Health and Sanity category archive

Sam Seder interviews Wendell Potter on tactics used by health insurance companies to keep customers in the dark about coverage and costs.

What they are most desirous of insuring is the executives’ country club memberships.

In the Tampa Bay Times (the renamed St. Petersburg Times), Robyn Blumner describes her treatment for cancer. After praising the doctors, she moves to the subject of billing (emphasis added).

But not every part of this experience has been as smooth. America spends more than any other industrialized nation on its health care system, with often worse health outcomes. Coming through breast cancer from diagnosis to cure demonstrated quite clearly to me why this is.

First, trying to be an educated consumer of health services by understanding pricing schedules is like cracking Enigma code. Second, the way the medical establishment and private insurance system is organized ensures that Americans get impersonal, redundant medical care for the highest cost, a subject I will discuss in my next column.

Any one who has had the simplest test done at a hospital become bewildered by the flurry of bills: two or three from different departments of the hospital, one from each doctor, one from the janitor, several from persons you never heard of. It is easy to imagine that the process is impenetrable on purpose.

Republicans like to talk about shopping for health care as if it were like shopping for a television.

Try it.

The sleazy used car dealers down the side streets are paragons of openness and disclosure when compared with the business end of the health care industry.

Via Bob Cesca’s Awesome Blog.

Life insurance has been described as a wager: You bet that you are going to die, the life insurance company bets you won’t, and you hope that they win the bet.

Of course, you know the death rate is the same everywhere, as Mark Twain observed: One per person.

Nevertheless, the gag points out what gets forgotten: insurance companies don’t want to pay claims; they want to pay the bosses’ country club memberships. Their business model is founded on not paying.

The Philadelphia Inquirer details the attempt of a severely crippled 27 year old woman–one whose hands and legs are too weak for her to maneuver herself–to get a modern wheelchair.

It took months, and three appeals of her insurer’s denials, to get the wheelchair she now uses in her family’s small home in Gibbsboro, Camden County.

People who evaluate and fit patients for wheelchairs say cases like hers have become more common in recent months. They say many requests for the kind of chairs that patients like Lorey use – expensive, motorized units with multiple custom features – are being denied because insurers and Medicare officials are worried about high costs and fraud. Doctors, physical therapists, and patients must appeal the decision, or else the patients give up and accept lesser chairs.

“It’s gotten to the point where words are not enough to convince the medical directors” of insurers, said assistive technology professional Robert Townsend of Jeff Quip, a Boothwyn company that supplies complex chairs.

Experts said patients who fight – especially those who appeal in person – often can get the chair they need, but during the bureaucratic battle, they must make do with loaner chairs or lie in bed.

So we don’t need special events like these:

About 1,500 dentists, hygienists, dental assistants and other volunteers treated 2,172 people. More than $1 million in services were donated.

So many people stood in line seeking dental care Friday than many were told to come back Saturday. Many of those who couldn’t see a dentist before the event ended were given information about dental clinics around the area.

Woodstock police estimated 2,300 to 3,000 people were waiting outside the church when the doors opened Friday morning at 5 a.m. Some had waited since Thursday morning.

Price competition in health care: The fee hand of the market at work.

Jackson spokesmen say the financially strapped system can’t reveal how much it pays (for big-ticket medical equipment-ed.) because it has signed contracts with vendors that include clauses that call the prices “trade secrets.”

Such “trade secret” clauses are standard in the medical world and exempt from public records laws, they say. But the secrecy means that Jackson can’t compare its prices to what many other hospitals pay. That’s like a consumer going to buy a flat-screen TV and not knowing what others are paying for the same brand, said Curtis Rooney, president of the Health Industry Group Purchasing Association. “We call them gag clauses. … People can’t find out the best price.”

Free market.

Competition.

It is to laugh.

Field reports from the field:

I see where some poor guy just robbed a bank for a dollar so that he could get proper medical care. (h/t Vaughn for this story) That is not a good look for A-merry-ca. This reminds me of the story of that Michigan woman who is trying to sell her handwritten letter from O to pay her house note. Both cases of desperate people doing whatever it takes to survive in these post Bush apocalyptic times.

Follow the link for the citation.

Click for a larger image.

Via BartBlog.

Not payola payers.

We are headed to a society with three classes: the insurance executive bonus babies, the insured, and the dying.

A University of Pennsylvania study in which callers posed as mothers seeking pediatric specialty care found that two-thirds of publicly insured children were refused a doctor’s appointment, compared with only 11 percent of privately insured children.

Even the low-income children who were not rejected had to wait an average of 42 days for appointments for urgent conditions such as diabetes, seizures, asthma, or a bone fracture – 22 days longer on average than children with private insurance.

June 16, 2011 | Posted by: Frank | Posted in: Health and Sanity | Bookmark this post

Jay Bookman of the Atlanta-Journal Constitution debunks the lie that competition will magically reduce the cost of health care to consumers.

Here’s one of his charts. Follow this link to read the article.

Via Bob Cesca.

At Bloomberg, Paul Ryan has an article claiming that competition will lower health care costs, a favorite claim of righties.

Missing is reality. Obtaining medical care is not like buying an MP3 player.

• In much of the country, there is no competition. In my part of the world, one hospital company controls almost all the hospitals. If the EMTs have to transport me, they get to choose among Sentara, Sentara, Sentara, and Sentara.
• If someone has, say a heart attack, he or she doesn’t get estimates for the cost of treatment. He or she likely isn’t even conscious so as to be able to shop around.
• If a woman is having a baby (something that gives more notice), she doesn’t shop around for a delivery room; she goes to the hospital her doctor uses.
• If I need an EKG, I’m not going to shop for a new lab; I’m going to where my doctor sends me.

Republican paeans to market competition are no more than empty propaganda to perpetuate oligarchy, promote monopoly, and placate the most significant Republican constituency: Wall Street bonus babies.

Or maybe they’re just all smoking dope.

Also, the Atlanta Journal-Constitution has a long story about hospital markups, that is, what persons with no insurance have to pay. A nugget:

Hospital pricing is less transparent than in most industries, allowing prices to rise faster than the costs of services, said Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins School of Medicine.

That’s largely because people don’t shop for medical care and hospitals don’t provide cost estimates, Anderson said.

“There is nobody saying to [the hospitals] on behalf of the uninsured and a few other groups that they can’t do it,” Anderson said.

“You just had a heart attack or your appendix burst, so you can’t negotiate a price and you wouldn’t know how much it cost even if you could,” he said.

Via Balloon Juice.

This is not news.

This is why cooking was invented.

Also, 136 samples?

Half the meat and poultry sold in the supermarket may be tainted with the staph germ, a new report suggests.

The new estimate is based on just 136 samples of beef, chicken, pork and turkey purchased from grocery stores in Chicago; Los Angeles; Washington, D.C.; Flagstaff, Ariz.; and Fort Lauderdale, Fla.

(snip)

The new study found more than half the samples contained Staphylococcus aureus, a bacteria that can make people sick. Worse, half of those contaminated samples had a form of staph that’s resistant to at least three kinds of antibiotics.

I am more concerned about the “resistant to at least three kinds of antibiotics” part.

. . . because a health insurance industrial complex whose primary purpose is paying the country club memberships of its executive bonus babies by denying health care is likely to have a whatchamaycalllit oh! right conflict of interest:

Blue Cross Blue Shield of Delaware violated state law by signing a contract with a company that guaranteed the health insurer would save money by denying high-tech imaging tests such as nuclear cardiac exams, according to findings of an investigation by Delaware’s Department of Insurance.

MedSolutions was hired in July 2009 to review claims before doctors administered tests such as knee MRIs and CT scans of the brain. The firm stood to lose money if it did not reach its 20 percent savings target, according to the report. Such a contingency violated state law. It was removed from the contract last summer.

The high cost of health care in the U. S. all about the country club memberships–and not for the doctors. Derrick Jackson in the Boston Globe:

IF MASSACHUSETTS is the model, then national health care reform is ultimately doomed. That can be the only conclusion after this week’s news that Blue Cross Blue Shield of Massachusetts is in the homestretch of paying out nearly $28 million in retirement and severance pay in the last five years to its last two CEOs.

(snip)

But Massachusetts is not alone. Blue Cross Blue Shield of Michigan doled out $1.54 million to 34 board members, even as the company was losing $145 million, the Detroit Free Press reported in 2008. In 2009, Blue Cross Blue Shield of North Dakota, nationally touted as a well-run alternative to the vilified “public option,’’ was exposed for paying out millions in bonuses, charter flights, Caribbean junkets, and severance for a CEO who had been busted for drunk driving.

Read the whole thing. Then you will need a doctor for those heart palpitations.

The week before Crystal Stringfield’s health insurance expired, her 5-year-old daughter was diagnosed with attention-deficit hyperactivity disorder and prescribed a medicine that cost $179 a month.

Stringfield, 31, had been laid off in October from her job as a retail manager at an Exxon-Mobil station. Her health coverage ended on Dec. 31, and she wasn’t able to immediately find insurance she could afford on her unemployment check.

Sitting at her kitchen table in Chesapeake recently with Katelyn and 3-year-old Brianna, Stringfield could only shake her head. “I don’t know. I really don’t know,” she said. “I could care less about me.”

This lady was able to get insurance for her daughter through the state.

Many cannot. Later in the same article:

Most children without coverage live in households with income less than 200 percent of the federal poverty level but with at least one adult working, according to a report from the foundation. More than 50 percent are white, and about 26 percent are black. All but a few are U.S. citizens.