Don't Give Up On Health Care Reform Around Town, posted by jrm, a member of the Vista Grande Elementary School community, on Feb 9, 2010 at 3:34 pm
The recent headlines regarding Anthem's decision to raise rates up to 39% for individual policy holders is yet another example of why we must rise up as citizens and say enough is enough. I am an experienced healthcare executive with over 25 years experience both on the provider side and as a manufacturer of medical devices. I also worked for Anthem for a few years as a director in their disease management division. Unfortunately I was widowed years ago after my wife's lengthy battle with breast cancer and I saw firsthand how one can be faced with economic ruin simply because of random chronic illnesses that each of us can be faced with. If the reform opponents take anything away from this thread I hope it is this...the United States and South Africa are the ONLY 2 industrialized nations in the world that do not have cradle to grave government sponsored healthcare. The fortune 100 company I work for is global and we deal with single payor market dynamics as a regular course of doing business in all other countries. Do not give up, keep fighting, this overhaul is long overdue and simply must happen in the long run as the current status quo is not sustainable. The story on AOL today about the woman offering herself in marriage to obtain health care coverage as a spouse says it all. Folks, we are a better country than that and now is the time to take charge and reset the rules for the good of all of us.
Posted by Diane, a resident of the Danville neighborhood, on Feb 9, 2010 at 4:32 pm
jrm - very well put, and thank you for sharing your personal and professional experience and why they motivate you to speak out regarding the current health care crisis. I work in a health care setting and have seen multiple families bankrupt themselves and eventually lose loved ones to disease process that may have treatments - just not covered by their insurance. Some even die while waiting for approval.
Sadly, until people realize that this will affect them and their family members (and not just whomever it is that they feel does not deserve health insurance for whatever reason - undocumented, on public assistance, etc.)I think we will be stuck with the status quo.
Maybe your comments will open opposing minds up to seeing where we are headed without a meaningful overhaul. I surely hope so. Thanks for starting the thread.
Posted by George, a resident of the Alamo neighborhood, on Feb 10, 2010 at 6:22 am
Sorry... single payer government run health care is not in the cards. Perhaps America is one of few countries remaining in the world where the gov't doesn't provide health care. It is also one of the few remaining countries in the world where the free market continues to rule despite efforts by an obese government to swallow it. If there was more competition, Anthem wouldn't be raising its rates. Competition in any market for any product stimulates competition and keeps prices competetive. There are many ways to attack the current problem without turning it over to the government.
Posted by Bill, a resident of the Danville neighborhood, on Feb 10, 2010 at 7:57 am
Think about your life being dependent upon a person with the power to decide between you and their jobs. Think about the bonuses served out to CEOs for creating dividends simply by denying your claim (and thousands of others) over and over until you are dead. Maybe you take out a second mortgage to pay for the procedure or treatment (if you are lucky enough to do that.) People don't think this can happen to them, but it happens all the time. Just wait and chances are that this will come around to you. Are you really willing to play a game of chance with someone making lots of profit until you get sick? Got good lawyers?
Competition in the health care delivery system is the worst choice we can make. Competition for things is fine, except when it pollutes or poses a real danger to all. Competition for services is fine, except in the cases like medical care. Let the doctors and health care professionals determine what is acceptable, not some insurance adjuster. Death will always win in the end, but it is inappropriate to let profit be a part of the process. We can afford this as a nation.
We have a choice about how we treat each other, and health care is an important part of every person's life. Let's make our choice for the greater good and keep insurance out of the equation.
Posted by Mike, Danville resident, a resident of the Danville neighborhood, on Feb 10, 2010 at 10:33 am
The problem with our health care system recently became frighteningly clear to our family when my wife was recently diagnosed with lymphoma. The bills are truly staggering. One procedure, a surgical biopsy, required an overnight stay at the hospital. The cost of the surgery and overnight stay? More than $100,000. That's just a fraction of the costs her medical treatment so far. We have health insurance and they have been covering most of the costs up to this point.
Through this experience I can see that some of the costs in our health care system are structural. Things such as drugs are required to pass through many hands on the way from supplier to patient, and each time a margin of profit is tacked on. One example: in our initial emergency room visit, my wife was given two Tylenol to relieve pain when she was released from care. On the bill summary we subsequently received the charge for the Tylenol was more than $200.
Posted by Karla, a resident of the Danville neighborhood, on Feb 10, 2010 at 11:19 am
Thank you Jim and I echo comments by Diane and have the same fear described by Mike. As I have been very recently diagnosed with lymphoma, I am fearful of the financial burden my family will carry and am just starting to experience the influx of Anthem statements flowing in stating they do not cover the testing and treatments I must have. Certainly the scales weighing insurance premiums and expenses covered are way out of balance. It is shameful and frightening.
Posted by psmacintosh, a resident of the Danville neighborhood, on Feb 10, 2010 at 12:15 pm
To BELIEVE that the Government will do a great excellent job of running a health care system, and will run it efficiently and at an affordable cost, is a nice idea and a nice dream.
Ask yourself the question, once the Government is running the national health care system, and all other alternatives are put out of business and eliminated, what will you do IF the Government's system then fails you; fails to meet your needs?
How easy will it be to cure a bad/poor Govt system--with no competitive alternative?
A Govt that will fight to maintain its power and control over the services and not allow alternatives (under the claim of treason).
Haven't you seen our Govt make many mistakes in providing services in the past, many denials of service, many cost over-runs, and huge exorbitant costs to operate empire-istic systems of agencies and burearocracies?
How can you be so politically religious to BELIEVE that Govt is the answer?
Let's say you need a kidney, or an experimental cancer treatment, and then the Govt rules determine "no" for you. What do you do then? Is the new Govt system, better or worse, than a free enterprise, insurance system?
The big flaw in your entire logic is to think that MORE and BIGGER GOVT is the answer to a "business" problem.
Govt should stay out of Business.
There should be separation of Govt and Business, of State and Enterprise.
Our rally cry should be "Let's put Govt out of business."
Of course, Govt has some valid purposes: very narrow, limited purposes, such as national defense, maintenance of borders, international diplomacy, and other tasks.
It should stick to those services alone and thereby cost us a lot less in taxes--an amount that an equal flat tax would pay for (just as the forefathers originally instructed).
Posted by jrm, a member of the Vista Grande Elementary School community, on Feb 10, 2010 at 12:24 pm
George's comment of "it's not in the cards" indeed accurately reflects the views of those opposing needed adjustments. However "competition" in the health insurance world is a thing of the past, in many states two or three companies absolutely dominate the market and consumers have very few options. A brief review of the facts, the various Blue Cross/Blue Shield liscensees were historically non profit corporations. Leonard Schaefer (at the time CEO of BC of CA) was the first to get approval to convert to for profit status and effect a highly successful public offering of stock (wellpoint). The other Blues looked at each other and said "why the heck don't we do that too?" and the race was on. "Anthem" as we now know it owns the Blue Cross and or Blue Shield franchises in CA, CT, GA, IND,KT,Maine,MO, NV, NH,OH,VA and Wisc. Each of these other state plans welcomed the Anthem deal makers when they flew into their state to discuss strategic advantages of selling to Anthem.
I am a capitalist at heart through and through, but Karla's story is one that we all must listen to...you could be next, I know I have been there. My late wife ran 5 miles every other day and was hardly sick a day in her life when she was diagnosed. These things happen to all of us randomly. Take a look at the unfortunate case of our city servant Mr. Shimansky. He was vacationing in San Diego, became suddenly and gravely ill and lingered in the hospital for almost a month accumulating huge bills. I am told his policy was capped and upon his passing there was a need to "pass the hat" to help defray life ruining expenses his family was saddled with. This was a good man who served his company and community effectively for years...what have we become that our system bankrupts folks regardless of their fiscal discipline and prudent spending due to a random disease?
George, I can relate to your comment about our free enterprise system making us what we are, I understand what you are saying. I just feel so strongly that when peoples lives and fortunes are at stake in such a reckless manner due to no fault of their own we all must take action. The time is now for those of us in the healthcare business to speak up and object to those resisting needed changes. They are not greedy evil corporate raiders however the trend is simply not sustainable from an economic and moral standpoint.
Posted by Mike, Danville, a resident of the Danville neighborhood, on Feb 10, 2010 at 1:39 pm
Karla, the costs of diagnosis and treatment of lymphoma are staggering. You will need to stay on top of the situation and work with your doctor's to get approvals for your treatments from your insurance company. Some insurers are better than others, and all have a ceiling on how much they will pay for the total costs of your diagnosis and treatment. In addition to the care and treatment you will receive, managing the insurance side is crucial to your recovery.
Posted by Diane, a resident of the Danville neighborhood, on Feb 10, 2010 at 6:24 pm
jrm, Mike and Karla - again, thanks much for sharing your stories in the hopes that we learn a valuable lesson through your experience. You have given us an opportunity to gain an understanding of how the current health care system can make a health crisis much worse than need be for the entire family. I hope people appreciate your willingness to share your stories and take to heart your message.
Mike - all the best to your wife, and Karla, best wishes for a quick recovery. I have a cousin and a friend who were both treated for lymphoma (one diagnosed very late stage, with B symptoms), both doing very well now. Hang in there!
Posted by jrm, a member of the Vista Grande Elementary School community, on Feb 11, 2010 at 9:34 pm
Diane gets it...okay George, how do you feel about Health Net and Aetna deciding to raise their rates as well announced yesterday from 34 to 39 percent? Still feel good about the American way and the free market? I'm sure you are a savvy business man as well and know the Aetna and Health Net actuaries were called into their CEO's offices this week and had to explain why Anthem was doing this and they were not....the result was predictable.
I am not advocating "nationalizing" this industry but merely allowing the "public option" for purchase the for profits so vehemently opposed. This is the structure of the German system, a mix of public and private option which has been deemed optimal by a blend of panel experts analyzing various plans available to the diverse industrialized nations except us and South Africa. I recognize this health insurance industry for which I worked is characterized as the largest centralization of wealth and assets on the globe, investing in many diverse markets including real estate so it cannot be eliminated, but the public option is a needed alternative. The Germans have already figured this out for goodness sake, they went this route under the last Kaiser before WW II. You guys just don't get it because you are ill informed. Also I assure you from my experience there are device and pharma industries thriving in these other countries. Genentec was recently bought by one. Most big pharma is based in Europe these days. Go ahead and cling to your old paradigm, you must be a medicare recipient and are happy with the goverment's plan as it exists and could care less about your kid's plight...
Posted by spcwt, a resident of the Danville neighborhood, on Feb 15, 2010 at 8:19 am
The federal government is bankrupt and cannot afford to take on another liability like subsidized healthcare.
Congress tried to trick us into thinking their healthcare bills wouldn’t add to the deficit by showing 10 years of taxes but only 6 years of healthcare spending. We weren’t fooled. And most of the "savings" came on the backs of seniors via $300 billion in cuts to Medicare.
Before we give out more freebees, like healthcare credits to people making $88,000 a year, we need to take care of our seniors first by plugging the $50 - $70 trillion hole in Medicare are Social Security funding.
Posted by Diane, a resident of the Danville neighborhood, on Feb 15, 2010 at 1:52 pm
spcwt - what do you take away from the comments by jrm, Mike and Karla regarding their experience with health crises and the devastating impact on their finances, battles with insurance for life saving benefits, etc? I don't think they are asking for any subsidy/freebees. Mike's wife and Karla are as entitled as anyone to appropriate treatment.
Sometimes the rest of us are spared the turmoil of a health care crisis yet still have the opportunity to learn from other's experience when they are kind enough to enlighten us. The divide between Medicare funding and the "donut hole" related to prescriptions is problematic - as is the penchant of insurance companies to deny coverage and stall decisions until patients of all ages wear out from the consistent battle, or worse - simply die while waiting for treatment. All this, while consistently paying higher premiums.
There is a great book on how health care is provided in other countries: "The Healing of America" by T. R. Reid. No specific models are heralded as perfect, but it certainly gives a nice overview and perspective of the pros and cons of other systems.
Posted by spcwt, a resident of the Danville neighborhood, on Feb 15, 2010 at 5:03 pm
It is heartbreaking to see people facing financial ruin over healthcare. Assuming they lose most of their wealth, won’t they then receive medical treatment via Medicaid?
They may not be asking for a hand out, but that’s exactly what the Democratic healthcare proposals were offering. They provided tax credits and other spending that would’ve cost the taxpayers $1 trillion for just 6 years of coverage. And that’s assuming you believe the overly optimistic assumptions submitted to the CBO. In reality, like all government programs, costs would’ve ballooned, just like they have for Medicare.
I hope we can fix healthcare so that it becomes more affordable.
Unfortunately, Congressional proposals did not address the main objective of bringing down healthcare costs. They would have merely placed yet another unfunded liability on the federal government’s balance sheet.
There will come a day when the federal government will no longer be able to borrow its way out of its problems, the federal credit card will be maxed out, and we won’t be able to pay our bills. I’m sorry, but we just can’t afford healthcare subsidies right now.
Posted by Diane, a resident of the Danville neighborhood, on Feb 15, 2010 at 7:00 pm
Some who become impoverished are able to then qualify for MediCal(they would need to virtually exhaust all financial reserves and have an income low enough to qualify or pay a whopping share of cost). Sadly, as reimbursement to physicians under MediCal is dramatically less than the typical fee for treatment, most physicians do not accept patients who qualify. If this should happen to our neighbors, Karla or Mike's wife, they would have to find another physician and facility for treatment - and they would likely not be as effective.
By sharing their experience with us, they are trying to help us understand the stark reality of a broken health care system without actually having to experience it first hand. I thank them for that kindness and will continue to advocate for an overhaul of the current broken system.
Posted by spcwt, a resident of the Danville neighborhood, on Feb 16, 2010 at 8:05 am
You mentioned doctors refuse to treat Medicaid patients because the govt. doesn’t reimburse them enough to cover their costs. The same is true for many seniors with Medicare. And it’s only going to get worse. No wonder people are afraid of increased govt. involvement in healthcare.
To avoid going bankrupt due to sickness, can’t people buy disability insurance when they’re well, so in the event they become sick they can continue paying health insurance premiums and continue receiving treatment?
I agree our system is broke, but sometimes the cure is worse than the disease. Hopefully, when you “advocate for an overhaul” as you say, you’re not talking about supporting the recent proposals Congress tried to ram down our throats.
BTW, are you the same Diane that I had a spirited Prop. 8 discussion with on this webpage? How are you?
Posted by spcwt, a resident of the Danville neighborhood, on Feb 16, 2010 at 10:28 am
spcwt - I'm a social worker in a health care agency that serves seniors and understand your concern re: Medicare reimbursement (though many on Medicare also have supplemental insurance). My point is that it doesn't have to be either we fix the system that applies to seniors, or we fix the system that applies to everyone else. The system itself is broken. One of the physicians in our office thinks we should go with Medicare for everyone. I'm not sure that is the answer but at least the field would be equal.
Disability insurance can help cover your salary if you are unable to work, but does not cover your medical bills unless you have money left over - it is not designed for medical reimbursement. We can "blame the victim" if we want and decide that if everyone purchased disability insurance/long term care insurance/ etc. that the impact of health crisis on a family would be lessened, or we can work on revamping the corrupt and broken system we currently pay in to.
Yes, I am the same Diane. I am doing well, not so interested in another debate with you as I think you need to be right rather than open yourself up to other's experience and opinions. I'm a busy woman and will leave additional attempted reasoning to jrm if he feels so inclined.
Posted by Derek, a resident of the Danville neighborhood, on Feb 16, 2010 at 8:11 pm
Congrats psmacintosh! Your mastery of Fox News talking points is truly breathtaking. I could discuss how even if your fearsome bought - and - paid - for BIG GOVERNMENT (ominous music rolls in the backround) does drop the health insurer's obscene profit levels by half, that they will still be fat, happy, and nowhere near close to going out of business. But you wouldn't be fooled by such logic, now would you? Must run, Glenn Beck's on soon and I need to open a can of Coors.
Posted by jrm, a member of the Vista Grande Elementary School community, on Feb 16, 2010 at 9:19 pm
Diane is right, spcwt really doesn't know what disability insurance covers and now is not the time to enlighten him. I hope he doesn't has a real world lesson but that will be his epiphany at John Muir Med Ctr when that inevitable day comes. I hope Bill takes the time to weigh in again. He had some good comments. I am not being dismissive but I feel it is true that at times debating with those opposed to those "resetting" our health care system is like having a serious discussion with a piece of furniture...there is dense wood and no intellectual give and take. What the heck does Glenn Beck have to do with things Derek?
For the rest of you go ahead and muse about the banal Alamo fire station if you like but looking forward on a more important issue your kid's healthcare coverage is at stake, and you are ignoring the most vital domestic issue we face. Trust me, the politicians want it to go away and relish the entropy surrounding the debate. In the meantime our situation will get worse as we get older and get bankrupt one by one. Interesting no one is talking about Mike Shimansky and his and many other's situation. My father in Omaha used to say to me "Son, sometimes you are feeding strawberries to pigs and they just don't get it" I do get it....people with my expertise in the system are now realizing we need to speak up with a global perspective others do not have. Nurses know, Doctors know, and capitalists like me on the services and device side know this is NOT sustainable...for someone to say "you can always get medicaid" is sooo ignorant. Sure, spend down all your assets in an elaborate scheme attourneys like Lem Tillum will guide you through,tell your kids to sell the house and forego their inheritance so you can go to a nursing home somewhere that will still take you. That is what you are facing unless you are a county or state employee with the kind of healthcare insurance none of us have. As Alexis De Toqueville said, in democracy the people get the kind of government they deserve..
Reform now....USA and South Africa are totally out of sync on this.
Here's to clean coloscopies and mammograms to all you sanctimonious supporters of the Anthem $100 million payouts to their execs...
Baa Baa Baa....I'm not an angry dude taking my time on this to exercise my demons, I just think it is time for those of us in the healthcare business to pause from our hectic world and express our opinions from inside the system that we see each day. I feel that for many Americans our healthcare system is vast and intimidating and therefore renders them timid about speaking out...that is over!
Posted by Diane, a resident of the Danville neighborhood, on Feb 17, 2010 at 7:31 am
jrm- Derek is on your side and was making a joke in an attempt to educate psmacintosh (who posted: "Let's say you need a kidney, or an experimental cancer treatment, and then the Govt rules determine 'no' for you" - I left this comment alone as it makes no sense to try to enlighten someone who doesn't recognize that they are stating the status quo within the current system).
So sorry about your personal experience - and please continue to share your message. Your experience (both personal and professional) lends itself well to helping people understand the issues with the current health care system - you just need an audience that is willing to open their eyes.
Posted by spcwt, a resident of the Danville neighborhood, on Feb 17, 2010 at 12:07 pm
How would you propose we pay for all this grand healthcare? If we can’t even afford the $50 - $70 trillion it’s going to take to cover our seniors' Social Security and Medicare, where will we get the money for this new entitlement?
The $1 trillion price tag that Congress touted would cover just 6 years of healthcare spending. And we all know govt. cost estimates tend to be overly optimistic.
You don’t really believe we can make the rich pay for it all, do you? There’s not enough rich people to tax. We would need to raise the income tax rate by 300% on every single person in the U.S. right now just to balance our current budget, let alone pay down the national debt. And that’s BEFORE any of this proposed new healthcare entitlement spending.
We all know the day will come when we can no longer borrow our way out of trouble and we’ll either need to cut services or raise taxes on everyone, including the middle class and poor.
Are you prepared to cut senior’s Social Security and Medicare benefits? Are you prepared to tax the middle class and poor in order to pay for this?
BTW, you might persuade more people if you didn’t refer to those who disagree with you as “a piece of furniture…with no intellectual give and take,” “pigs,” and “ignorant.” Just a suggestion.
Posted by Diane, a resident of the Danville neighborhood, on Feb 18, 2010 at 9:25 am
jrm - just an fyi. This is spcwt's nature - "baiting and trolling" is how it was referred to by others in another thread. I don't believe he/she is really this obtuse - just likes to stir the pot regardless of how heartfelt and logical the comments of others not in agreement. Clearly between the two of us you and I have some specific knowledge and experience that informs our opinions (for example, my professional life for over 20 years has been spent advocating for benefits for seniors, including Medicare and supplemental healthcare options), and all we can do it put it out there.
Posted by jrm, a member of the Vista Grande Elementary School community, on Feb 18, 2010 at 9:48 am jrm is a member (registered user) of Danville Express
An essential component of health care reform is the lack of "transparency" of actual total charges to complete a medical procedure. Case in point...a large well known self insured corporation based in Pleasanton analyzed the total individual charges of colonoscopies their employees had in 2008 in the Bay Area. The total charges varied from a low of $1,800 for one employee up to $8,500 for another. Same procedure....true story. This company has now benchmarked the total charges variablility for the top 50 procedures their employees incur each year and the vast differences are astounding and defy logic. In our area of the Tri-Valley if you had to have gall bladder surgery for example just try to get total estimated charges from Valley Med Ctr, San Ramon Reg Med Ctr and John Muir so you can make an educated decision where you will go to have it done. The data is simply not available to us. This is just one example of how the "free market" is ripping us off. Transparency is key going forward for us all since the average cost of coverage for a family of 4 is now around $1,300 per month (before the recent proposed 39% increase. We consumers carefully compare prices for everything we purchase EXCEPT medical care.
Posted by spcwt, a resident of the Danville neighborhood, on Feb 18, 2010 at 10:32 am
C’mon, Diane. We had some good times on that other thread, didn’t we? Shared a few laughs? Why don’t you play nice?
Is it really so outrageous to ask how we’re supposed to pay for all these fantastic healthcare proposals? That’s probably the main reason why it died in the senate, isn’t it?
JRM, your point is well taken. We need cost transparency. Our current system is a rip off. I’d bet most people would support that kind of reform, myself included.
But you still haven’t addressed the central question of how the government would pay for subsidized healthcare. According to the CBO, Congress’ universal healthcare bill would’ve cost $1 trillion for 6 years, even taking into account all the cost savings that would result from having a single payment system.
Posted by Reader, a resident of the Walnut Creek neighborhood, on Feb 18, 2010 at 11:40 am
I find it quite ironic that we can not figure out how to pay to support the healthcare of our citizenry but can always find the funds to go to war, in this case, two wars in which the total bill will... well lets just say a trillion dollars will look like a drop in the bucket.
I say end the wars and free up the billions of dollars a month is it costing our children. Surely that would be able to pay for some standard healthcare for the people who can't afford.
Posted by spcwt, a resident of the Danville neighborhood, on Feb 18, 2010 at 12:01 pm
One of the (many) reasons I couldn’t vote for McCain was his insistence on wasting money on those stupid wars. I was so hoping Obama would’ve ended those wars by now. But instead, Obama’s doubled down the bet, raising defense spending to a whopping $800 billion this year, the highest in history!
Unfortunately, even if we cut defense spending down to $0, that still wouldn’t be enough to plug our $1.6 trillion deficit this year. And the CBO estimates deficits of at least a $1 trillion a year as far as the eye can see. We are screwed.
Worse, we’ve already promised to take care of our seniors’ healthcare and social security and there is no way we are going to be able to afford that when the baby boomers start retiring en mass, as we are short $50 to $70 trillion on that promise.
People just don’t seem to understand the dire financial situation this country is facing.
Posted by Reader, a resident of the Walnut Creek neighborhood, on Feb 18, 2010 at 12:06 pm
Yes, I agree, if you are expecting Medicare and Social Security to sustain you in your retirement for the next 30 years, you have another thing coming. Baby Boomers should get their ducks in a row before they decide to retire. And I know, you have paid into it your whole working life so you are entitled to it, but as spcwt has indicated, there is no way its gonna happen.
Thanks for contributing all these years, but Uncle Sam mismanaged its finances and we surely don't want to burden our children with your healthcare and social security...right? That's what you say to all other government expenditures.
Posted by jrm, a member of the Vista Grande Elementary School community, on Feb 22, 2010 at 12:44 pm jrm is a member (registered user) of Danville Express
The reimbursement structure in our system now is way out of whack, some say perverse and play s a key role in keeping costs high. Let me explain, health insurers must prove they are spending at least 80% of all premiums collected on paying actual medical costs incurred by policy holders. This is the fatal flaw in that Anthem for example has no incentive to hold down costs because the more costs escalate the greater the dollars in the 20% bucket they get to keep. This is the essential break down in our system as it exists today. The private insurers WANT the increases to keep coming in billed medical expenses. 20% of 1 trillion is a whole lot more than 20% of 500 Billion.