Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group What to do about healthcare? Can it be fixed?

Hi Pete,

Yeah, I should be happy about it. I'm over 60 and will soon need my health insurance covered, but because I'm over 60, when the Gov. says, "don't worry" I worry. When they say that "There will be recommendations about what procedures," I'm pretty sure those recommendations will come with some pretty heavy strings attached. With the insurance industry, if they say I can't have a procedure (or they recommend I don't have a procedure) I can always appeal to a higher authority. That authority may, in fact, be the government. With the Gov. there is no higher authority, so I'm done. And I believe that is what the folks are nervous about. Those of us who managed to live through Vietnam don't always trust the politicians of any party.

While the proposed legislation may not interfere in the decision between you and your doctor, it is my interpretation (referring to H.R. 3200) that it doesn't mean that the government will pay for the decision at which you and your doctor arrive. You may want to familiarize/re-familiarize yourself with Sections 122 through 124. I don't think this will be any different than that decision being rejected by an insurance company. The only difference I'm left to wonder about is if you will have the ability to appeal any such rejection. My guess would be no.

Dear Timo,

Thank you so much for sharing this information about your supplemental insurance. It is eye opening to see this -- and brings into focus all the more how much we Americans are "suffering" in the current situation.

For instance, my son was diagnosed with severe articulation disorder, aka, nobody could understand him as a toddler/preschooler. He has profound issues with speech. I work for a pharma company and get "good" insurance, but though they paid for the diagnostic visit, our HMO simply refused to pay for therapy recommended (3 times a week at $90 per session) because they saw this as an "educational" issue. So, we clearly could not afford this and felt like terrible parents, so we searched for a solution and I ended up treking to a state university and worked with the grad students at a reduced rate, and when that became too much (25 mi. each way, a long walk on campus with 4 yr old and 18 month old in dead of NJ winter), we gave it up, and he suffered socially until he entered the school system at 5 and began to receive the services "free" and improve... Now at 7 he is cured, thank goodness, but would have been nice if we and his peers could have communicated with him earlier on... Why didn't he deserve treatment for this? The speech pathologist said there is no known cause, some kids just develop this way. We didn't mess up as parents, but clearly, this was something "in him"... how could it be educational????!!!!!

Anyway, I know I digress, but it is so astounding to see how these services, like RN and natropath are covered for you under this plan, and for us, I am not aware such insurance even exists... It's a pity, and many Americans don't recognize it, which leads me to tremendous frustration.

But thanks all the same, I learned a little bit more from you today Timo.

Jess

We hear often about all the trouble faced by US doctors-- lawsuits and malpractice insurance, and from what I can see, I suspect physicians are suffering by being forced to overpay for mal-p insurance to the point of some being forced out of practice (for example, shortage of OB-GYNs in NJ). That said, I wonder about the validity of this myth of widespread problems with enormous payouts for frivolous lawsuits, so I would really love to see data on this-- What is paid into mal-p insurance cos., what is paid out to patients, what is happening with all these supposed cases where people are being awarded these big, ridiculous and undeserved awards that patients are getting away with being 'overcompensated' for, and who are these judges and juries perpetuating this? I think I will look into this and share my findings here. Maybe starting with snopes.com....

Funny, I saw a lawyer some years ago on a malpractice consultation, and he told me that the doctors almost always win, mostly because there is an unwritten code where one dr won't testify against another.

Sadly, a friend of mine had an endometrial surgery to help her to conceive. The doctor of the illustrious clinic screwed up and punctured her uterus and quickly cauterized it. She was later told the clinic had not been equipped to handle this situation, and that she almost had to be rushed to the hospital, but luckily, they were able to get in there and take care of it... terrific...She wanted so very badly to be a mother, and was willing to go through extraordinary measures. So, after some time, she underwent invitro by the same acclaimed doctor, and was blessed and became pregnant with twins daughters. At 24 1/2 weeks, her uterus burst and her twins were delivered by emergency c-section weighing at about 1 lb. each, barely. What happened? Her uterus had burst right where he had cauterized it. She was later told by the doctor who performed her c-section that her uterus was like "tissue paper, in many pieces" and the babies were floating in her abdominal cavity when they were abruptly delivered. She was told she most likely would never carry another child. The babies went through hell, and about 4-5 weeks after they were born, one of her tiny daughters died. Today her surviving daughter is a beautfiul, smart, healthy miracle, but what about the big hole in this mother's heart that will never be filled, and the fact that she was robbed, and now cannot have more children? To my knowledge, she was unable to secure any medical expert testify on her behalf.

I am so sorry for this situation, and so she should have gotten money, for the doctor's mistake cost her a child and her ability to have more. And by grace of God, her daughter is healthy, but many preemies this small are not so lucky. It sickens me. And we Americans are fed propoganda about tort reform.

How about the issues of insurers having inherent conflict of interest to only insure healthy people. It is sad and ridiculous what has happened here. My husband says it started under Nixon, that I can't say, but I can say it is broken and I pray for a solution.

Just my 2 cents.... Jess

I have had the chance for this situation to hit close to home.

My husbands sister has 2 girls (our nieces) who are both in college right now and both will graduate with honors in 3 years instead of the typical 4.

They all came for a visit about a month ago and these beautiful girls have both decided to become Drs. the younger one wants to be a Dentist and the older wants to be an OB-Gyn. While we were talking to her the subject of malpratice insurance came up and I told her that I had read that on the average now Dr.s are paying a staggering $170,000 a year JUST for malpractice insurance. I told her that is something to think about.

Im not sure if it is like that for just specialty Docs that maybe they have a bigger chance of messing up as far as say surgery ect...or if that is pretty much accross the board.

If I had thought today I would have asked my Immunologist about it and seen if his malpratice insurance is thru the roof.

I do know that I have read over and over again that this is forcing wonderful Drs. right out of their practices and making it to where we have less and less Drs. to keep up with demand.

I hope to goodness that someone can come up with something to take care of this.

Lisa

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If a man does not/ did not work why should he be guaranteed insurance?

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Frankly, I'm shocked that anyone in this forum would ask this question, Lon. So many people with AS can't work, some from a very young age, meaning they were not able to pay much into the Social Security system or build up any other kind of insurance equity. And you honestly feel people like that should not be guaranteed some kind of health insurance? Really? I'm sorry, that seems a rather callous attitude given what so many of us here go through and now about how big medicine works (or rather, doesn't). Why should someone who hasn't worked be guaranteed insurance? Quite simply because access to healthcare should be a right that is guaranteed to every human being in this country or any other, period. I find it shameful to view access to healthcare in any other way. And before you ask, no, I don't know how to make that happen, and I don't know if any plan out there right now is one that could achieve that goal in a way that makes sense. I do know that other countries have managed to make this happen and thus, there has to ultimately be a way to make it happen here in the United States.

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For 35 years I have visited people in hospitals who have never had insurance, who have never paid their bills but are taken care of by our society. We have problems, but we have always taken care of our sick.

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Again, I have to disagree with you here, Lon. I just do not feel this is true, or even close to true. In every region of our country today, be it an inner city neighborhood that has been devastated by the loss of manufacturing jobs, or a small Appalachian town where jobs have always been hard to come by, there are millions of people who have no meaningful access to the the healthcare they need to live truly healthy lives. I need only look to one of my best friends to know this. He used to manage a large bookstore and earned a near-six-figure salary. However, his store was downsized, and he suddenly lost that job. Since then, he has applied for dozens, if not hundreds, of retail jobs and managed to land only one, which lasted only six months before that store cut back staff. After almost a year unemployed--and with no healthcare coverage--he finally found a job as a security guard that pays $10 an hour with no insurance. Since losing the bookstore job, he has had several sinus infections, colds, and at least one bout of the flu; he also suffers from chronic back pain. Since he makes barely enough to live on--and would not make enough if he was not able to live rent-free at his parents home (he's in his 30s and is ashamed he has to do this)--and gives almost all the money he does make to provide for the care of his 2-year-old son, he can never afford to go to the doctor when he is sick. Well, I think he did go once when he was so sick he could barely function, and then he went just because it was the only way he could get a script for the antibiotics he knew he needed. Other than that, nothing. He can't afford it, period, and there are no free clinics that we know of in this area.

He has checked with the county-level social services agency and been told that he makes far too much money to qualify for their healthcare assistance programs--at $10 an hour!!--because most of those programs are designed to help those at the poverty level and below. In a nutshell, he is basically screwed because he has decided to work at a low-paying job that offers no insurance. In all honesty, he would be better off if he simply sat home and remained unemployed. Then he would be in that poverty zone and would qualify for a number of government programs. Of course, then he would be labeled a lazy, no-good freeloader who is content to live off of decent Americans hard-earned tax money (read this with dripping sarcasm to get the full effect) when he is completely able-bodied and able to hold down a job. I mean, what a leech, just sitting there living off the government dole.

Can you not see the absurdity of this situation? Can you not see how people like my friend, and millions like him working these $10 an hour or less) jobs, or even working two of these jobs at a time if they are "lucky" enough to make that happen, are being penalized by this ridiculous catch-22? Everything I've written here about my friend's situation is the truth and an exact representation of the absurdities he's encountered since losing his bookstore job. How can a system that actually rewards people for not working--when it comes to healthcare anyhow--not be completely broken and in need of massive changes? We absolutely are NOT "taking care of our sick," and there is not enough charity or generosity in the world to cover the healthcare costs of the millions of people caught in this working-poor trap. Free clinics are almost nonexistent here in metro Detroit, so few and far between that they cannot even remotely meet the needs of everyone who cannot afford to pay for even basic care. Yes, churches and other charities meet some of the burden, but that amount has dwindled to a tiny portion of the whole since the economy tanked. What these folks face has nothing to do with how generous a country we are, or how much charitable giving people can handle. Those people you've visited in the hospital for the past 35 years are the lucky ones, Lon, but more and more, they are the minority. What you aren't seeing in those hospitals are the increasingly overwhelming number of people who simply do not have access to the kind of charity care you encounter in your visits. Is there any rational way to say that those people do not deserve the exact same level of care as those who were lucky enough to receive the charitable assistance? Too many people are falling through the cracks today, cracks that have become Grand Canyon-sized craters. The system is broken at its most fundamental levels and needs to be fixed sooner, rather than later.

Brad

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Our health care industry is the envy of the civilized world, and there are people outside the US that are wondering why we want to change it. We are trying to fix something that isn't broken.

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Dean, do you honestly believe that our system isn't broken? That stuns me. While yes, we might have access to the best technology money can buy in our healthcare system, and we have more money being spent on medical research than other countries, I'm afraid that saying our healthcare system is the envy of the civilized world is not even remotely true anymore. Yes, they envy our state of the art hospitals , unparalleled resources, and large number of doctors that practice here, but as far as how we treat people and the way that only people who have insurance have access to that amazing quality healthcare, well, in that regard, we are an international laughingstock. Other nations look at us and wonder how it is that the most powerful, and perhaps wealthiest, country in the world lets tens of millions of people live without insurance--that is, live without access to basic healthcare. How is it that this great nation with its amazing medical industry has an infant mortality rate that ranked 29th in the world in 2008? Socioeconomic factors such as lifestyle choices, teen pregnancy rates, etc. certainly play a part in that mortality rate, but so too does a lack of access to prenatal care and basic healthcare services.

What the U.S. healthcare system does well, it does better than any country in the world--that is irrefutable. But until everyone has at least basic access to that system, to say it is not broken is equally indefensible, in my opinion.

Brad

Look, I live in Detroit, and let's not even start with this nonsense about what happened the other day at the forum where people were supposed to find out about potential government help with utility bills, etc. Sure, it's easy to mock people because so many people showed up and because the stress of waiting in line for hours cause some to lose their temper and unruly behavior to break out. It's even easier to mock people like the woman who was interviewed and said she was there to get her "Obama money." Is that statement ridiculous? Of course it is. Does it change the fact that the unemployment rate here in Detroit is nearly 30 percent--read that number again, folks--and that people are so desperate for ANY kind of help keeping their homes and feeding their children that they would stand in line with 20,000 other people for an entire day just for a chance at one of 3,400 vouchers that would provide a small amount of relief?

It's so easy to laugh at those people, to mock them, to think that they are just out to live off the government dole and are ready to get into fistfights to get their free handouts. And yet the vast majority of Americans are, what, two or three missed paychecks away from being desperate themselves? Why are so many so quick to judge those that were in that crowd in Detroit without knowing a single thing about them? Everyone sees the news stories, many of which were slanted to make the people there look as bad as possible because, hey, that's good television, and instantly think they know exactly what's going on, that those lazy bums and freeloaders saw another way to live large off the government, and yet nothing could be further from the truth. Go ahead, laugh at those people if it makes you feel better. But before you do, think about just how close you or other family members might be to standing in that exact same line with 20,000 of your neighbors, your dignity in shreds, all so you can hopefully get some kind, any kind, of relief for your family.

If you'd like to read an excellent story about what happened in Detroit that day, a story that explains what I just touched on in a far more eloquent way, please read this article from Laura Berman from last Sunday's Detroit News. Maybe then people here won't be quite so quick to mock people for being desperate and angry.

Rush-ing to Judgment: National Commentators Don't Understand Detroit's Plight

Brad