Posts Tagged Health+insurance
Turfed too
Posted by redlinedoc in Medicine, Universal HealthCare on August 22nd, 2009
It amazes me that in the land of the best healthcare we’re more in the business of denying care than providing it.
I get a call the other day that a kid has stepped on a piece of glass. Its off hours but I say “sure, bring him in, I’ll take a look”.
A pale frightened 13y/o arrives at the clinic with parents. Apparently yesterday he jumped up off a picnic table (in the way that 13 year old males do) and sprang directly onto a wine glass lying on the ground. The glass shattered into the bottom of his foot. The parents, correctly, take him to the nearest emergency room. He waits approximately 3 1/2 hours since its “only a bleeding foot”. Xrays show glass in the wound and the physician diagnoses tendon injuries to the tendons of the toes. Ahh, you say, a case for the surgeons.
Not so fast. He has a state option child health insurance. They sew up the foot (with the glass inside) and direct him to a private practice clinic the following day. He continues to bleed, slowly, through the night. Mom and dad pack him off to the local recommended doctor only to find that he (nor most others) do not accept this insurance. They are tempted to return to the emergency room but call me.
He cannot be treated here. He needs advanced care which we cannot offer to him. I make some calls with the assistance of our pediatrician. He’s transferred to a tertiary care facility. By 4PM he’s in an operating room and being cared for.
What went wrong? Why didn’t the emergency room transfer him inter-hospital when they realized they had a severe injury they couldn’t handle? Why did they refer him through out patient when clearly there was no real outpatient option?
Insurance. When the insurance pays so poorly that even the most basic of services are covered but lose money, then the hospitals, left to chose to bleed monies or to restrict services chose the latter. In the land of ‘the best healthcare” we are forced into rationing that healthcare based not on need, not on priorities but on the needs of the stockholders of insurance companies.
All the Michaels are dead…
Posted by redlinedoc in Universal HealthCare on August 13th, 2009
How did we allow the discussion to move away from health to how we should save the health insurance industry? How did that conversation move from a public healthy option to saving the profits of some of the most profitable companies in the world?
As there is increasing talk in Washington about the AMA time clicks by. And to whom are the insurance companies responsible? Ahhh shareholders, the same folks who brought us the current bank debacle, to whom we the people pay extravagant sums so that they can support CEO’s in a style to which they’d like to become accustomed. As there is continued agglomeration of insurers, they flock together, eat each other, thereby decreasing real market competition, in the guise of bringing lower cost to the consumer.
In medicine we speak for the patient. In insurance they speak for the money. There’s an inherent split here. When it comes down to it, shall we authorize care OR shall we make 0.02 for the stockholder, the stockholder and CEO options always win out. Duplicity is the name of the game. When Hurricane Andrew roared across the South Florida Pennisula devastating the area. Aetna group was the major insurer holding more than 4 billiion dollars in losses. That past year they golden parachuted their worthy CEO for 987 MILLION dollars (or there abouts) and then cried the blues that they didn’t have monies for claims. Hmmmm
I personally have run into the dealings of insurers. Serveral years ago one of the Connecticut health insurers sent out a note that all billing should henceforth be sent to a POB in Enfield. We all did send claims there and as weeks went by and no claims information was forthcoming, we were told that the claims were lost or that they should be re-submitted. Whoops. Someone bad in the company made an error and there is no POB in Enfield for our claims. We’re really sorry but you’ll have to re-submit them all over again. Hmmmm
I’ve had several friends who’ve suffered death at the hands of insurers, not in any direct sort of way but the usual games playing with existing conditions and difficult to access portals.
Working in a safety net group we see patients bounced from one provider to another, mostly based on non paying insurances. I think most of us are insulted when the insurers talk about the Medicare program, and how it fails to work. It succeeds with a 5% overhead, a draconian fraud unit, and coverage that most of us envy. Are there faults? Are there fixes to be made? Of course. We can in one swoop, make our system succeed. It needs a government backed program, devoid of usurious profits, not socialism, just good medicine.
We need to recenter the discussion, not about death notes but about how to prevent the needless deaths from an unwieldy bloated system which spends much of its monies not on patient well being but on corporate well being. Straight speak or soon, all the Michaels will be dead
You’ve been turfed!
Posted by redlinedoc in Commentary of the times, Medicine, Universal HealthCare on June 21st, 2009
More of my patients are being turned away at the gates every day. Often they need advanced care which we at the primary care level can’t give them.
I have always felt that we were most lucky, we are a smallish state and have a training institution and hospital which are owned and operated by the state. This hospital should be seeing the those at the fringe, those in great need. For many years the hospital was located in the center of an immigrant community. In the 70’s it relocated to a suburban location, very upscale. At first there was a bus to take people from the community but that quickly was quashed. Now it takes two busses and a local jitney at the heath centet, about 2.5 hours, to get there. Not much of a barrier.
Patients going to his greater facility of learning often encouter trolls at the gates. Trolls? Admission to this center of ‘much higher learning’ requires the proper insurance, not some of the lower paying kinds that our patient’s possess. When they call, the answer is frequently, call back when you have better insurance.
A few weeks ago, after some harsh notes from our facility, several well dressed physicians show up to try to make arrangements to expedite the admission of our patients into the gleaming tertiary care facility, state owned and supported. To show magnanimity one of the docs takes out a card with driving directions and some special parking near his clinics. There is muffled laughter as we tell him that the majority of our patients don’t drive nor own cars. He’s a bit culturally disconnected.
Lest you think that this is peculiar to the country estate hospital, the in-city institutions answer similarly.
Recently a patient shows on a Friday afternoon, all hunched over, the Groucho Marx walk, right upper quadrant pain, rather classic gallbladder symptoms; a surgical problem. She is referred, complete with small note from the doc, and ambulance transported to the in citty emergeny room to prevent her from having to find transport. The attending physician there concurs but adds the diagnosis ’shitty insurance’ and instead of wheeling Senora Patient to a holding area for surgical admission, gives her back a note with the names of two surgeons in the area saying she needs urgent and immediate care. She of course calls those offices only to find that neither surgeon participates with her insurance. Quel suprise! Monday morning, quite more hunched over she comes back to our primary care clinic, sicker, with the note and no scar. A nasty note and a phone call, she’s retransported and admitted for care. This is a good outcome?
With all the ballyhoo about insurance companies participating in health care, and contrary to their every present advertisements that ‘they take care of you’ we need remember that there’s a profit motive totally separated from any health provision. The recent squealing and wheezing from the health insurance companies and their paid compadres in government about the death of health care should we use single payor or government sponsored health care is quite self serving, serving only their investors.
The only investors in Medicare are we the users. Its far from perfect. It has a 5-8 percent overhead, unmatched anywhere in the insurance industry, even with draconian plans which provide and income source for the insurance companies not safety nor security for their policy holders.
We need to re-direct our efforts and energies toward providing a comprehensive Medicare type system. A single payor system will insure fairness. I see no reason why the private companies can’t compete for business as they do in every other country with single payors. Lets see them for what they are, trolls at the gates.
Death by insurance –
Posted by redlinedoc in Medicine, Universal HealthCare on June 21st, 2009
Yesterday I lost another, friend. Death by insurance read the certificate, or so it should have. Geno was a kind fellow, gentle soul, never made lots of money but found himself suddenly underemployed, a polite term for being older and getting paid for fewer than 20 hours a week, then finding there is no health insurance
Ok, you think. Let this guy pull himself up by the bootstraps. He did. He got a second job. Still no insurance. Then he got Diabetes. Oops. Its not quite like a third job because you pay them instead of getting paid. You work harder. The doc says you should have less stress. Ok. I’m working a job to pay the insurance and another to pay for food, now I have to pay rent because the diabetes job just doesn’t bring in enough.
Oops.
Now you can be on state sponsored insurance, some of the time. You feel really terrible. He did. He worked all his life and was always responsible. Now he’s a ward of the state and working. He gets headaches. He’s not feeling well. One day he falls. He goes to a doctor but they can’t see him because his limited HMO insurance wants him to see a doctor 40 miles south. He bucks the system but there are not many alternatives.
Finally he gets an appointment with neurology. He has a grade 4 astrocytoma; not a good prognosis. Although he has insurance for this and has coverage, because of his limitations (he has memory lapses and poor focus) after the tumor is primarily removed, he often forgets to take his medications or takes them improperly. Insurance has no use for home visits.
He slips. He has difficulties. The secondary job is history. The primary job lays him off. He’s now totally on the HMO. They say he’s ok free living. He has slips and fall. He’s ok free living. He forgets his medications. He’s ok free living. He asks for assist but they say he’s not elegible on this cheaper chicken HMO insurance.
He died yesterday. Now the HMO is off the hook. No more insurance payments. No doctor visits. No Gene. Seems like a good system. Death by insurance.
Lest you think this is an isolated incident -
Two years ago a friend of mine, a retailer, sucessful in business but a small retailer, began to have urinary tract pain. He had no health insurance because at more than 1500$ a month it was more than he could afford. Additionally, that amount was for catastrophic insurance, you see, as a child he’d had bladder problems and every insurance company pro-rated him. Finally he gets insurance. He’s had, what he thinks, is a bladder infection. Its been so severe that occasionally he sleeps in a bath tub with warm waters. Small catch. There’s a 90 day waiting period.
He goes to his doctor who, as he’d suspected, sends him to urology. They want to examine his bladder and because of prior difficulties with anatomy need to do this in a hospital. There’s this 90 day thing. We wait. He’s more comfortable but of course not better.
The bell rings. Its a bladder tumor. They biopsy – perhaps benign, although most are not. It is benign it seems. But theres a second troubling spot next to it. Not benign. The tumor is resected, he starts chemo and radiation and everyone is hopeful. There are all sorts of limits to this insurance policy he has – so greater exploration, whole body films and the like, aren’t done.
Two months forward, he’s a bit dizzy and falls. There is an ominous cracking sound in his neck. There’s a baseball sized tumor there. Now we do more work up. Its a metatastasis. Alas it was a death knell. When removed and the neck repaired a shower of tumors widely spread show up. After an enormous fight he choses to let go.
No more store. No more employees. No more friend. These tumors when seen early are frequently non-fatal. With time the outcomes are more dire.
Death by insurance.
Moments of madness
Posted by redlinedoc in Commentary of the times on July 13th, 2009
I was driving home this evening listening to the discussion about why the financial institutions are putting out the same hybrid products that brought us this wonderful recession, hearing the pundits explain that it brings capital into the markets and although its a bit (a bit?) risky, these instruments help to drive the market. Ok. I’m no financial whiz but didn’t we just loan billions and trillions of dollars to these self serving financial institutions to NOT have them bet the store? Wasn’t part of the project to make them more fiscally responsible? Somehow we the poor schmoes who pay taxes are subsidizing a very wealthy gambling habit. We’re bound to lose. We may be the house but in this case we hold none of the trump cards.
Trump cards? Isn’t this banking? Isn’t this where the banker sits across the table and says “Well Joe, opening a restaurant is a risky business and we’ll need some collateral” — or so it was in the past. Now we have bankers betting (your house) on 10:1 or 100:1 odds knowing that the worst will be that the government will for a time be paying into their bank. Where are their ethics.
Ahh ethics. It seems that capitalism trumps ethics. Do undo others before they do unto you. The Ivory Tower at Havard spoke several weeks ago about plans to include teaching ethics to the business school. Its the piper teaching the cobra. Once the cobra leaves the nest, well then its just a bunch of snakes isn’t it?
It wasn’t until the sentencing the other week that I got it. Bernie Madoff…. made off with our monies. Too sweet. such onomatopoeia. No one saw the deal too good to be true, 30:1 winnings? Get real folks. Its all about the casino, and we the taxpayer have been at the largest gaming table ever, Bernie and his friends (and there are more no doubt) are pikers compared to the banks and so called financial houses that take our monies and throw it on the international craps table. Oh lost a few billion in that scheme. Not to worry Uncle will back you. . . .and he has.
bonus, Chrysler, ethics, executive+compensation, Health+insurance, other+peoples+money, risk
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