Oklahoma Senate candidate Andrew Rice, on his family's recent tussle with their health insurance provider after their 11-month-old son was hospitalized for pneumonia (via BlueOklahoma):
One month later we learned that our health insurance company was refusing to pay the $10,000 hospital bill because they said our baby Parker had a "pre-existing condition." I'm not kidding. When we argued that baseless reason away, they changed their excuse to "improper notification" by the treating physician, and said it was not a big deal because the hospital would just "write it off." They don't think it is a "big deal" to avoid providing the coverage we pay them for every month, and instead have the Oklahoma taxpayer foot the bill. That tells you something about how they see the world.
Not until they learned that Apple is a physician did the insurance company bureaucrats finally admit they had made a mistake and agreed to pay the legitimate claim....
The career politicians in Washington do not have the courage and integrity to reform this system, while 47 million Americans go uninsured and those of us who are insured must fight a system that is structured to deny claims first and ask questions later! (emphasis mine)
When you contrast Andrew's record with that of current Sen. James Inhofe as Senate2008Guru has done, the need for real change becomes crystal clear.
We have had our own family battles with insurers, and they usually end at the point where I mention both my husband and I are lawyers and can read our coverage provisions -- and say the words "bad faith." It is beyond annoying to have to go through this while paying substantial monthly premiums for coverage. Especially given that most folks throw up their hands in disgust and just pay for things that ought to be covered.
Which is really the point, isn't it? Profit by attrition.
Let's ask tough questions on health care, beginning with those that Ian points out in this thought-provoking post on our current system and potential changes. And this one about costs to all of us. Because it isn't just Andrew Rice: Jane has battled her insurer on whether her surgery to remove invasive breast cancer and subsequent chemo was "medically necessary." I've had hassles with my chronic lupus diagnosis, but not to the extent that Jane has the last year or so. My point? We are both well-informed consumers who aren't afraid to speak up if there is an issue...and yet we haggle, too.
So long as insurance companies are for profit enterprises, their goal will not be the best health care possible. It will be this -- not paying claims. That is the truth of it, because that is how they profit. For real change, we need better, smarter folks elected to represent OUR interests, not just the biggest contingent of lobbyists and campaign cash.
You can contribute to Andrew Rice's campaign here -- one of our many excellent Blue America candidates. You can also make a big difference campaigning on behalf of progressive candidates in your area. Real change happens one election at a time...here's to a whole lotta good change in the near future.
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Hi Christy.
Hi Christy…
Redd!!!!
Morning all. Good to see you MissAnn — how are things with you these days?
Health Care Reform!
Yeah! Look at Gilda Reed in LA-01 she is fighting the good fight!
Not much to say - you said it all: Take the profit out of health care.
These days when a person needs medical care, they need a doctor and a lawyer. I think “bad faith” and complaint to the State Insurance Commission only work if the insurance co thinks that the persons has the resources to follow up.
I remember that. I was quite amazed. What moronic nonsense…
Is this a specialty field of law now? Fighting insurers for denial of medical coverage?
I was so horrified by the idiocy of saying to a state Senator and doctor that they shouldn’t worry about their medical bill because the hospital would just write it off. Jeebus, that’s insulting on far too many levels, not the least of which is how it would affect their credit rating and the insurance company customer service person could clearly care less.
Sometimes, you just want to throw up your hands and laugh at the absurdity…
Worth saying every time this subject comes up. Insurance is the ultimate moral hazard industry. Earns higher profits but not fulfilling its function. Not unique to medical insurance. Just ask any Katrina survivor (including Trent Lott).
And why the Ds want to make “insurance” the arbiter of universal medical care is a mystery to me.
Fabulous. I am heartened by our Yahoo group in LA. Great things are happening. New folks are running for the Dem central committe. The grassroots are trying to basically create a party from nothing. Very very exciting. The folks that have been in charge here in Louisiana have been letting the party die a slow death. Well I am here to say we are a swing state and always have been.
Mom is doing well with her cancer. She is traveling and enjoying life again.
We still have lots of work to do in the state of LA, but things are looking up for me. New Orleans is as fabulous as ever. We have about 150 more restaurants than before Katrina. Probably all good too!
Hope you are having a great New Year!
I think “bad faith” and complaint to the State Insurance Commission only work if the insurance co thinks that the persons has the resources to follow up.
What - you don’t have a friend or family member who’s a lawyer?
Think about it. *Sure you do*. heh.
That’s where we turned a corner in the way people regard Health Ins. Not only is it too costly but now they don’t even pay the goddamned bills.
I am, as a matter of fact. And I am happy to say that I am eight pounds down and counting on my New Years “get healthier and exercise more” resolution. Boo yah!
Thank you for the post. Healthcare is a mess.
As someone who is fast approaching 65 I have been inundated with “information” pamphlets. I am utterly and totally confused. The only this I know is that I am going to get royally screwed it is just going to be by who. The system sucks.
Good Post CHS
I’m hip to this, and this needs to be brought to the front. Hell of an issue for a progressive presidential candidate. Do we know anybody like that ?
The US badly needs to invest heavily on its future: education and health care, for starters.
‘morning CHS. Thanks for the post. This is a big, big deal for CBL and I. Our cost for covering her and our 16 year old son on my employer provided policy has just gone from $605.00 a month to $660.00 a month. When GWB took office our (CBL and I) company paid $587.00 a month for a family of 4. The new coverage is not even comperable to what we had before. However, we are finally reinsured after 3 extremely tense years without. Thanks again for highlighting this issue.
I am for total universal health care. But I do remember a time when insurance companies were not so hard to deal with. In 1987 my first husband, a physician, became neurologically impaired and eventually passed away. We had health care through Allstate (i think)and it was a very good policy. But in the middle of his illness the policy was rewritten for the rest of the family. They were bound legally to continue his medical care. I see this moment in time as the beginning of the end of a fair and substantial health care industry. It has been degraded by pure greed and purchased politicians. I guess my point is one that we all accept. Over time the insurance industry has won the right to kill us with their concern for the bottom line.
Vote for the candidate who will effect the most positive change in this amoral, fascist country we have become.
We have a friend who had two serious medical problems while living in Oklahoma and had no insurance. The doctors treated him great, but the hospitals are still after him to pay his bills. Even after declaring bankruptcy. “Writing it off” means the insurer doesn’t have to worry, but the patient still does, years later.
I’ve told this story before. My employer wanted workers to contribute more to the cost of health ins. (understandable). The union fought it (also understandable). We had no contract because of this issue for 2006 and 2007. Well, it’s been settled and we lost. Also, adding to the picture, I was promoted effective 1/1/08. I’ve now rec’d my first 2008 paycheck. Taking into account 3yrs worth of raises and a modest promotion, my net is down about $5.00/wk.
Indeed so.
Christy, succinctly stated and, ‘universally,’ the ‘truth’.
Our ‘leaders’ should be ashamed to accept their stellar benefits while many have none and the rest are hostage to simple, unrestrained greed.
Indeed. I find this inexplicable (from a common sense point of view only of course.)
in this amoral, fascist country we have become
You know, there was a time not long ago when my spine went wacky hearing “fascist” as an adjective for this country. It’s telling that that no longer happens. And a darn good thing, because I doubt my insurance company would cover spine wackying.
I worked in the billing office of a medical facility for fifteen years. I spent more hours trying to collect on unpaid medical claims from insurance companies than you can imagine. I think if everyone, and I mean EVERYONE, were required to share in this excruciating job, we wouldn’t have this problem anymore. The insurance industry is at the top of my list of criminal cabals and the politicians that cover for them are equally liable.
The only way that we will get single payer is if “Big Business” decides it is in their best interest and throws the insurance companies under the bus. The idea that “tax payers” would assume all of big business health obligations and costs pisses me off but that is probably what it will take. As an example, for every dollar that GM spends for health care, Toyota spends 1 cent.
We should collectively stop paying our health insurance. Oh yea, this is not voluntary anymore is it? We will stop paying health care costs because there is no money in the average American’s income as it spirals down into poverty.
This subject is one reason why I support Edwards over the other two front runners. And it is the reason he is not getting airplay on the corporate news hours. He is not afraid to tackle the issue because he made a career of fighting the big guys. Hillary has way too many health insurance sponsors who have decided to make nice with her and thereby preserve their profits (and existence.)
my guess is that health care costs is one factor in jobs going offshore.
This kind of behavior is what keeps me from signing up with any health insurance provider. (I’d like to have insurance, but …. I’ve heard way too many stories of coverage denied or care delayed. Or hospitals and doctors spending far too much time trying to get reimbursement from the companies.)
Christy -
When does the insurance company, which normally records its income and expenses using the accrual method of accounting, record a filed claim as a liability? How does it record claims in process that await approval? Are those claims treated as contingent liabilities? If so, they will not appear as liabilities, although, if I recall correctly, contingent liabilities should be disclosed in footnotes to the insurance company’s financial statements.
That was going to be my next point - that once business saw that they would benefit from a single taxpayer, then they would push for that reform.
Until recently, this average American was paying nearly $800/month for individual medical coverage. And when I submitted one of my very few claims (for orthotics to deal with a multi-sprained, and then arthritic foot), it was denied. $400. Half of one month’s premium.
As a self-employed small biz owner, I had to switch to a high-deductible policy last year. Monthly premiums for regular HMO (Kaiser) were just getting too high - $1000 for a healthy family of four. So now the premiums are half that, for what amounts to catastrophic coverage only. Up to $7k per year we are cash out of pocket. But hey! We get to use a health “savings” account, so it’s all tax deductible… The HSA model works only if you can manage to feed the account to the full amount ($5850 in 2007) which still leaves a coverage gap - our version of the Medi-Care donut.
Edwards has pledged to take congress’ healthcare away until they pass universal healthcare for all.
Surge Edwards…surge!
I need help with my theory here. If I take the 18,000 people a year in California who DIE from lack of coverage or failure of coverage and figure out this cost across the country and then multiply is by eight years of corruption I get over a million dead. I this is not a perfect way to come to this number but the only way I know how to do it.
one million dead.
oops I meant to say single payer, not single taxpayer @34.
Same opinion here. Where does Obama fit into this mess?
Here I go, talking to myself. P.S. The orthotics are a hedge against surgery. Looking only at dollars . . . . oh, never mind.
My salary hasn’t changed since Bush was appointed to office. With no place else to go, I’m glad just to be working. While I suppose I should show gratitude to the Republics because I’m not being forced into a gay marriage, it’s hard to feel anything but threatened by the economic situation they created.
People should understand that once someone develops a “condition,” they become a liability to their insurer, who then wants to get rid of them, i.e., wants them to die.
Bush seems to enjoy yhe deaths of others.
Welcome to the GWB ownership society. You own your own healthcare but you can’t afford it.
IMO, If a Dem becomes President, who it is will have little effect on the health care debate. It will come down to Congress and Big Business. All of my political contribs are going to progressive challengers for Congressional Seats.
I with you!
this is a subject dear to my heart because I have what I believe is a perspective that is not discussed but needs to be;
a the health of a companies labor force is important for their bottom line, just as maintenance of their machinery
why does their macinery get maintenance from the company and people do not?
the answer, the workforce’s health is an expense of the idustry and instead of paying that expense they defer the cost onto the middle class
health care must be provided by industry not the individual
now, you get that part of the discussion and I GUARANTEE “republicans” will get on board for a single payer national health care program
Yes it is. One of the leading law firms in this field is in Southern California. I actually specialize in insurance litigation but not medical insurance.
My question on this is always isn’t the denial of a claim saying it is not medically necessary the unlicensed practice of medicine, especially since most of the people making these decisions are not doctors. Something to consider.
I’m going to place my bets on John Edwards for President. Proverbial bets, that is, since there isn’t any MONEY left to put on the table.
I’m with you on this. That and $4 will buy you a hotsy-totsy latte.
Great point.
Bill Durston for congress!!!!! He is in district 3 running against Dan Lungren. He is an er doc, vet, and very progressive. Bill is the most honest man I know. Never would he turn into a blue dogger. Universal health care is one of his mantras. Here is his statement on health care:
“I believe that access to necessary medical care is a basic human right, not a privilege based upon one’s ability to pay. The United States spends 2 to 3 times more per capita on health care than the other leading democratic countries of the world, yet ranks below average in overall measures of quality, and is the only country that does not provide some form of universal health care coverage for all its residents. Throughout my career as an emergency physician, I have provided the best possible care to my patients without regard to their financial status. As a U.S. Representative, I will continue to be a patient advocate, and I will work toward a system of universal health care under which all U.S. residents receive comprehensive, affordable medical coverage.”
hmmm…sounds very promising!
As I was being treated for a ministroke, I had one doctor who was originally from Africa tell me I’d need an MRI and a drug such as Plavix. Then another doctor came in, realized I was uninsured and said, “You can take aspirin and have a CT instead.”
I looked at the nurse and said, “OK, never mind, if you’re going to deny me proper care I’ll just die.” So she went and got the social worker and started some financial aid paperwork.
Please remember this if you get in a situation like that (and you can still talk). Make some noise!
Here’s the link to Edwards’ positions on health care.
“Mandate” us till we wake up one morning with nothing! All a taken by corpogovernment! Keep up the good work CHS!!
Yes, another among the reasons Edwards is deserving of our support.
Further, it is not just the ‘economy’. It will take fundamental changes in the economic system and in the distribution of wealth to bring about the changes we need as a people, not just for our personal economic and physical well-being but for the restoration of democracy itself.
Edwards is, I think, far more aware of this and more likely committed to its undertaking than either Clinton or Obama appear to be (or would be allowed to be - sort of like the meaning of ‘is’ if you catch my drift).
Most of these doctors have contracts they sign with the insurance companies in order to get in-network wirte offs and such. Are there protections, inserted into the body of the contracts, for this kind of suit?
OT somewhat: In addition to healthcare plans, the Democratic front-runners have now crafted economic stimulus packages, and per Krugman:
Among other things, Edwards embraces/promotes a national strategy for cancer survivorship. Elizabeth, of course, but also my David, FDL’s Jane, and . . . ?
IMHO the whole health care system is broken. When I went to nursing school(the dark ages at a hospital school), the majority of hospitals were NOT for PROFIT, usually run by some religious group. I wrote two comments over at kos about my recent experience in the so called “Best” health care system in the world… ya right..
Since I met you at Yearlykos
Have cancer and can’t get chemo unless I pay
I support anyone who is willing to take on this giant. As a person who was a part of this system, someone who worked in the belly of the beast, who left in disgust. Please we need to fix it,
The insurance companies can also count on our inability to fight them or notice the BS while we are sick. Imagine, having to fight for medical care and for coverage of same while ill.
A few years ago I had been ill, and it was not until 9 mos. later when prepping for my taxes that I found they had denied coverage for a doctor I never saw (AFAIK) who diagnosed something the insurance company later said I did not have, but it was consistent with the diagnosis at that point.
I fought them and was reimbursed for that out-of-pocket, but it took a long time. I could never have done it while I was sick. And I barely figured it out from looking at the bills.
Obama is a stealth corporate operative.
I think it’s gonna be tough to get a dr to actually put his name to a denial of claim since they would loose their md license pronto
One example of how bad the insurance companies have become. My doctor now will ONLY bill Medicare. Other patients have to pay up front and then fight it out with their own insurance company. Thankfully, I will be going on Medicare with the next month. My doctor said that she simply is tired of dealing with the companies. Who can blame her?
me. Thrive not just survive!
OT..The latest from the Huckster:
link
Christy -
About time someone pointed out that any of the candidates’ plans that involve insurance are hopeless because even having insurance at best signs you up for a war with your insurer that you will lose more often than not. If you get your health insurance through employment, as most do, you are really screwed because the courts have held that your state law based bad faith claims are preempted by ERISA and ERISA provides no remedies at all. Single payer is the only answer.
OT, but somewhat important…
From Der Spiegel A Q&A with Bin Laden’s Second in Command
Christy’s post is excellent for two reasons:
1. A politician is making the case for better medical.
2. It is a step in the stairway to universal coverage:
Imagine all of the paperwork from all of the contested claims were supeonaed and stacked on the capital steps by a congressional committee headed by say…Rep Dennis Kucinnich (on NBC debate tonight) millions of yards of medical records even if just representing the existing files in medical offices and insurance companies all over the USA…huge evidence of all the contested SICKO non healthcare industry.
Faith based health care?
Oh, lordy, katymine . . . I am so sorry. I am SO sorry that this country has totally let you down. Crap. We have walked some of this with David, even when we bit the bullet and trekked to Mayo. And it’s a helluva bullet, let me tell you.
It is the insurance companies that are getting sued, not the doctors. The remedy against a doctor is typically a malpractice suit not a breach of insurance contract action.
A doctor that denies benefits without examining a patient is comparable to Bill Frist diagnosing Terry Schiavo via videotape as far as I am concerned and should be subject to discipline, at the very least.
By the way MsAnn, my wife, my daughter and I will be visting your fair city next month. We are all very excited at the prospect. Our thoughts have been with the people of your city since a certain, particular ’surge’.
I once got a very quick turnaround on a claim denial because the insurance representative told me that there were cheaper ways to treat my daughter’s strep complications. I happily told the doctor’s office and they blistered the phone lines for me about practicing medicine without a license. But, then that was in the ancient time of 2001. It might not work in the modern world.
One of my wife’s doctors will only accept Aetna because he hates dealing with multiple companies (or any at all, really). My employer, thankfully, offers Aetna, but it is $130/wk more (yes, more) than any of the other plans that are offered. There is no difference in what is covered, except the doctors.
faith based health care-”Please God, don’t let me get sick!”
I pray to God I’m covered for this!
Unfortunately, as president he would have no ability to do that. But it’s a good thought. (Edwards supporter here.)
He would have the soapbox to keep it on the radar tho.
sounds very christian and very scientific in a cristian scientific sort of way
*g*
What we need is universal health care NOT “universal coverage.”
Coverage = Insurance. Now, tell me who’s responsible for the current mess?
Right — Insurance companies.
Care NOT Coverage!
The current system still isn’t broken enough to overcome the years of “brain washing” of the evils of “socialized” medicine. The evolving economic “shit storm” (depression?) could change to public debate. Without torches and pitch forks by a very large majority of the public, single payer isn’t going to happen.
But if we have socialized medicine, I’ll have to wait for months to get my nose job.
My daughter had a biking accident during a p.e. class last spring. She was knocked unconscious and taken to the local emergency room. She was there for five hours. The bill was $25,000.00. The school paid for all of it but $4,000. The $4,000 that she had to pay would have paid for her first semester in nursing school. Of course, she had to borrow the money from one of the “privatized” school loan companies.
We live our lives looping through the bowels of corporate America until we have been fully digested.
CaliCat: I didn’t make myself very clear. My question was about the insurnace company being able to cover for the people on their review boards (nurses and doctors)that are responsible for the review and denial of claims. Not the physician that filed the claim.
And yes, the Bill Frist fiasco should be taken to court by all means.
I don’t mean to sound cranky, I just don’t have the refined communication skills as the rest of the fine FDL crew.
Faith based health care?
Nope - just your basic constitutionally-mandated theocracy.
there’s the thing though and that’s exactly why it’s NOT “socailized medicine”
social medicine implies the competitive market is not at work however the private sector can still compete and therefore this is NOT socialism
in addition, elective surgery would obvioulsy need private funding not public funding
Where only the ‘good’ is allowed insurance.
PJ
You can make a premium account for yourself say in T-Bills that pay interest. When you have a medical event you have some bucks to cover. Some medical offices and hospitals require insurance…don’t know how that will work for them. Anyone know why we can’t pay in cash?
Chronically ill people who have been reamed by the system have no cash or coverage.
It appears that on Feb. 5, I’ll have to choose between Obama and Clinton, even thought I prefer Edwards. I don’t particularly like either of them, Obama for his right-leaning domestic policies and rhetoric and Hillary for her right-leaning foreign-policy stances. Hillary seems influenced by the neocons and Obama by the paleocons.
OT
Lieberman left a robocall
for McCain on the answering machine of dKos diarist Brainwrap, who lives in Michigan.
My son broke his foot at school in May of ‘06. The bill for xrays and doctor care was $12 and I paid an extra $75 to have a waterproof cast.
He broke his foot again at school in August of ‘06. This time, the bill was again $12 but they sent us to an orthopedic specialist who decided not to cast it. No charge for the specialist.
We had high taxes, but still made more than most in our lower-income rural area. We lived quite comfortably (well, except for the fact that the houses aren’t heated in winter, but then there is long underwear!). We also knew that none of our neighbors, many of whom were very low-income, would be denied basic care.
No, not in America, but in New Zealand.
Survivors: Mr. Gnome and my mother.
Faith based health care: Thank God I live in Canada? (Which I don’t but I did once and delivered a baby emergency c-section and had the best care I ever got in a hospital, but that was 26 years ago.)
To the best of my knowledge any and all medical professionals will accept cash at the time of treatment. There are some who now deal strictly in cash, as filling out the paperwork required by the insurance companies has become too onerous.
…and Prairie’s Mr. Sunshine…
Christy, thank you for this post! The healthcare industry has driven many people to work, not for the income net on a paycheck, but the healthcare benefit…which too often they have to fight for. And more too often still don’t receive.
Again, the once-hads are finding how much has been taken from them.
I didn’t hear any reference to healthcare - I think he wants some kind of amendment re the sanctity of human life.
IOW, a dog-whistle to fundies that he’d ban abortions nation-wide - Roe v. Wade would be history, and that states would not be allowed to make any choice as to how they would treat the question. A federal preemption of abortion rights.
I just wish everyone would see “Sicko”. It was eye-opening for me. I did not realize that we are the only advanced nation that does not provide healthcare for its citizens.
Sorry I misunderstood. Many of the claim denials are not made by doctors or nurses on review boards. My point was that the denials made by non-licensed physicians may be the unauthorized practice of medicine, which I believe is a felony in most jurisdictions.
There are a lot of things we don’t do for our citizens that other advanced nations do. If the Rethugs had their way we would do a lot less. They seem to want to make us a third world country with a ruling elite and poor masses and not much inbetween.
You are, of course, correct. I was being snarky and trying to focus on candidate health policy.
Keep in mind that one of the best examples of successful socialism is the Green Bay Packers football team.
Community-owned.
Community-owned healthcare for all.
OT- the court ruled in Kucinich’s favor.He’s planning to be in the NBC debates.However, a Mr. Jeremy Gaines , vice-president at MSNBC is filing an appeal to stop him.
I really admire Dennis’s righteous tenacity. I was dismayed to learn he doesn’t offer health insurance to his campaign staff.
Much as I like Edwards, I’m not happy with his medical care proposals. Any serious plan has to provide for a transition to a single-payer system. Perhaps patchwork proposals such as Edwards’ are the best we can hope for right now, but until someone steps forward to take on the insurance industry, costs will remain obscenely high and our medical care outcomes will continue to lag those of the other developed countries.
Between 9/11/07 and 12/31/2007 my incurred medical expenses is around $75,000. None of this was elective as it was a medical crisis.
Returning from my surgeon’s office one day a caller into our local progressive radio station stated he had just totaled his wifes medical expenses for a year following the diagnosis of breast cancer…. over $500,000. In a single year…..
I just do not have that much cash on hand to pay those kinds of incurred expenses, THAT is why I have insurance.
We are there now. People have been able to prop up their standard of living
via home equity and credit cards. I, myself, am living on the last forking fifty dollars on a card. I may have to go see a doctor about this.
The system is totally crazy..for years, I discounted the patient bills to insurance..ie no insurance.. no charge..and no balance billing. The Feds made that illegal..you have to bill the patient and you can’t discount co-pays..
OfT - new polling data:
The poll further shows that 77 percent of Americans believe the country is on the wrong track, topping a record high in early 1996, when Republican congressmen shut down the federal government in a dispute with Democrats over funding.
In other words, a government run by George W. Bush is less popular than the complete absence of government. heh.
http://rawstory.com/news/2007/....._0115.html
True enough, but bear in mind they pronounce Favre fahrv.
They have got to put something in the water up there. Either that or community ownership does strange things to people. Once a cheesehead, always a cheesehead, even when they move away. Oh wait. This should be on EW’s Trash Talk site. Sorry. *g*
He’s speaking in GA to support a bill that would say “personhood” begins at fertilization and would, therefore, be a backdoor to ban abortions. Thing is, it would also appear to ban anything that affects pregnancy based on hormones (i.e. birth control) and open the door to murder charges for miscarriages if it could be shown that any action by the mother could have prevented the miscarriage.
Here is a link to an op-ed in today’s AJC.
WTF?
Insurance co says $10 thou is no big deal to hospital, they can just write it off & I think of my local small town hospital where most locals know the staff from administrators to doctors & nurses to the support staff personally. We appreciate the convenience & great care we have available to us. We support our local hospital in many ways. Most of us know that writing off thousands of dollars is a very big deal if we want to keep our hospital in our community.
America needs more news reporting on these issues:
http://www.calnurses.org/
Thanks CaliCat, I just wish there were balls in Washington willing to help us take this subject on. The money is dirty.
Busted. I am woefully ignorant about particulars. Point me to a good overview of health care reform, please!
It is hard to find anything other than free market oriented policy on the web.
http://www.calnurse.org/media-.....-plan.html
Edwards’ plan DOES transition to “single payer” — but it starts out giving people a choice.
I was never very interested in the “billing” but basically discounting bills or co-pays is IIRC a form of illegal competition. The doctor has to bill the patient 2 or 3(?) times. The is,however, no rule or law that the doctor has to try to collect the money. That was my way around the law..no one was referred to a collection agency.
I have a friend that owns a body shop I know him and a claims professional. They send the insured to two shops for estimates and then fix the car. Why not use the auto insurance mode. Everyone who drives has it, Everyone who breathes should have medical no matter how it is paid for?
‘Interesting’ no? The AMA fought this tooth and nail, or fang and claw …
Me too. We are cutting things to the bone. I have to track down a life insurance agent and cancel a term policy we’ve had on Mr. Gnome forever. It is more than the monthly payment on my car. My car gets paid off next year, but the insurance keeps rising forever. The doctors say Mr. Gnome will have a normal life expectancy, so we cannot keep paying on this stupid thing for 20 more years.
can’t you just bill the client and forget it when it’s not payed?
The health care crisis is long term, low level disaster capitalism.
I used to represent insurance companies and can tell you that they spend ALOT of money on their lobbying efforts at both the state and national levels. That is one of the strengths I see in Edwards being essentially an outsider. (Leaning to Edwards)
The disaster will be hitting a lot faster since we consumers are maxed out on our credit cards and have stopped buying anything but necessities. And sometimes not even that!
His position at the link doesn’t make any reference to this. It appears for all the world to be an insurance mandate system. If he’s, in fact, committed to a relatively near-term single-payer system, I’m with him.
But the best physicians do what Steve-AR @ 122 does.
Jaysus - that’s a whole lot worse than I’d thought. To be fair, his support of *that* ridiculous law may not be identical to the constitutional amendments he’s (not specifically) proposing, but it’s pretty goddamn scary nonetheless.
No sex unless for purpose of procreation, essentially.
(how’s that quote go? “I’ve never seen a white man more in need of a blowjob in my entire life”)
Massachusetts like California is trying to do, has mandated that the taxpayer now purchase health insurace. $60,000 per houshold or more and you are on your own. Now refuse to be hostage by not getting health insurance and tax code is use to penalize you. One tidbit, most of the insurers/providers/hmo’s are tax exempt corporations who lobbied Beacon Hill for the new law, and have the force of “mandated health insurance,” to keep them in business. What a deal for America!
Instead of “essentially”, I should have said - “among other things”.
God(dess) help you if you are self employed and have a chronic condition (diabetes). One insurance company gave us a quote of $1,100 a month, and that was just to cover me, Mr. Votus not included. We haven’t had health coverage for 3 years now–it sucks.
The doctors office I worked for, had to collect co-pays in full at time of service, per their contract with the insurance companies. For example: The physician has a preferred provider contract with Blue Cross Blue Shield, they are required by the contract to collect the copay at time of service. If the physician doesn’t collect the copay, they are in breech of contract. (IIRC)
I can only tell you what he said at the rally I attended. While his plan starts out being shared by the government and businesses, the aim is to get folks into the Medicare “doppelganger” Edwards’ plan creates.
Essentially, he’s sugar-coating the approach to what some call “socialized medicine.”
Thanks. This included a link to a site with more info, including a petition to provide everyone CheneyCare. References the deal about Cheney being treated for an irregular heartbeat and that he’d be dead by now had he been anyone else. Don’t start!! *g*
OT–
Mitt’s Rodney King moment:
What GdP said… it is an absolute moral tragedy how the insurance industry has debunked their paying clients…. get ride of deregulation, bring back strict regulation to all industries, deregulation and greed have brought us the mess this country is in. Capitalism will never function without proper regulation. To many insiders of industry are greedy beyond belief and have no morals and thus we have what corporate America is doing to the good people of this country. Lost jobs, lost homes, soaring bankruptcy and soaring numbers of families forced into emergency rooms for treatment being paid for by the public. just MHO
If you live in a state that has costco you can get a policy that is relatively reasonable. You need to have proof of a partnership. Make one up if you don’t already have one. You can go to your country or city and get a business license. That is all the proof they need. If you want more info you can reach me at mary at dahothouse dot com.
BCBS of Massachusetts: “Tax exempt not for profit corporation” ???????
The problem with that model is that it does not allow for choice of provider. I do not want to have to go to 2 or 3 different doctors in order for the insurance company to decide which costs less. I have a relationship with my doctor and find that adds value for me regardless of what the insurance company thinks.
Also, while the people you know seem very ethical, I have had clients who could not get their cars fully fixed after going to several repair shops. This model does not always work to the benefit of the insured person.
I don’t know about Mass., I’m in Missouri and didn’t work for a non-profit. Interesting question though.
Interestingly enough, Ron Paul has authored several bills in Congress trying to establish the same thing…odd because he has also been a big proponent of ending “anchor babies” citizenship rights.
Sicko was very moving. I already knew everything that was in the movie and more. I thought it was great how Michael focused specifically on people who do have insurance. That was a wonderful way to change the debate. Up until that point the debate was focused on insuring the uninsured which is noble but it allows people to think that it is an issue that does not affect them. “Those people don’t have insurance they need help not me I have insurance.” What the movie really hammers home is that the health insurance industry as it exists today gives folks a false sense of security. They pay and pay but as soon as they become sick or loose thier job they are in big trouble. Some are even in big trouble without losing their jobs because of denial of claims.
As John Edwards says the system is broken. The system is rigged against ordinary folks who are just trying to get by. The industry will fight this reform tooth and nail. I believe that whatever reforms are proposed we will be lucky to get half of it because of the special interests an
Congress’ willingness to pander to them. So we need bold ideas in this area because the powers that be don’t want to change the system that generates huge profits.
For that matter I think we need to look at other insurance reform as well. Exhibit A: Homeowners claims after Katrina. So what is the point of owning a home if you can’t be assured your insurance will pay? The insurance industry likes the system they have now that allows them to live by different rules in every state. They can lobby each legislature for favorable rules and if one state makes an unfavorable law it only applies to a portion of their business. This is a boon for them. So some states require them to cover birth control and others do not. The difference in just this one law is no doubt worth millions of dollars in the pockets of insurance companies.
Take that idea and multiply it over all insurance types and 50 states and you get the idea. Again the system is broken. We need the boldest of leadership if we are going to take back our country from the special interests.
It is fair for them to make a profit, but how much and at what expense? People are dying because they can’t get insurance companies to live up to their promises.
Ok sorry for the long post…this topic really gets me going!!!
Yeah but that is the guy’s name and he is from Mississippi!
At an Edwards houseparty:
Edwards explained that as part of the offering of both commercial and Medicare type coverage will be offered. It would be easier at first than driving loggerhead into the beast and IF everyone chose the equivalent of the government run such as Medicare for All or Congressional Plan then the commercial insurance plans will be relegated to the “extras” coverage.
Everyone knows about the January 18 fund drive for Edwards, right?
http://www.dailykos.com/storyo.....182/437130
Ah! *light dawns*
When I go to the doctor there is a sign that says “we must collect the co-pay..Fed Law…State Law…” There must be a work around for those who can’t pay it.
It’s obvious this is a sore subject. Why in hell are the Dems fighting about black, white, boy, girl and not focusing on the important issues facing us and our children?!! AAARRGH!!!!
It is a good idea but keep in mind in my state of Louisiana about 50% are uninsured motorists. So how do you get them healcare when they can’t afford insurance for their cars?
Of course 50% uninsured makes our car insurance very, very expensive.
Fund early, fund often…start the tide now…
Thanks for posting this link, solai. Will add to my site, too.
Oh, pups, ‘twouldn’t hurt to include this link in every piece of email you send out this week… evangelize, spread the word, guerrilla the market….
They are playing into the Republics hands. They really do not want to win.
Christy…quick OT question. Digby has a post up about Bush trying to tie the hands of the next President with regards to Iraq. Apparently, he is trying to work out a status of forces agreement to replace the UN mandate and, essentially, put our troops in Iraq indefinitely regardless of what the next President or the voters want.
I say bullshit but want an attorney’s opinion. I say that since this is NOT a treaty and requires no approval by the Senate, then it is no more binding upon the next President than the gag order is wrt abortion counseling or for stem cell research funding. I say that what one President creates with the mere stroke of a pen can be just as easily wiped away by the next Prez with a stroke of a pen.
What say you?
I also say that we must all extract from Obama, Clinton, and Edwards a comment that states that any agreement made by Bush is NOT binding on the next Administration, is fully and 100% provisional, and would be reviewed and amended immediately upon their taking office.
I agree. The only response I heard to this was “There are Medicaid plans available for you if you can’t afford copays.” They have made it sooooo hard for people to survive.
But, I don’t see any mention of the “Medicare type coverage” in his Web posted position. He only talks about insurance mandates.
Not to mention cutting We the People out of the loop :/
This is what burns me up. If you work for a big company you keep your coverage. If you are a small business they raise the premium to an unpayable level to get rid of you. If you lose your job and have a condition like diabetes, cancer, heart condition, seizures and a number of other things you are now “uninsurable”. You can do cobra but that only lasts 18 months if you worked at a company with greater than 500 employees. If you work for a small business in Louisiana your state continuation of benefits only lasts for 12 months. Uninsurable means you can’t get an individual policy on the open market. You can shut down your business and go work for someone who offers a group insurance or do without. Some choice aye? Considering small business generates many jobs in this country this is a huge disincentive for people who have a pre-existing condition to either start a business or stay in business for themselves.
Thank you, Mary!
This is all why I believe that the ONLY answer is non-profit based insurance. We must lock out any for-profit insurance companies from the core of US medical care and it must be replaced with non-profit insurance. It is unacceptable that treatments are based upon maximizing shareholder value or maximizing CEO bonuses.
That is a great way to end this discussion. The way we started it. Change the damn system!
Amen!
Republics will never understand this issue. Really, why weren’t we smart enough to be born wealthy like they were?
My bad
Coverage should be: medical care I agree with you. I should be more careful and write exactly what I mean which is single payer universal medical care (Kucinnich style). I used the word coverage to indicate “universal” for all. As I said:
1. A politician is making the case for better medical.
2. It is a step in the stairway to universal coverage:
Although you in a sense are making a circular argument I think you could say everyone gets the treatment required.
I would like to point out that as much as possible preventive medicine or lifestyle practices that promote good health should be a requirement.
1. No Smoking period get the patch get off of tobacco.
2. Exercise daily even disabled people can do breathing execises and some can do in chair or in bed routines like dynamic tension and strtching.
3. A good healthy diet less sugar and caffiene more roughphage.
4. Walk/run progrmas for the able.
5. Stress manage ment groups can help too.
Health is a two way street and I believe we are responsible to the degree we can live healthy lives.
6. If you are sexually active take precautions.
Ireland had a real economic boost when the state provided universal medical. Business like not having to pay unions and business can be sold. Also we will be qa healthier population with less carier. Check out the Center for Disease Cintrol web site.
Edwards Healthcare details [pdf]
Go to page 3
luck of the gentic draw!
I am looking globally and not intending to rewrite the insurance laws. Of course people that have catastrophic medical events and expenses outside their means deserve that assitance. One poster mentioned he pays the smaller exoenses out of pocket and has a high deductible that covers the more severe medical.
There is no one size fits all. Each case is different and I am not well informed in the subject. I have no medical insurnace or dental. I pay out of a disability check of about $900.00. I am not allowed to earn as it will be deducted or i may be disqualified and have no income.
My nieghbor friends hadf a cancer bout all last year and ended up wit huge bills somehow they are remodelling their house inspite of no chemo coverage.
Their are literally millions of specific situations and I have to generalize. Of course one with the size bills you mention can’t take it out of their cash flow, but many starting out healthy can.
Health Insurance is a risk pool. Coubty medical as state and federal are also risk pools those that are healthy pay in untill they get sick and have to get help. In theory any plan to keep us all well will do that.
Those who are well heeled may chose to have elite medical care that they pay out of pocket or through some insurersthat have high premiums.
I was ver glad to see my neighbor make a good recovery for his cancer. And I certainly wish all well.
Schock Doctrine: keep them weak then they can’t resist..disater medicine what a hypocratic disater.
That is the idea, “corporate constitutional usurpation” enabled by “corporate aristocrats,” like??? Want to name a few????
Jefferson’s worst fears for America’s future, all enabled by the failure of politicians to follow the rule of law, while continually working to usurp it.
Like, since when is “torture” not illegal, Shrub? Answer: Since shrub and the DOJ’s OLC said so. Oh I forgot, Congress makes the laws right!
Stupid me!
Too Funny
and it should!!!!
Stae allows uninsured they shpild pay the dif?
You can download a form and address on his website and mail in a check or do credit card. Hve my checkbook on it. Thanks for the reminder.
Prairie;
Now that you mention it. I monthly pledge is a good idea. It worked when I was funding a public lawsuit for $100,000.00. The lawyer got every dime and we did owe nothing (proud of that).
What a marvelous idea NP insurance companies still gives the medical work force their career benefits and job security and makes it an attractive career choice.
I learned how little I know about the medical industry, even thoughI studied medicine for a year. I believe in prevention first especialy to all the young. Everyone must have medical care. Thank you for a very informative thread.
“So long as insurance companies are for profit enterprises, their goal will not be the best health care possible. It will be this — not paying claims. That is the truth of it, because that is how they profit. For real change, we need better, smarter folks elected to represent OUR interests, not just the biggest contingent of lobbyists and campaign cash.”
There seems to be a giant leap of faith here or the usual indirection of the American corporate system. “Better, smarter folks elected”? We need a single payor system where that single payor does not profit from denying healthcare to those in need. We need Medicare for all; Medicare that is carefully supervised to protect against waste, fraud and abuse.
“Sometimes, you just want to throw up your hands and laugh at the absurdity…”
Except for most people this isn’t funny…
Our Board of Supervisors closed our General Hospital that served those unable to pay. That is another way to deprive us of care…close the facilities.
You mention the one big forgotten aspect of fighting the insurance companies just to get them to pay legitimate claims. They give you a two year run around and in the mean time turn you into collections for nonpayment. It happened to me this year. The never mentioned fact in all of this, health care bills are now the number one cause of bankruptcy in America. No one in any of the other 20 top industrial countries goes bankrupt due to medical bills because they all have universal health care.
And yet another reason to support Edwards — we need serious campaign finance and lobbying reform for things to change. As long as our representatives are taking their money, the rest of our votes are greatly diluted, when they count at all. Where’s the democracy in this scenario? Edwards is the only top tier presidential candidate who refuses to get in bed with corporate interests because he recognizes as the others seem not to, or don’t care, that once you take their money, they own you.
I am not usually an “us vs. them” kind of thinker, but enough is enough. “They’ve” had every opportunity to reform the system to make it work for everyone and this is where we’ve ended up. I’m paying almost $10,000/year in health insurance premiums as a self-employed individual who got kicked over to my state’s risk pool mostly because I have asthma and polycystic ovarian syndrome, both of which are under control. Granted, this is a huge financial burden that I can ill afford but I find a way to pony up because I can’t justify the risk that I’d end up burdening my family. But my situation is not anywhere close to deserving of sympathy (at least not yet) as the millions who either can’t get insurance or can’t pay for it or who do pay for it and end up fighting for every nickel of coverage every step of the way. I know several people in each of these categories. This situation is beyond reprehensible and those who are to blame for it, including those who have the power to fix it and do nothing while paying only a couple of hundred a month for their own first-rate coverage, deserve a front-row seat on the karma train.
A single-payer system appeals to lots of people. There are several problems: one is the political opposition, another is difficulty and cost of changing ways, another is effects to the economy because of the effects on the insurance and health care companies.
It’s not clear to me that preferring a government-run system over a private system makes any sense whatsoever. After all, isn’t the basis of our Constitutional Republic that we are free and that government is NOT to run our lives? The Edwards plan leaves private insurance in place. He says, they’re free to do this as this is America, not the Soviet Union. Second, he says, we’re going to create competition in the insurance industry by offering alternatives through a government program. That is a typical way to use government to patch over problems which the free market system don’t handle well. Third, he says, we’re going to assist those who can’t help themselves. That’s the Democratic way to ensure everyone is lifted up in America — not just the wealthy.
I don’t know a lot of the details, but I sure do like the basis for this plan (and Clinton’s).
A law requiring doctors decide what is in the best interest of their patients and not insurance companies just has to be a winner. Edwards wants that too.