How Our Health-Care System Wrecks People Who Play by the Rules

Anyone notice how the problem inevitably arises when costs are such that people cannot afford them? Reform is great, but unless ways are devised to tame costs such tragedies are bound to recur over and over again. Sadly, there has been little talk on cost-taming.

Our Lord Jesus admonished us to care for the poor, the sick and the elderly and we have a Moral Responsibility and Obligation to do so. Calzone

Lots of responses--not the least of which is to "ditto" wood0742

As you are painfully aware, a universal plan (e.g.Medicare extended to all), did not stop this scenario. So there is a bit of a disonnect between the story and your policy advocacy. That is OK. The story is powerful and will pray for parents. I also back a call for universal access. But I simply note that leaves much unanswered.

You likely have experienced that all the medicare and medicare supplemental policies in the nation can still leave you high and dry. There are no guarantees.

One thing we all must face is that there is an end. There are limits. There are choices. There is pain.There is sickness. There is death. And we fight.

Your parents have you. You have them. For now you each have life.

I am not lecturing--this is a share of my own experience.

My wife was critically ill for 4 years before passing (3 years ago on Wednesday). She had marvelous care and coverage--and it still sapped every ounce of my energy. Anyone who has critical needs does not need insurance--they need multiple coverages in this environment. Which for the vast majority isn't even possible.

I think the point I am circling is this: On the one hand we have advocates of a universal system arguing it will solve problems it will not solve. And on the other hand we have advocates of doing even less so as to allow the market to do more who believe it will solve things it will not solve. A starting point is to affirm there is much of great worth we have an ethical obligation to do--and that it has limits. Without lining up our values (what is good and the limits therein) we end up pushing for answers that aren't answers--because we frame the wrong questions.

When my wife was ill I'd listen to my pre-schoolers pray for their Mommy. I'd tell God, "OK, maybe you won't hear my prayers; but if you are going to sit there, all-powerful, and listen to these simple prayers of children who fully believe you can heal, that you desire healing, and that you are all-good; that just want their Mommy to live; what kind of God are you?"

They played by the rules. They lost their Mom.

And God was very, very good.

Your blog is rich because it raises many issues. One of which is our woeful health "system". I want it to be healed. But also know other of the issues you raise will remain.

I go for single-payer as a strategy to seriously go after the costs--using the resources to deliver access--and allowing the provision of services to decentralize. Then somehow allow states to move out of single-payer if we could innovate other ways to control cost/increase access/better outcomes.

Your handle makes me hungry....mmmmm....calzones....

We have relatives on both sides of the US/Canada border. To be blunt, this NEVER happens in Canada. NEVER. Is it some socialist paradise? No. However, the country does not spend the majority of its finances on a military occupation of the whole planet, to the tune of more than all other countries combined. Nor does it have a predatory greed-motivated medical "insurance" system. It does have the second most expensive medical system in the world as it is equivalent in quality to that of the US - but it covers everyone and the country is largely middle class with few poor and many wealthy folks. The budget is balanced and a Conservative government has been in power for some time - and the unemployment is far less than here.

What a shame and a scandal. No one in Canada need worry about finances when challenged with expensive and catastrophic diseases - or even ones that shouldn't cause catastrophe, but do here in our own nation.

I guess we have sown the wind and reaped the whirlwind.

So why is Medicare not paying?

Atleast with BCBST I can appeal to the state. But with Medicare I would be appeal government to make government to the right thing.

Why would you want the rest of us under the governments thumb as well?

There is a law suite working it way through the courts to let people opt out of medicare and still get their social security.Here is the link.

http://online.wsj.com/article/SB100014240527487...

That situation really sucks, to be honest. I wouldn't want my parents, or anybody's parents, to be in that situation. Working way past retirement is evidence of a good work ethic and a value of hard work and responsibility for one's family. My father recently retired, and is always thinking and planning about the next stage.

On the other hand, a few things about this author's attitude really concern me. The glib comment about people profiting from sickness is misleading, since nobody is profiting from sickness, they are profiting from (at least) an attempt to heal and (at best) the actual healing or restoration of one's human body functioning. With this logic, nobody selling or producing food should profit based on people's hunger, and throughout history we've all needed to eat. We haven't always had great health care opportunities.

But even that aside, and even if that indeed is the scenario (which I don't believe it is), the solution is nothing short of, "My parents don't have money, and my (and their) church isn't able or is unwilling to help. I can't go take all your money, or the money of your wealthy neighbor, so please please please vote for those who can take it from them by law." It reminds me of what Butler Shaffer said in "Boundaries of Order": "Few of us would have the stomach to personally confront a neighbor, or even a total stranger, and do to him what we thoughtlessly approve of government officials routinely doing to millions of others through their collective authority."

This is nothing more than envy disguised as justice. I don't wish anything tough on anybody, but that doesn't abrogate social ethics and moral boundaries.

Medicare does not pay for everything. Most people on Medicare also purchase supplemental coverage that extends coverage and fills in the gaps. In my state, there are probably over 50 different kinds of supplemental coverage one can buy, most of them reasonably priced. You can end up with a package that is very good coverage, unlimited hospitalization for around $200 a month including basic Medicare, supplemental and perscription coverage. And you get an otion to change your coverage once a year, so if your medical circumstnances change, you can opt for different coverage.
I suspect a lot of seniors have a hard time going through all the information they receive and do not get good advice when making the decision on what to select.
I spent many years in the insurance industry and yet when my sister was approaching age 65 and trying to decide on supplemental coverage, it was a nearly incomprehensible pile of paper to dig through and I was not as much help as I had hoped. I did tell her to make sure whatever she chose had no upper limit on hospitalization coverage. It was probably the only time she followed my advice. She ultimately had a two plus month hospitalization that would have cost $250,000 without the supplemental coverage she bought.
Anyone who has a parent or sibling or knows anyone approaching Medicare age should make it their business to make sure thier senior makes an intelligent decision.

"Nobody is profiting from sickness."

The health insurance industry is making profits from taking premiums and then paying as little out as possible by all means legal or at least difficult to challenge by the average person - all means fair and foul - especially successful with those sick or disoriented by age and illness.

These are the same folks up to their eyeballs in the same financial legerdemaine as the rest of the bailed-out Wall Street banksters were and still are.

The enormous glass towers and bonuses looted out of the premiums don't go towards providing any sort of health care.

So yes, they ARE making profits off people's illnesses.

Last time I looked, we didn't need private "food insurance" yet - can you imagine how much it would cost if it required buying it from insurance cartels to get it?

Of course, then we could argue that the private food insurance system is so ideologically and religiously sacrosanct that we have to let millions go without enough to eat.

Government is allowed to compel us to create mass injury, death and pestilence via war, as a matter of fundamentalist distortions of Romans 13, but we have to resist obedience rather than allow it to do anything to alleviate suffering?

Health insurance as a payment for regular services is absurd, which is part of the problem with the system. Imagine if "car insurance" paid for tune-ups, tires, oil changes, or even gasoline (a "basic service" or "preventative maintenance"). Insurance is a hedge against risk.

I was referring to doctors who "profit" from helping those in need. I wasn't accounting for insurance companies. I won't defend a particular company, especially big business. most of the insurance companies would love to have universal health care because it means guaranteed income for them.

Just curious if anybody here can cite statistics on what percentage of claims are actually denied? Last I heard it was 3%, but that was about 3-4 years ago, and could have been stats from previously available data, so that could be 1-2 years prior to that.

The cost of healthcare in the countries with universal government insurance are all cheaper than any insurance plan in the US. Even if you throw in all the uninsured people in the country we still pay more per person and are less healthy, and have higher malpractice problems than countries with government health care. There are many many ways to cut government spending with Zero loss of collective wealth or security . The largest area of waste and spending inordinate to any real need is the Defense Department. You could cut that budget in half and nobody would know the difference. We might have to give up foreign wars and some foreign bases but we would still have a larger military than anyone. Another area is the cost of political campaigns. In the US the people own the air waves and rent them for commercial use with a stipulation about public service that is not enforced; let broadcasters contribute time for democracy to work , let every qualified candidate be guaranteed a voice in public debate; let's make this a living democracy. Another area is Corporate and private tax loopholes allowing US corporations to falsely have headquarters offshore and evade taxes. This is only the beginning , but if we did this and instituted medicare for all and allow the government to bargain for lower costs we could easily cover everyone with no increase in taxes and be able to afford to begin to green the country.
I say we shut down TV 3 days a week and encourage walking, dancing, biking, baseball, volley ball and gardening. Let's start to walk the lard off for a healthier America. Let's start to talk to each other while doing things we all love. TV is not freedom it is an unhealthy addiction that lowers school performance, breaks up family communication, and makes people forgetful, numb and overweight. Would you let Saddam, or Stalin, or Bernie Maddox in your house every day to walk around your hose spouting off. Why let the creeps who run TV control your brain.

The story Steve tells is heartbreaking and all too common. Health care is not a right as of today , but we are the people who give ourselves rights and put limits on the greedy. We can make health care a right with no loss of freedom and a great gain in freedom and equality and security for individuals and businesses for whom it would remove a tremendous waste of energy and money. Right now businesses and individuals are hanging separately because we don't hang together and stand together.

Power is out of balance in America. Corporations control political speech. The richest 1 percent owns more than the bottom 90%. When universal single payer is off the table then the fundamental principle of one person one vote is off the table.

The number of claims denied remains a mystery, although health insurers' own limited disclosures range from around 10% to 40 %.

It also depends on how you define denials, since sometimes claims denied several times but fought through the system are not said to have been denied if eventually litigated or arbitrated.

In addition, the kinds of claims that experience very high rates of denial are just the ones that cause individuals medical bankruptcy - the insurance company is very motivated to deny them if at all possible despite the validity of the claim. Realistically, it pays to do so, because many people will just give up, tired and overwhelmed as they are by their illnesses.

Yes, insurance companies would love to have the kind of mandated health care that most corporate shill politicians are pushing at the behest of several hundred million dollars of insurance company lobbying money this year.

Imagine that a national government will punish its citizens by requiring them to purchase from private insurers at exorbitant prices just for the privilege of living in a supposedly "free" country. This takes to new obscene heights the marriage of self-interest of big government and big business conspiring against the citizens of the country, to compel by threat of criminality, imprisonment and bankruptcy that already bloated and engorged financial institutions speculate with mandates premium-fueled finagling investments in just the same manner as the worst of the Wall Street banksters do.

No new taxes? How about a new $20,000 annual government tax, but paid instead directly to a private corporation?

The Blackwaters of health care?

I am not in favor of a universal plan like "letjusticerolldown" but I agree with several of his comments. I think he is ultimately getting at this: even if you have THE best insurance in the world, and tons of coverage, etc... there still is no guarantee that you won't suffer, and die (at some time... since obviously, we all will one day die).

Since we are not God, and we are not gods, there are many things in our lives that are simply out of our control. Health care obviously is in need of reform, but even if it goes universal, we will never create a utopia. Sometimes it seems to me as if people are hoping for that. A sort of utopia in which there will be no suffering, no financial hardships, and no death.

There will still be plenty of problems, even if this health care "reform" passes. It is not going to be some sort of problem-free, perfected health care system. I think this story shows that even Medicare, a govt. program, can fail people. Same with Medicaid. I recently read that Medicaid patients have a 50% higher chance of dying after a heart bypass than those with private insurance. Also, 40% of doctors don't take Medicaid because Medicaid doesn't reimburse costs of treatment.

Now, from what I see, the only thing being discussed in D.C. with regards to these two programs is cuts to Medicare, which I can't see how that will improve the quality of either Medicare or Medicaid. So, here we are, creating another govt. run health care system, while we already have two that are in dire need of their own reform.

Even if there had been universal health care in place, the author's parents could've still been going through and have gone what they are going through. I highly doubt that universal health care is going to pay for everything a patient might need, including the millions in expensive treatments that those who are elderly might be in need of.

Supplemental policies do fill in the gaps--but that is very deceptive. They fill in the gaps THAT MEDICARE COVERS. If Medicare pays nothing--the supplemental pays nothing.

Now this is just not true at all. I have read many stories, which I've shared on other blogs here, of people being denied health care in Canada, of people going to the U.S. for health care that they either cannot get in Canada, or the wait is extremely long, and of pepole who have huge wait times for care that they need.

I watched a video of a guy named Steven Crowder, who works for PajamasTV.com, and he went "undercover" in Canada (similar to the way the two people did with ACORN), and he filmed it. He and his friends went to one clinic and asked for a blood test. The nurse said... Nope, we don't do that here. The guy did not have a doctor and asked how long it'd be for him to be able to see a doctor (whic
h was the only way he could get a blood test). She answered: "THREE YEARS!!"

He also interviewed a woman whose mother had a leg infection. She couldn't get into a doctor for an entire year. By then, they had to amputate BOTH her legs!! The woman said, "My dog can get quicker and better care at the vet!"

Or take this story of Suzanne Aucoin. (http://www.helpsuzanne.com/index2.html). She had stage IV colon cancer and her doctor prescribed the drug Erbitux. In the U.S., private insurance companies cover Erbitux. But Suzanne lived in Canada, and under their "great" socialized insurance system, they denied it. She actually fought it, something not a lot of Canadians do when certain care is denied them. Unfortunately, she died 2 years ago.

I also read a story of a man (can't think of his name now) whose doctor recommended hip surgery. Canada denied it because he was basically... too old. So, he paid for it himself. Then, his other hip was causing him problems. Doctor said the same thing. Hip surgery. Again, Canada said NO. Not only that, but they said... and you cannot pay for it yourself either. So... he went to America and had it done there.

Pretty pathetic and pitiful.

And yet you state that "this NEVER happens in Canada," and that is just simply and totally untrue.

Well said, NMRod. Our seniors up here have their share of challenges, but few to rival Steve's story. To take away peoples' security and familiarity at a time when they most need security and familiarity is simply wrong and unworthy of any nation purporting to be remotely Christian.

Below are some very interesting and insightful quotes from Brian Day, 2007-2008 president of the CANADIAN MEDICAL ASSOCIATION:

"Our government health scheme (it is not a "system"), wastes many billions of dollars by depriving sick Canadians of access to care.... Canadians are actually paying to ration care and prevent patients from receiving early treatment -- a process I called irrational rationing. It is time for change and adaptation."

http://www.brianday.ca/medical-tourism-canada.html

AND THIS:

"It is a source of shame that we have over a million patients waiting for care and 5 million without a family doctor."

"In Canada, patients serve the system. That's backwards. Our report card, released this week, revealed that only 10% of Canadians believe we have a patient-centred system. Our patients - the consumers - receive poor value when governments alone dictate spending, control service delivery, and have the final word on training and employment of medical professionals."

"The private-public rhetoric on health care is a relic of tedious and tiresome propaganda. Those who relentlessly argue against and demonize the private sector need a reality check. It's a strange paradox that in Canada we can universally buy private insurance for death, but not for illness."

http://www.brianday.ca/

Ashleigh, your constant snipping notwithstanding, my wife has worked ER on both sides of the 49th for 25 years plus and can out-story, out-anecdote, out-tidbit these faux journalists you come up with any day of the week. The health care system in Canada has its fair share of problems and any reporter can find someone to whine about how badly they were treated. Usually, important details are completedly omitted in the telling of their sob story. I can tell you stories of 85 yr old church people who thought they'd outsmarted the system by receiving new knees at their age. No one was laughing at the wasted cash when the same people were dead 6 months later from unrelated causes associated with aging, so "yes" at times health care officials have to make difficult decisions based on the fact that most 80+ yr olds are already living on borrowed time.

The fact of the matter is, as NMRod well knows, the kind of story that Steve relates here NEVER, hear it again, NEVER takes place in Canada under normal circumstances.

More eye-opening quotes regarding Canadian health care:

"The evidence shows that delays in the public health care system are widespread and patients die as a result of waiting lists for public health care"
- Supreme Court of Canada, June, 2005

"In fact, the Canadian health care system is perhaps the most rigid and oppressive (to physicians) within the free world."
- David J. Dandy, Vice President, Royal College of Surgeons of England

"People are waiting longer than they should have to, and longer than their health can afford."
AND...
"Today, you've got one and a half million people on a waiting list for surgeries and/or procedures in Canada. We know the wait times in Canada, they're published anywhere you want on the Internet. It's just long, and people are dying."
- Tracy Bevington, owner of EcuMedical, a referral company that helps Canadians find timely medical treatment in the U.S."Instead of having a system that works to serve patients, we have patients that are forced to work the system as they languish on waiting lists for care. There are countless examples of how patients are subservient to the system, a system that sometimes acts with astounding arrogance."
-Brian Day, 2007-2008 President, Canadian Medical Assoc.

"Per capita spending in Canada is just more than half, or US$3,165, of what it is in the United States. All good, sure. But there's a price to be paid. Managing overall costs has meant managing individuals' access to care. The result? Overcrowded emergency rooms, growing wait lists for services ranging from hip replacement to heart surgery, and less access to life-saving drugs for those who need them most. Some Canadians have opted to travel to places such as India or China for surgery in private hospitals; others have mortgaged their lives away to purchase drugs not covered by provincial formularies."
-Brian Day

"Per capita spending in Canada is just more than half, or US$3,165, of what it is in the United States. All good, sure. But there's a price to be paid. Managing overall costs has meant managing individuals' access to care. The result? Overcrowded emergency rooms, growing wait lists for services ranging from hip replacement to heart surgery, and less access to life-saving drugs for those who need them most. Some Canadians have opted to travel to places such as India or China for surgery in private hospitals; others have mortgaged their lives away to purchase drugs not covered by provincial formularies."

http://www.brianday.ca/canadian-business-magazi...

"The fact of the matter is, as NMRod well knows, the kind of story that Steve relates here NEVER, hear it again, NEVER takes place in Canada under normal circumstances."

Steve very well could've died while waiting on a waiting list. Or been denied much of the treatment he had in America, due to his age and the kind of treatments that he had.

If Medicare does not cover everything, what makes us think that another govt.-run program that will cover "everything?" Or that it will cover any more than what Medicare covers?

And I agree with you that NO person should get Medicare alone! A lot of doctors won't accept it by itsself, and like you said, it's not enough. Both my parents just started on Medicare and both have supplements. But they also both pay close to $300/mo.

"I can tell you stories of 85 yr old church people who thought they'd outsmarted the system by receiving new knees at their age. No one was laughing at the wasted cash when the same people were dead 6 months later from unrelated causes associated with aging, so "yes" at times health care officials have to make difficult decisions based on the fact that most 80+ yr olds are already living on borrowed time."

Well, since we don't know when a person's time is up (unless they are dying of a terminal disease), who are we to deny them care? My grandmother had open heart surgery in her middle 80's. Fifteen years later, and she just turned 95 yrs. old a few months ago, and she and my grandfather still live ON THEIR OWN in their own home!

Why shouldn't an 85 year old receive new knees if they need it? Why shouldn't we care about the quality of their end years? These are the people who've bore us, raised us, and so much more.

You could apply the same logic to young people with things like Stage IV cancer. You could say why "waste" the money on the very expensive chemo and treatments when they're probably going to die anyways? Some do die. Some end up surviving. Some survive only to die months or years later.I think it's terrible that you consider knee surgery to be a "wasted cash" because the 80 year olds are "living on borrowed time." How do we know when they are going to die due to aging? If knee surgery can add to their quality of life, so be it. We owe it to them, and they deserve our help, our respect, and for us to view their lives as valuable and important... not just lives that are "living on borrowed time."