Call the Doctor!

They did it!

They upheld the healthcare act! I'm thrilled! I'm beyond thrilled. As a victim of pre-existing conditions that kept our family from buying insurance for 25 years (for us and our seven kids) I know the extreme anxiety of living without the option of healthcare. I know the stress of a $77,000 heart attack with no coverage, making decisions about cancer treatment based on our savings account, digging deep for $800 a month to buy medications. Not having access to affordable healthcare causes panic attacks!

Dee's long-awaited medicare birthday gave us much needed relief last October. But knowing many families in similar straits, I'm happy they won't face bankruptcy fears whenever they notice a mole that looks suspicious. (It's not the pre-cancerous mole that causes fear, it's the tag of pre-existing that scares the daylights out of an uninsured parent.)

Thank you to Teddy Kennedy. I wish he was alive to see this day! This is as important a supreme court decision as granting Civil Rights in the 60's. Universal healthcare is constitutional!

Click here for posts that explain why I'm so passionate:

Obamacare

We're going to celebrate by standing in the fresh air without worrying about an asthma attack!

Congratulations, America!

Health Care Emergency

Nurse Nancy

"Mama called the doctor, and the doctor said . . ."

"We have an opening Friday. What kind of insurance do you have? Oh, you don't? Actually, I don't have anything available until July. I'm sorry."

—AND—

"For a non-insured patient we require a $250 deposit before we can schedule an appointment. Can I have your credit card number?"

—AND—

"Our new patient fee is $200, payable when you sign in. The rest of your charges will depend on what you have done."

—AND THEN—

"Before we talk about hot flashes, I'll need a full blood work-up." ($1,000.) "The blood work showed your hormones are out of balance. To rule out a tumor, I want to schedule a CT scan." ($3500.) "No tumor. But you don't need your 'equipment' anymore. A hysterectomy guarantees you won't get ovarian cancer."

"I didn't think hysterectomies were routine anymore," I said. "Oh, I do them all the time," she replied. "They're my bread and butter." (I can't afford to pay for your butter, I thought.)

The Deseret Morning News wrote this editorial on April 10, 2008:

"In our opinion, lack of insurance is deadly.

"The nation's uninsured are 25 percent more likely to die prematurely than adults with private health insurance. In Utah, at least three working-age adults die each week because they are uninsured or they have too little coverage. More than 800 Utahns ages 25-64 died between 2000 and 2006 due to this problem.

"As we consider meaningful health-care reform, the medically uninsured must occupy a high place on the agenda. If they are placed in health-care plans that have high deductibles, it is unlikely they will receive primary or preventive care that can eliminate or control small problems before they become health crises.

"As it stands, the medically uninsured or under-insured are three times more likely to delay seeking health care. Cost and access are clear impediments. They are three times more likely to have difficulty obtaining needed medical care. When they receive hospital services, for instance, they are charged almost three times what insured patients are billed.

"It is somewhat difficult for average Utahns to comprehend the challenges faced by people who are uninsured or under-insured. That's because nearly 80% of Utahns are covered by a medical insurance benefit plan offered by their place of work. As such, they do not encounter the full cost of medical procedures and services, nor do they face extraordinary challenges obtaining health care.

"Policymakers must be mindful of the estimated 100,000 working adults who work full-time—many of them self-employed—and have no medical coverage.

"Medical costs are skyrocketing due to many factors. People with insurance are not the most careful stewards of the benefits. Hopefully, as architects of health care reform set about their work, addressing the needs of the under-insured and uninsured should be a key factor in their deliberations."

Doctor Dan

Maybe by Sunday there will finally be a cure for what ails me.

(Good luck to all of us with health issues!)

Fever!

Patients

Temperatures are still rising on Health Care.

The whole subject has given me a fever. And I'm not the only one. Some people seem to be hallucinating, dreaming up crazy maladies, while others are going into shock.

"I found this site helpful in clearing up some of the rhetoric going around," wrote Pete, with a link to an excellent site: Health Insurance Reform Reality Check. His comment popped up today on one of my Health Matters posts, and it's just what the doctor ordered. Thanks Pete!

I'm anxious to examine the actual symptoms myself instead of listening to the fear-mongering blather that is rampant and contagious. Panic provides a poor bed-side manner when discussing a nation's health care. I'm impressed with anybody, on either side of the emergency room, who presents a reasonable cure to our complaints. An intelligent discussion on how something will or won't work would move us toward compromise and solutions: it could cool the fevered frenzy.

But trying to find logical, calm, fair dialogue on the health care predicament isn't easy. I am nauseated by the hate-filled attacks and rumors that blast from my radio. It's becoming epidemic. My blood pressure goes up, my stomach churns and my heart aches. This fever is bad for my health!

Health Matters, Update

Why good health care matters to Sco

I got this comment from my son-in-law and it deserves a wider audience, so I have turned it into a guest post. (You'll see why I call my in-laws Heroes, too.)

Marty - your son-in-law Sco here.

Yes, our system needs change; there's no doubt about it. My opinion is that the problems are so huge that a large or sweeping change is required to fix everything. And as far as I understand (and I'm not the most educated on the many and various issues involved) it's impossible to come up with a solution that can be explained by a blog post, or a comment on a blog post. Every solution like "universal healthcare" and "cheaper prescriptions" sound great in the press, but there are huge negative impacts that come along with such "solutions." I don't think there's a silver bullet. "Universal healthcare" and a healthcare system more like France, Canada or Great Britain means vastly increasing taxes. It's not an easy question of who would pay for it, because someone would. It would also likely mean our most promising intellectual talent to leave the medical field and work in something that gets them more money. And it may likely mean longer wait times to get doctor appointments.

Everyone's for the option that costs themselves less money and gives them better healthcare. That solution is different for everyone's situation. And usually there are economic winners and losers in any change. It's a very divisive topic, and very difficult for any president on which to get anything significantly changed (recently Bush Jr. and Clinton).

Full disclosure: I'm employed by a small-ish company (75 employees or so). Our health insurance costs are crazy high. We pay about $340/month for the lower of 2 insurance coverage options. I'm very happy that we're able to get coverage. MY COMPANY COVERS ANOTHER $600 OR SO A MONTH FOR MY COVERAGE!!! Basically $1,000 / month for the health insurance coverage my family and I are thankful to have. Does that sound like everyone in America can have this? No way, it's just too expensive. This is why companies scale back on what they cover - their resources aren't big enough to keep up with skyrocketing costs. And our premiums go up about 10% (or more) every year. And my wife and I and our 3 daughters happen to be healthy right now (knock on wood).

And there's so much money in healthcare, that sweeping change won't happen. The only reason I say that is because opposition to a sweeping change would be ENORMOUS from those that stand to lose $$$. And with any sweeping change, there will be a lot of people who end up with less $$$. We're going to be stuck with incremental change that no one will be happy with (except for the incremental % of the population who's better off under an incremental change).

My beef with the current bills being debated in Congress is that 1) they still leave a ton of people uninsured, 2) the solution is to tax and spend. Yes, it's an incremental "solution." In my opinion, the "solution" doesn't address underlying causes, but just dumps more money into a broken system. I don't think that's going to fix anything in the long term, but it would be good to get more people covered. The next fix in 5 years will be to just dump more $$ into the same broken system (with incremental changes). Seems like a flushing toilet to me...

I would rather see some solutions that address underlying causes, such as:

1. Better healthcare results at a lower cost. The US has really sunk in recent world ratings in desired healthcare outcomes per dollar of cost. For a country that prides itself on healthcare innovation and new solutions, that fact really sucks. We should be able to be close to #1 in the world if not #1 in the world at providing the best cost-effective healthcare solutions.

We sometimes seem to seek for the latest and greatest technological healthcare solution, which also happens to be the most expensive, instead of a going with more tried-and-true methods. Drug reps and medical equipment reps influencing doctors, doctors' reimbursements from insurance companies (paid for a procedure instead of a desired result), and attitudes that you don't have to pay since your insurance will pay, all feed into this.

2. Revised compensation to doctors to more closely align doctors' compensation with what we all want - results - instead of compensating them (and thereby incentivizing them) to perform more procedures, see more patients during a day, etc...

3. Higher deductible insurance plans, so that we as consumers of healthcare will have more incentive to shop for a good solution at a good value. We'll be more price sensitive. My wife and I are now on such a plan (my company changed our insurance plan with IHC about 6 months ago in order to lower costs this last year - we didn't have a choice in the matter, really. And for the record, it's been a fine change so far.). And we have become more price sensitive and have asked doctors how much that will cost us, and when we hear an answer that's expensive, we ask for alternatives that give us a good result at a lower cost. I'm going to guess that we've incurred about $1,500 less this year (less money paid by an insurance company, hopefully translating into lower premiums in the future) just from being more price sensitive.

No, we will never be able to shop for healthcare as easily as we shop for homes or cars. We just don't have the knowledge base that doctors have. There's an information asymmetry between the provider and the consumer in healthcare, and that information imbalance will never go away. However, if we are more price sensitive, we're going to be asking our doctors more questions about different procedures that could be done for a lower cost, all in the name of getting a better result at a better cost (better value). We won't just walk in and say yes to receiving a Cadillac-costing procedure for the $30 cost of a co-pay for a visit.

4. More acceptance in the general population that doctors and medicine can't solve everyone healthcare issue in 1 hour and restore you to perfect health 100% of the time. Doctors are people and are helping you to the best of their ability 99.9% of the time, and healthcare issues can be complicated. And there are a lot of conditions that have no cures (unfortunately).

5. Less litigation, and perhaps formula driven ranges (not exact amounts) for damages related to medical mistakes (when doctors are grossly negligent).

6. Sweeping change in insurance laws, specifically in defining insurance pools. It's ridiculous that employees of huge companies have access to good insurance plans that are cheap, and just because I work at a small employer (approx 75 employees), my cost for the same type of coverage costs a lot more. How is that fair? And how is that common sense? Yes, insurance companies are pricing risk in a defined insurance pool. But the price differences are merely driven by insurance laws and how people can legally be grouped into insurance pools (if I understand the basics correctly). Why can't states designate their entire citizenship as the insurance pool, and have insurance companies write policies for that huge pool? Or give the general population access to the same insurance coverage that our Representatives and Senators receive? I'm not extremely knowledgeable about pricing health insurance, and I'm pretty sure that there would have to be some kind of pricing tiers (at least for healthcare costs that are under our control by the choices we make - smoking vs. non-smoking for example), but couldn't state laws also require pre-existing conditions to be covered?

7. This change would actually hurt me, but it makes sense (at least to me). There's a tax break that employees of companies receive that self-employed people do not get. I'm not taxed on the the approximately $600 each month that my company pays for my health insurance premium. Self-employed people basically get taxed on that $600 amount. That's not fair. Fix that tax break so that employees of a company and self-employed individuals are on a level playing field when purchasing health insurance.

Whew. Sorry for the long comment. I've tried to not rant and rave - hopefully I've come across in the manner I intended.

Anyway, those are the 7 things I want to see addressed first in healthcare reform. Some of the items I've mentioned above can't be solved by legislation, or by legislation alone. I don't think government can solve this issue by itself. And the more money that the government takes from us in taxes to "reform healthcare", the more accountability they should have and will have to the American taxpayers. But let's face it - government is an important part of the solution, but not the only part of the solution. And how much input do our opinions really have in Congress after a bill is passed? Voting incumbents out over their voting record and public pressure over their positions and actions are about the only things stopping existing bills from just getting bigger in their scope and $$ outlays.

Congressmen and women most likely (and hopefully) receive more complete information regarding the situation and what can be done to fix the situation. However, the "solutions" being produced by them are poor fixes, at least in my opinion. They're expensive stop-gaps that make for good soundbites in the media ("more universal coverage") that Congressmen and women are using to make themselves and/or their political party look better. Crappy (but classic) posturing and politics.

I'm hopefully optimistic that incremental changes will get us there over the next 15-20 years. I don't think a quick fix is practically possible. There's just too much to change, and too much money involved. Hopefully I'm wrong about that. I'm also concerned that the system will really have to break down before we see some of these needed changes. Hopefully I'm also wrong about that.

I know that I want my current healthcare coverage at a cheaper cost. And it's just not right that certain people aren't able to get affordable insurance under their current situations. What's fair about that?

We need the right kind of healthcare reform, and hopefully we'll get it. If we don't (in each of our opinions), we have the duty to voice our opinions and to also exercise our right to vote.

Sco

P.S. Here's an interesting read:

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

The following is Wikipedia, so realize it's limitations, but it's a decent summary:

http://en.wikipedia.org/wiki/Healthcare


Thanks Sco! Are we getting informed, or what?

Health Matters

At the risk of repeating myself . . .

I'm going to continue this topic for one more day, mainly to encourage you to read all the insightful comments that follow my last two posts. They are evidence that health care reform deserves a healthy debate.

Our country has a fabulous opportunity right now to create a more perfect plan. People like Diane, Keri, Annie and Beck (just some of my knowledgeable readers) along with many others, can share their experiences about what works and what doesn't work in Canada and elsewhere. Differing opinions are vital. When the conversation concludes, hopefully congress will come up with something uniquely American.

I just finished work on a book about Nazi Germany where people were in danger of being arrested if they voiced their disagreement with the government. Neighbors and even family members spied on each other to catch the rebels. Freedom of speech, and freedom of expression were dead. It's hard to imagine the distrust and fear of such a time.

Ronni Bennett, of Time Goes By, quoted A. J. Liebling: "freedom of the press belongs to those who own one." Ronni went on to say, "Freedom of the press still belongs to those who own one, and blogging means practically anyone can own one . . . with blogging we designate a fairly beautiful thing: the extension to many more people of a free press franchise, the right to publish your thoughts to the world." I love having that right.

My anonymous friend "risked my contempt" (his/her words—I never feel contempt) by challenging my own experiences with health-care. He said my attitude seemed very hostile. What nonsense! The whole point of this debate is to find some answers to  an overwhelming problem. Anonymous said, "as I am sure you know, there are ways to get it (health-care), they may just be unacceptable to you."

I truly don't know!! What are the ways?? I'm not trying to push any agenda or political party. The unacceptable thing (to me) is the status quo. Does this ghostly person have a number for me to call (that I haven't already called) or an insurance company that doesn't care about pre-existing conditions? Does she have a friend who beat the system somehow? Don't hide the answers along with your identity! 

And, Anonymous, why would I be less candid if you had revealed your identity? I am the one with my name all over this blog every day! My every thought is floating through cyberspace as a public record. I had a letter to the editor published in the newspaper yesterday, with my semi-private opinion available to anyone; I am obnoxiously candid, an open book, sometimes interesting, sometimes boring. 

You're the mystery person. I'd be as open on this subject with a trustworthy stranger as I would be with any of my kids, (most of whom would fall on the other side of the debate.) 

Hmmm . . . Suddenly I'm wondering . . . Are you one of my kids? You sound smart, wordy, lawyerly, young, cocky . . . One of  my sons is totally in favor of me becoming a greeter at Walmart to get on their insurance plan . . . is that the idea I already know about that is unacceptable to me??

Hey! Am I on Candid Topics? Is someone going to jump out of my computer and give me $1,000,000,000 to donate to the children's hospital?  (Anonymous, don't be insulted that I'm comparing you to one of my kids. They're all scholarly and brilliant and like to disprove my theories. It's a compliment.)  

Don't worry. I don't know how to do the site meter thing and at this point you're more interesting anonymously.  I'll try to sound more intelligent to everyone I meet now, knowing it could be you.  (I'd rather think of you as someone I know and love, who's just toying with me, than as somebody who thinks I'm hostile or contemptuous.  I'm assuming you're someone I like.)  We'll never know.

Thanks, everybody for a healthy discussion.

Health Care Discussion

Thanks for joining the discussion yesterday. I was glad to read your comments and I'd like to respond to a couple of them.

Annie, I think there are a few good systems that work fairly well. We're not locked into choosing a whole mediocre health-care plan, but we could pick the best aspects of several, and piece them into the parts of our system that work already. I'm hoping that's what's happening.

Beck, I totally agree that we should have choice. That's why I feel so picked on. I have NO CHOICE!

Insurance companies exempt pre-existing conditions. That means that if you've been diagnosed with a chronic disease such as asthma, diabetes, arthritis, etc. before you apply for insurance, the company will not sell you a policy that will cover those costs. It's frustrating, because chronic conditions don't go away. People are doomed by them, even when they aren't life-threatening, because they rob you of time and money forevermore. This situation is getting attention as more and more people are losing their health coverage, and trying to buy insurance.

To Anonymous: Your "perspective" here seems judgmental and naive. I hope that, through your wise choices, you never have to experience "hardships you should have considered eventualities so many years ago." Our circumstance has nothing to do with a selfish or irresponsible career choice, as you imply. It has to do with poor health.

In our case, we have always been anxious and able to pay for fair coverage, but we are not a good risk. Because we have "known" health problems, the insurance company decided, "These folks will require expensive medical care, now and in the future. We don't want them in our pool. We want healthy people who have a better chance of staying healthy and therefore won't cost us as much." The agent might sell us a high-cost policy that exempts any benefits for the health problems we already have, but we cannot buy insurance that will actually help us. We do not have that choice.

We know of a young woman had two premature babies. Her doctor tested her blood and found a possible cause, and told her it might be genetic. He suggested her sister (someone we know well) also be tested. It was determined she might carry the same gene. Years later, when the sister applied for maternity insurance, she filled out the requisite questionnaire. One of the questions asked if she, or any of her relatives, had any genetic blood disorders. She checked the yes box, anxious to be totally up-front and honest. She was denied maternity insurance because she might carry a gene that might cause premature labor. The actual test didn't help anybody, and ultimately hurt her. She doesn't live in Canada or England—she lives in the USA, and she has no choice.

In further response to Anonymous: I am certainly not against the development of safer and more effective prescription drugs. It's not an abstract to me. Those very drugs have kept my husband alive for 30 years. Between Dee and I, we spend at least $500 a month on prescription drugs, and we have very common conditions. I feel we are supporting an unfair percentage of drug research when we regularly pay $140 for 30 pills, compared to a $10 co-pay.

Besides being miserable, poor health is expensive. For instance, although insulin is fairly cheap, the tiny little paper test strips a diabetic uses three times a day (to know how much insulin to use) are a dollar a piece= $100 a month. Syringes cost. Regular blood tests to monitor meds cost hundreds of dollars. It's upsetting to know that someone who had health insurance before he got diabetes has help meeting these high prices, and yet we cannot buy that same coverage.

People die of treatable diseases in the USA because they cannot afford their medicine. I think it is shameful that people know this is happening and don't want to help. Anonymous says my ideas (which ones?) and a quote about following Christ's example of caring for the sick "seem like two diametrically opposed positions, and very ironic in today's American outcry for separation of church and state."

Just for the record, I am a believer, and I want to follow Christ's example. I can't separate myself into "church" and "state." I'm suggesting that WE, as Americans, religious or not, Democrats and Republicans, ought to watch out for each other.

Anon said, "Yes, we should be generous and benevolent towards those in need, but why should government have any role in that?" Because I'm part of the government and I don't want a young mother with leukemia to go without treatment because it was a pre-existing condition. I think the choice to buy insurance should be a legal right, open to everyone. And I think the cost of medication should be the same for all of us. That's all. I don't want those of you who have it all to lose a thing. I just think the rest of us deserve the same opportunity.

But since I'm a little riled up, I have to say something else. Anonymous said "Sorry to be posting anonymously, but I really don't want your opinion of me to change because of what I have to say."

My opinion of someone goes up when they stand behind their convictions. I love discussing ideas with friends, even when we disagree. It exercises my mind. I learn from people who are enthusiastic, knowledgeable or experienced in what they're talking about. I have even more fun when we're both passionate about a topic, and don't know what we're talking about.

Keep your identity secret, Anonymous; my opinion of you would change if I found out who you are. I would be disappointed in you, not because of what you said, but because you didn't have the courage to stand up for it. Your confidence will soar when you realize your opinion, no matter what it is, is valuable because it's yours. Others will value it, too. You don't have to be Anonymous.

It's Time For Another Leap

July 20, 1969

I'm ready for another giant leap.

It seems like we've side-stepped the health care issue long enough. To me, it's a very personal subject.

A career change in 1985 put an end to our health insurance. We moved to York, England for a year where we were automatically covered by their national health plan. Seven kids can rack up a lot of doctor and dentist emergencies in one year, and I needed a couple of fillings and a crown. Dee had some problems with his eyes, plus we needed medications. Excellent, immediate care didn't cost us a dime.

While in York we visited friends in a couple of different hospitals and a rest home. We were surprised at the high quality of care. Although the buildings were older and smaller (no private rooms) than we were used to at home, patients had the treatments they needed, when they needed them.

Dee's master's thesis was on the adaptive reuse of buildings in Britain. Many old manors had been converted into small hospitals, and we toured several good facilities that were available to anyone, no questions asked.

We didn't come home totally converted to the British system of health care, but we experienced it in action and were favorably impressed. Since then we've had a chance to compare it to the American system.

When we re-applied for health insurance we were denied because of pre-existing conditions. Being self-employed compounded the problem. It seems that in the USA only healthy people are insurable. So we are "self-insured." Regular doctor's visits are expensive, extra tests are extra, and our medications cost over $500 a month. Our medical costs are usually around $1500 a month. Unless they're more.

A few years ago we found a group plan, and signed up for "catastrophic" health insurance. It required a year of payments before we could recieve any benefits. We paid $890 a month for 11 months and 10 days, while still paying for our regular care and Rx. When I had emergency gall bladder surgery they denied payment because I was 21 days short of a year. That episode alone racked up $23,000 of hospital bills. And there have been others.

It's offensive when people with health insurance imply that those of us who want it are asking for a freebie. It is simply unavailable to many people. I was disappointed to read an article saying that the religious right decries "the socialist tactics of robbing people who take individual responsibility, and giving to others who fail to earn their keep."

Angie Gray said it beautifully: "Health care is so inherently intertwined with religion. How we treat the sick and the poor is of utmost importance in the eyes of God. Christ spent most of his time teaching religion and healing the sick; it ought to be one of our top priorities today." Let's Talk Politics and Religion

I hope steps are taken soon to stop insurance companies from denying coverage based on pre-existing conditions. Other steps towards lowering the cost of both prescription drugs and malpractice insurance would help everybody. It's not rocket science, but it would be another giant leap for mankind.