Fertile ground for Medicaid pitch- The Washington Post

Remote Area Medical back in western Virginia, as the battle to expand Medicaid rolls on…

The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.

Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

- The Washington Post

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The French way of cancer treatment | Anya Schiffrin

An account of cancer care in France.

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.

The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.

Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.

That time was priceless.

The French way of cancer treatment | Anya Schiffrin

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I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

 

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

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Opinion: Cancer survivor: Obamacare got me covered - CNN.com

 In January, for the first time since my diagnosis 36 years ago, I will have an individual health plan that offers quality coverage for me and my family. I will save $628 every month on premiums. Best of all -- I wasn't even asked if I've ever had cancer.

Opinion: Cancer survivor: Obamacare got me covered - CNN.com

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Medical debts put patients at risk of financial collapse | Detroit Free Press | freep.com

Medical debts put patients at risk of financial collapse | Detroit Free Press | freep.com:

Frances Giordano found out she had lung cancer in June. After that, the bad news just kept coming.

First, she discovered that even with a good job and health insurance, her medical expenses were more than she could afford on disability.

Then she started slipping into debt, like millions of other Americans who don't have the cash to cover their medical bills. Hospitals expect to be paid promptly and offer little leeway to insured patients. Unpaid bills go to collection agencies, damaging a person's credit history for years.

Finally, she learned that fighting for her life was not her only battle or maybe even her toughest. When she finished her chemotherapy in December, she was fired. "Due to changes in business operations," wrote her employer of more than six years, "we can no longer hold your position open."

It arrived nine days before Christmas.

"I'm a good person," the 58-year-old Giordano said. "I worked hard. Isn't having cancer enough?"

- Sent using Google Toolbar

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Escaping To England To Find Treatment She Can Afford

From Kaiser Health News Today:

Sometimes my husband Roger gripes about what he calls the British “nanny state.” So much is done for the English, he maintains, they can’t think for themselves anymore. Showers, for instance, are statutorily equipped with automatic shut-off valves on the thermostats. In case the water gets too hot. I remind him that the opposite of the nanny state is me in the U.S. with breast cancer and no steady job and insurance.

I had some wonderful doctors in New York, caring and helpful. But I also had to fight with my hospital there to get the tests I needed, and several of the specialists were so difficult to deal with I chose medical protocols to avoid them—no matter what the best option for treatment was. What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.

A nice piece about the nightmare that medicine is not in England. She left the US to go to England because she couldn't afford the US health care system, and found out there were other bonuses to a differenet model of financing health care.

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Broken healthcare and broken lives - DFA's Alex Blum

Broken healthcare and broken lives - latimes.com:

In the middle of one night during my training at a county hospital outside of Los Angeles, a 12-year-old boy arrived at the emergency room. He was having a seizure. From a brain scan, we made the terrible diagnosis: He had suffered a massive stroke. At best, he would be severely disabled for the rest of his life.

When I sat down with his mother to tell her the bad news, she told me that he had been a happy, healthy child through most of grade school. But there had been one other trip to the hospital. When he was 7, he'd had a stroke from which he recovered quickly and completely. His mother had been instructed to take him to a specialist to find out what was wrong so he would not have another stroke. But she was the family's sole provider and simply could not afford the expensive out-of-pocket bills.

At first I was shocked and angry to learn she ignored a physician's advice that could have prevented this tragedy. I quickly realized, though, that the true culprit was our broken healthcare system. Because this system denies millions of Americans access to care, my patient's mother was forced to take a gamble on her child's health. The result was a debilitating stroke that should have been prevented.

Until the system changes, health catastrophes like this will continue to be commonplace in America. Until we reform the system, Americans will continue to be forced to choose between feeding their families and taking them to the doctor.

From Doctors for America's Alex Blum...

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Daily Kos: A few anecdotes about medical care in America...

Daily Kos: A few anecdotes about medical care in America...

I posted this on DailyKos tonight. Please go read the rest and chime in!

On many levels, I hate to venture into anecdote territory when it comes to health care reform. I don't think it informs the debate in a helpful manner, and yet, it seems to be one of the two major arms of the conservative campaign against health care reform. First, they argue, look how awful it is everywhere else and how wonderful we have it here in America with THE Best Health Care System in the World (TM) and second, they find even Medicare, Social Security and unemployment benefits ideological anathema.

I can't do anything about the second one, but I do have something to
say about the first.

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DrMatt: I'm worried about the death panels...seriously...

Over at DailyKos, DrMatt has collected a nice selection of anecdotes for my collection.

I have some more from Doctors for Amercia I'll try to post later today...

I will be on KDKA Radio Pittsburgh tonight (Thursday Aug 13) at 9 PM with conservative talker Mike Pintek.

You can listen live at www.kdkaradio.com

Cheers,

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The Associated Press: Long lines as free health care offered in LA area

The Associated Press: Long lines as free health care offered in LA area:

The Los Angeles event marks the first time Remote Area Medical has provided such medical care in a major urban area. The medical group typically serves patients in rural parts of the United States and travels to underdeveloped countries.

The piercing sound of teeth being drilled and scraped echoed up to the rafters where the Los Angeles Lakers once played to the roar of capacity crowds. Mobile health trucks provided other medical examinations, and tables full of donated eyeglasses were available to those who had eye examinations done.

Since 2000, The Forum has been owned by Faithful Central Bible Church, which donated the use of the facility for a week. The medical professionals volunteered their time and covered their own liability. Cash and services were donated by local hospitals, health systems and charitable groups.

Tennessee-based RAM's founder Stan Brock said he helps organize 30 to 40 such health care events a year, with a total of 567 events held to date, adding: 'We just wish we could do more.'

'This need has existed in this country for decades and decades,' said Brock. 'The people coming here are here because they are in pain.'
The event came at a time when the national debate over President Barack Obama's health reform plan has boiled over at town hall meetings, with opponents sometimes shouting down Democratic members of Congress who favor the program.
Rep. Maxine Waters, D-Calif., told a cheering crowd of volunteers and medical professionals at The Forum that she would continue to advocate for health care reform because 'we can do a better job of providing health care to those who desperately need it.

Let's see, 567 events times maybe 500 people each, how many anecdotes is that?

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A reality check on that Canadian "Brain Tumor" story

A reality check on a reality check:

Still, I found Holmes tale both compelling and troubling. So I decided to check a little further. On the Mayo Clinic's website, Shona Holmes is a success story. But it's somewhat different story than all the headlines might have implied. Holmes' 'brain tumour' was actually a Rathke's Cleft Cyst on her pituitary gland. To quote an American source, the John Wayne Cancer Center, 'Rathke's Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts.'
There's no doubt Holmes had a problem that needed treatment, and she was given appointments with the appropriate specialists in Ontario. She chose not to wait the few months to see them. But it's a far cry from the life-or-death picture portrayed by Holmes on the TV ads or by McConnell in his attacks.
In Senator McConnell's home state of Kentucky, one out of three people under age 65 do not have any health insurance. They don't have to worry about wait times for hip or knee replacement or cancer surgery -- they can't get care. The median household income in Kentucky is $37,186 -- not quite enough for the $97,000 bill at the Mayo Clinic. CNN didn't mention that in its 'Reality Check.'"

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Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign

Bill Mann: Americans Who've Used Canada's Health-Care System Respond to Current Big-Lie Media Campaign:

"The scare ads and op-ed pieces featuring Canadians telling us American how terrible their government health-care systems have arrived - predictably.

"There's another, factual view - by those of us Americans who've lived in Canada and used their system.

"My wife and I did for years, and we've been incensed by the lies we've heard back here in the U.S. about Canada's supposedly broken system."

Read on...

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Foregoing care due to cost | New America Blogs

HEALTH CARE: If This Is An Emergency, Please Press "Can't Afford It" New America Blogs:

From the New America Healthcare Blog ...

"Imagine being sick enough or hurt enough to rush to an emergency room—and then leaving without getting the recommended tests or treatment because you can't afford it.

"Doctors have a name for those discharges—'Against Medical Advice.' It seems to be happening more often, both in the ER and in the rest of the hospital as health costs rise and insurance coverage falls.

"MSNBC interviewed several doctors and patients about how the economy is affecting emergency care. A patient with acute appendicitis needing emergency surgery who waited for his mother to drive him to the hospital so he wouldn't have to pay for an ambulance. A patient with an infected kidney stone. People with chest pains who were not in the throes of a life-threatening heart attack that very minute but who couldn't or wouldn't follow up to find out what the pains signaled. A 31 year old knocked unconscious in a bike crash, who asked about the cost of the recommended follow up, only to be told by the ER doctor, that she was 'a physician, not an accountant.' Declining treatment, he still got a $600 bill."

There's more at New America and at MSNBC...

I would only add this, from a wise NY Times reader:

Mr. Krugman rightly notes that emergency room care cannot substitute for health insurance since the cost will be billed directly to the patient.

There is another reason emergency rooms cannot provide adequate health care. Emergency rooms are for emergencies. They can treat a patient in a diabetic coma, but they cannot provide continuing help in managing diabetes. They can treat a full-blown asthma attack, but they cannot provide the medications needed to manage asthma daily.

They can treat a woman who has gone into early labor, but they cannot provide prenatal care.Emergency rooms cannot offer any help for managing Parkinson’s, Alzheimer’s or cancer. On a more basic level, they cannot provide eyeglasses, hearing aids or dentures.

Republican claims that no American is without access to health care because “you can just go to an emergency room” are openly false as well as appallingly callous.

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With Son in Remission, a Family Struggles to Find Coverage - NYTimes.com

With Son in Remission, a Family Struggles to Find Coverage - NYTimes.com:

"Now the Walkers face the possibility that Jake will no longer be seen at Houston’s renowned M.D. Anderson Cancer Center, which they credit for his remission.

“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the maternal ferocity of a black bear. “You just — not give up — but you just feel that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really have to lose my home to save my son’s life?’ ”

Neither of the Walkers has been able to land a job with the kind of large group coverage that would disregard Jake’s health status. His cancer history effectively makes him uninsurable on the individual market. He is too old to qualify for Medicaid as a child, and it is virtually impossible in Texas to qualify as an able-bodied adult.

Because the Walkers own their modest house, they have been told they do not merit other government assistance. With little predictable income beyond Ms. Walker’s $688 unemployment check every two weeks, the family cannot afford the state’s high-risk insurance pool or continuation coverage through the federal Cobra law.

To date, Jake’s treatment has cost nearly $2 million. Almost all of it has been paid by Cigna under a preferred-provider family policy that Ms. Walker paid $426.28 a month for through DHL, the troubled shipping company where she worked as a billing agent.

Until last fall, Mr. Walker was the co-owner of a business that supplied DHL with trucks and drivers, but it too fell victim to downsizing. The feed store, the last in an area where suburbs are swallowing ranchland, has been losing money.

What has made the Walkers feel most helpless, though, is that their son has been left so exposed, after all he has endured.

“Your job as a parent is to protect your children at any cost,” Ms. Walker said. “I really felt like I had let him down.”"

At the beginning of the article, Mrs. Walker's salary was noted to be $37,000. She paid, out of that, $426 a month for her health insurance (admittedly, pretty darn good insurance given the expense of Jake's treatment). $426 x 12 = $5112 per year bringing her salary down almost 14%, not counting the subsidy on the employer side, probably close to another $5K.

The economic costs are brutal enough, but the fear, uncertainty, and skimping on care (prescriptions, skipping office visits, etc.) are just not acceptable in the richest country in the world.

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The Globalist | Global Health -- What Obama Can Learn from European Health Care (Part I)

The Globalist Global Health -- What Obama Can Learn from European Health Care (Part I):

"Imagine a place where doctors still do house calls. When I was visiting my friend Meredith, living in the small rural town of Lautrec about an hour’s drive outside Toulouse, France, one day she was stung badly by a wasp, causing a sizable and painful swelling on her hand.

"She called her doctor, and to my great surprise within 15 minutes he had shown up at her door — the famous French doctor’s house call. I couldn’t get over it. “House calls in the United States went out when Eisenhower was president,” I told her, shaking my head."

Part Two of this article is here.

"The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits — la santé d’abord, “health comes first,” as the French are fond of saying.

"It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive — or running it as a for-profit commercial enterprise. "

And this section is well said:

Unlike single-payer Britain or Sweden, other nations like France, Germany, Switzerland and Belgium have figured out a third way, a hybrid with private insurance companies, short waiting lists for treatment and individual choice of doctors (most of whom are in private practice).

This third-way hybrid is based on the principle of “shared responsibility” between workers, employers and the government, all contributing their fair share to guarantee universal coverage.

Participation for individuals is mandatory, not optional, just as it is mandatory to have a driver’s license to drive a car.

These healthcare plans are similar to what Massachusetts recently enacted — but with two essential differences. First, in France and Germany, the private insurance companies are non-profits. Doctors, nurses and healthcare professionals are paid well, but you don’t have corporate healthcare CEOs making hundreds of millions of dollars. Generally speaking, the profit motive has been wrung out of the system.

The second key difference is in the area of cost controls. In France and Germany, fees for services are negotiated between representatives of the healthcare professions, the government, patient consumer representatives and the private non-profit insurance companies.

These are a nice pair of articles to send to people who need a basic primer on what "socialized medicine" really is, rather than what the Right wants you to think it is.

Cheers,

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Fraser Institute still allowed space in WSJ

A friend sent me this piece from the WSJ from the seriously delusional Fraser Institute (whom I may have to give their own subject tag at this point, but I'll stick them in with the Right Wing Noise Machine for now). My reply:

I love how these people love to site anecdotes. I note they never site the horrible anecdotes from the US.

I have some collected here: http://cmhmd.blogspot.com/search/label/%22Anecdote-Off%22

The first entry on my blog in my "anecdote-off" section is from a BBC documentary on US healthcare from January.

Have fun. See how many anecdotes you can count in this brief half hour program. I think there are at least a thousand if you count all those poor people at the RAM Medical program. But there are stories every bit, actually worse, than any Canadian anecdote I've ever seen.

Keep scrolling down, you'll get the idea. If you are uninsured in America, you may as well be in Cambodia until you're sick enough for the ER.

Oh, and hip replacements in the US do have a short waiting time, thanks to OUR single payer system, Medicare, which is funded well enough to make it so,

And finally, the Fraser Institute is full of poopy-heads, and dishonest ones at that. ;-)

I love you, but aren't you seriously tired of being systematically manipulated by Fraser, Heritage, Club for Growth and the rest of the noise machine?

Cheers,

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Panorama (BBC) Documentary on US Healthcare

The episode is entitled "What Now, Mr. President?" Sadly, there is probably nothing you didn't already know in here, but it is a good program to share with your friends who still beleive in the Best Healthcare in the World(TM) myth.

Part 1

Part 2

Part 3

Has a section on RAM Medical, which "60 Minutes" covered last year, as well as a section on wealth disparity, health care lobbying, drug pricing, and a few striking anecdotes, if you like that sort of thing. (Getting chemo in a tent, begging for Tennessee Medicaid toive a liver transplant, and thousands seeking help at RAM.)

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Medical Debt Is a Growing Worry, for Those With Insurance and Without - washingtonpost.com

Medical Debt Is a Growing Worry, for Those With Insurance and Without - washingtonpost.com:

"'People who are underinsured end up facing almost identical problems as the uninsured,' said Karen L. Pollitz, director of the Health Policy Institute at Georgetown University. 'The difference is, they paid for the privilege.'

"Medical debt is likely to figure prominently in the looming national debate over reforming health care.

"Jim Eyler, 57, of Westminster, Md., says he needs help. The cement company manager said he spends about 33 percent of his take-home pay on unreimbursed medical bills, many connected with the advanced breast cancer his wife has been battling since 2005. 'I keep wondering, where's the money going to come from?' he asked."

More anecdotes here, of course, but the larger point is that our current cost structure is unsustainable.

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Blue Shield to restore coverage for dropped Californians - Los Angeles Times

Blue Shield to restore coverage for dropped Californians - Los Angeles Times:

"In an attempt to settle investigations prompted by articles in The Times, the insurer agrees to reissue plans to almost 700 Californians and reimburse them for expenses that would have been covered.
By Lisa Girion [January 7, 2009 ]

"Blue Shield has agreed to reissue medical coverage to nearly 700 Californians whose policies were canceled after they got sick and to make changes in the way it handles insurance bought by individuals, officials said Tuesday.

"Blue Shield of California's Life & Health Insurance Co. also agreed to reimburse consumers whose coverage was canceled for medical expenses they paid out of pocket."
...
"Most of the state's health insurers remain mired in litigation over the practice that has led to the cancellation of thousands of policies of sick patients, as well as financial losses for them, physicians and hospitals. In addition, Los Angeles City Atty. Rocky Delgadillo has sued Anthem Blue Cross, Blue Shield and Health Net, accusing all three of improperly dropping customers."
...
"When the state's charges were initially filed, Ross called them "grossly unfair." Blue Shield and other insurers have maintained that state law allows them to review a patient's old medical records after they get sick and rescind coverage if it finds something the policyholder failed to disclose on his application -- whether intentionally or by mistake.

"Consumer advocates and lawyers have accused Blue Shield and other insurers of using purposefully confusing applications designed to trick people into making mistakes that can later be used against them and of failing to properly vet the applications before issuing coverage."

God bless the American Businessman! Or woman. (Sorry, Loretta!)

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Insurer Is Sued Over Liver Transplant - NYTimes.com

Insurer Is Sued Over Liver Transplant - NYTimes.com:

"The family of a 17-year-old leukemia patient has sued the health insurance giant Cigna over her death in 2007 after the company initially refused to pay for a liver transplant."

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