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November 16, 2007

Disillusionment

A sad close to a sad story of a woman with a terrible genetic illness who found that just because she had health coverage didn't mean anyone would cover her health problems:

In recent weeks, Mrs. Calder has been lobbying Mr. Calder and her children to move to Belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. One of the leading researchers of EDS is a Belgian geneticist who works at the University of Ghent.

Mr. Calder, whose father was a doctor and mother was a nurse, grew up believing the U.S. health-care system was the best in the world. But he says his wife's struggle has eroded that faith. "I've actually turned around to where I'm thinking, 'Yeah, Europe may not be a bad thing.' "

It's worth noting that this story is a frontpager in today's Wall Street Journal. If business does prove more constructive in the upcoming health reform fight, it will be, in part, because the Journal's news staff has spent the last decade providing constant, substantive, and humane coverage of America's health care crisis. Indeed, the story is accompanied by an online poll asking "how would you grade your health insurance?" These polls aren't scientific, and the response rate for this one isn't particularly high, but it's a potentially interesting snapshot of a very privileged group's tepid feelings towards their own insurance:

Wsj Insruance Poll

And the comments below are interesting. A couple selections:

C, because I'm ticked right now at all the convolutions just to see a doctor.

I've got gold plated benefits about which I do not complain, just complaints against the specific health insurance company (though it is the best of three options) and getting it to work for me, not the other way around.
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B.

It is Medicare. Doctors and Hospitals know the rules. There is no prior permission from the 'insurance' company for treatment. Costs are well established. Don't get any bill from any provider, either. There are no gimmicks. If a provider does not get paid enough from Medicare, that is just too bad; patient is fully protected from gouging. And there is literally no limit for treatment.
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I have Medicare and blue Cross supplemental insurance. I have had major surgeries and not paid a cent,including a 9 and a half hour open heart surgery this year.
The phony spin out there is that while you may be OK with your coverage, there are tons of folks that are dying in there bedrooms because they can't get medical care. Most of the uninsured are between jobs for a few months, are twenty five and never get sick and so would rather spend their bucks on beer, nice cars, fancy cloths , and bar bills looking for babes.
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I grade my current coverage, a plan that's available through my employer and which covers about 20,000 other employees, an A.

The coverage I had while I worked for myself, I give an F. Not only was it inadequate to start with, but since it was essentially individual coverage, the first answer to every claim submitted was "no." If you didn't have the time, talent and energy to wrangle with the insurer's 1-800-whocares claims office, they didn't pay. That's scurrilous, and it drove away from self-employment.

I'm treated well now that I'm backed by an employer who's an 800-pound gorilla of a customer. Amazing how that works!

I love my current job, and I'm glad I'm here. But no one living in a first-world country should have their employment choices governed by the need for health insurance.

Remember: This is all in The Wall Street Journal.

November 16, 2007 in Health Care | Permalink

Comments

Another reason for health isurance (public or private) to seek a way to pay on diagnosis. The problem would be corruption (false diagnosis).

Posted by: Floccina | Nov 16, 2007 12:12:27 PM

Stories can be dug up of people in socialied medicine countries that fall through the cracks. These stories tell us little we need to look at the statistics.

Posted by: Floccina | Nov 16, 2007 1:01:31 PM

Floccina- So, the bad side of our system is that people either move to another country or die. The downside of another system is corruption.

Only a real heartless asshole like you would think the former is preferable to the later.

Posted by: soullite | Nov 16, 2007 1:10:39 PM

These personal stories constantly popping up to sway public opinion are doing far more harm then good in regards to educating people and allowing us to decide how we wish to move forward. Like the Frost story it is poorly written, full of errors, and raises more questions then it answers. If you try to ask these honest questions you’re accused of attacking children or sick people.

It's extremely disingenuous to hold out anecdotes like this then not allow anyone to question them. That the Wall Street Journal has resorted to this sort of yellow quasi journalism makes it even more painful.

Posted by: Nate O | Nov 16, 2007 2:00:58 PM

soullite where did that come from?

Posted by: Floccina | Nov 16, 2007 2:14:59 PM

I read the article before it was posted here and found it to be an incredibly inapy example of whether your insurance is any good or not. Yes, the subject has a heartrending disease. But, there's not a damn thing anyone can do about it. If she had great insurance, no insurance or somewhere in between, the outcome is completely the same. It is a rare incurable genetic disease. Her treatment is not going to make any difference, because there is no treatment, except to take celebrex to ease the pain (this, btw, is one of those "useless overpriced copycat" medications that Ezra at least used to rail against).

I fail to see how socialized medicine is somehow going to make her situation better. I doubt it will get more funding for rare diseases; if anything I'd suspect the pressures would be in the other direction for funding to be more on common, easily treatable diseases.

I think the tendency to discuss health insurance policy by anecdote is extremely unfortunate and ultimately will come to bite you lefties in the butt. Once you get 300 million people insured by the government, I'd have to think it won't be too difficult to find a couple hundred of them who got screwed in one way or another. The correct response to that is that there are about 299,999,799 for whom it worked just fine, but if the policy discussions are going to be dueling anecdotes, that is hardly the way to get the best outcome.

And Soullite, the lady is going to die anyway whether she goes to Belgium or not, there's no treatment if she has the bad form of the disease. The problem she had was getting a genetic test to see which form she had, which will certainly be useful information to her, but will not chnage the outcome. There may be more experts in Beligium, but I believe that would only be because it is a genetic disease common to that ancestry.

Posted by: Scott | Nov 16, 2007 2:26:09 PM

NateO, the case for having universal health coverage and the advantages have already been made from a quantitative point of view. The only remaining step left is to humanize the issue for the voters so that they realize the personal and piece-of-mind advantages. And that's where anecdotes come in. Floccina, for example, when presented with data, will, along with many of his ideological cohorts, decompensate into a tirade of rants against socialism and how there is one MRI in the entirety of Canada while a little old lady with a broken hip waits, in the cold, outside by the door to the MRI facility for 6 months.

So anecdotes that show the human side of having universal coverage are a good thing.

Posted by: Tyro | Nov 16, 2007 2:29:38 PM

"I think the tendency to discuss health insurance policy by anecdote is extremely unfortunate and ultimately will come to bite you lefties in the butt."

I don't know, Scott, righties have made hay with Willie Horton, the welfare queen, the small business that is hurt by this or that program or helped by this or that tax cut, and any number of other anecdotes, many completely mythical. I have always hated the anecdote because it really is BS when it comes to large scale programs, but I would like to see if it works for lefties causes. If we get 'bit in the butt', it will probably only confirm my suspicions that such muddleheaded reasoning is IOKIYAR.

Posted by: Ricky | Nov 16, 2007 2:46:24 PM

Scott,

That she will not be cured is irrelevant. What is relevant is how the fragmented US system makes it hard to diagnose diseases that aren't common to a majority of the population and how difficult it can be to actually move from seeing a general practitioner to a specialist even with insurance.

There is a valid argument to make that she should not have been required to spend 16 months waiting for a diagnosis.

Once you get 300 million people insured by the government, I'd have to think it won't be too difficult to find a couple hundred of them who got screwed in one way or another. The correct response to that is that there are about 299,999,799 for whom it worked just fine,

I don't think any progressive would complain about a healthcare system than could achieve such results. Of course our current system doesn't work at all for about 45,000,000 of us and works poorly for several million more.

Conservatives are apparently completely ignorant of what an "illustration" is. An "illustration" is an anecdote that accurately portrays something else, such as a story in the WSJ that shows the types of shortcomings that are endemic to our healthcare system.

Arguing from anecdotes, which is all conservatives seem to be able to do, is saying things like "I heard about some dude in England who doesn't like his doctor so that means all healthcare systems in the world suck except for ours."

And Scott, I really do appreciate the concern you have for us liberals and our ability to implement our plans and goals for American healthcare. We'll all be sure to listen to your concerned advice, as we can be sure that you have only your political opponents' best interests at heart.

Posted by: Stephen | Nov 16, 2007 3:14:44 PM

From a practical standpoint, the "Wall Street Journal" has to do these kind of stories. Let's face it, if we forget all of the humdedoo about socialism, blah, blah, blah, American businesses know that they are at a competitive disadvantage if they must continue to provide health care to employees while every other civilized country provides it universally. I suppose we could return to the days when no one had health insurance at all, but that creates its own set of competitive disadvantages, such as people spreading deadly communicable diseases because they had to choose between food and vaccination for the kids or having your project manager die of cancer in the middle of the job.

I've long thought that in the end, the United States will eventually get universal health care that is federally funded in some fashion just because it's to the benefit of every industry except the health insurance industry. Those are some lobbyists who earn their paychecks.

Posted by: Magenta | Nov 16, 2007 3:18:55 PM

The left has been very vocal about personally attacking people that question the legitimacy and/or accuracy of the anecdotes though. The Frost SCHIP debate being a recent example of this. The financial status of someone requesting public assistance is a legitimate question but by asking that question we were attacking kids and all sorts of nasty things.

The WSJ article is full of errors. The $1200 COBRA rate is almost certainly not for a single individual, most likely it is for Emp and Spouse or they have a child so could be employee and family. If that rate was for a single employee it would be the second highest I have ever seen. She could have stayed on the self-funded plan for $300-$600 a month, via COBRA, and received her diagnosis within weeks.

Insurers’ computer systems know every diagnosis code contrary to what the Doctor said. This piece of misinformation is added to make things look more complex and discombobulated then they really are. We all buy a database of all codes from the same 1-2 companies, every code that exist is in the data when you load it.

HAS does not make coverage decisions for her husbands ex-employer, if she read her Plan Doc it would specially say her employer is the fiduciary and not the claims processor. If HAS did act in that capacity they would be liable under ERISA for damages.

She apparently never filed an appeal which is always the first step if you don’t like what the TPA says.

If you have a mastectomy you wouldn’t call your insurer and ask them to pay for a boob job. I thought the article said she was college educated, to call and ask about genetic testing in such generic terms and not mention your diagnosing a specific illness makes no sense.

From the very limited information WSJ provides most of their problems where brought on themselves from the coverage perspective. If a client was in this situation I would have told them to immediately take COBRA on just the wife till she qualified for Medicare.

Posted by: Nate O | Nov 16, 2007 4:30:23 PM

Tyro, the argument has been made the case is far from proven.

Posted by: Nate O | Nov 16, 2007 4:31:26 PM

Tyro where did you get this:
Floccina, for example, when presented with data, will, along with many of his ideological cohorts, decompensate into a tirade of rants against socialism and how there is one MRI in the entirety of Canada while a little old lady with a broken hip waits, in the cold, outside by the door to the MRI facility for 6 months.

When did I ever given an indication of that. I have said that we should demand that our Politician cover everyone with the French spending level. I have said that the only reason for socialized medicine is to cut spending, but that is a pretty good reason since we spend 2x as much as the French and get only slightly better outcomes.

Now sorry I worded the following wrong in my earlier post:

Another reason for health insurance (public or private) to seek a way to pay on diagnosis. The problem would be corruption (false diagnosis).

What I mean is that if we could figure away to provide people with a lump sum of money when they are diagnosed with a dreaded disease, they could then buy care weighing the costs and also have money to live on if and while they cannot work. This would be good in any health insurance system public or private. The obvious danger with the idea is that such a payment might cause some people to conspire with some medical doctors to get diagnosed with an illness that they do not have.

Magenta wrote:

From a practical standpoint, the "Wall Street Journal" has to do these kind of stories. Let's face it, if we forget all of the humdedoo about socialism, blah, blah, blah, American businesses know that they are at a competitive disadvantage if they must continue to provide health care to employees while every other civilized country provides it universally.

Unless spending on healthcare is cut they will have to pay the bill ether through employer Health Insurance or through personal or corporate taxes (unless you want to get poor people to pay for it through cigarette and alcohol taxes). which is back to my idea the goal of socialized medicine should be to cut spending.

Posted by: Floccina | Nov 16, 2007 4:56:38 PM

Sorry

Unless spending on healthcare is cut they will have to pay the bill ether through employer Health Insurance or through personal or corporate taxes (unless you want to get poor people to pay for it through cigarette and alcohol taxes). which is back to my idea the goal of socialized medicine should be to cut spending.

Posted by: Floccina | Nov 16, 2007 4:58:46 PM

NateO, the case for having universal health coverage and the advantages have already been made from a quantitative point of view.

The case has been made, and the case has failed. That's why you're trying to bamboozle the public into supporting "universal health coverage" through ancedotes.

Of course, "universal health coverage" is itself a term of art that is used by many different people to refer to many different kinds of policy. Since you don't even have a clear idea of the health care policy you actually want (universal coverage of what?), it's not surprising that you find it so hard to persuade others to share your view.

Posted by: JasonR | Nov 16, 2007 5:12:22 PM

JasonR, quite the opposite-- the case supports universal health coverage, which has the public support, while the opponents are reduced to Harry-and-Louise style anecdotes and fearmongering, such as, of course, the one MRI that exists in all of Canada.

Obviously, of course, one can simply oppose anything than one can support a goal that has many possible policy solutions (that range from single-provider to single-payer to hybrid public/private methods). Proponents of universal coverage have different ideas of how to get there, while opponents simply oppose any such ideas as a matter of principle.

Posted by: Tyro | Nov 16, 2007 6:05:41 PM

"Love of money is the root of all evil."

Every time I see a blog about universal health care, all I ever see is economic issues discussed. That tells me what the priorities are of almost everyone who responds, either for or against. So sad.

I contend the issue is actually one of "Is it the right, ethical thing to do?" Almost all industrialized countries of the world seem to say "Yes, it is" The US seems to be one of the few who don't even ask the question, or says "No". So sad.

Posted by: bob in fla | Nov 16, 2007 6:34:44 PM

"The sanctity of poverty is an invention of the rich," bob in fla. Economic issues are ethical issues.

Posted by: NBarnes | Nov 16, 2007 8:04:10 PM

NBarnes: What are you trying to say, because I'm confused.

While not happy that the SCHIP program would be funded by cigarette taxes (I'm a low income smoker), I still support it, even though at this time it would not help me or mine. Again I say, it is the right thing to do. Now you or others may feel otherwise. That is your right.

Posted by: bob in fla | Nov 16, 2007 9:02:55 PM

Perhaps we can take more out of this article than an opportunity to espouse our own political views on universal health care. Perhaps you can also have a bit of empathy and learn a little about a fairly unknown genetic disorder that affects a lot of people (1 in 5,000).

I had a normal kid, a very athletic kid, a very good student, who had persistent pain in her joints and dislocations. We are fortunate to have great insurance coverage and live near one of the best hospitals in the world, but the way that insurance works, many docs aren't willing to go outside the box to order tests that could easily diagnose such a disorder. They'd rather say (well, it doesn't seem to be something in my specialty, just go get some physical therapy). Once we got to the geneticist (after 2 years of doc after doc), we received a confirmed diagnosis after only 40 minutes. There are a lot of roadblocks to diagnosis for a lot of medical issues. I think that all that the person in the article was looking for was a diagnosis to figure out what was causing her problems. She wasn't looking for a handout, just an answer so that she could figure out how to proceed. No, you can't get rid of EDS, but you also can't cure high blood pressure. That's not a reason to say oh well, too bad for you. There ARE a lot of things that can be done to help people with EDS, well beyond taking Celebrex or any other medicine.

It would be nice to be able to see just one comment that said, "I sure hope that everything turns out ok for that lady in the article and her kids" rather than a lot of postulating about whose opinions on universal medicine are best.

Posted by: mb | Nov 16, 2007 9:04:57 PM

JasonR, quite the opposite-- the case supports universal health coverage, which has the public support, while the opponents are reduced to Harry-and-Louise style anecdotes and fearmongering, such as, of course, the one MRI that exists in all of Canada.

No, neither "the case" nor the public supports "universal health care." That's why all efforts to enact it have crashed and burned. On some level, you know this, which is why you're reduced to anecdotes to try and con the people into supporting it.

Posted by: JasonR | Nov 16, 2007 10:04:11 PM

"No, you can't get rid of EDS, but you also can't cure high blood pressure. That's not a reason to say oh well, too bad for you. There ARE a lot of things that can be done to help people with EDS, well beyond taking Celebrex or any other medicine."

Thats a BS comparison. HTN can be well controlled on a number of medications, from ACEIs, diuretics, CCBs, beta blockers, salt restriction, weight loss/exercise, etc.

EDS is a totally unmodifiable disease.

Back to the article. This lady was a fuckin idiot. All she needed was a one time diagnosis by a doctor who charged $650 for a consultation. Which is a very low fee considering he's one of the few people in the country who is qualified to diagnose such a rare genetic condition. We're not talking about years of prohibitively expensive treatment, we're talking about a one-time fee of $650 for a diagnosis.

Yet this stupid bitch cant find the money to pay for this? Fuck her. She just wants a free ride at somebody else's expense.

You take all the wasted time/effort she spent fighting with bureaucrats its obvious she has wasted far more money than $650

This stupid bitch is a good reason why healthcare cant and wont operate like a free market. All the "customers" suddenly forget they have a brain and they make irrational decisions like deciding to incur thousands of dollars fighting a bureaucracy instead of just ponying up the 650 fee out of pocket when she could hve gotten a diagnosis within 4 months after the initial presentation.

Posted by: joe blow | Nov 16, 2007 11:23:50 PM

On some level, you know this, which is why you're reduced to anecdotes to try and con the people into supporting it.

And I'm sure that the face you see in the mirror is astonishingly handsome, Rsole.

Posted by: pseudonymous in nc | Nov 17, 2007 2:12:02 AM

"Every time I see a blog about universal health care, all I ever see is economic issues discussed."

That has not been my experience with this blog.

"This stupid bitch..."

This is another reason why I should stop reading these threads.

Posted by: jmack | Nov 17, 2007 8:30:24 AM

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