RATIONING

I have spoken, on these pages, about the delivery of  Healthcare only to those who can afford it. In a land of such abundance as ours, this rationing is unconscionable. For a stark example, we need look no further than a heart clinic's recent letter to a woman seeking a heart transplant:

"Your medical situation was presented to our multidisciplinary heart transplant committee on Tuesday, October 20, 2018. The decision made by this committee is that you are not a candidate at this time for a heart transplant due to needing a more secure financial plan for immunosuppressive medication coverage. The committee is recommending a fundraising effort of  $10,000....We thank you for the opportunity to participate in your care." 

WTF?! 

This woman has been told to beg for $10K from GoFundMe, a crowd source where, I'm told,  one of three appeals is based on healthcare needs. and this in the United States where the plutocrats have more money than they know what to do with, and yet the leading cause of bankruptcy is healthcare bills.  Alexandria Ocasio-Cortez is dead-on to decry GoFundMe as official policy: "Customers can die if they can't raise the goal in time - but sure, single-payer healthcare is unreasonable." 

Her sarcasm stems from her knowledge that Single payer is in fact the only reasonable healthcare proposal out there. It's based on the premise that there can be plenty of healthcare resources for all -- plenty of medicines, plenty of healthcare providers, and plenty of  money to pay them. Plenty, I say, with one big seemingly intractable exception:  organs for transplant. There are far more patients needing them than there are organs available, and that situation is not likely to change any time soon.

I have a personal interest in this, having inherited a kidney disorder which can lead to renal failure and dialysis, which could shorten my life substantially. By the grace of God, so far I am holding my own in this. Yet should I ultimately need dialysis, I'm sure I'd be better off in many other medical systems than the one under which we currently suffer.  

Eight years ago, there appeared in THE ATLANTIC MONTHLY  an article which shook me up. It was called God Help You. You're on Dialysis. It began as follows:

Every year, more than 100,000 Americans start dialysis. One in four of them will die within 12 months—a fatality rate that is one of the worst in the industrialized world. Oh, and dialysis arguably costs more here than anywhere else. Although taxpayers cover most of the bill, the government has kept confidential clinic data that could help patients make better decisions. How did our first foray into near-universal coverage, begun four decades ago with such great hope, turn out this way? And what lessons does it hold for the future of health-care reform?

It goes on to detail how our dialysis programs are set up for corporate profit, at the expense of patient health, and contrasts it unfavorably with what it calls The Italian Solution, and singles out a town called Reggio Calabria,  dusty and poor, and whose hospital "has the tired grubbiness of a bus station," but whose unit for kidney patients is "world-beating," and concludes:

Other countries provide universal access to dialysis care, much like the United States. But some, notably Italy, have better patient survival and cost control. Italy has one of the lowest mortality rates for dialysis care—about one in nine patients dies each year, compared with one in five here. Yet Italy spends about one-third less than we do per patient.

It's really a terrific article -- though 8 years old, it's more timely than ever!
I recommend it heartily. Here's the link: God Help You. You're on Dialysis   After I read it I figured that if worst came to worst, I'd learn Italian!

But if we should get Single payer health care by that time, I wouldn't have to move abroad.  I might have to reconcile myself to the fact that a younger man with his life ahead of him would more likely to be allotted  a scarce kidney than would an 82-year-old like me. But I wouldn't have to shudder -- as I do now -- that the corporate blood-sucking ghoul of greed  would be stalking our hospital halls,  lurking in corners of our clinics, and standing drooling over the surgeon's shoulder as he cuts open a patient's chest to replace his heart.

Dio

I welcome comments, which you can enter by clicking on the number of comments area. Don't be afraid to teach me something -- I'm learning all the time!

REMEMBER THIS MAN?

He's Martin Shkreli, who in 2015,  as C.E.O. of Turing Pharmaceutical, raised the price of the life-saving drug, Daraprim from $13.50  to $750 a tablet -- an increase of 5456%, rendering its cost prohibitive, and sparking great outrage in this country and the rest of the world. There followed Congressional hearings, in which Shkreli, following advice of counsel, repeatedly took the fifth amendment, refusing to answer any questions except to confirm his name.  Shkreli's smirking face became known everywhere, and he became the poster-boy of Corporate Greed in general, and Big Pharma's price gouging in particular. In the media, he became known as "Pharma Bro," and "the most hated man in America."  

According to Wikipedia,  Shkreli had set a business strategy for Turing: "to obtain licenses on out-of-patent medicines and reevaluate the pricing of each in pursuit of windfall profits for the new company, without the need to develop and bring its own drugs to market. As markets for out-of-patent drugs are often small, and obtaining regulatory approval of a generic version is expensive, Turing calculated that with closed distribution for the product and no competition, it could set high prices." 

A closed distribution for the product, as Shkreli well knew, made it very difficult for would-be generic manufacturers to get enough samples to create and test a generic version to compete with the original. From a strictly business point of view, it was an ingenious plan, and a colleague in the Pharmaceutical Industry hailed him as a "brilliant thinker, a visionary."

All the same, in 2018 he was sentenced to 7 years in federal prison for securities fraud.  Federal prosecutors said that he had "engaged in multiple schemes to ensnare investors through a web of lies and deceit." All this is very serious indeed, and criminalizing such behavior protects those fortunate to have enough money to invest.  But what about those not so fortunate? What happens when the price of a life-saving drug is raised to the point where it becomes -- to those who have no money to invest -- unaffordable? Is that a crime? IN THIS COUNTRY, IT IS NOT.

As they say in New Jersey, "you have a problem with that?"

Do I ever!  Our healthcare system, like so much in this country, is skewed toward the interests of the moneyed classes. We ration our health care, making it unavailable to those who cannot afford it. 

Now don't get me wrong -- I think that the Profit Motive is a great thing -- so long as its excesses are well regulated, that the people and the planet may be protected. But the Profit Motive has no place in healthcare. where the interests of those seeking healing, and those seeking to maximize profits are opposed to each other.  Our system is riddled with examples, some of which I have presented in my posts up to now. God willing, I hope to show more. 

But I also hope to show that we need not put up with a system in which we spend twice as much on each patient than any other country in the world, with outcomes that are worse than many. And I also hope to show that our country as a whole has, in aggregate healthcare expense, an albatross around our necks choking us and inhibiting innovation. We can spend less and get more.

I speak from the perspective of an ordinary person, who -- other than experiencing the healthcare afforded me and my wife -- has no specific expertise or training in this field. BUT I KNOW INJUSTICE WHEN I SEE IT.

Of course readers are encouraged to contribute their comments (just click on the number of comments area and the comment box will appear). I hope to continue learning from them.

Until our next exploration of the Healthcare Jungle, I remain

Faithfully yours,

Dio

"YOU FELL IN THE WRONG STATE"

Without giving our exact ages away, let me say that -- thanks be to God -- my wife and I have been around for a while, and have seen a lot. We have been privileged enough to have seen, close up, the finest traits in human nature, and, I'm afraid, have been sobered by witnessing traits that are, shall we say, not so fine.

In 2011, we drove down to the D.C. area -- for years our favorite holiday destination -- to visit some museums. The hotel we chose was in Maryland. On the evening of our second day, my wife tripped over some uneven bricks in the Hotel's courtyard, and fell hard, face forward, onto the brick surface. 

She extended her arms to break the fall, but the shock of her landing traveled up her arms and broke both shoulders. 

Tbe staff at the hospital -- a satellite of Johns Hopkins -- could not have been more caring or more efficient. The orthopedist on call was likewise professional and caring. "The most important thing." he said, is to call your orthopedist and have him see you -- at once, with no delay. You understand, right?"

Of course we understood.

We had come by car, with two close friends as passengers. If they hadn't volunteered to cut short their vacation and drive home with us, the trip would have been even more difficult than it turned out to be. We got home too late to phone the orthopedist's practice, but we called early next morning, and were told the my wife could not be seen for two weeks. I begged them to reconsider, but they were adamant -- no doctor would be available. Now this was the dominant orthopedic practice in our area, with more than a score of excellent physicians, one of whom had actually treated my wife recently. "But this is an emergency," I pleaded,"what if the bones set wrong?" They were sorry; there was  nothing they could do.

I was beside myself. We called our family physician, who is as scrupulous as she is smart. She phoned the orthopedic practice and went to bat for us. Result: We had an appointment the next day, in Poughkeepsie, where the physician, after an x-ray, pronounced Carol's bones well aligned. Then, indicating the sling she was wearing, said, "that sling looks terribly heavy and uncomfortable; shall I get you another, lighter one?" 

It was true that the sling, which had been issued us by the Maryland hospital, was solid and well built. "Do you recommend we change it, Doctor?" I  asked.

"I think she may be more comfortable in the new one," he said. And he brought out a very light rayon sling, which looked as if it couldn't have cost more than a few dollars to produce. The consultation had lasted 30 minutes.

That day, our family physician told us to have my wife sleep in a recliner chair. From personal experience she had learned that a recliner chair was the only way to get to sleep despite the pain. Trouble was, we didn't have one. So right after the visit. we went to the local furniture store and found a nice, modest sized one. I asked if they would deliver it, but they said  not for 3 or 4 days at the very soonest. It was going to snow tomorrow, and the store policy was to make no deliveries while it was snowing, or if it was in any way slippery. I begged them to make an exception, indicating her sling and rehearsing the whole sad tale. But they said store policy was store policy, and that was that, adding that the store was going to close in 15 minutes.

"Oh my God," I said out loud, "what are we going to do?"

At this moment I heard from behind me the words, "will you allow me to help you sir?" uttered in a deep, bass voice. I whirled around, and then looked up: The man who had spoken was enormous -- at least six-foot three, and built like a fullback. "I have a pick-up truck outside," he continued in his basso profundo," and if you'll allow me, I can put it in the truck and follow you home."

I just stared at this giant, thoughts of caution warring with thoughts of caring for my wife. I must have stared for a long time, because I finally heard from her, "just say yes." 

So I said yes, paid for the recliner, whereupon the giant picked up the recliner as easily as if it were  a Teddy Bear, put it in his pick-up truck (it was starting to snow already),  followed us home, and easily ported it up the stairs to the top floor of the raised ranch we were living in at the time. I took my wallet and offered to pay him, but he refused: "It would be wrong to take money for doing a kindness," he said. 

"Surely you must know someone who could use the money," I insisted.

He said his father was Minister of a church in Newburgh. He might know who could use the money.

So I pressed the money into his hand and said, "Do me a favor: Give this to your father, and say that we trust him to spend it well."

"I will, sir," said the giant, "but before I go, will you allow me to pray over you?" And before I could reply, he placed an enormous hand on me, and the other on my wife. "Dear Lord," he intoned, "bless this woman with swift healing, and may she and her husband know joy for years and years."  And then he was gone.

After a few days, when I had established a routine, I phoned the orthopedic practice to ask why they had initially refused to see my wife for a couple of weeks. "Oh," I was told, "we'll connect you to the Ombudsman." I was connected to the Ombudsman, and heard that worthy explain to me that while they had reciprocal agreements with many states, they did not have one with Maryland.  

"What does that mean?" 

"You see sir, the largest share of insurance reimbursements goes to the doctor who treated you initially, and any other practice gets short shrift.  A reciprocal agreement would have ironed out such problems, but we have none with Maryland. You fell in the wrong state."

I was incredulous. "You mean you would risk my wife's health because of something like that?!"

"I see I didn't explain it well enough, sir," said the Ombudsman.

"You could have sung it to Mozart, "I said, trying to control myself, "but it still would have stunk to high heaven!"

When, a few months later Medicare sent us the statement, we found they had been charged some $400 for the Poughkeepsie visit, the operation code specifying "surgery." Immediately we phoned the office, telling them that we feared that there had been some mistake. No knife had come anywhere near my wife's flesh, let alone cut into her. All that had happened was the taking an x-ray and the issuing of a very light sling.

"Oh, don't worry, sir," said the respondent at the other end of the line, "this is the code we always use in these cases."

When, in time, we considered all the expenses incurred by my wife's injury, we determined that the lion's share of reimbursement was not enjoyed by the Maryland doctor, but by the Kingston practice -- despite the lack of a reciprocal agreement.

A side note: My wife attended Radcliffe, which imparted to her "a Harvard education for women."  By the time of her 50th reunion, Harvard had subsumed Radcliffe, and the alums in her class were given the privilege of attending the commencement. As each school was declared graduated, that school's students threw their caps into the air -- except for the graduating class of the Business School. What they threw into the air was not caps, but money -- lots of it, My wife was shocked  But in retrospect, she asked herself why was she so shocked?  This was why those students had gone after the Harvard MBA in the first place  -- to make money, and lots of it. For them, the bottom line was the bottom line, and a person's worth was quantifiable.

But not everyone is like that, not even all Business School graduates, I keep telling myself. There are people for whom things unseen can sometimes be more important than what is material. That does not make us losers, nor does it make us suckers. Carol's friends were not losers. Her family doctor wasn't a loser. The giant wasn't a loser. They were human, because they sensed something more important than money. Those who don't agree want to define us. determine us, rule us.

We mustn't let them.

Dio

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YOUR MONEY OR YOUR LIFE -- Part II

A couple of days ago, the New York Times came out with a story which begins:

The burden of high drug costs weighs most heavily on the sickest Americans.

Drug makers have raised prices on treatments for life-threatening or chronic conditions like multiple sclerosis, diabetes and cancer. In turn, insurers have shifted more of those costs onto consumers. Saddled with high deductibles and other out-of-pocket costs that expose them to a drug's rising list price, many people are paying thousands of dollars a month merely to survive.

For more than a year, President Trump and Democrats in Congress have promised to take action on high drug prices, but despite a flurry of proposals, little has changed.

These are the stories of Americans living daily with the reality of high cost drugs. And there are millions of others just like them.

The article continues with the stories of seven individuals struggling to stay alive.  This is superb reporting. Not once do the reporters resort to statistics -- percentages, patient counts,  and the like.  Statistics tend to distance the reader from the reality, and make the the narrative easier to take.   And that narrative could be ours, for these people are middle-class, having too great an income to qualify for what aid may be available to the poor, yet not having nearly enough to pay for life-saving medications. If any of you reading this is unlucky enough to have such a life-threatening, chronic disease, chances are that none of this is news to you -- you're going through it every day. On the other hand, if you have escaped that fate so far,  I humbly encourage you to click on the link and read what comes up:

The Price They Pay

These are stories about people with no good choices but, to keep breathing, they choose whatever is available. Should they ration dosage? Should they skip a medication entirely and focus on a another, which, in their estimation, might be more likely to keep them alive until they have the money to pay for the drug they've been skipping? "I'm stuck between a rock and a hard place," says one, "and I'm sure a lot of other people are as well."

And the thing is, little or none of this has to do with the costs of development, or of production.  One of subjects needed a drug -- albendazole, an old medication, on the market for years -- the price of which was raised from $6 a pill to $120.  The purchaser said she is furious that she was forced to pay $750 for an old drug. "'They price it because they can,' Mrs Williams said,  'Wall Street decided they could make money off of prescription drugs, which is just scary and depressing.'"  The seller of the drug refused to give the reason for the price hike.  He didn't have to; the reason is obvious. 

Some of these pharmaceutical companies have what they call Patient Assistance Programs (PAPs).  But these are engineered to limit the losses to the company. For example, according to our article, "Novo Nordisk requires low-income Medicare beneficiaries to spend $1000 on drugs in each calendar year before they can qualify for free drugs through its  program. In a cruel irony, many patients don't have that $1000 to spend. 

What I want to know is why these companies offer such programs in the first place. It can't be for humanitarian reasons; their arbitrary jacking up of prices could scarcely qualify them for the encomium "humanitarian." I'm guessing they do it for the same reason that pigs wear lipstick. It's what their PR people term optics. They want to look as good as they can under the circumstances. They want to give cover for the legislators whom they bought with campaign money. And they hope to fool you into thinking they're not  that bad. 

DON'T BE FOOLED! Stand up and tell your legislators -- repeatedly and very loudly -- that you can tell the difference between a politician and a pig, and if they won't move for, and vote for a health system which is NOT profit driven, but driven by good, healthy outcomes for EVERYBODY, then you'll find a legislator who will.

DIO

If you'd like to leave a comment, just click on the link showing the number of comments, and the "comment box" should drop down. Don't be afraid to teach me something! I'm learning all the time.

YOUR MONEY OR YOUR LIFE!

I remember hearing Jack Benny on radio -- late in the forties, well before TV became available in my home town (Newton, Massachusetts). For those of you who may not have heard of him, Benny played a a vain skinflint whom it pained to part with even one penny. In one skit, Benny was confronted by a coarse-voiced bad-guy who said, "your money or your life!"  Benny didn't answer, but there was uproarious laughter from the audience, who well understood the stinginess of his stage character. When the laughter subsided (in a hilarious 8 seconds), the gunman said, "look bud, I said your money or your life!" whereupon an exasperated Benny shouted, "I'M THINKING IT OVER!" 

You can hear this classic moment on You Tube -- I just did, and it's still funny. What's not so funny, however, is that in real life,  every minute of every day in this country, some poor soul hears from Big Pharma that same demand -- "your money or your life!", and then that unfortunate has to figure out how to get the money that will keep him -- or her -- alive. Too many cannot, and suffer grisly consequences and death.

A well known example is the case of Alec Raeshawn Smith, who had Type 1 Diabetes. He had turned 26 and was thus "aged out" of being covered by his mother's insurance. His mother said he had been shopping for health plans, But could not find one he could afford. When he went to pick up his Insulin and glucose strips, he was told it would cost $1300. He knew that at his salary  -- $35000/year  (he managed a restaurant) --  he couldn't afford to buy as much as he needed, so he decided to ration his supply, hoping that he could make it last until his next salary check. Four days before pay-day, he died of diabetic ketoacidosis, where you go into a coma, your blood having turned to acid.

According to a recent study at Yale, 1 in 4 Diabetes sufferers have admitted to doing the same thing, though they realized how dangerous it was. Since 2002, the price of insulin has skyrocketed. A vial of insulin which used to cost $40 in 2002 now can cost more than $300. There is no generic.

There are insulins that you can get over the counter -- the old fashioned kind -- for a relatively resasonable price, but they work differently, and unreliably, compared to the expensive versions, one which is tailored to peak faster or another which is tailored to last longer. With these highly refined and tailored versions, you can get an insulin which peaks quickly so it's ready for you to have a meal, or, alternatively one which lasts for a longer period of time when you're between meals. With the old fashioned versions, you have to count on planning your life's schedule and your diet with exquisite precision, and hope for good results, which don't always come. Or you can fly to Canada, where you can enjoy such savings that the first batch you order pays for the plane flight, while the other batches can be just gravy on top of that. And customs, I hear, will let you bring in pharmaceuticals if they are for your personal use. The same applies, they tell me, if you prefer to drive to Mexico. Those countries, like all of Europe, watchfully regulate the price of medicines, lest greedy manufacturers raise the prices to the point where they cause severe hardship.

NOT SO HERE. In this country, profits have primacy, and everything else is secondary -- including people. And in between the manufacturer and the customer, there are a whole string of agents, benefit managers retail outlets, etc, who want their cut, too!

Acquainted with all this, I can understand and sympathize with the irate comments people made to the New York Times article, upon which some of the current article is based:

The cost of insulin is determined by one's drug plan if you're lucky enough to have one. I have an excellent, rolls royce Medicare drug plan and the cost of my Lantus, the only pen on my plan's formulary, is still outrageous.
--------------------
During hurricanes and natural disasters people are prosecuted for charging people hundreds of dollars for food and gas but when it comes to medicine, allowing people to die is the actual business model of Pharma.
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My 34-yr. old son with Type 1 since age 18 works all hours of the day and night to make a living and get ahead. When his insulin and supplies keep going up, he never gets ahead. His insurance premiums also keep going up. Some days he comes home tired and wonders why it has to be so hard in America just to stay alive
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I am in an academic Endo practice in WV. The price of insulin has gone up about 225% per unit in the last few years.
Regular insulin and NPH are less expensive than the new insulins but patients have poorer outcomes due to "insulin stacking" phenomena leading to hypoglycemia and death. The donut hole in part D medicare coverage results in the most vulnerable patients reducing their insulin doses and getting complications such as diabetic ketoacidosis and death in the type 1 patients. The type 2 get acceleration of micro and macrovasular complications. This situation should not exist in the U.S. It is time for single payer and universal health care.
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My response to all of this is if we could have medicare for all, universal healthcare or single payer -- whatever you want to call it -- none of us would have to hear Big Pharma tell us: "Your money, or your life!"

Dio

If you'd like to leave a comment, please click on the "number of comments" link. The comment box will appear, and you can share what you think. Thanks to  these comments, I already have learned a lot!

IT'S AN EMERGENCY!

On July 5th of this year, PBS NewsHour had a very short presentation about the skyrocketing costs of  emergency rooms. A link to it is below, and I really think you should see it; it's as revelatory as it is short:

https://www.pbs.org/newshour/show/why-there-are-shocking-costs-on-your-emergency-room-bill

When the patients got the bill for these procedures, the sticker shock must have been amazing! $629 for a single band-aid for this Connecticut one-year-old, $939 for a bit of toe ointment for the Virginia toddler, and $7924 to fix the broken jaw of the man in Texas -- what was going on, here? There was a lot going on that you could see -- and a lot that you were not allowed to.

Not very many people know that there is a "Facility Fee" charged for just going through the Emergency Room door. This fee is often the greater part of the patient's bill. And that fee varies widely depending on the deal that the Hospital can make with the insurance companies. As was pointed out in the video, there could be a hospital across the street whose Facility Fee would be nothing like that of its medical neighbor. 

How can they get away with this? The reporter expressed the opinion that these hospital ER rooms were acting like monopolies. After working hours, or during the weekends, the ER is a patient's only recourse. and it can charge what it likes. When you add to this the not infrequent practice of having the patient treated by out-of-network doctors -- as was the surgeon in the case of the Texas man with the broken jaw. -- the patient is due for a rueful shock.

Of course the hospitals rightfully point out that it's very expensive to run a hospital, to keep the lights on in the emergency room, with  enough doctors, nurses, technicians, etc ready to go even if there is nobody to treat. And of course. there's the expense incurred by many of the patients, who, if not indigent, will be unable to pay the exorbitant rates charged. 

Is the hospital merely trying to cover costs,  here, or do they see the ER as a profit center?  They hold their fiscal cards so close to their chests that you can't know for sure. 

But in web forum Quora I read; "Modern Healthcare quotes Dr.Andrew Agwunobi, head of the hospital performance practice at Berkley Research Group, as saying that hospitals traditionally did not invest much capital in the ED in the belief that it provided mostly uncompensated care. The underlying assumption was that delivery system reform would ultimately reduce the number of visits to the ED and steer patients toward lower-level settings.'What they found was that the financial health of the hospital was actually in jeopardy. Most of the revenue of the hospital was actually coming from the emergency department.'"

This suggests to me that Dr. Agwunobi was portraying the ER as a hospital-saving profit generator. And he was not the only one to recognize this: President Obama proposed regulations that would limit the ER profits, but such a loud howl sprang up and such a strong push-back came from the hospital community that he abandoned the idea, and it has not been touched since.

Meanwhile, the insurance companies have become increasingly unhappy about the  ER charges they were having to pay -- so much so that in the Vox series alluded to in the video included here, it was reported that the Anthem Insurance Company has decided that -- in 4 states at least  -- it would pay only for ER visits to address conditions that proved life-threatening.  As you can imagine, this has caused very unhappy results! There was a woman -- a nurse as it happened -- whose severe pain felt to her like it might be appendicitis. It being a weekend, she went to the ER, which performed a battery of tests on her and determined that what she had wasn't appendicitis but ovarian cysts. They gave her  a couple of pain killing pills and an order to see her Gynecologist. They also gave her a bill for some $1200. Anthem informed her that since her condition wasn't going to kill her any time soon, the charges were hers to pay -- not theirs. 

In other words, the insurance company was telling the woman to be her own doctor, and decide whether or not the ER visit was really necessary, or whether she could risk waiting for Monday when her Gynecologist would be seeing patients.

This is only one example of how the profit motive has become so enmeshed with medical practice, that lives are put at risk -- human lives being secondary to the fat profits of the industry, and the huge salaries of their CEOs.

We cannot go on with this broken system. The price-gougers and the very rich may like it just fine, but for us regular folks, it's an emergency.

Dio

A Stern Warning

Today in the New York times there appeared a column by Harold Pollack warning the Democrats that if they really want to improve Healthcare in this country, they had better start working on it RIGHT NOW, and that, "unlike the the Republicans, Democrats should put in the hard work to create a smart bill they actually intend to pass, one that commands broad public support."

His article is really worth reading: Here's a link to it: https://nyti.ms/2Dsxnqz  As you can see, Professor Pollack is an incrementalist. Though he fully believes that Single Payer would save a lot of money, he deems it politically unrealistic to expect it to pass any time soon. So he proposes approaches like a public "buy-in" to Medicare -- for folks who are sick of the price-gouging manipulations of Big Insurance -- coupled  with an expansion of Medicaid. This would be, he thinks, a big improvement.

Doubtless it would. At this sad ebb of public policy, almost anything would.

But things can change.  Personally, I can't forget the delighted amazement I felt when I saw the preponderant attitude of the country had softened toward the LGBTQ community. This was a development that, in my youth, I had supposed impossible. Now here it was, seeming to happen overnight! Could not the public attitude about Single Payer change as well?"

To tell you the truth, I don't believe many people object to saving money. And the fact is that the vast majority of them would be paying far less for healthcare -- taxes included. Of course, the one or two percent paying more would scream bloody murder. And in this country, money doesn't merely talk, it shouts aloud with lies,distortions, even threats, aimed at persuading the people to vote against their own interests. That's what they met to plan in Troy, NY a few days ago.

Still it would be wrong to suppose that  public attitudes must always be immutable. Look how just a few years ago, Obamacare seemed to be hated by very many conservatives, yet the Democrats won the midterms mainly focusing  on pre-existing conditions! What had changed? Two things -- the advent of Trump, and the people beginning to see to see that Obamacare could not only be life saving, but a good source of employment in communities fallen on hard times.

And have you checked out the responses to Pollack's column (also included in the link)? Many of them were full of outrage against Trump, and full of withering sarcasm against Pollack's incrementalist approach! 

If the Democrats are smart, they'll see that they have their work cut out for them, and that  they had better get to it.

We had better make sure they do.

Dio

If you'd like to leave a comment, please click on the "number of comments" link. The comment box will appear, and you can share what you think. I'm hoping that this blog will teach me a lot!

The Event in Troy, New York

Yesterday, a coalition of  healthcare professionals, unions, and activist groups gathered at the Troy Hilton Garden Inn to picket the annual conference of the New York Health Plan Association, a trade association for the state's health insurance companies. It was frigid out there, but my wife and I were glad we showed up, pickets in hand. We wielded our home-made placards, which read,

BIG PROFIT$

FROM

PAIN?

$HAME 

ON YOU!

and we shouted chants like

HEALTHCARE IS A HUMAN RIGHT --

NOT JUST FOR THE RICH AND WHITE!

Sometimes, in the hope that the the NYHPA would hear us, the Chant Leader aimed his bullhorn up to where they were meeting. They had assembled, after all, mainly to figure out more ways to oppose Single Payer healthcare in New York, by promoting what they called the "realities" of Single Payer.

In the first page of our Press Packet I found the following powerful snippet:

But even more striking was the testimony of a nurse, delivered powerfully through the bullhorn:

"We nurses get to see pain and suffering up close. One day, when I was tending to a patient, I overheard through the partition what was going on with his roommate. This poor man, a truck driver, had a 95% blockage in his heart. His nurses were trying to ready him for the surgery, and they told him that the operating room was being prepared  for him. But he told them that he'd rather not have the surgery because he doubted his insurance would pay for it. They begged him to go through with it: After all this was a life he was talking about -- his own life -- which was priceless. But he said no -- he'd rather leave. And he did -- he just got dressed and walked out the door. I never knew what happened to him."

But my wife and I felt that we knew. Rather than saddle his family with crushing debt, this poor man felt it was better to die. Effectively he was committing suicide.  He felt that he was too poor to live.

Alexandria Ocasio-Cortez famously has said that nobody should be too poor to live, and I agree with her. 

After all that, the "big secret" that I touted in yesterday's "teaser" turned out not so important.  But for what it's worth, not only did our group have demonstrators outside, I learned that we had operatives on the inside as well. Through an ingenious scheme that I'm not at liberty to disclose, they found a way to infiltrate the meeting, and some had even volunteered to disrupt the meeting, even though it could mean being arrested. There was even someone appointed to tend to these people should they land in jail!

But so far as I knew, none of this came to pass. The "suits" somehow got wind of the resistance outside, and just to be safe, they ended the meeting an hour early, whereupon a few of our leaders went to the Aetna headquarters in Troy. What happened there I have yet to find out.

There was a brief  break for lunch; our host was a personable young actor and writer. I asked him if he thought this was a class struggle. 

"Certainly I would," he replied. It's been going on for years, but only now are we wising up to it."

"Class warfare?" I offered.

"That, too. People are dying."

Dio

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SHAMELESS TEASER

My wife and I are excited about a BIG EVENT upstate tomorrow, though we are not at liberty to disclose what it is. When it happens, it will be obvious why it had to be kept  secret beforehand. Then why mention it now? It's a shameless teaser, posted in the hope you'll return in a couple of days to see what happened. and what condition we're in.  STAY TUNED!

Dio

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WE WOULD DO IT AGAIN

A few days ago, The New York Times published the following:

OKLAHOMA CITY — A jury has ordered Aetna to pay more than $25 million to the family of an Oklahoma City woman who died a year after the insurance company refused to cover a type of radiation therapy.

Jurors found that Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case before denying her coverage for proton beam therapy in 2014, The Oklahoman reported . The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer.

Aetna is considering whether to appeal the ruling, which was issued this week. Company attorney John Shely said the insurer tries to do the right thing.

“If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”

The background is scary. Mrs. Cunningham’s cancer was located so close to the brain that regular radiation would likely have disabled her — with blindness, and worse.  Now, with this sort of situation, Medicare routinely pays for Proton Beam Therapy, and it is covered by insurance companies for people younger than their early twenties. But for everyone else, Aetna has denied it, claiming it  is”investigational and experimental.”  Aetna’s spokeman told the Jury, “we’d do it again.” 

Mrs. Cunningham’s doctor had strongly recommended proton beam therapy; her husband had pleaded for it, but Aetna would not budge. The Cunninghams had to mortgage their house and resort to a “fundme” website, but by the time the money was raised it was too late, and she died.

THIS IS WHAT TOO OFTEN HAPPENS WHEN PROFITS ARE PLACED ABOVE PEOPLE. 

In my opinion, our system of delivering health care is as sick as the patients it treats. The purpose of this website is to detail what is wrong with our system, and to suggest why the only real improvement is to largely remove the profit motive from medicine.

In the meantime, I’d love to hear the opinions of anyone reading this. And if you know of a patient whose story is disturbing — or inspiring — please let us know that, too. Obamacare has saved lives which would have been lost without it. Those stories also need to be told. 

The best thing would be to share your thoughts on this blog, but if for any reason you wish to communicate to me privately, use the email link provided in my profile. Thanks!

Dio. 

PS: To add a comment, please click on the "number of comments" field (below) to bring up the comment box. Thanks!