Over at the Great Orange Satan, I came across a post by a father of a type I diabetic (type I diabetes is an auto-immune disorder wherein a person can not produce insulin, and needs regular injections). To anyone who is familiar with type I diabetes, it's terrifying: maintaining blood glucose 'control' (i.e., keeping blood glucose within the 'normal' range) is an integral part of your daily life. There is the possibility of having too much blood glucose (too little insulin), which, over the long term, is very bad for your health (the effects mimic those typically associated with type II diabetes)--in the short term, a sharp spike in blood glucose can lead to nausea, and, occasionally, hospitalization to stabilize the patient's condition.
Having too little blood glucose (too much insulin) is even more life threatening, and can rapidly lead to starving the brain of oxygen (and this can happen over a very short time frame--a few hours). Worse, as the the symptoms get more severe, the diabetic will cease to think clearly and be unable to deal with the problem.
The point is that the ability to inject insulin and monitor its effects is critical. Which brings me to this open letter to President Obama (italics mine):
You've asked for my support. What am I supporting? I am not supporting the "Baucus Bill." I will not support you blindly. I will not back off. I will confront those who seek to belittle and demean the value of a public option. You, Mr. President, have given me nothing to fight for.The fight for me is personal. I have a thirteen year old daughter. When she was nine we learned she was a type 1 diabetic. Five years of pin pricks, of needle stabs and of counting carbs. At times not being able to share cake and ice cream at the birthday parties of friends. Five years of monthly disagreements with our insurance company over the numbers of needles, test strips. Last month I went to pick up her supplies and saw a note attached to a bag. "The insurance company will only allow four needles a day."
Managing diabetes is about preventing future complications and a greater expense. My daughter's Doctor had prescribed six needles per day. Each needle represents a meal, a snack or a correction. In effect the insurance company was saying to her you may eat four times a day.[*] Or, eat three and correct once. Well her Doctor believes in more and smaller meals. Tell me Mr. President who stands between her and her Doctor? Who has a concern for preventive care and maintenance? Why do I have to have this conversation month after month? Why does my policy increase nearly ten percent a year and some times more?
I know several type I diabetics, and all of them, to a greater or lesser extent, have had to fend off insurance companies who want to alter their regimens. Keep in mind, we are talking about the administration of a key hormone, one where screwing up said administration has severe consequences. What's more infuriating is this response from a reader who offers some advice (italics mine):
When needles are so cheap.... I hate to say this, but you should check out a mail order pet veterinary supply house because they sell packaged sterile needles (for their vaccines or other animal needs) that are the exact same thing as are used on humans, only for dogs, cats, horses, etc.
I can't believe I just had to type that.
There seems to be a lot of that going around.
*Because the pancreas of type I diabetics can not adjust their blood glucose levels at all, they often will eat small snacks to raise blood glucose levels (e.g., after physical exercise).
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Sounds like said Insurance Companies are effectively attempting to practice medicine without a license. I wonder how hard it would be to get a class action going....
My son is Type 1, and a collegiate athlete. Needles are not his problem, as he is on an insulin pump, but the insurance company is trying to limit the number of test strips he can use each day. As Mike has noted, physical exercise, and I would add especially if one is trying to perform at a competitive level, plays havoc with blood sugar levels; limiting his ability to test can be, frankly, dangerous.
And we have very good insurance. To me, this suggests that some of the people complaining about gov. insurance are not aware of the limitations of their private insurance. You don't have to be the government in order to ration health care.
Is there, (and if not someone needs to create) a list or site that has examples like this; examples devoid of hyperbole, so when a GOP fan(atic) cites the horrors of Canada, we should be able to come up with ten real life American insurance stories that will scare the hell out of them.
Why is nationalized/socialized health care the answer to this problem?
Specifically, it would seem to make sense to pass a law forbidding any insurance company from interfering with a licensed provider's order. If the doctor says six then that's it. Period. Only covering 4 or only reimbursing for 4 would be illegal.
If you want to underwrite health insurance then this is the rule: you are not licensed to practice care and you cannot interject any decision that hints that you are licensed or have any position to judge medical care; you pay bills from the provider and hedge your bet that your premiums are high enough to make some money. If not then you raise your premiums or go bankrupt.
Seems like it would cut the bureaucracy on both ends which leads to cost cutting, thus making it more affordable.
Please, tell me how nationalized/socialized health care gets your diabetic child 6 needles/day instead of 4.
Colin:
It is not clear that it would, however, this demolishes the current false meme that the current system does *not* get between the patient and the doctor.
@COlin
I think the problem is that for every single question that comes up like this, the insurance companies answer is "we'll do this until you make it illegal, and when you try to make it illegal, we'll lobby like hell NOT to make it illegal."
That was their stance on recission as well, if you'll recall from the congressional discussion on the subject.
When asked by congressmen, across the board the insurance company reps refused to stop recission because "the law does not require that."
Nationalized or socialized healthcare doesn't need to make a profit. Right now, in the individual insurance market only 70 cents on the dollar goes to patient care. 30 cents on the dollar goes to underwriting, the bureaucracy of denying medical care. Historically, government run insurance keeps overhead down.
That's not to say that it can't be done by private insurers. It's to say that the empirical evidence says that insurers would sell their grandmother to help their bottom line.
KeithB, I didn't know that people believed the status quo was such. I suppose people who've never, ever had more than a physical and have no family might think that.
Throwing out some wild speculation, I'd wager that the vast majority of people know someone who's had cancer or diabetes and have heard of the shenanigans that insurance companies pull.
I'm Canadian and have Type II, and as far as I know, the Canadian system doesn't pay for your test strips (or at least the Ontario system doesn't... it's actually a provincial system not federal, but the feds enforce some general rules since they pay a part). In my case my employee plan covers them (85%)and it covers however many my doctor and I think I need. The Canadian system does not pay for drugs or test strips unless you're getting them in hospital. There are exceptions and I wouldn't be too surprised if it covers insulin for type I or II (I'm not there yet) as it covers some long term stuff like that. Low income people and seniors can get meds covered.
And I know of people who get their personal antibiotics from pet supply stores.
I'm Canadian (and, more importantly since pharmacy coverage is a provincial thing, British Columbian) and type I - syringes and test strips are covered to a varying degree. Combined with my extended coverage (yay school) I pay nothing for strips, syringes, or insulin (well, not quite - I pay 1$ or so for Humalog as opposed to regular).
Without the extended coverage, I'd pay about 500$ over the course of the year before everything was covered - this changes based on your income level (I have none (boo school)).
Try and force me to go through a US-style system and I will shank you.
Also, limited to only 4 syringes through puberty? That's goddamned criminal.
@BAllanJ: In Ontario, there are various levels of cover. Most working adults have private drug cover; ODSP (disability) and OAP (old age pension) have fairly good cover publicly, as does Trillium (the low-income prescription drug support). WSIB (worker's comp) covers those injured at work. If you don't fit into any of those, that is harsh. Most doctor's offices have a "stash" of drug samples they provide to help mitigate costs for people with nor or lousy cover.
In Quebec, prescription drug insurance is mandatory and if you are not eligible for a programme with your employer, the provincial gov't covers you, with certain limitations (though not on insulin, syringes, or testing equipment). We should lobby for the same.
Happily, insulin is about the cheapest drug out there. But those strips are a pain.
While it is not in and of itself damning it has to be noted that companies selling health insurance have a very substantial interest in having people with expensive chronic conditions die off sooner than later. Failing that causing them to violate the terms of the insurance policy or otherwise finding some excuse for dropping them without significant blowback is their second choice. The main reason for slightly preferring death over discharge comes down to dead people being far less efficient at raising a stink over their mistreatment, and the relative ease of smearing the motives of any surviving relatives.
Their business model makes every dollar spent on patient care a dollar that doesn't appear on the bottom line. Patient care is, in their terms, theft of the investor's wealth. Maximizing the investor's return on investment comes down to raising the price of coverage and minimizing patient care. This is medical rationing for profit, disease and disability for profit, sacrifice of the weak and poor for profit. All so some nameless investor can get a few extra pennies in dividends.
@ Art
And that is why we need actual, serious, medical insurance reform in this country. And also why we'll never get it. Because those investors are the ones who own Washington. The only way I see anything real getting done is if a Clean Elections bill were to be passed making campaigns publicly funded. Even then I'm sure corporations will devise new and different ways to control the government. And one must never underestimate the roll of fear mongering and power corruption. (Like the battles going on at the town hall meetings.) Congressmen have perfectly serviceable health insurance so they really don't understand what regular people go through.
Companies and politicians are people, just like everyone else. If the status quo persists then it's because "the people" let other people do it to them. There are certainly vocal people but there are many more magnitudes of people who don't do anything about it.
"actual, serious, ___ reform in this country" won't happen until many more people become disenfranchised by it. The sugar tariffs are why HFCS is cheaper for pop and it costs people actual money every year in sugar prices to maintain this tariff, but it's not significant enough for anyone to actually care.
If health insurance companies were smart they'd throttle back their shenanigans until this health reform bit is squelched so they don't their stronghold on it.
Stacey C. @14 - "And that is why we need actual, serious, medical insurance reform in this country. And also why we'll never get it."
True. Sad but true.
Colin @15 - "actual, serious, ___ reform in this country" won't happen until many more people become disenfranchised by it."
It doesn't help any that all the major actors in this issue have health insurance they are quite happy with. The senators and congressmen have health insurance packages. The lobbyists for the drug and insurance companies are all taken care of. The talking heads on TV and the bloviators on the radio all have very generous insurance packages. They can demagogue the issue because they have nothing on the line.
Having had type 1 diabetes for over 26 years myself, I feel the author's pain. I've fought my share of test strip wars with my insurance over the years. The reason for the limitations is pretty simple: for diabetes care, the insurance standard leans almost entirely toward standards established for type 2 diabetes, which is far more prevalent in society (over 95% of cases). The jury is out on whether frequent testing makes any difference for type 2 diabetics, as their disease does not typically involve the extremes of high & low blood sugar. Most doctors don't prescribe more than a few test strips per day to type 2 diabetics. Since they are the lion's share of the claims, it follows that most health insurance companies make no distinction between type 1 and type 2 diabetes--there's no difference to them and thus no coordination on what a doctor prescribes, nor is there an allowance for different types of diabetes and what care differences may exist. In the past I've even had insurance companies try to limit how much and what kind of insulin I can receive, and my doctor has had to wrangle with them far more often than any doctor should have to. It's as if I have to justify my case every time, simply because of the type of diabetes I have.
All I can say about the current debate is that I never had better coverage, less hassle or lower copays, deductibles and premiums in my life than during the couple of years I was in the Federal Employee Health Benefits Plan. I didn't have to change doctors, could see any specialist I liked and never had the test strip issue arise once.
Kathy, I don't doubt your direct experiences in what insurance companies will cover for type 1 diabetes. You have it and I don't.
However, I find it exceedingly unlikely that insurance companies are unaware of the difference between type 1 and type 2. They all have licensed MDs on staff. Maybe some employees of the company don't know the difference, but in general, the company knows.
Which is actually worse, when you think about it. If they really are applying the same coverage standards to type 1 and type 2, they're doing so in full knowledge that they are not the same disease.
(I doubt that's the case, though. Most likely, they have some argument why they think > 4 needles or test strips is not medically necessary specifically for type 1.)
Kathy, I don't doubt your direct experiences in what insurance companies will cover for type 1 diabetes. You have it and I don't.
However, I find it exceedingly unlikely that insurance companies are unaware of the difference between type 1 and type 2. They all have licensed MDs on staff. Maybe some employees of the company don't know the difference, but in general, the company knows.
Which is actually worse, when you think about it. If they really are applying the same coverage standards to type 1 and type 2, they're doing so in full knowledge that they are not the same disease.
(I doubt that's the case, though. Most likely, they have some argument why they think > 4 needles or test strips is not medically necessary specifically for type 1.)
Posted by: qetzal | August 10, 2009 4:32 PM
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You would think so, but I've had MDs of all types (including my own, at one point!) make confused comments about type 1 diabetes. I've even had more than one say, "Are you sure you know what type of diabetes you have? You're an adult after all, it's impossible to have juvenile diabetes at your age." This is from regular medical professionals, some at university teaching hospitals. I doubt the level of education within the health insurance industry is at that standard.
Throw The Healthcare Obstructionist Out!
More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 76% of all Americans want a strong government-run public option on day one (85% of democrats, 71% of independents, and 60% republicans). Basically everyone.
We have the 37th worst quality of healthcare in the developed world. And the most costly. Costing over twice as much as every other county. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don't die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.
I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. A trillion dollar taxpayer funded private health insurance bailout is all you really get without a robust government-run public option available on day one. Co-OP's ARE NOT A SUBSTITUTE FOR A GOVERNMENT-RUN PUBLIC OPTION. They are a fraud being pushed by the GREED DRIVEN PRIVATE FOR PROFIT health insurance industry that is KILLING YOU!
YOU CANT HAVE AN INSURANCE MANDATE WITHOUT A ROBUST PUBLIC OPTION. MANDATING PRIVATE FOR PROFIT HEALTH INSURANCE AS YOUR ONLY CHOICE WOULD BE A DISASTER AND UNETHICAL, CORRUPT, AND MORALLY REPUGNANT. AND PROBABLY UNCONSTITUTIONAL AS WELL.
These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!
Republicans and their traitorous allies have been trying to make it look like it's President Obama's fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.
But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.
But you don't have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.
Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will make you feel better too.
There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.
I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!
You have been AMAZING!!! people. Don't loose heart. You knew it wasn't going to be easy saving the World. :-)
God Bless You
jacksmith â Working Class
I REST MY CASE (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healt…)
Republican Senators up for re-election in 2010.
* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah
Kathy,
Um. Well. All I can think to say is, that's scary!
jacksmith @20 - You might want to take "* Mel Martinez of Florida" off your list as he has informed us, I'm from the state, that he will not be completing his term and will not be seeking reelection. Sounds like he is out of politics for the time being.
Deepest irony is that if he never works another day in his life he will have far better health insurance and retirement package than the vast majority of Americans. Must be nice.
Greatest irony of all about health care.
Many insurance companies are publicly traded. Many shareholders of insurance companies are mutual funds. People invest in mutual funds for their retirement. Ergo, people save for their retirement in companies who are "trying" to get them in the grave.
If people were seriously pissed off at insurance companies then why invest in them? You'd think that if people were so mad about the insurance companies that they'd dump all their investment vehicles that invest in insurance companies. I've yet to hear a single advocation of such a "voting with your dollars".
Insurance companies do nothing wrong. They are FOR-PROFIT publicly traded companies whose obligations are to their shareholders. It's actually illegal to some degree for them not to make as much profit as they can. They don't make money by paying out. They make it by NOT paying out. It's capitalism, folks
Whether health care is something that should be (out)sourced to the private sector is one question, and reasonable people can probably disagree. But expecting the private sector to act like the public? That's just crazy.
Ridger, "wrong" is a judgment call (be it moral, ethical, legal, etc.). Being a for-profit company is not, in and of itself, "wrong" and their motive is patently clear, but that doesn't mean they don't acquire it "wrongly".
Back when I was on Aetna they revoked a $6k payment for a CT scan *6 months* after they approved the claim and paid for it. The hospital then came after me (and subsequently over-billed me putting my credit card over the limit). It was an absolute nightmare for me to get straightened out.
I would call this "wrong", you? And that's just a personal anecdote of an ocean of similar stories. Yes, it's in their interest to not pay but they ride the line between not paying and breech of contract.
I think it's "wrong" for an insurance company to decide "medically necessary"; I think the state licensed provider is the decider of "medically necessary".
I think it's "wrong" for an insurance company to rescind properly paid claims.
Etc.
Colin, it may be wrong from your personal point of view, but as far as they are concerned their motive is making money, and that's all that you should expect from a private company in a capitalist system - to make money for it's shareholders. That's the way capitalism works, and it's great for most sectors of a society.
It's also obviously not great for others - you don't want to have let's say a bunch of private military companies competing for who is the best bang for the buck - although that used to be the case in certain societies long ago.
The question is in which category healthcare belongs, and unless you're willing to live in a society where you let people who can't pay die, I think the choice is pretty obvious.
Oh and as for your idea about passing individual laws for what is illegal and what isn't - you seem to be under the impression that making things illegal is enough to stop them. In reality, laws need to be enforced, and who do you think is going to enforce these laws? We're going to have a huge government bureaucracy regulating the industry to make sure it works properly? Or are you going to expect individual citizens to take insurance companies to court everytime they deny coverage? Who's going to decide what's "medically neccesary"? While all these problems are probably solvable, it won't happen cheaply.
Coriolis, I have fully acknowledged the capitalism aspect. I thought #25 made that abundantly clear so I'm not sure of the point of retelling me it.
Funny you use the military as an example. Military + medicare/medicaid + social security = 65% of federal budget at almost $2T. The majority of the budget, which you indicate you fully support, are about killing and not-killing.
The doublespeak in your last paragraph made my head snap. Why do you presume that laws, as I mentioned, would be wholly ineffective, yet other laws, as you implicitly support, that nationalize health care would be wholly effective?
On the contrary, like I said at the end, these problems are probably solvable - but it wouldn't be cheap or free, anymore then universal health care would be. Of course you haven't really mentioned anything explicit about how you want this to be setup. You seem to want the government to decide what's medically neccesary and what isn't - and regulate the insurance companies to force them to comply. The dumb way to do that would be making individual laws, the better way would be to setup some expert committee to make these decisions. That's perfectly fine by me and as far as I understand the current bills will do just that with something called medpac.
Of course if the government is telling the insurers what they should be paying I don't really see what exactly would be "private" about those companies anymore. Except profits I guess.
Personally instead of having to regulate these companies so heavily to make them act properly I'd rather just have Medicare for everyone.
And incidentally, of course as any lefty I am against our insane military spending. I don't know why you assumed I'm for it. I was simply trying to explain to you that there are things that even in our capitalist society we consider to be a public good, provided by the government without competition, like for example military defense. Or (some) schooling. A point that was apparently too complicated for you.
A close friend of ours told us this story about her sister, who has been struggling with cancer for several years. Friend's sister (will call her FS) was going through chemo to keep the cancer at bay. Her sick time was limited, so in order to keep her insurance, she had to keep coming to work through the treatments. Like many chemo regimens, hers caused nausea.
Her insurance covered her chemo, but not her anti-nausea medication. After dragging herself to work through miserable bouts of nausea, being unable to afford the meds that would make her feel better, she started to call the insurance company for help. After being turned down several times, she finally reached a manager on the phone. FS offered to demonstrate her need for the meds by visiting the manager's office and throwing up on the desk.
She got her prescription covered.
Idiotic statement.
To be clear, wrong is a moral judgement, not a legal judgement. There could be a law FORCING insurance companies to shoot sick people in the head for profit, and it would still be morally wrong. There is no such law.
To argue that insurance companies are doing things that are legal, that's a different kettle of fish.
Recission is legal. That's why insurance companies do it. When questioned on the subject by congress, the insurance company representatives uniformly said that would NOT stop practicing recission because recission is legal. There is no question that recission is morally wrong. So insurance companies can do wrong, and do so regularly.
I hate the "It's capitalism." argument. It's not capitalism. That's not the definition of capitalism. I encourage you to open an economics textbook. Capitalism is an economic system in which the means of production are privately owned, and labor/goods/capital are traded on a to-varying-degrees free market. Capitalism says NOTHING about insurance companies "paying out."
Infact, in a large way insurance companies as-they-are-now are anti-capitalist, or at least anti-freemarket. "Free markets" only work when certain assumptions are met including:
-Markets need to be open: They generally aren't in healthcare, you can only choose from options your employer has.
-Information is abundant: Not true in the insurance markets. Even the insurance reps don't understand what they're selling most of the time. I promise you most of my patients don't know head or tails of what the options in front of them mean.
-People act rationally: Also not true in healthcare. People don't understand their own "self interest" when it comes to healthcare. That's the entire point of doctors - you're paying for our expertise to give you an idea of what's in your best interest. And there are no good markers to determine how to rationally choose a "good doctor," which feeds the information problem above.
-No externalities: That is, the freemarket assumes every benefit or cost in the system is contained within the prices given. That's 100% not true for healthcare. Your health is the definition of an externality. You can't reasonably put a price on it, and if you could, you could not rationally divide up that price. That is, even if you said "X dollars is the cost of a life," you couldn't reasonably say "and Y percentage of X is the value of keeping my blood pressure under control."
There are others, but those are the ones that come to mind. Clearly, it's not just "that's capitalism," and saying so betrays a huge misunderstanding of the basic concepts we're talking about.
The question was never having the private sector act like the public sector. The question was "can the private sector blatantly deceive it's customers about what it's selling forever with impunity."
Whitecoat, will you post that response to your blog? I would *love* to be able to link to it. I have some acquaintances from college who are (very) conservative that are using all of these arguments.
@Kelly
Posted :-D
Hope it helps!