Zed, baby!

{{{{JANE}}}}}

damn, “vultures” doesn’t begin to cover it…

unconscionable.

Fight them. Fight them. Fight them.

And let us know how we can help.

RevDeb @ 4

unconscionable.

Fight them. Fight them. Fight them.

And let us know how we can help.

Whatever you need, Jane. We’ve got your back.

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

{{{{{{{{{{JANE!!!!!!!!!!}}}}}}}}}}

it never ceases to amaze and infuriate me the kinds of things that insurance companies deem “unnecessary” and “cosmetic”. I had a disintegrating molar that required a root canal and capping; it had previously been improperly capped by another dentist. But because the root canal was within five years of the original cap, it was ruled cosmetic despite the fact that I had no choice but to get the root canal done. Didn’t matter how much documentation my dentist and I sent in; I wound up paying out of pocket for that. I hate medical insurance companies like you would not believe.

RevDeb @ 4

unconscionable.

Fight them. Fight them. Fight them.

And let us know how we can help.

Uh, click on the site and they have telephone numbers. you can call them; don’t mention Jane.

Repo fucks

Jane!

You are a living (thank Mithras) example of all that is wrong with for-profit healthcare in this country.

Stand firm against the vultures…maybe John Edwards would like to hear from you too. A nice public youtube of this crap might get them off your back, at least.

alank @ 6

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

Hey but we can all go to the emergency room, right?

peanutbutter @ 8

it never ceases to amaze and infuriate me the kinds of things that insurance companies deem “unnecessary” and “cosmetic”. I had a disintegrating molar that required a root canal and capping; it had previously been improperly capped by another dentist. But because the root canal was within five years of the original cap, it was ruled cosmetic despite the fact that I had no choice but to get the root canal done. Didn’t matter how much documentation my dentist and I sent in; I wound up paying out of pocket for that. I hate medical insurance companies like you would not believe.

Do you mind if I ask what company? I’m battling a similar problem, one in which they keep asking for the same information over and over again. Going on 6 months now.

I remember travelling to Britain as a raw teenager (all of nineteen but oh-so-proud of my maturity ;-). At one point I developed a very painful conjunctivitis and wound up going into the emergency room. I still remember being utterly shocked when I asked them what the bill would be and they said not to worry about it, and I walked out of there with eyedrops and everything. I was utterly gobsmacked. I’d always been basically liberal but I think that was the day I realized that progressivism was where it was at.

We need to get insurance companies out of the decision-making process. That isn’t what people are paying them for. (I looked at the information on my company’s health-insurance coverage. As far as I can tell, it’s great for the insurance companies. For anyone else, good luck: there are no straight answers anywhere about what you get for what amount of money. It’s all written by lawyers.
Two of the three choices I have are being investigated in my state for, among other things, denial of coverage and cancellation of valid policies.

JPL @ 14

peanutbutter @ 8

it never ceases to amaze and infuriate me the kinds of things that insurance companies deem “unnecessary” and “cosmetic”. I had a disintegrating molar that required a root canal and capping; it had previously been improperly capped by another dentist. But because the root canal was within five years of the original cap, it was ruled cosmetic despite the fact that I had no choice but to get the root canal done. Didn’t matter how much documentation my dentist and I sent in; I wound up paying out of pocket for that. I hate medical insurance companies like you would not believe.

Do you mind if I ask what company? I’m battling a similar problem, one in which they keep asking for the same information over and over again. Going on 6 months now.

Delta Dental Insurance, may their souls rot in h*ll.

Health care! these insurance companies are totally and ONLY in the business of making obscene profits. They don’t make profits if they have to pay for medical care.

Tell me about it! Mr. Gnome has had a rare cancer for seven years and now my mother has just been diagnosed with breast cancer. I have been raging about our health care system for over 20 years, ever since I moved back from Canada and tested their “horrible” system [NOT!]by have an emergency C-section without a bill or a complication. The good news is that I feel more hopeful now than I ever have that we will be tackling the issue in earnest after the next elections.

Grant & Weber is going to be really sorry that the name of Jane Hamsher appeared on their “deadbeat” list. Like mc said, we’ve got your back, Jane. Go get ‘em.

Ya know – if one clicks the link to the collection agency, there’s some phone numbers….

Jane Hamsher @ 13

alank @ 6

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

Hey but we can all go to the emergency room, right?

Actually there are vultures who hound you over ER fees as well.

I have been denied, by my insurance company, for a stress test, after finding out that my blood pressure was up during a routine physical. It took 9 months for them to get me a bill and turned it over to a collection agency before the review was finished. Still denied, and I paid it, but it is impossible to convince the collection agency that my balance is current. My claim was denied because my raised blood pressure was discovered 3 days before my 90 day waiting period was over when I bought a new private insurance policy after my COBRA policy ran out. Luckily I don’t have a heart problem, because I’m sure anything related to that would have been denied as well.

Go get ‘em, Jane. “Not medically necessary” my eye.

In the mean time, I get a lengthy email from a friend that was clearly anti-abortion, hyping the allegory of a 24-week preemie that was saved, SAVED!! The email had been forwarded numerous times to hundreds of recipients…

And I never saw anyone in the chain question the veracity of the story, let alone the costs that would have been involved in saving this 24-week-old preemie.

My mother calls them “million dollar babies”, the ones born so early that they have numerous deficits that require many surgeries and life-long care. The parents of these preemies are rarely able to pay for their care — and somebody ends up doing so.

Somebody decides that those millions of dollars of care are medically necessary.

We have one of those “million dollar babies” in our family. A hospital ate most of the expense for the care of her siblings who eventually died months after their multiple birth event, and likely passed the cost of their care on to other patients as part of their overall operating expenses. The remaining child is profoundly retarded and blind, has other deficits we don’t yet recognize; she will never be able to care for herself. Should something happen to her parents, who will provide for her care?

Medically necessary.

Bah.

Peanutbutter, my dental is with Unithed Healthcare. The idea is to spend more on denying coverage that actual coverage.

I don’t know why there aren’t riots in America over health care. You have to be Tony Snow and work for the government to get a good plan these days it seems.

And Blue Cross has decided to deny the $4000 test I had last fall which determined I had invasive breast cancer as “not medically necessary.”

Even after the test results came back, and they’ve paid for your surgery and chemo (I assume), they’re still claiming it wasn’t necessary? This sounds like one of the stories in SICKO.

Blue Cross is gonna regret this.

The pharmaceutical and insurance companies are major supporters of Hillary Clinton.

For her 2006 Senate campaign, she ranked fourth in contributions from the insurance industry, and 20th in contributions from the drug industry

citation: Hernandez R, Pear R. Once an enemy, health industry warms to Clinton. New York Times. July 12, 2006:A1.

hmmm… follow the money, not the poll-driven, consultant tested, triangulated rhetoric.

Dental care? Must be nice. I’m just so thankful to have access to DOCTORS. Dental care seems like a pipe dream.

I’m rapidly coming to the conclusion that a modern feudal society is upon us.

This kind of shit is just one more example.

sporkovat @ 27

The pharmaceutical and insurance companies are major supporters of Hillary Clinton.

For her 2006 Senate campaign, she ranked fourth in contributions from the insurance industry, and 20th in contributions from the drug industry

citation: Hernandez R, Pear R. Once an enemy, health industry warms to Clinton. New York Times. July 12, 2006:A1.

hmmm… follow the money, not the poll-driven, consultant tested, triangulated rhetoric.

Or the bought-and-paid-for media hype, pushed by media outlets that made contributions to the candidate…ahem.

I hate insurance companies. Bastards.

(((((We love you JANE)))))

Rayne @ 23:
I would wager you can check snopes, about, or urban legend and find out some semblance of the truth on this one.

I try to check most all the internet miracle type stories I receive then very regretfully inform the sender that s/he is an idiot for falling for the BS. It just depends on how close a fried or family member for me to inform everybody on the list as well.

OT Snow to step down as White House press secretary.

As a disgruntled Tony Snow said today, “Lying just isn’t fun anymore. The Washington Press Corps believes everything I say. It’s too easy. Where’s the challenge? If I am going to lie, I want to do it in a job that pays more money.”

OK, I made that up but it’s still true.

dakine01 @ 33

Rayne @ 23:
I would wager you can check snopes, about, or urban legend and find out some semblance of the truth on this one.

I try to check most all the internet miracle type stories I receive then very regretfully inform the sender that s/he is an idiot for falling for the BS. It just depends on how close a fried or family member for me to inform everybody on the list as well.

That “reply to all” button is your friend. :D

Sicko bastards.

I just got my spouse out of a hospital stay of 26 days. I already have the attitude, with my BC plan, that I’m going to give them sh*t over everything. But, it means that you have to get into warrior mode to do it, something the sick spouse couldn’t possibly manage. I fear for us when we get older, tho, since that’s when you don’t have the energy to fight it anymore.

And this to protect the shareholders and highly-paid execs. I really do hope there is some kind of karma in this life or the hereafter where these greed-heads will suffer.

That said, there are interesting developments in California afoot. Even the Governator is on board with extending SCHIP.

There are so many good articles at Calitics, you should probably just peruse the site (an interesting by blow to Craig’s indiscretions is there, as well) but take a look at these at least:
SEIU United Healthcare Workers West looking for an Online Campaigner Interesting indicator of the growing blogospheric influence on health care
Lots In The Air On Healthcare Reform An overview
Small Businesses Support Reform: Fight Back Against Right-Wing Attacks Small business – surprise, surprise – want themselves and their employees to have affordable coverage
Schwarzenegger Does The Right Thing, Writes The President To Expand S-CHIP
Crunch Time For Healthcare Reform

Ah yes, United Health Care. Lovely people, they. I have to pay out of pocket almost $500 a month for a med because the reason I am prescribed it does not fit their extremely narrow definition of what it should be prescribed for. They also just tried to not pay a $4,000 CT scan bill on Mr. Gnome because of “pre-existing conditions”, wait periods and all that. Fortunately we had all the documentation showing them the continuous coverage and all the BS insurance lingo that they need. That and the fact that Mr.Gnome is CEO of the large company they are serving, might have something to do with their reconsideration.

sporkovat @ 27

The pharmaceutical and insurance companies are major supporters of Hillary Clinton.

For her 2006 Senate campaign, she ranked fourth in contributions from the insurance industry, and 20th in contributions from the drug industry

citation: Hernandez R, Pear R. Once an enemy, health industry warms to Clinton. New York Times. July 12, 2006:A1.

hmmm… follow the money, not the poll-driven, consultant tested, triangulated rhetoric.

And that, friends, is the primary reason I am very ambivalent about HRC even though I should theoretically be very enthusiastic abou t her. (The second followup reason is the pro-Israel lobby that’s all behind her, too.)

Edwards ‘08!!

newdealfarmgrrrlll @ 18

Health care! these insurance companies are totally and ONLY in the business of making obscene profits. They don’t make profits if they have to pay for medical care.

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

dakine01 @ 33

Rayne @ 23:
I would wager you can check snopes, about, or urban legend and find out some semblance of the truth on this one.

I try to check most all the internet miracle type stories I receive then very regretfully inform the sender that s/he is an idiot for falling for the BS. It just depends on how close a fried or family member for me to inform everybody on the list as well.

Thanks, dakine01, but I already know it’s a crock of shite. Doesn’t matter.

They’re still hyping how very valuable it is to preserve the life of a fetus that nature never intended to live outside the human body, at any expense, regardless of the quality of the outcome.

And for a bargain $4000, we could have our Jane.

I just don’t understand how we got here, where the promise of a potential human being with likely diminished ability is worth more — and we actually pay for it — over a living, breathing, productive, tax-paying adult human being. What kind of f*cked up values do we have?

And why don’t we ever question who’s really behind this? Who benefits financially when we “save” a nominally viable fetus versus a full-fledged adult?

Our promise to Americans: work with us, vote for us to build the world’s largest third world economy. The way god wants it to be. Love, The Rethug National Committee.

(disclaimer.. I actually am a Christian.. obviously a different god)

burnspbesq @ 41

newdealfarmgrrrlll @ 18

Health care! these insurance companies are totally and ONLY in the business of making obscene profits. They don’t make profits if they have to pay for medical care.

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

I don’t think Healthcare should be a for-profit business, so any profit is obscene.

peanutbutter @ 40

And that, friends, is the primary reason I am very ambivalent about HRC even though I should theoretically be very enthusiastic abou t her. (The second followup reason is the pro-Israel lobby that’s all behind her, too.)

Edwards ‘08!!

This is DLC mode–that corporate contributions are more important than the fuckin’ votes they need to win.

Think HRC would have any trouble winning if she said–outright–that her first piece of business would be single-payer health care, and to hell with the insurers? (And, that we’re getting out of the mess in Iraq created by the Bushies?)

She’d get 70% of the friggin’ vote.

paul @ 22

I have been denied, by my insurance company, for a stress test, after finding out that my blood pressure was up during a routine physical. It took 9 months for them to get me a bill and turned it over to a collection agency before the review was finished. Still denied, and I paid it, but it is impossible to convince the collection agency that my balance is current. My claim was denied because my raised blood pressure was discovered 3 days before my 90 day waiting period was over when I bought a new private insurance policy after my COBRA policy ran out. Luckily I don’t have a heart problem, because I’m sure anything related to that would have been denied as well.

My brother had trouble with a collection agency a few years back. He paid his bill and a few months later another collection agency went after him for the same bill. Turns out the first collection agency never sent the payment on to the original company (who had not waited for the negotiations on the original disputed bill to conclude before sending it out to the first collection agency). At any rate, it is somehow sweetly ironic that all the companies (both the original companies and the collection agencies) happily screw each other over as well as the customers/clients/patients themselves. What an outrageous mess…

Jane Hamsher @ 13

alank @ 6

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

Hey but we can all go to the emergency room, right?

Damned straight!

Rayne @ 42

dakine01 @ 33

Rayne @ 23:
I would wager you can check snopes, about, or urban legend and find out some semblance of the truth on this one.

I try to check most all the internet miracle type stories I receive then very regretfully inform the sender that s/he is an idiot for falling for the BS. It just depends on how close a fried or family member for me to inform everybody on the list as well.

Thanks, dakine01, but I already know it’s a crock of shite. Doesn’t matter.

They’re still hyping how very valuable it is to preserve the life of a fetus that nature never intended to live outside the human body, at any expense, regardless of the quality of the outcome.

And for a bargain $4000, we could have our Jane.

I just don’t understand how we got here, where the promise of a potential human being with likely diminished ability is worth more — and we actually pay for it — over a living, breathing, productive, tax-paying adult human being. What kind of f*cked up values do we have?

And why don’t we ever question who’s really behind this? Who benefits financially when we “save” a nominally viable fetus versus a full-fledged adult?

Rayne,
I have no doubt that you are aware of the BS, but I like to let the senders of those types of emails know that they are full of it and I know it. Keeps ‘em thinking.

And it works to their advantage to keep folks distracted by having to care for profoundly ill infants/children/etc. No time to call BS on all their other lies

there are times when getting litigious is not such a bad thing. Or going to arbitration, if it’s in your policy…

Gee, if you only had a good lawyer on your staff…(ahem).

I’m in the trenches watching the Big Pharma and Big Insurance screw patients over all the time as a pharamacy tech. It’s absolutely insane, but we find our ways through it so they get treated. Which therefore means we spend at least 60% of our time on the phone negotiating things or finding out the alternatives for gods only know how many plans.

Crazy shit, but i do it for those patients. I’m there for them, not the corporations.

Jane, say the word, and I’m sure a couple thousand FDLers could exert a little…”influence” on the collection agency!

Ridiculous. I can’t BELIEVE they would deny that claim given the results of the test. Down the rabbit hole…

The Grant & Weber web page is hilarious. Thanks for the link.

Biggus Diggus @ 25

I don’t know why there aren’t riots in America over health care. You have to be Tony Snow and work for the government to get a good plan these days it seems.

Look, I’m a Fed — my take-home pay is less than $20K a year, and unless you make 3 times what I do, the health insurance you get as a Federal employee doesn’t do a whole lot.

Yes, there are FEHB plans that cover just about everything — I don’t make enough money to be able to afford them. I’d need to make $60K a year to do so.

So I picked the plan that covers my prescriptions. Thank Goddess my partner’s plan covers some dental and vision care — otherwise I wouldn’t be going to see them at all.

There used to be a plan in my area that I could afford and it covered all those things, but they decided to leave the FEHB program because they weren’t making enough profit…

Blue Cross has decided to deny the $4000 test I had last fall which determined I had invasive breast cancer as “not medically necessary.”

of you don’t mind my asking Jane, what test is this and what precipitated your doctor requesting it?

burnspbesq @ 41

newdealfarmgrrrlll @ 18

Health care! these insurance companies are totally and ONLY in the business of making obscene profits. They don’t make profits if they have to pay for medical care.

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Standard Medicare has an administrative cost under 5%. They do not make a profit.
Currently, private health insurance has administrative costs of 25-40%.
Denied claims is 100% profit.

Currently trying to get a bill out of collections even though I have proof (canceled checks) that my part was paid. The MD office sent me to collections for $75.00 but neither the MD office or collections will back down. The next step will be attorney general and an attorney. I know it is only $75 bucks but I PAID it!

Gnome de Plume @ 44

burnspbesq @ 41

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

I don’t think Healthcare should be a for-profit business, so any profit is obscene.

Are you saying that you think it’s OK for healthcare to be provided by the private sector, but only if nobody makes any money doing it, or are you saying that you think healthcare is a pure public good that should only be provided by the government? And if the latter, are you saying that it should be funded entirely out of general tax revenues, or are you OK with defraying all or part of the cost out of user fees?

Jane: This makes my blood boil. There is a special place in hell for insurance company executives.

I have heard Sen. Ted Kennedy speak about when his son was being treated for cancer and how he would wait in the hospital with other parents whose children were undergoing similar treatment. Kennedy spoke of how many of these families, already overcome with worry about their sick children, were further stressed out by the additional burden of finding the money for treatment for their children. I believe it is a source of inspiration for him in his fight for access to health insurance for all.

This country desperately needs to move to a single-payer system such as medicare for all Americans. Private health insurance companies serve NO meaningful purpose. I want every candidate for president to be required to state whether he/she believes affordable health insurance is a right or a privilege. I also want every candidate to state their position on the Conyers bill that I believe would establish a single payer universal system.

katymine @ 55

burnspbesq @ 41

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Standard Medicare has an administrative cost under 5%. They do not make a profit.
Currently, private health insurance has administrative costs of 25-40%.
Denied claims is 100% profit.

Currently trying to get a bill out of collections even though I have proof (canceled checks) that my part was paid. The MD office sent me to collections for $75.00 but neither the MD office or collections will back down. The next step will be attorney general and an attorney. I know it is only $75 bucks but I PAID it!

Yeah, so getting people to pay the same bill twice ’cause they don’t want the hassle of contacting a lawyer is 200% profit. Nice work if you can get it ;) Go get ‘em katymine.

itwasntme @ 37

I just got my spouse out of a hospital stay of 26 days. I already have the attitude, with my BC plan, that I’m going to give them sh*t over everything. But, it means that you have to get into warrior mode to do it, something the sick spouse couldn’t possibly manage. I fear for us when we get older, tho, since that’s when you don’t have the energy to fight it anymore.

And this to protect the shareholders and highly-paid execs. I really do hope there is some kind of karma in this life or the hereafter where these greed-heads will suffer.

As observed in Sicko and in many other places, stress compromises the immune system. You can’t afford that to happen in America. Just sayin’.

dakine01 @ 48

Rayne,
I have no doubt that you are aware of the BS, but I like to let the senders of those types of emails know that they are full of it and I know it. Keeps ‘em thinking.

And it works to their advantage to keep folks distracted by having to care for profoundly ill infants/children/etc. No time to call BS on all their other lies

They’re sheep, dakine01. Not worth my time. They’re the kind that would send me hate mail and clutter up my mail box with their spoor. Not to worry, I’m working at it from a different tack.

Awww, see, you just gotta pretend you’re a tearrist-evil-doer an get sent ta gitmo

http://www.youtube.com/watch?v=yiEl1EcqnAY

I want every candidate for president to be required to state whether he/she believes affordable health insurance care is a right or a privilege.

Fixed the typo.

I am FAR more frightened by what’s going on with healthcare and insurance than I am of terrorists, but what are we spending in Iraq, which isn’t even about terrorism!

Being a Mass. resident, we had to be insured by July 1. I joined a local buisiness guild to avoid going on the state’s plan, which would have prevented me from seeing my doctor. I got the group insurance, but of course I can’t afford it. And while going through the paperwork, I asked if I could get a discount if I paid the year’s premium in full up front. The woman told me I could not, and then said something about “WHEN”, not “IF” but “when” the rates go up in April…

I lose sleep over this. I’m the opposite of Jane. I’ve had a total of $3,000 in health care in 25 years of being an adult (three non-cancerous moles removed), so for someone like me, it feels like they’re just taking my money via extortion. For people like Jane, it’s a RICO crime: taking the money and then denying coverage.

This is criminal, whether you are someone who is paying through the nose for something you use very little of and are STILL told you can’t go to the doctor of your choice, or if you are someone with serious health problems and are denied coverage despite having paid thousands in premiums over the years.

And yet, the only solutions I hear about have to do with dealing with the consumer. There is never, ever, any talk about reinging in this obscene greed or putting the screws to these insurance companies that are clearly running a racket (include Pharm and other medical industries in that).

That is why I think nothing will change. IT’s like telling a battered woman that you will work with her to see what she can do to keep from getting hit again but never confronting the batterer and telling him to knock it off.

damn it…screwed up the strikeout…fix, please?

I’m curious, Jane–how long after BC denied the claim for the test did the hospital and/or surgical PC turn the bill over for collection?

Presumably, even though BC denied the claim, you were still fighting the denial, right?

I feel for ya all, been there, done that, can see it coming again.Hurt my back when I was 20.
Spent five MISERABLE years with constant pain and nerve inflammation. Went through TWELVE fucking DR.s who kept telling me they couldn’t find anything wrong.
Cat scans.
Mylograms.
MRI’s.
Xrays.
Dye injected into my spinal cord.
I even had one asshole write a letter to my surgeon saying I was just lazy and didn’t want to work!
Finally, My surgeon looked at the same Xrays as all the rest of em had and said out loud, “What the hell is wrong with these guys?”
He got behind me and stuck his thumb in my lower back and asked me if that was where the pain was, I just about pissed myself.
2 weeks later I went under the knife for five hours.
Two laminectomies and they took a piece of bone out of my pelvis and broke it into pieces and stacked them around my lowest vertebrae to fuse it all together. Took 2 years.

36,000 dollars in 1985.
I know about the grief with insurance companies and medical bills.
Thats why I said the other day, the sad part is even with insurance, you are one problem away from financial ruin.

(((((Jane!)))))
Every moment you spend with us is a treasure. Let us know if there’s anything we can do to help fight your vultures.

Bob in HI

Gnome de Plume @44: I agree, I think in a civilized society, health care should not be for profit. The healthcare crisis is but one of many symptoms of a country in a death and rebirth struggle.

burnspbesq @ 56

What we’re saying is “Universal Health Care” not INSURANCE.

Health Care cum Insurance Companies became more concerned with producing profits for shareholders, rather than taking care of patients — that’s where things went wrong.

And it’s not just patients who are suffering. Nurses are underpaid and overworked, because for-profit hospitals try to do more with less staff. This isn’t just bad for the patients, it’s bad for the nurses, they burn out quicker and leave in droves.

Doctors order tests, and insurance companies say “no, not necessary” and the person making this decision does not have a medical degree, much less a license to practice.

Health Insurance is breaking the health care professions just as much as Bush is breaking our military. Someone needs to put a stop to it.

burnspbesq @ 41: I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Since you asked, how about 0, as in zero, as in no profit.
Mine to you is, how is insurance company profit not in conflict with the health care needs of the insured?

Jane, maybe Michael Moore would be interested in this story. It might not hurt to tell the vultures you have his contact information (which I’m sure someone you know might,) and you’re not afraid to use it.

Just sayin’.

In the meantime, as another poster has already said, stress is bad for the immune system. You don’t need it. We’d be more than willing to dish it out to the vultures, though.

-S

peanutbutter @ 8

it never ceases to amaze and infuriate me the kinds of things that insurance companies deem “unnecessary” and “cosmetic”. I had a disintegrating molar that required a root canal and capping; it had previously been improperly capped by another dentist. But because the root canal was within five years of the original cap, it was ruled cosmetic despite the fact that I had no choice but to get the root canal done. Didn’t matter how much documentation my dentist and I sent in; I wound up paying out of pocket for that. I hate medical insurance companies like you would not believe.

How can a root canal EVER be “cosmetic”, no one sees it?

burnspbesq @ 56

Are you saying that you think it’s OK for healthcare to be provided by the private sector, but only if nobody makes any money doing it, or are you saying that you think healthcare is a pure public good that should only be provided by the government? And if the latter, are you saying that it should be funded entirely out of general tax revenues, or are you OK with defraying all or part of the cost out of user fees?

I can’t speak for Gnome, but as someone who’s worked in health care for nearly a decade, I can tell you my view.

Insurance companies don’t provide health care. First and foremost we need to get them out of the equation. They just siphon off money that could be spent on health care or remain in the hands of the patient.

To me, the insurance industry is the most obscene part of our for-profit system because they contribute nothing the the actual delivery of health care.

Next on the list is big Pharma. Pharmaceuticals at least provide a benefit in the delivery of health care, but the profits enjoyed by the companies are just obscene. Much of the R&D they whine about being so expensive is done on the government dime anyway.

Pharma needs to be heavily regulated. And thank to our for-profit system we have no cure for diseases like AIDS, but we’ve got about seven different options for erectile dysfunction. Because coming up with a new boner pill is a guaranteed money maker even if there are already plenty of medicines on the market that do the same thing.

As far as I’m concerned doctors and nurses deserve to earn a nice living. They not only have a lot of expenses related to their education, they’re doing one of the most important jobs there is — literally saving lives.

That being said, some of these physician-owned hospitals and other private practice arrangements can be quite problematic. Those kinds of facilities generally cherry-pick the people with good insurance leaving public hospitals with all the patients who don’t pay. Even a public hospital can’t operate long if they lose money on every single patient.

Then you have additional problems of docs referring exclusively to health care facilities where they have a financial interest. Maybe the patient will get decent care there, but the conflict of interest is very disconcerting. The potential for abuse is enormous.

Personally, I’d like to see a national, single-payer system similar to what Canada has. And I think we could actually improve on their system if we really put in the effort.

I’m not as keen on a completely socialized model where the care givers are actually employed by the state.

Medicare denied payment to the ambulance company that carried my dying quadriplegic father to the hospital b/c Medicare deemed the ambulance ride not medically necessary.

My father was ventilated and sent straight to ICU where he died three days later. The hospital billed Medicare $23,000.

When I questioned the ambulance company re: the legitimacy of Medicare’s claim that there was a lack of medical necessity, the ambulance co. asked me to mail them a death certificate. So I did.

As it is time to settle the estate, I am informed by my attorney that the ambulance company maintains their claim against the estate. IOW, Medicare won’t pay them. I must pay the ambulance company out of pocket.
There is no recourse.

Bloix @ 52

The Grant & Weber web page is hilarious. Thanks for the link.

I particularly liked the “Our Family” section. Charming group. I’m beginning to understand the relationship between “family values” other Republican values.

looseheadprop @ 72

How can a root canal EVER be “cosmetic”, no one sees it?

Oh, I can answer this one — because a tooth that has had a root canal must have a crown, and crowns ARE considered “cosmetic.”

So the root canal is considered to be prep for a cosmetic procedure. (Been there, lost the tooth, and got the partial plate because I couldn’t afford the crown…)

Which of the Presidential contenders is best positioned to help with health care?

Oklahoma kiddo @ 77

Which of the Presidential contenders is best positioned to help with health care?

That’s easy, Dennis Kucinich. That’s a big part of why he’s such a long-shot. You can’t get taken seriously by corporate media when you rock the boat of corporate cash cows.

The stories coming out about these “insurance” companies are frightening.

Wifey just came back from a second series for breast cancer and she was really scared. She’s ok and she’s giving up cigs finally. We have 1199 and she works at a hospital so I wonder how her employer would treat her…

Tell me again, what do insurance companies do for our health?

SufiLizard @ 78

Oklahoma kiddo @ 77

Which of the Presidential contenders is best positioned to help with health care?

That’s easy, Dennis Kucinich. That’s a big part of why he’s such a long-shot. You can’t get taken seriously by corporate media when you rock the boat of corporate cash cows.

Dennis tells more truth than ANY of the others. The Truth hurts.

This thread puts me in the perfect mindset, because I’m going to see Sicko tonight! Great post and comments.

The France model depicted in Sicko was quite remarkable. Very family friendly, yet, births are falling on the continent. You can have an au pair in addition to pre-natal, post-natal, and pediatric care provided by the State system. And the doctors are payed well. The pharmaceuticals in Europe (Britain, at least) are generics, as I recall from the film. It was absolutely amazing!

Jane, you keep fighting them.

Actually, with you fighting them, I pity the poor insurance comapny–they won’t know what hit em’

I got calls after being hospitalized from a collection agency. They demanded a huge payment. I said no, I could pay them $20.
“Richard” from “Chicago” (Dinesh from Mumbai, more likely) said, “That’s an insult, no way would we take that! Next time you go to hospital, they won’t take care of you! We’ll sue you!”
So I said, “Fine. Then I’ll die. No problem. Or you can sue, you’ll get nothing. Up to you.”
Next time they called I told a supervisor the same thing. Fuck’em.

Tell me again, what do insurance companies do for our health?

Well, first off, they want you to pay their premiums. Then, they want you to die before you can ever make a claim.

This creates the ultimate profit for the company and it is their goal and best case scenario.

OT I was intending to go offline for a bit but came back online when I heard this program on NPR called The World. It was like listening to a lovefest for the “surge”. Michael O’Hanlon without any reference to his recent op-ed and general Iraq war cheerleading gets to throw in how tough it is to change troop levels with all the progress being made in Iraq. Another reporter talks about how safe Ramadi is. He waxes poetic about an Army (Marine?) officer who worked wonders with the local police. The guy was later killed by an IED. I’m sorry but what does this say about your success if your posterboy for it gets knocked off? The story has a few caveats but mostly these are deluged in a flood of happy talk.

All in all and after a few hiccups the selling of the surge is back on big time. And NPR has signed on. Thank goodness we have Democrats like Harry Reid to stand up for us. Oh wait, . . .

It’s like an invasion of the Pod People but this time around they’re Very Serious Persons.

RevDeb @ 4

And let us know how we can help.

Ummm, I imagine one way everyone could help would be to go to the FDL Paypal button top-right of the page. Let’s just pay for this thing right here and right now, and there’s one less thing for Jane to worry about.
Go do it. We’ll wait for you to get back.

Jane,

Two things:

1. FDL needs to endorse a candidate. The no-endorse position FDL has taken is a defacto endorsement for HRC, who is wholly owned by the pharmaceutical and medical insurance industries, the kinds of people who are making your life hell.

2. Fax the following to the collections agency (or read it to them over the phone):

I would like to draw your attention to Section 806 of the Fair Debt Collection Practices Act, 15 U.S.C. 1601 et seq., which states in relevant part:

§ 806. Harassment or abuse [15 USC 1692d]
A debt collector may not engage in any conduct the natural consequence of which is to harass, oppress, or abuse any person in connection with the collection of a debt. Without limiting the general application of the foregoing, the following conduct is a violation of this section:
* * *
(5) Causing a telephone to ring or engaging any person in telephone conversation repeatedly or continuously with intent to annoy, abuse, or harass any person at the called number.

Because phone calls to my employer from bill collectors would embarrass me or may even threaten or endanger my employment, I will henceforth consider any such calls to be harassment.

It doesn’t have to match your situation exactly (you being self employed and all), but they would hardly know that. This usually does the trick. Can’t hurt to try.

JPL @ 14

peanutbutter @ 8

it never ceases to amaze and infuriate me the kinds of things that insurance companies deem “unnecessary” and “cosmetic”. I had a disintegrating molar that required a root canal and capping; it had previously been improperly capped by another dentist. But because the root canal was within five years of the original cap, it was ruled cosmetic despite the fact that I had no choice but to get the root canal done. Didn’t matter how much documentation my dentist and I sent in; I wound up paying out of pocket for that. I hate medical insurance companies like you would not believe.

Do you mind if I ask what company? I’m battling a similar problem, one in which they keep asking for the same information over and over again. Going on 6 months now.

Got one even better. Went to the hospital as an emergency patient because I had chest pain and thought I was having a heart attack. I’m a woman, so they didn’t do any tests other than and EKC (a joke) and sent me home. The insurance company, Pacificare, wouldn’t pay my hospital bill because I didn’t have a heart attack! Well, got on a treadmill shortly thereafter, had a 99% blockage in the big artery..got a stent. I was a walking heart attack. I got them to pay the emergency visit bill after many letters and phone calls. What finally did it was that I said the word ‘lawyer’ in my last letter. Go John Edwards, a trial lawyer!

I had occasion to go to an emergency room three years ago. I already knew that the hospital was on my insurance plan. Imagine my shock a couple of weeks later when I get a pretty large bill from some group of emergency room doctors for an additional amount that insurance did not pay! I called the hospital and was told that they were not considered hospital employees, and thus were not under contract to my insurance plan. My insurance company at the time said that they had been unable to get the doctors under contract, and there was nothing they could do about it.

I have nothing against these guys earning money in return for their special training, etc. In my opinion, they were just being greedy about it. I attempted to negotiate the bill down and they refused — until I wrote the company president and threatened to cc the letter to our local newspaper. Then they were happy to take what insurance paid them!

Someone wrote above that health care should not be about profits — and I fully agree! Something has to change…

Brisingamen @ 76

looseheadprop @ 72

How can a root canal EVER be “cosmetic”, no one sees it?

Oh, I can answer this one — because a tooth that has had a root canal must have a crown, and crowns ARE considered “cosmetic.”

So the root canal is considered to be prep for a cosmetic procedure. (Been there, lost the tooth, and got the partial plate because I couldn’t afford the crown…)

Yes and no. The crown is cosmetic in the lay sense of the word. In the medical/legal world, “cosmetic” surgeries are usually defined as those which are performed to improve the appearance of a normal structure. And the “normal” part of the definition is key. If you have a big huge tumor on your forehead, and your doctor determines that it’s not life-threatening, the surgery to remove it would STILL not be considered to be “cosmetic surgery”, since it isn’t normal to have a big huge tumor on your forehead.

Gutsy!

JPL scientists sue over new ID checks
By ROBERT JABLON, Associated Press Writer
Thu Aug 30, 6:20 PM ET

PASADENA, Calif. – Jet Propulsion Laboratory scientists and engineers sued NASA and the California Institute of Technology on Thursday, challenging extensive new background checks that the space exploration center and other federal agencies began requiring in the wake of the Sept. 11 terror attacks.

The lawsuit says NASA is violating the Constitution by calling on employees — everyone from janitors to visiting professors — to permit investigators to delve into medical, financial and past employment records, and to question friends and acquaintances about everything from their finances to sex lives. Those who refuse could lose their jobs, the suit says.

…

Brisingamen @ 69

burnspbesq @ 56

What we’re saying is “Universal Health Care” not INSURANCE.

Health Care cum Insurance Companies became more concerned with producing profits for shareholders, rather than taking care of patients — that’s where things went wrong.

And it’s not just patients who are suffering. Nurses are underpaid and overworked, because for-profit hospitals try to do more with less staff. This isn’t just bad for the patients, it’s bad for the nurses, they burn out quicker and leave in droves.

Doctors order tests, and insurance companies say “no, not necessary” and the person making this decision does not have a medical degree, much less a license to practice.

Health Insurance is breaking the health care professions just as much as Bush is breaking our military. Someone needs to put a stop to it.

Hold up a sec. I’m not the enemy here. I’ve got my own set of issues with the status quo. I’m just trying to understand what it is that people want, and figure out how to get there.

But what I see here is a lot of people who seem to be in denial about two fundamental truths: (1) nothing is free; and (2) nothing exists in infinite supply.

Even under a pure government-provided single-payer system, your access to healthcare is going to be rationed somehow, because as a society we aren’t ready to pay “whatever it takes.” SOMEONE is still going to be a gatekeeper.

It may be a scheduler at a clinic, who tells you you have to wait a period of time that you’d rather not wait before having a procedure done, because demand has outrun supply and they can’t increase capacity overnight. It may be Congress deciding that “this year, given the tax revenue that’s available, we can build ten new hospitals or one new aircraft carrrier, and we need the aircraft carrier more than we need the hospitals.”

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

No disrespect intended, but I happen to think that I’m more capable of making smart,informed decisions about my family’s healthcare than anyone else. And I have a problem with giving up that autonomy.

It would not be unfair for you to ask whether my beliefs on this issue are influenced by where I sit on the income-distribution curve. And I’ll answer that question honestly: yeah, they probably are.

But I generally believe that individual autonomy is a good thing, and I have a problem getting comfortable with a system that would take fundamental decisions about the quality of your life out of your hands.

Be careful what you wish for; you may get it.

Americans need to drop their insurance plans en mass, all 250,000,000.

Send these companies into bankruptcy and overwhelm the system, finally breaking it, so something can get done. AS long as people pay, they’ll keep extorting.

“Not medically necessary”?

Feh. Sue the bastards.

every fucking goddam day
we pester congress to hear what we say
chain them to their chair
and forcibly detain them there
give us care, and make it free, or you will live just like me
without any care, without any future, and without your “retirement” benefits.

it is time they lose their health coverage until they give us ours

So is “ADT” one of these collection agencies that everyone is talking about? I get fairly regular messages on my answering machine saying, “This is ADT. We need to hear from your or your attorney by noon tomorrow.” They get points for persistence, but I don’t like threatening phone messages, so I still haven’t found any time in the last two years to call them back.

outrageoftheday @ 89,
This is a big problem, women not being as aggressively treated when they come in complaining of chest pain. Huge problem. Keep complaining and refuse to leave. You need an EKG, need to be hooked up to heart monitor, you need a cardiac panel (blood work that will show if you’ve had heart attack) and a few other things I can’t think of.

alank @ 82

The France model depicted in Sicko was quite remarkable. Very family friendly, yet, births are falling on the continent. You can have an au pair in addition to pre-natal, post-natal, and pediatric care provided by the State system. And the doctors are payed well. The pharmaceuticals in Europe (Britain, at least) are generics, as I recall from the film. It was absolutely amazing!

In Canada, a legal immigrant with a work visa and a prospective job is entitled to Provincial health care as soon as she enters the country. She can, literally, get off the plane, take a bus to the health care office and get a health care card. She must pay $40 per month.

All her health care needs are met immediately. If she has a baby, prenatal, ultrasound, everything is paid for. She gets 9 months paid maternity leave at 80 percent pay plus she is elligible for 6 months sick pay. When the child is born, she gets a check for $500 and a stipend of $120 per month.

We can’t do that b/c Rush Limbaugh, Glen Beck etc. say that would be socialized medicine. See, that’s a bad thing.

Frank Probst @ 91

Brisingamen @ 76

Oh, I can answer this one — because a tooth that has had a root canal must have a crown, and crowns ARE considered “cosmetic.”

So the root canal is considered to be prep for a cosmetic procedure. (Been there, lost the tooth, and got the partial plate because I couldn’t afford the crown…)

Yes and no. The crown is cosmetic in the lay sense of the word. In the medical/legal world, “cosmetic” surgeries are usually defined as those which are performed to improve the appearance of a normal structure. And the “normal” part of the definition is key.

Sir, what I stated above is what my insurance company told me — as neither root canal nor crown were covered, the tooth had to be extracted, the dentist could not leave it due to the risk of infection.

Let’s also remember that these insurance companies are friends of those stalwart Christians, Republicans.

Good thing Christ never said anything about healing the sick or caring for them in general.

How does anyone with a conscience do work for these companies and do these things to people?

AZ Matt @ 92

Gutsy!

JPL scientists sue over new ID checks
By ROBERT JABLON, Associated Press Writer
Thu Aug 30, 6:20 PM ET

PASADENA, Calif. – Jet Propulsion Laboratory scientists and engineers sued NASA and the California Institute of Technology on Thursday, challenging extensive new background checks that the space exploration center and other federal agencies began requiring in the wake of the Sept. 11 terror attacks.

The lawsuit says NASA is violating the Constitution by calling on employees — everyone from janitors to visiting professors — to permit investigators to delve into medical, financial and past employment records, and to question friends and acquaintances about everything from their finances to sex lives. Those who refuse could lose their jobs, the suit says.

…

Sex lives? How come none of these people never interview me?

Intrusive questioner: Has the applicant ever said anything to you about liking oral sex?

Me: Like it? Hell, no! He LOVES it!

Argh!

Why do we not have universal health care in the USA, considering it’s a fixture of life for virtually everyone in the industrialized world?

We don’t need a halfway, insurance-company-friendly measure … we need a system where we’re not all under the fear of being one medical procedure away from the poor house.

I’ve seen no mention of this anywhere on the net but maybe someone else will be aware of this. I have chronic asthma which is so bad that I must carry a “fast acting” inhaler with me at all times. It can be triggered by the wrong brand of cologne or something as simple as getting into an air-conditioned train car on a hot day. I also have no health insurance, haven’t had for 4 years. The pharmaceutical industry is phasing out the (relatively) cheap albuterol inhaler that I’ve been using. My pharmacist (god bless him) has been giving me these at cost for the last four years (about $12). A few months ago he informed me that he could no longer let me have them for that price and from that day forward would have to charge me $20 each. He also informed me that once this particular inhaler was off the market, the replacement inhaler (which is supposed to NOT contain those ‘deadly’ fluorocarbons) will be costing me about $45 dollars, and that’s still at no profit to my pharmacist. In a good week, I use my inhaler a couple of times about 5 out of 7 days. On a bad day, I could use it 5 or 6 times in a single day. What is a person like myself who makes very little money to do? I suppose eventually I will suffocate to death because I won’t be able to afford this new and much costlier inhaler. Oh, well!

For a short time the postal union in this country had a great dental plan and other unions were getting on board.
Then Reagan showed up and raped the working class!
I was in the dental industry then as a crown and bridge technician. We did good work and were nicely paid and of course our dental problems were covered six ways from Sunday by the doctors that we worked for. I once complained of a tooth ache at 10am and had a root canal done before lunch!
Now I’m out of the biz and the place I work for has the dreaded Delta Dental. Their plan is little more than a facade to make my employer look good.
It’s depressing when you realize the whole thing is a sham.
Fuckemall

burnspbesq @ 93

Brisingamen @ 69

burnspbesq @ 56

What we’re saying is “Universal Health Care” not INSURANCE.

Health Care cum Insurance Companies became more concerned with producing profits for shareholders, rather than taking care of patients — that’s where things went wrong.

And it’s not just patients who are suffering. Nurses are underpaid and overworked, because for-profit hospitals try to do more with less staff. This isn’t just bad for the patients, it’s bad for the nurses, they burn out quicker and leave in droves.

Doctors order tests, and insurance companies say “no, not necessary” and the person making this decision does not have a medical degree, much less a license to practice.

Health Insurance is breaking the health care professions just as much as Bush is breaking our military. Someone needs to put a stop to it.

Hold up a sec. I’m not the enemy here. I’ve got my own set of issues with the status quo. I’m just trying to understand what it is that people want, and figure out how to get there.

But what I see here is a lot of people who seem to be in denial about two fundamental truths: (1) nothing is free; and (2) nothing exists in infinite supply.

Even under a pure government-provided single-payer system, your access to healthcare is going to be rationed somehow, because as a society we aren’t ready to pay “whatever it takes.” SOMEONE is still going to be a gatekeeper.

It may be a scheduler at a clinic, who tells you you have to wait a period of time that you’d rather not wait before having a procedure done, because demand has outrun supply and they can’t increase capacity overnight. It may be Congress deciding that “this year, given the tax revenue that’s available, we can build ten new hospitals or one new aircraft carrrier, and we need the aircraft carrier more than we need the hospitals.”

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

No disrespect intended, but I happen to think that I’m more capable of making smart,informed decisions about my family’s healthcare than anyone else. And I have a problem with giving up that autonomy.

It would not be unfair for you to ask whether my beliefs on this issue are influenced by where I sit on the income-distribution curve. And I’ll answer that question honestly: yeah, they probably are.

But I generally believe that individual autonomy is a good thing, and I have a problem getting comfortable with a system that would take fundamental decisions about the quality of your life out of your hands.

Be careful what you wish for; you may get it.

My bold but the reality is, most folks are not in charge of their own health care now as it is. That’s the problem. And most folks seem to prefer having someone/something without a vested interest in denying the care in charge. Right now the vested interest of the Insurance companies is no where near their presumed clients’ interest.

Remember the guy in SICKO who told his HMO that he had contacted Michael Moore (he hadn’t yet) about their refusal to cover his claim? Remember the weasely, saccharine phone response, “Uh, Mr. X, uh, I have some good news for you . . . .”

Not that you need my two cents, Jane, but I hope you have someone who is making calls and advocating for you. HIPAA be damned. You don’t need this shit. You need to channel all your energy into your recovery.

Oh. And have them contact Michael Moore. I’m guessing he’d be mighty interested.

Danbury @ 101

Let’s also remember that these insurance companies are friends of those stalwart Christians, Republicans.

Good thing Christ never said anything about healing the sick or caring for them in general.

How does anyone with a conscience do work for these companies and do these things to people?

Jesus may sit at the right hand of God, but, for these people, Profit sits on the left….

A year ago, I was fighting with a dr. office in KS that was billing my US daughter for doctor’s visits. She was sure she hadn’t been in the office those days and they admitted that there were no doctor notes, but there “was something on the schedule.” But as I was making the case, they, of course sent the bill to a collection agency. Now, I was in New Zealand and doing this all long distance for my daughter who was completely freaked out by all this. The dr. was theoretically treating my daughter for, among other things, stress. So false billing and a collection agency is part of the solution to stress related illness. What a crock.

Meanwhile, in NZ, my son broke his foot. Twice. Treatment costs – $12 each time, including xrays, casting, and some meds (and the second time, he saw a specialist too). Our NZ taxes are high, but we know that we and others get at the minimum, basic treatment.

It isn’t a perfect system, but it beats the paperwork and inequity of this systematic extortion.

AZ Matt @ 92

Gutsy!

JPL scientists sue over new ID checks
By ROBERT JABLON, Associated Press Writer
Thu Aug 30, 6:20 PM ET

PASADENA, Calif. – Jet Propulsion Laboratory scientists and engineers sued NASA and the California Institute of Technology on Thursday, challenging extensive new background checks that the space exploration center and other federal agencies began requiring in the wake of the Sept. 11 terror attacks.

The lawsuit says NASA is violating the Constitution by calling on employees — everyone from janitors to visiting professors — to permit investigators to delve into medical, financial and past employment records, and to question friends and acquaintances about everything from their finances to sex lives. Those who refuse could lose their jobs, the suit says.

…

I have to agree with the government on this one. I think the threat from terrorist Martians has been grossly understated. I suspect this is all part of a larger plot by the Neptunians. You know, how they are.

Brisingamen @ 100

Sir, what I stated above is what my insurance company told me — as neither root canal nor crown were covered, the tooth had to be extracted, the dentist could not leave it due to the risk of infection.

I don’t doubt that your insurance company told you that. What I’m saying is that the insurance company is absolutely wrong. The “cosmetic surgery” excuse is something that they like to use, because when they ask, “Well, does it look better?”, you have to say yes, and some people will walk away at the point and think, “Well, I guess it WAS cosmetic surgery.” It wasn’t. It was a medically necessary surgery that had a positive cosmetic outcome. They’re two entirely different things.

I’m an American expatriate living in India the last 14 months — and the healthcare here is fantastic.

My partner had a retinal tear fixed in a modern super-specialty clinic in Bangalore a couple months ago — for the sum total of $38. Diagnostic exam, laser surgery, and follow-up, all for thirty-eight bucks.

Two days ago, I’d noticed I was feeling run-down and asked the local town doctor to come for a house call. He took blood, spent a good 40 minutes talking with me about what was going on, and eventually diagnosed my problem as anemia (giving me some iron-supplements). Total cost? Four bucks.

C’mon people. You all are being taken for a ride by the parasite known as the healthcare and insurance industry.

Because phone calls to my employer from bill collectors would embarrass me or may even threaten or endanger my employment, I will henceforth consider any such calls to be harassment.

I tried that one probably thirty times on behalf of some employees. Didn’t work worth a damn. They’d always promise that it’d never happen again, but within a couple of weeks they were doing it again. I should have sued the bastards.

“in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.”

I’m not the ultimate decision-maker as it is. The insurance company is. And they don’t want to pay because they want to make money, not provide the best quality care. And if one is living in poverty, one is not the ultimate decision-maker with respect to healthcare choices, one’s poverty is the ultimate decider.

Aussies pay a 1% tax and provide universal health care. Rich Aussies can pay more for even more coverage. Everyone is covered. End of story. They just do it.

We don’t do it because too many of us are useless greedy wankers like Bubble Boy.

jim oconnor @ 70

burnspbesq @ 41: I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Since you asked, how about 0, as in zero, as in no profit.
Mine to you is, how is insurance company profit not in conflict with the health care needs of the insured?

If, as you posit, “insurance company profit” is “in conflict with the health care needs of the insured,” then if the market for health insurance is competitive (which it is), the problem takes care of itself over time.

Who makes the decision about who to buy health insurance from? By and large, corporate HR people. Companies buy health insurance for their employees for two primary reasons: (1) healthy workers (and workers who are not losing time fighting with insurance companies) are generally more productive than unhealty workers, or workers who are stressed out from dealing with the health insurance carrier; and (2) it costs less to provide group health insurance than to pay high enough salaries so that everyone can go out and buy individual health insurance.

When employees start bitching to HR about the health insurance carrier, HR pays attention, and if the problem doesn’t get fixed, that carrier gets kicked to the curb. It happened at my company last year. United was a flippin’ nightmare to deal with. We’re now with Aetna.

It shouldn’t be different in the individual market. If your mailbox is anything like mine, it gets a fairly steady stream of come-ons from insurance companies (my fax machine also gets a steady stream of illegal junk faxes from them, but that’s another story for another thread). If you don’t like the service you’re getting from your current carrier, there are multiple other carriers out there who will be more than happy to take your money and try to earn your repeat business by providing superior service.

Markets have a tendency to work if you let them.

New thread upstairs.

burnspbesq @ 93

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

Good Goddess, man, what makes you think the individual with health insurance is the “ultimate decision-maker with respect to their healthcare choices?”

My insurance company tells me which health care providers I can use, and mandates that I get my long-term meds from their pharmacy.

If you think there’s freedom of choice somewhere in there, I’ve got some beachfront property on Hoth I’d love to sell you. *g*

burnspbesq @ 115

jim oconnor @ 70

burnspbesq @ 41: I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Since you asked, how about 0, as in zero, as in no profit.
Mine to you is, how is insurance company profit not in conflict with the health care needs of the insured?

If, as you posit, “insurance company profit” is “in conflict with the health care needs of the insured,” then if the market for health insurance is competitive (which it is), the problem takes care of itself over time.

Who makes the decision about who to buy health insurance from? By and large, corporate HR people. Companies buy health insurance for their employees for two primary reasons: (1) healthy workers (and workers who are not losing time fighting with insurance companies) are generally more productive than unhealty workers, or workers who are stressed out from dealing with the health insurance carrier; and (2) it costs less to provide group health insurance than to pay high enough salaries so that everyone can go out and buy individual health insurance.

When employees start bitching to HR about the health insurance carrier, HR pays attention, and if the problem doesn’t get fixed, that carrier gets kicked to the curb. It happened at my company last year. United was a flippin’ nightmare to deal with. We’re now with Aetna.

It shouldn’t be different in the individual market. If your mailbox is anything like mine, it gets a fairly steady stream of come-ons from insurance companies (my fax machine also gets a steady stream of illegal junk faxes from them, but that’s another story for another thread). If you don’t like the service you’re getting from your current carrier, there are multiple other carriers out there who will be more than happy to take your money and try to earn your repeat business by providing superior service.

Markets have a tendency to work if you let them.

Bullshit. You left out the word “free” in the above sentence. We DO NOT nor have we had in decades a FREE Market econonmy in this country. We have a rigged corporate welfare society. And the LAST people who want a truly free market economy are the big corporate CEOs, their enablers on Wall Street, and the politicians lining up at the trough. Give me a break…

jayt @ 113

Because phone calls to my employer from bill collectors would embarrass me or may even threaten or endanger my employment, I will henceforth consider any such calls to be harassment.

I tried that one probably thirty times on behalf of some employees. Didn’t work worth a damn. They’d always promise that it’d never happen again, but within a couple of weeks they were doing it again. I should have sued the bastards.

This cannot be verbal. It has to be in writing. (30 years in credit management)

Jane, IANAL, but get familiar with the Fair Credit laws. You can shut the collection agency down by sending them a certified letter simply telling them not to bother you again. It is actually kind of fun to do. It is even more fun to have one of these chuckleheads to call you after you have sent the letter and you know that they have received it. You can find model letters online if you need an example.

By law, that agency risks serious issues with the Federal Trade Commission, and possibly some state agencies, if they bother you again after getting your letter. The important thing to do is to have proof with that certified mail receipt. (If you have access to a fax machine that will print out the details, that will work, too!)

The debt will be sent back to the original creditor, who will probably send it to another agency for collection. As soon as you are contacted, ask them to send it to you in writing. When you receive their letter, drop another certified letter on them!

People do not have to put up with the BS these idiots want to dole out. There are a number of in’s and out’s in debt collection practices, but these techniques have worked for me in the past.

If you read between the lines, even $168K/year and a Federal employee health care plan isn’t enough for Tony Snow.
This system has been broken for over 20 years.
We, as a nation need to move beyond denial.

perris @ 54

Blue Cross has decided to deny the $4000 test I had last fall which determined I had invasive breast cancer as “not medically necessary.”

of you don’t mind my asking Jane, what test is this and what precipitated your doctor requesting it?

Jane, I am curious also. Was it an MRI? My friend in Texas had an MRI done with her breast cancer- NYT did a big article on the use of the MRI for cancer detection in the last year, even interviewed her – and the test saved her life.

burnspbesq @ 93

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

All these examples being listed in this thread are detailed, illustrative examples of having no control whatsoever over healthcare when it’s under the control of the insurance companies.

Ball’s in your court, I believe.

SufiLizard @73
I agree with you completely. I don’t begrudge health care professionals making money. It’s the insurance companies and Big Pharma that are the problem. For your information, Edwards is against insurance companies being part of the solution, judging by what he said the other day. At least Edwards has a chance.

Dee @ 122

perris @ 54

of you don’t mind my asking Jane, what test is this and what precipitated your doctor requesting it?

Jane, I am curious also. Was it an MRI? My friend in Texas had an MRI done with her breast cancer- NYT did a big article on the use of the MRI for cancer detection in the last year, even interviewed her – and the test saved her life.

If it was a breast MRI that they declined to pay for, you really should have the local news crew pay a visit to your insurance company.

Here is another one of those vultures. I get calls from them regularly even though they are in the middle of a lawsuit over harassing people about collections & other nefarious medical administration “games”.

Isn`t living in the middle of the 15th century fun ?

“Once you go through something you think will kill you and it doesn’t, every day is like a present.” – Elissa B. Terris

NZ Expat @ 109

I had a relative who had surgery (successful operation). The relative died in the hospital a few days later (heart attack). Afterward, his widow was billed by a doctor who lived two hundred miles away and had never seen him.
We figured it was a coffin-chaser trying to scam her.

When my father died, it was a full year before we got a bill for the ambulance. (We thought that was a bit long.)

burnspbesq @ 115

jim oconnor @ 70

burnspbesq @ 41: I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

Since you asked, how about 0, as in zero, as in no profit.
Mine to you is, how is insurance company profit not in conflict with the health care needs of the insured?

If, as you posit, “insurance company profit” is “in conflict with the health care needs of the insured,” then if the market for health insurance is competitive (which it is), the problem takes care of itself over time.

Who makes the decision about who to buy health insurance from? By and large, corporate HR people. Companies buy health insurance for their employees for two primary reasons: (1) healthy workers (and workers who are not losing time fighting with insurance companies) are generally more productive than unhealty workers, or workers who are stressed out from dealing with the health insurance carrier; and (2) it costs less to provide group health insurance than to pay high enough salaries so that everyone can go out and buy individual health insurance.

When employees start bitching to HR about the health insurance carrier, HR pays attention, and if the problem doesn’t get fixed, that carrier gets kicked to the curb. It happened at my company last year. United was a flippin’ nightmare to deal with. We’re now with Aetna.

It shouldn’t be different in the individual market. If your mailbox is anything like mine, it gets a fairly steady stream of come-ons from insurance companies (my fax machine also gets a steady stream of illegal junk faxes from them, but that’s another story for another thread). If you don’t like the service you’re getting from your current carrier, there are multiple other carriers out there who will be more than happy to take your money and try to earn your repeat business by providing superior service.

Markets have a tendency to work if you let them.

There is so much wrong with this I don’t even know where to start, but to begin with, what if the way you find out that you company is not serving you well is when you are already in the midst of a catastrophic illness and you suddenly find yourself tens of thousands of dollars in debt and your credit destroyed and none of those insurance companies in your mailbox want anything to do with you? And that’s assuming you’ve gotten the care you need and that someone down the bureaucratic line didn’t nix your treatment for reasons of corporate profit and you’re not struggling with the problem of, you know, dying.

It’s well and fine to take the “long view” and discuss these things in the abstract if it’s not you.

Hugh @ 110

AZ Matt @ 92

Gutsy!

I have to agree with the government on this one. I think the threat from terrorist Martians has been grossly understated. I suspect this is all part of a larger plot by the Neptunians. You know, how they are.

The Plutonians are really pissed cuz they got downgraded.

jayt @ 113

These idiots don’t care about the harassment issue because it is your word against theirs. If you read a few messages up, I left one for Jane about a letter you can send to halt collection — and agencies can really get hung out to dry if they violate it. Since they are not the original creditor, they cannot continue to try to collect in any way. The original creditor can, but will likely just send it to another agency.

Check out http://www.ftc.gov/os/statutes/fdcpa/fdcpact.htm, which is the text of the Fair Debt Collection Practices Act.

burnspbesq @ 115

(snip)
Who makes the decision about who to buy health insurance from? By and large, corporate HR people. Companies buy health insurance for their employees for two primary reasons: (1) healthy workers (and workers who are not losing time fighting with insurance companies) are generally more productive than unhealty workers, or workers who are stressed out from dealing with the health insurance carrier; and (2) it costs less to provide group health insurance than to pay high enough salaries so that everyone can go out and buy individual health insurance.

When employees start bitching to HR about the health insurance carrier, HR pays attention, and if the problem doesn’t get fixed, that carrier gets kicked to the curb. It happened at my company last year. United was a flippin’ nightmare to deal with. We’re now with Aetna.

It shouldn’t be different in the individual market. If your mailbox is anything like mine, it gets a fairly steady stream of come-ons from insurance companies (my fax machine also gets a steady stream of illegal junk faxes from them, but that’s another story for another thread). If you don’t like the service you’re getting from your current carrier, there are multiple other carriers out there who will be more than happy to take your money and try to earn your repeat business by providing superior service.

Markets have a tendency to work if you let them.

Um, burnspbesq? That only works if you WORK for a large company that provides health insurance, and, in many states, do not have a same-sex spouse (because they won’t be covered) or any other non-covered dependent.

So basically you’re saying that the unemployed and under-employed and small business owners and their employees are out of luck?

More importantly, all those lovely insurance offers hitting your mailbox are garbage — unless you are healthy, young, and in no need of insurance. If you have ANY pre-existing condition, forget about getting coverage. Period. You will be denied over and over again — and I have the paperwork to prove it.

You’re living in a dream world there, burnspbesq, and you’re one ‘reduction in force’ away from COBRA payments that’ll drain your savings — and that’s just 18 months for overpriced coverage. After that, you’re on your own.

Better hope you never had any back problems, asthma, headaches, or a wife of childbearing age — as these are all reasons that can be given to deny coverage.

Another lovely habit insurance carriers have pushed onto companies is they now often disallow coverage for pre-existing conditions. Oh, you’ll get covered…just not for the ongoing oncology treatments for that enlarged prostate that caused you to have to quit your last job. (Just as an example.)

Markets have a tendency to work — if properly regulated. If you ‘let’ them do what they want, you get an out-of-control parasite that is happy to kill its host organism for the sake of next quarter’s profit margins.

But it’s long since time to take BASIC healthcare out of the hands of the market and make it a simple human right. If there aren’t enough doctors and nurses to provide every child in America with immunizations and exams and basic care — we need more doctors. If there aren’t enough clinics to provide standard diagnostic tests and treatments, we need more clinics.

If there’s not enough compassion in America to say that EVERYBODY deserves basic care — we need more empathy for one another.

We’re not saying “Diamond” level care for everyone — just the basic stuff here. Surely America is wealthy enough for that? Hell, EVERY OTHER ADVANCED NATION IN THE WORLD does it. Why can’t we?

Oh yeah: All hail the God of Market. Yeesh.

The concept of insurance, before cdos, SIVs, conduits, or what have you in finance was to pool money among all subscribers so that that the relative proportion who needed the coverage would get it. It is the job of the actuary to actually figure out what kind of contribution should be made by subscribers. It’s called a premium. It was sort of a social contract between members, so that large unplanned expenses could be incurred without impoverishing individual subscribers. Sound familiar?

My amusing healthcare story (I have some unamusing ones, too). The birth of my 2nd kid was done by a midwife, in a ‘birthing’ room at a good hospital. 5 hours from when we went in to when we came out. No drugs, no doctor, no nursery, only the one room.

I ask the hospital for the detailed bill, but the only send me a one liner, and it’s humongous. I keep trying…

Meanwhile, insurance finds something wrong in the paperwork, decides it’s only going to pay one part, and that at 50%. That decision, of course, takes forever.

So at about the same time, I get the decision, and the detailed bill. The hospital billed us for delivery room, nursery, 24 hours… the whole 9 yards. I inform them that they’re wildly mistaken, and get a new (correct) bill. Which comes almost exactly what the insurance was willing to pay on the inflated bill.

So I smiled and kept my mouth shut.

Oh Jane- You should not be going through any of this…the test you had was needed, so needed…and you are even recieving treatment based on that test, they have no right to refuse….but you know all of that…and that you are being harrassed by Bill Collectors is also wrong…as a nurse, and an uninsured nurse, I so understand…but I also have been helping my neighbors fight Insurance bills and harrassment…so if I can help you…a blogger neighbor I offer that…enigma4ever@earthlink.net….I have been a nurse for over 20 years, I am great at analyzing Medical Bill bullshit….fight on good woman…give them hell….

Several years ago my son fell at a friend’s pool party and needed 8 stitches in his chin. I received the bill about 2 weeks later–$800.00 I called them and told them that next time my son needed stitches, I would bring him to my taylor, who charges $6.00 to hem a whole skirt.

Canadian story

A couple of years ago, my optometrist told me she thought I had the bane of middle aged women, closed angle glaucoma. She sent me off to an opthamologist to be diagnosed and treated.

Six weeks later, I was in his office, where he confiremd the suspicions. He apologized that his next day in surgery (Tuesday) was fully booked. However, he had space on Friday.

I was astonished. I thought that specialists and surgery meant long waits. So I asked him if this was on the provincial plan or if I had to pay for the laser surgery to my iris.

He twinkled as he spike his rejoinder: “Only for the parking.”

I was out of the hospital in 3 hours and back at work on the Monday.

Once again – for all of you Californians – SB840 (Keuhl) Universal single-payer healthcare for ALL CALIFORNIANS regardles of employment status, income, age or immigration status. This bill coversa everyone by using the current profit margin of 30%(or more) It cuts out the insurance industry. Thsi bill, unfortunately, has been pulled in order for the “leadership” of both parties to work out a deal that still guarantees the insurance industry a larger pool of folks to bleed – why? Because the industry pays big campaign dollars. Until and unless the elected start doing our bidding, and not that of the corporate overlords, its just business as usual.
I expect that Senator Keuhl’s bill will come back in the future as a voter initiative.
It makes sense. It returns decision making power to the dr.’s and patients. It saves money and makes sense. It’s a model for
national universal single payer. Check it out.
Status quo is literally killing us.
As for the question about profit and what level may be acceptable – the same level of profit that we grant the fire department. NUFF SAID!

burnspbesq @ 93

Brisingamen @ 69

burnspbesq @ 56

What we’re saying is “Universal Health Care” not INSURANCE.

Health Care cum Insurance Companies became more concerned with producing profits for shareholders, rather than taking care of patients — that’s where things went wrong.

And it’s not just patients who are suffering. Nurses are underpaid and overworked, because for-profit hospitals try to do more with less staff. This isn’t just bad for the patients, it’s bad for the nurses, they burn out quicker and leave in droves.

Doctors order tests, and insurance companies say “no, not necessary” and the person making this decision does not have a medical degree, much less a license to practice.

Health Insurance is breaking the health care professions just as much as Bush is breaking our military. Someone needs to put a stop to it.

Hold up a sec. I’m not the enemy here. I’ve got my own set of issues with the status quo. I’m just trying to understand what it is that people want, and figure out how to get there.

But what I see here is a lot of people who seem to be in denial about two fundamental truths: (1) nothing is free; and (2) nothing exists in infinite supply.

Even under a pure government-provided single-payer system, your access to healthcare is going to be rationed somehow, because as a society we aren’t ready to pay “whatever it takes.” SOMEONE is still going to be a gatekeeper.

It may be a scheduler at a clinic, who tells you you have to wait a period of time that you’d rather not wait before having a procedure done, because demand has outrun supply and they can’t increase capacity overnight. It may be Congress deciding that “this year, given the tax revenue that’s available, we can build ten new hospitals or one new aircraft carrrier, and we need the aircraft carrier more than we need the hospitals.”

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

No disrespect intended, but I happen to think that I’m more capable of making smart,informed decisions about my family’s healthcare than anyone else. And I have a problem with giving up that autonomy.

It would not be unfair for you to ask whether my beliefs on this issue are influenced by where I sit on the income-distribution curve. And I’ll answer that question honestly: yeah, they probably are.

But I generally believe that individual autonomy is a good thing, and I have a problem getting comfortable with a system that would take fundamental decisions about the quality of your life out of your hands.

Be careful what you wish for; you may get it.

For many of us, this is ALREADY the system we have, where we have almost no choice at all, and pay alot of money for that non-choice.

burnspbesq

you ask a stupefying question as to what should be a tolerable profit margin for health care. Should not access to health care be a human birthright? I do not understand how you lot put up with this mess – politicians in all other ‘developed’ countries wouldn’t even dare go there. Even Howard, the Aussie neocon, had to backpedal heavily on dismantling Medicare here. We’ve won a few fights lately and the support was across the political spectrum of all parties with female Members of Parliament and the Senate taking the lead, including, free morning after pill, free vaccination of all girls in Years 11 and 12 against HPV, free mammograms for all women over 40 years (should be 30 years but lost on that) and a few more. I had been in the USA but seconded to the UN as a Federal public servant so was totally covered by my Government – I wouldn’t have stayed any other way. I can’t even comprehend how you can tolerate your situation and swallow all that nonsense about ’socialised medicine’. Its the same re broadband access – I was amazed how much of your country simply doesn’t have it.

BC/BS just paid my surgeon for a back operation I had five years ago. Nothing was denied, so why the wait? Geeze.

Biggus Diggus @ 25

I don’t know why there aren’t riots in America over health care. You have to be Tony Snow and work for the government to get a good plan these days it seems.

You know, this is why I get so viciously sarcastic over people who start muttering about the Second Amendment as a guarantee of freedom. If you won’t take up arms to get back at a system that may literally have condemned you to a painful death for its own profit, then why would you take up arms against a “soft” dictatorship that poses you no immediate threat? Seems that when resistance is concerned, a lot of Americans are all hat and no cattle. They’ll hug their useless guns like a baby’s pacifier, but are pretty crappy at actually getting a popular movement going or doing something practical to change the situation. (Present company excepted, of course.)

I know I’m behind the curve here on FDL, the way discussions take place (or don’t) once a new post is up but I have a couple of things I want to mention.

When people start talking about reforming our health insurance system, don’t roll your eyes and stop listening when they talk about “transparency” of charges. Here’s a little tale:

I am fortunate to have health insurance through an excellent PPO. I just had a lumbar laminectomy with fusion. I arrived at the hospital at 7:00a in the morning and went home the next afternoon at 2:00p. The hospital bill was $38,017.16 The insurer allowed (and the hospital accepted according to their contract with the insurer) $3,584.38 and that was it! Not even 10 cents on the dollar!

The surgeon fared a little better. His bill was $38,173.00 and, according to his contract with the insurer, accepted $4,906.64 as payment in full.

So, the question is what the hell is the real charge? The providers have contracts of all sorts with a plethora of insurers with whom they have agreed to accept a pre-determined fee. The charge is one thing; the accepted payment is something else completely.

My advice to those with insurance who lose their fights WRT medical necessity or the like, is don’t back down from the providers who will, of course, try to charge the “sticker” price rather than the fee they’ve agreed to by contract with your insurer. Even if the insurer won’t pay it themselves you shouldn’t have to pay the full billed amount and if the $$ are big enough, I think you could easily find a lawyer who would be happy to make some case law on this issue.

I think this whole area is the most abominable of all the scams of our health insurance system. The people who don’t have insurance get stuck with the outrageously out-of-line billed fee, while the insured pay 10-15% of that. Disgusting! And yes, SiCKO!

If, as you posit, “insurance company profit” is “in conflict with the health care needs of the insured,” then if the market for health insurance is competitive (which it is), the problem takes care of itself over time.

BWAAA-HAAA-HAAAaaaa

[ explosion of laughter segues into quiet, heartbroken sobbing ]

You need to get out more.

I’m not usually one to just ridicule a statement without even bothering to refute it, but if you think that the free market is the solution rather than the cause of the problems so pathetically documented up-thread, you’re seriously delusional. And almost certainly young and healthy, or you have a job with excellent insurance that insulates you from thinking about what it might be like to have crummy insurance. Or none. Or to have beloved family members who have shitty insurance. Or none.

Senator Warner announced he’s retiring when his term ends. He said most important to him is the men and women in the armed forces. And also what’s best for the nation.

When asked what he thought about the job Bush had done, he said Congress made a law and Bush was to respond in 15 days and he would wait till he heard from Bush. He said something about the the branch of Congress having equal power (as Executive branch). Wonder what’s going on here? Some thing to watch.

I recommend watching Sen. Warner’s announcment to retire if the video is replayed on Cspan.

Sounds like Warner is not only not backing Bush, but crossing the isle to our side and he’ll probably bring some fellow co-workers with him.

My wife and I are in the enviable position of being Michigan teachers with strong union contracts. Our union has set up a non-profit insurance company, MESSA, and that arrangement is miles better than BCBS and others, in that a) their interest is in finding ways to cover what you need rather than in finding ways to deny coverage; and b) they maintain health records rather than turning them over to employers. Since she was diagnosed with breast cancer four years ago, she has had nothing but support from doctors and our insurance company–she has to listen to other people in the chemo room having to rule out some therapies because they aren’t covered (e.g., “experimental” and therefore not available).

Those who are in the position of negotiating contracts–when you look at the monthly cost, which is always high, keep in mind as well the hassle of fighting for what should be a basic human right, adequate health care.

Vulture, ghouls, vampires, Republicans and all around capitalists.

Jane

My heart goes out to you. You really should not have all of this on top of your illness.

One of the real joys of living in the UK is that we have a fully functioning National Health Service. It’s not perfect, and you can sometimes jump queues through health insurance (to my shame I have, but if you think you might have another heart attack before they get to you believe me principles aren’t in it).

Basically, if you get really ill, they do their damnedest to fix it and it comes free at the point of use.

Of course we pay more in taxes for it, but we think that is acceptable.

One of the interesting things is that here, even the Conservatives our slightly rightwing, (by your standards) party, has realised that you meddle with the NHS at your peril.

I shall remind my more right wing friends of your story to keep them focussed.

Wondering minds want to know.

Do Dr’s have equal access to hosp rooms for their patients? If only 20 rooms are available and 50 Dr’s want to preform elective surgery, how is it decided who get’s the rooms first?

Do Dr’s who bill higher fees (hosp makes more $) have better access to hosp/surigical rooms?

Do Dr’s who support certain organizations get more opportunities to use hosp services? Therefore making more $ than others.

Here in MI I have seen hosp with empty rooms but patients wait 8 or more hrs in emergency because the floor the patient needs to be on is not staffed with nurses. I was just curious how this works.

Figbash @ 142

I know I’m behind the curve here on FDL, the way discussions take place (or don’t) once a new post is up but I have a couple of things I want to mention.

When people start talking about reforming our health insurance system, don’t roll your eyes and stop listening when they talk about “transparency” of charges. Here’s a little tale:

I am fortunate to have health insurance through an excellent PPO. I just had a lumbar laminectomy with fusion. I arrived at the hospital at 7:00a in the morning and went home the next afternoon at 2:00p. The hospital bill was $38,017.16 The insurer allowed (and the hospital accepted according to their contract with the insurer) $3,584.38 and that was it! Not even 10 cents on the dollar!

The surgeon fared a little better. His bill was $38,173.00 and, according to his contract with the insurer, accepted $4,906.64 as payment in full.

So, the question is what the hell is the real charge? The providers have contracts of all sorts with a plethora of insurers with whom they have agreed to accept a pre-determined fee. The charge is one thing; the accepted payment is something else completely.

My advice to those with insurance who lose their fights WRT medical necessity or the like, is don’t back down from the providers who will, of course, try to charge the “sticker” price rather than the fee they’ve agreed to by contract with your insurer. Even if the insurer won’t pay it themselves you shouldn’t have to pay the full billed amount and if the $$ are big enough, I think you could easily find a lawyer who would be happy to make some case law on this issue.

I think this whole area is the most abominable of all the scams of our health insurance system. The people who don’t have insurance get stuck with the outrageously out-of-line billed fee, while the insured pay 10-15% of that. Disgusting! And yes, SiCKO!

You need to talk to an insurance bad faith lawyer. Please contact my friends, lawyers Steve Dawson and Anita Rosenthal, in Sedona, AZ. They specialize in cases like yours and routinely get spectacular results. The best way to reach them is at sadawson12@msn.com

Oprah is soliciting input from people who have sad tales to tell of dealing with insurance companies. I think that Susie Madrak has the link. So far I have decided that John Edwards has garnered my support by virtue of his stance on universal health care.

For a taste of the other side, try Megan McArdle’s site: http://meganmcardle.theatlantic.com/
She has been explaining the libertarian view of health care which apparently has something to do with whether Warren Buffett should get money from poor people to pay for his health care. Don’t ask.

OK, someone else might’ve noted this, and I just breezed right to the bottom of the comments after reading the posting, but there was a piece in the NYTimes editorial page yesterday (I think it was yesterday) about how, with 45 million uninsured, we are ALL uninsured.

Even for those of us with health insurance, we all run the risk of what Jane is dealing with, or having coverage otherwise denied, or having our doctor no longer accept our insurance, or having to choose between our premiums and other basic necessities, or having a loved one deal with a catastrophic illness without insurance, and on and on. Even with insurance, we all live with the uncertainty of our coverage, and the ramifications of living in a system where so many go without, and as such we are all indeed uninsured.

Vultures, to be certain, but how are we going to make change happen?

Even under a pure government-provided single-payer system, your access to healthcare is going to be rationed somehow, because as a society we aren’t ready to pay “whatever it takes.” SOMEONE is still going to be a gatekeeper.

Health care is already rationed. There are 47 million people in this country who have no health coverage. Every year, thousands of them die preventable deaths or go into bankruptcy. This doesn’t happen in civilized nations.

They pay the price so you can have “choices.”

According to Paul Krugman, “[E]very available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries—even Britain, which spends only about 40 percent as much per person as we do.” 7/9/07

Instead of picking apart other people’s ideas, where are yours?

sporkovat @ 27

The pharmaceutical and insurance companies are major supporters of Hillary Clinton.

For her 2006 Senate campaign, she ranked fourth in contributions from the insurance industry, and 20th in contributions from the drug industry

citation: Hernandez R, Pear R. Once an enemy, health industry warms to Clinton. New York Times. July 12, 2006:A1.

hmmm… follow the money, not the poll-driven, consultant tested, triangulated rhetoric.

From what I’ve heard, Hillary has always been in with the big boys’ insurance cos. It was the small and medium sized insurance companies that went after her in the early nineties since her health care plan cut them out of business.

get an attorney. quit messing with it yourself.

Late to the party as usual….

FDLers… I think this topic could merit its own blog, perhaps an annex to FDL? It’s too important, as revealed by content in the comments.

burnspbesq @ 115

Markets have a tendency to work if you let them.

Oh yeah, kinda like how the “markets” are working now. . .Or for the last hundred years. Are you Milton Friedman come back to haunt us?

Jane Hamsher @ 13

alank @ 6

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

Hey but we can all go to the emergency room, right?

The ER doesn’t deal with dental problems!

I had a problem with a tooth and went to the ER on a weekend, just to get some pain killer to last me until I could get in to see a dentist. What’s up with hospitals not handling dental problems? Don’t they realize that’s a health care issue too?

No Blood for Hubris @ 95

“Not medically necessary”? …

If the doctors say it’s necessary then why should ANY insurance company ever be allowed to contradict that?

MarkH @ 159

No Blood for Hubris @ 95

“Not medically necessary”? …

If the doctors say it’s necessary then why should ANY insurance company ever be allowed to contradict that?

As you might have seen in one of the entries above this is one of the problems with Medicare claims. I audited Medicare hospital and nursing home cost reports for nine years so I ran into this a few times. It will have to be addressed even under a radically changed system.

I’ve always liked a pragmatic approach to things- eliminating private insurance seems so unlikely that I want to hear about something practical instead. But that moment in SiCKO where Moore asks the Canadian resident, “what’s your deductible?” and you can see the look of non-recognition of the term in the person’s eyes and then the recollection-”oh yeah, that’s something they have in the States.”

I want some of that – my daughter had an unscheduled appendectomy last November and what was my deductible? It had recently been changed, which is always bad news. It turned out to be $2,000 (two thousand dollars) and I’ve been asked to pay about $2,400; still trying to get the excess amount removed from the bill.

I hope that just maybe, to compensate for the absurdity of the early primaries, a benefit might be found if the Democratic candidate can then have a discussion and try to answer Michael Moore’s question, “what kind of people are we?”

burnspbesq @ 41

newdealfarmgrrrlll @ 18

Health care! these insurance companies are totally and ONLY in the business of making obscene profits. They don’t make profits if they have to pay for medical care.

I am not trying to be a pain in the ass or a troll in asking this question, because I am genuinely curious, but what level of profit (measure it any way you want — operating margin, return on equity, whatever) would you consider not obscene? And why do you draw the line where you draw it?

None. Just like medicare. Which would reduce administrative costs from 20% to 30% down to the 2 or 3% medicare has. Americans pay 50% more for healthcare than the average OECD country and receive substantially worse care on almost all the metrics while having over 40 million people uninsured and tons of people who are ostensibly insured who don’t get the care they need.

Margot @ 84

I got calls after being hospitalized from a collection agency. They demanded a huge payment. I said no, I could pay them $20.
“Richard” from “Chicago” (Dinesh from Mumbai, more likely) said, “That’s an insult, no way would we take that! Next time you go to hospital, they won’t take care of you! We’ll sue you!”
So I said, “Fine. Then I’ll die. No problem. Or you can sue, you’ll get nothing. Up to you.”
Next time they called I told a supervisor the same thing. Fuck’em.

Collection agents are really only scary to the middle and working class. The really poor just say “fine, take me to court. I got ‘nuthin”. The rich sic their lawyers on them.

But for the middle and working classes they can be terrifying, because they threaten to take everything, they call everyone, and they will even call your employers. So make sure you know your rights, take no crap from the, record every call (check your state laws on the legality of recording calls) so you can prove they’ve been abusive (and 90% of them are). And make your offers by registered mail.

burnspbesq @ 93

Brisingamen @ 69

burnspbesq @ 56

What we’re saying is “Universal Health Care” not INSURANCE.

Health Care cum Insurance Companies became more concerned with producing profits for shareholders, rather than taking care of patients — that’s where things went wrong.

And it’s not just patients who are suffering. Nurses are underpaid and overworked, because for-profit hospitals try to do more with less staff. This isn’t just bad for the patients, it’s bad for the nurses, they burn out quicker and leave in droves.

Doctors order tests, and insurance companies say “no, not necessary” and the person making this decision does not have a medical degree, much less a license to practice.

Health Insurance is breaking the health care professions just as much as Bush is breaking our military. Someone needs to put a stop to it.

Hold up a sec. I’m not the enemy here. I’ve got my own set of issues with the status quo. I’m just trying to understand what it is that people want, and figure out how to get there.

But what I see here is a lot of people who seem to be in denial about two fundamental truths: (1) nothing is free; and (2) nothing exists in infinite supply.

Even under a pure government-provided single-payer system, your access to healthcare is going to be rationed somehow, because as a society we aren’t ready to pay “whatever it takes.” SOMEONE is still going to be a gatekeeper.

It may be a scheduler at a clinic, who tells you you have to wait a period of time that you’d rather not wait before having a procedure done, because demand has outrun supply and they can’t increase capacity overnight. It may be Congress deciding that “this year, given the tax revenue that’s available, we can build ten new hospitals or one new aircraft carrrier, and we need the aircraft carrier more than we need the hospitals.”

But the simple, inescapable fact is that in a public-sector-only system, you are not the ultimate decision-maker with respect to your healthcare choices.

No disrespect intended, but I happen to think that I’m more capable of making smart,informed decisions about my family’s healthcare than anyone else. And I have a problem with giving up that autonomy.

It would not be unfair for you to ask whether my beliefs on this issue are influenced by where I sit on the income-distribution curve. And I’ll answer that question honestly: yeah, they probably are.

But I generally believe that individual autonomy is a good thing, and I have a problem getting comfortable with a system that would take fundamental decisions about the quality of your life out of your hands.

Be careful what you wish for; you may get it.

You are, of course, free to believe what you want. It is, however, simply a FACT that Americans pay more for worse healthcare and ration by price. In fact the US pays more per capita in government spending than some OECD companies, and not much more than many others.

And yes, if you don’t want universal healthcare, you are, in fact, part of the problem. You are spewing propaganda that is functionally a lie – again, in other OECD countries, they pay less and on the measured statistics, get better care. And there are no uninsured. Of course there is rationing, as there is in all systems, but it isn’t rationing on price.

The funny thing about your rationale is that unless you’re truly rich, odds are that a severe illness in your family would bankrupt you no matter what insurance plan your “choice” has given you. 50% of US bankruptcies are related to medical expenses and most of them are from people who were insured.

I’m really sorry, Jane. Just when you need all your energy to fight for health, you have to undergo this harassment and mental torture. Just let us know if we can help with $.

How about turning the tables on the collectors by simply publishing the collector’s information online, and we collectively (pun intended) start bombarding them with calls asking them why they’re trying to collect on claims that Blue Cross (or any other insurer) hasn’t paid? Or start making our own collection calls to Blue Cross Blue Shield?

There’s power in numbers friends….

-Tim

Let me preface by saying that I firmly believe in universal health care, I think health benefits as a for-profit commodity is immoral. However, the question that everyone needs to ask when a service is denied is whether your plan is “fully insured’ or ‘ASO’ (administrative service only. If your plan is fully insured the insurance company is making the coverage decisions and you can fight them all the way to the state insurance commissioner. If your plan is ASO YOUR EMPLOYER is making the coverage decisions and you need to spend your energy fighting your human resouces department. I think people who are denied should fight everything but often people waste energy fighting the wrong entity because no one will ever tell you, unless you ask, if the plan is fully insured or ASO. Just wanted to pass that info on – keep up the good fight – Heathcare is a right not a privilege!!!

Addition to my last post: For a fully insured plan the insurance company’s money pays for the service so their bottom line is affected. For ASO the employer providing the coverage pays for the service.

Govt insurance is NOT the best. I know, I have had fedgov ins for the last 30 years. The dental is totally pathetic, it is only included because the fedgov says you have to have it, so dental pays out about $6. for anything. I don’t have(and never have had) an HMO. rather I have a PPO plan from fedemployees BC/BS which is not bad at all. In 1998 I spent 10 days in Hosp with a pulmonary embolism, wound up paying less than $100-of course I came in thru the ER, in 2002 I had a DVT which put me back in hosp for another 10 days, once more bill was less than $100. The only really good thing about federal health insurance-well 2 things actually-you can change insurance every november if you want to, and, they can’t deny you for a “pre existing condition” other than that, nothing. I pay $3000 a year, for just myself. When my wife was on my ins, it was about $6000 a year-and I am retired-now she has ins that is even better than mine. CHAMPVA-which because of my 100% VA disability she gets for free. I also have VA medical and dental benefits(which started in 2004) but it is so hard to get an appointment in the VA system, they are just overwhelmed, esp now that the Iraq/Afghanistan vets are coming into the system. BTW, I just had an appointment for some surgery at local VA hosp, and as I spent quite a lot of time waiting I got to talking with many other vets who were also waiting. NOBODY, NOT ONE PERSON had anything good to say about either bush or the repig congress. I did hear many saying some good things about the dems, but most expressed much (anger? not quite, but can’t think of another word) about the dems total lack of spine esp in dealing with matters dealing with the VA Semper Fi

Jane, good luck with your struggle.
A few years ago i had to deal with collections while i was suffering from a mental collapse.
I hope that everyone will see this as something that affects us all. I worry about all the poor vets who have so little help dealing with that system and for the elderly who are too frail and hurt to jump through all their hoops.
I could go on and on but the bottom line is that no person should have to have their health and lives held hostage for dollars.

Jane Hamsher @ 13

alank @ 6

The long and short of healthcare in America is that it works as long as you stay healthy, don’t get sick, don’t get hurt, or don’t otherwise need medical attention.

Hey but we can all go to the emergency room, right?

Yeah, here in Los Angeles – we could die right on the emergency room floor!

Ain’t we lucky to live in the greatest country in the world?????????