patients who earn less than $40,000 a year said they have chosen not to undergo a recommended treatment due to cost — compared with 11.2 percent of those earning between $40,000 and $80,000 per year and 4.8 percent of those earning more than $80,000 annually.

Similarly, 65 percent of all respondents with late-stage cancer said the out-of-pocket cost of treating their cancer has caused them distress. Among all cancer patients earning under $40,000 per year, that number jumps to 77 percent.

“The physical and emotional burden of illness is not the only challenge cancer patients face,” said Bill Marder, PhD, senior vice president and general manager for the Healthcare business of Thomson Reuters. “Many also struggle to cope with medical costs. This survey shows that the cost of cancer treatment is affecting patients’ ability to get the care they need.””

I think this research speaks volumes about the American healthcare system. This is why I have it categorized under so many topics (see links below and to right). It speaks to the de facto rationing by income in the US, it speaks to how consumers “drive” healthcare (i.e., decision making is not rational), how our waiting times are trimmed by not including those who don’t seek care due to financial concerns, and how those who love to try to compare anecdote horror stories just don’t geet how bad our system is for so many people.

Study: Bankruptcies soar for senior citizens – washingtonpost.com

Study: Bankruptcies soar for senior citizens – washingtonpost.com:

“It all worked fine for Noda, a widow for 23 years, until she was forced to undergo double-bypass surgery and deal with respiratory problems. She started using two credit cards more frequently for food and bills. Before long, she was $8,000 in debt and behind on car payments.

‘I’d go to bed and all I had on my mind was bankruptcy,’ she said. ‘I had nothing left.’

Noda’s car was repossessed, but her trailer home wasn’t in jeopardy because her daughter owns it. While she’s covered by Medicare and receives $968 in Social Security each month, she relied on her job for other expenses. She had no choice but to get help from Jacksonville Legal Aid and declare bankruptcy.

Most bankruptcies are still filed by people far younger than Noda, but the percentage the younger filers make up has fallen over the 16-year period, according to the Consumer Bankruptcy Project analysis, which will be published in the Harvard Law and Policy Review in January.

In 1991, the 55-plus age group accounted for about 8 percent of bankruptcy filers, according to the study, which looked at more than 6,000 cases filed in 1991, 2001 or 2007. By last year, filers 55 and over accounted for 22 percent.”

Need Some Botox With that Flu Shot? : NPR

Need Some Botox With that Flu Shot? : NPR:

“Primary care doctors say they’re having more and more trouble making ends meet. They’re drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.”

No surprizes in this story, except at the end there is a bit of discussion of the reimbursement differential among procedure-based specialties and the rest of us.

And NPR really seems to be giving healthcare the full coverage blitz lately. Lots of stories about healthcare including this one on Morning Edition documenting the travails of two patients with MS. The first in the “new and improved” NHS in Britain and the other, a man in Philadelphia who thought he had good healthcare insurance.

And here is a link to their “Health Care for All” home page.

Sunday Forum: Medicare for all (“Australian Rules”)

Sunday Forum: Medicare for all:

“Some Americans believe that countries like Australia, Canada and nearly all of Europe have ‘socialized medicine.’ For many, it’s a vague concept that often conjures images of uncaring doctors, dirty government clinics, cracked plaster, crowded waiting rooms and really old magazines. And if you don’t like it — well, you can’t fight city hall.

But that’s just a dark fantasy. Australia has attractive offices and hospitals, great doctors, state-of-the-art care and, most importantly, quick and easy access to high-quality emergency care.

It’s not socialized medicine, it’s Medicare for all. You are born with it, you die with it and you get all the care you need in-between. Everyone has insurance, all the time.”

Dr. Flanders is a psychiatrist in Pittsburgh and does a nice job of contrasting healthcare in the US and Australia. I’ve written for the Sunday P-G, so I know they really limit the length of your column. I hope this means we can hear more from her in the future.

Drawing Lots for Health Care -[Oregon] New York Times

Drawing Lots for Health Care – New York Times:

“Last month, right after he had the heart attack and then the heart surgery and then started receiving the medical bills that so far have topped $200,000, Melvin Tsosies joined the 91,000 other residents of Oregon who had signed up for a lottery that provides health insurance to people who lack it.

Melvin Tsosies is among Oregonians who signed up for a health insurance lottery. “They said they’re going to draw names, and if I’m on that list, then I’ll get health care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So I’m just waiting right now.”

Despite the great hopes of people like Mr. Tsosies, only a few thousand of Oregon’s 600,000 uninsured residents are likely to benefit from the lottery anytime soon. The program has only enough money to pay for about 24,000 people, and at least 17,000 slots are already filled.”

further down…

“Oregon once sought to serve a far larger population of those in need.
It has been more than a decade since the innovative Oregon Health Plan became a forerunner of state health care reform as it pursued universal health coverage. Conceived on a restaurant napkin in the late 1980s, the program had by 1996 reduced the number of the uninsured to about 11 percent of all residents, down from more than 18 percent in 1992. But then, early in this decade, the state endured a wrenching recession.
“Oregon was way ahead of everyone else,” said Charla DeHate, the interim executive director of Ochoco Health Systems. “And then we went broke.” “

Top o’ the world, Ma!

Single Payer Debate at Duquesne U, 3/10/08

SEPP Organization – SEPP Events

(The link above takes you to the details of the event.)

I attended the debate last night among Dr. Scott Tyson and Gariel Silverman, arguing the single payer case, and Sue Blevins and Nameed Esmail, arguing against at Duquesne University last night. First, props to Duquesne: Great venue in the Power Center, easy parking, nice facility all around. And props to both groups for getting attendance to a surprisingly high level (over 200, I’d guess). Pro-single payer were in the majority, I’d guess, by a significant amount.

I’ll cut to the chase: Jerry Bowyer, moderator, at the end of the evening, asked if the discussion had changed anyone from their pro or anti single payer or undecided camps, and only a handful of hands went up. Sigh. But, not, of course, unexpected.

To those of us who are familiar with the issues and arguments for and against single payer, and familiar with the players (esp. Mr. Esmail’s Fraser Institute), there were not many surprises. My most pleasant surprise was Dr. Tyson’s excellent performance. Powerful, personal and passionate, Dr. Tyson did a very good job of making the moral, practical and economic case.

As my bias is obvious, I won’t pretend to disguise it. I found the same old arguments from the status quo/free market/every man for himself side very tiresome indeed. I’ll just toss out a few “highlights.”

Single Payer advocates see Canada as a Panacea solution for America’s woes. I don’t know of any, but it somehow forces single payer advocates into the silly position of defending Canada’s system, even though it is not the one we would emulate. From now on, we should respond to the Canada graphics with ones comparing us to Germany, France, Belgium, Japan, or almost anyone, and leave Fraser to shit on their own country as they seem wont to do. Heaven forbid they offer constructive solutions. And by this, I mean ones that at least 30 or 40% of the Canadian population would at least consider.

Showing a spending chart showing Canada at the high end of spending on healthcare compared to the rest of the world, and omitting the US, cause we’re so off the charts as to make the chart look laughable.

Arguing that taxation sufficient to pay for healthcare would strangle economic growth. This is just too brain-dead to answer, especially sitting in a country that spends 16.5% of its GDP on healthcare. And especially from an economist who said, specifically, that there is no “government money” only our money in government’s hands.

Waiting times in Canada are intolerable and/or deadly. Please click here.

$32 Billion in Medicare fraud annually is an outrage and a scandal. I don’t know the source or veracity of this figure, but the 2006 Medicare expenditures were $408 billion, meaning 92% of the money gets where it’s supposed to, which needs work, but isn’t awful. And the suggestion that I think Ms. Blevins made was that she preferred private insurer’s solution: deny care first, and then sort out who was trying to scam you, rather than covering claims in good faith and then going after the perps. I’m all for getting the perps, but not until I’ve made sure the patients are taken care of first. Silly me.

Patients in Canada often have to wait 10 or 12 hours to get a hospital bed when admitted through the ER. Imagine our shock. (He did know Pittsburgh was in America, right?)

Veterans Administration hospitals are horrible places. Dr. Tyson did try to set Ms. Blevins right on this one, though I think she didn’t believe him.

You cannot pay for treatment in Pennsylvania outside of your contract with your health insurer.
This one got my attention. I hope somebody will post a comment for me about it, because I’d never heard this before, and it seems exceedingly odd.

The usual “anecdote-off,” for which I’ll just refer you to our special section.

I was pleased to see Mr. Esmail’s praise of other systems, particularly those of Switzerland, Japan, France, Sweden, Germany and some others. He rightly pointed out that the old PNHP proposal, from 1993, was fairly beholden to the Canadian model, but there are newer proposals from PNHP, and besides, they are not the only proposals out there. As has been often pointed out by our side, and always ignored by theirs, we need a uniquely American system, pulling from the best of all other extant systems. Though Mr. Esmail did seem gratified to sear Dr. Tyson say this, I doubt it was the first time he heard it. (You don’t suppose he didn’t watch Sicko, even as an academic exercise?) Oh, and Esmail even admitted we were rubbish for Mental Health care, too.

Oh, and a personal shout out to Scott Tyson for his wonderfully dismissive treatment of HSAs. Made me chuckle and even snort a bit!

OK, folks, that’s all I can remember at this late hour, but please add your comments to remind me of things I forgot to mention….

Cheers,

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

Crooks and Liars » 60 Minutes: Charity Trying To Make Up For Failing U.S. Health Care System

“If you’re looking for a story that shows the abysmal state of health care in America, look no further. 60 Minutes traveled to Knoxville, TN to film a free clinic set up by a charity group called Remote Area Medical Volunteer Corps, or RAM. The charity was initially started in the 90’s by it’s founder, Stan Brock, former co-star of Wild Kingdom, to give health care relief to remote areas of Latin America, but after watching this segment it’s clear that America’s health care system doesn’t look too much different than that of a third world country.”

The video of the 60 Minutes story is available for viewing at the C&L site and it is definitely worth watching, if only to count the thousands of anecdotes available for those who like that sort of thing.

In a related anecdote, a patient I saw today with (now) advanced lung cancer, who had this gem in his history and physical: “He developed severe, unremitting left sided chest pain beneath his clavicle and along his left anterior chest about 4 to 5 months ago. He did not seek medical attention due to lack of health insurance.”

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times:

“Calling Woodland Hills-based Health Net’s actions ‘egregious,’ Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.

‘Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured,’ Cianchetti wrote in a 21-page ruling.

Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.

Then, ‘I thanked God,’ she said. ‘I praised the Lord.’

Bates called the arbitration judge ‘an angel . . . a real stand-up kind of judge.’

When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.

Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.”It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the judge wrote.”

Of course, this will get reduced substantially on appeal, but at least this tort case got the attention of the insurer to improve policy (for the time being, anyway).