Fool’s Gold: US Healthcare System Cheats Patients
By Donna Smith –
In case any one of us needs reminding, the profit-driven healthcare system in America is broken. Driven by its primary motivation to make money, there is little that compels those currently in control to care about patients like you and me. We are most assuredly a necessary component of the healthcare market – they cannot make any money without us – but we are treated like children to be seen and not heard.
The vast majority of us cannot access or pay for the care we need without health insurance coverage through either a private, for-profit health insurance company or through a government program for which we qualify. A small minority of people can afford to pay for care outright with cash or credit.
For that small minority, concierge care is the answer. Wealthy patients can pony up money in advance to assure services that used to be a matter of course – like return phone calls from our personal physicians, a doctor’s visit with our own doctor within a reasonable period of time should we get hurt or sick, or even a call with test results as soon as our doctors learned those results. Some of us remember the days when that was what doctors did for their patients routinely. But now humanity and decency is for sale in our medical system. Our doctors need to have the pot sweetened a bit with a little extra cash in order to deliver services that require extra time and attention like personal phone calls to patients.
Many of us support ending some of this insanity by improving and expanding Medicare coverage to all for life. A progressively financed, single standard of high quality care for all would be an amazing improvement and would put an end to many of patient abuses we endure today. But, sadly, some abuses are spreading through providers so deftly that we come to accept being cogs in the wheel of profit without control of our own health destiny, and simply fixing the payment mechanism will not be enough to fix the broken human interactions or lack thereof.
Like the vast majority of Americans, I do not have easy access or attention from my doctor and I certainly do not have concierge care. I have insurance coverage through my job from one of the giants of the insurance industry. Six weeks ago, I began trying to get a diagnosis and treatment plan after symptoms of cancer returned to my body for the first time in more than eight years. I still do not have my answers or my care. First, the insurance company denied the tests my doctor felt would be best after lab work showed the elevated cancer markers. Then I had the tests the insurance company would approve at that point, though the doctor was sure those tests would not be exactly right. I had to be injected with radioactive isotopes and scanned for four days in a row. A week later, after making yet another doctor’s appointment as is now often required to get any test results, I learned that, as expected, the test results were inconclusive. My doctor referred me on to the oncologist.
Ten days later, I saw the next doctor and he ordered more lab work and the original scans, with contrast die. The insurance company approved this time. I drank one contrast solution, and at the time of the scans, I was injected with another contrast. That was two weeks ago. And I am still waiting for the results. I dropped in to the medical records department of the hospital and requested they send my results to me, but nothing yet. When I called to follow up with the doctor, a visit was scheduled for another week later – his first available appointment. Though I tried to remind both the hospital and the doctor’s office that I am worried and waiting is hard, neither flinched. They are very busy.
Then this past Saturday, I got an email from the insurance company asking if I want to view my most recent claim. So, I clicked on the link to see the claim. Sure enough, every one of the healthcare providers who touched my body and tested me over the past six weeks has already managed to bill the insurance company and the covered portions of the claims have been paid. I, of course, paid my co-pays at the front desks of those providers before I even got through to the exam or testing rooms.
What’s so very wrong with this picture is that the money has changed hands before the patient been cared for. I am still waiting for the results which may well include news about my health that will include a recurrence of cancer. What mattered most to everyone was making sure the money was handled, and so it was. I wait. I am angry. In what other area of our financial lives do we actually give up so many of our rights to fair dealings? I have paid for services I have not received. As far as I am concerned, the contract made with me has been broken. An awful lot of people have made an awful lot on money, yet I still wait for answers.
Anyone who thinks we have a patient-centered or patient first system is seriously deluded. The U.S. healthcare system serves its profit-driven masters – not patients, like you or me. We’ve been cheated, not treated.
Donna Smith
Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.
This is a tragedy that, no doubt, plays out in many American’s lives on a weekly if not daily basis. I am fairly new to the forum but feel that insurance companies need to be gotten rid of altogether and to ignore that fact anymore is neglect. It is my opinion as a registered nurse and an American citizen that you’re either for a single payor system or you’re against it. Being for it, you stand for the right thing and being against you stand for cooperate greed and fraud and willful neglect of patients all across this country and that includes President Obama.
Even if one qualifies for government healthcare like Medicaid, one will not receive any type or degree of medical treatment, if one is residing in the wrong location like the state of New Jersey – especially South Jersey, where there are no first-tier university hospital facilities. South Jersey was always considered a bedroom community of the city of Philadelphia, PA. Therefore, the state government and local community governments never felt the need to build a viable public health infrastructure. Whatever present public health infrastructure exists, the Governor Chris Christie is dismantling by selling off government assets to hedge fund managers to repay for state government debt. Hence, the selling off of the Rutgers University Camden division. Even though I am now enrolled in an HMO plan with Horizon BCBS of NJ, I cannot receive any type of consultative treatment from the necessary professors of medicine at the Hospital of the University of Pennsylvania and the Thomas Jefferson University Hospitals. The Horizon BCBS of NJ is refusing to pay for all of my pharmaceuticals with the exception of three medications: MS CONTIN, MSIR, and Plaquenil. The former Governor Corzine terminated my HMO enrollment and placed me on the fee-for-service program in 2007. I then gained access to both my doctors and the necessary pharmaceuticals by 2009. Then, Governor Christie again enrolled me into an HMO plan, even though he knew all of my treatment would once again be terminated. In the year of 2004, a representative of the Horizon came to my residence to coerce and intimidate me for utilizing the E.R. at HUP and subsequently spending 4 days as an inpatient. I complained to the Dept. of HS and its DMAHS. In 2006, I was placed in the TJU Hospitals for 3 days as an inpatient for a tooth extraction and jaw bone biopsy (IV Aredia for 11 yrs.), because the director of the department wanted to avenge how I was being mistreated and abused by the system. I require 2 implants now and fear I will once again become a prisoner of the hospital for a good week, perhaps longer. Even though my brother purchased private comprehensive Delta dental insurance for me, the Governor Chris Christie and his commissioner of the dept. of HS enrolled me into an HMO dental plan with Horizon, for which the NJ taxpayers must pay. I would have been able to hold onto my private healthcare insurance long enough to enable me to leave the state of NJ, but my mother foolishly enrolled me into the SSI plan in the 1990s. The state of NJ took over my Horizon Plan B, which then enabled the Horizon reps to contact and send forms to my mother to downgrade my Plan B to a Plan D, causing the premium and deductible to rise exponentially. When I tried to regain control over my private health insurance, I was offered a Plan D with a $1,500 deductible. I have suffered from SLE from the age of eight and a half yrs. I was definitively diagnosed for SLE at the age of 16 yrs. I have never held any substantial gainful employment. Even so, the SSA maintains I did not become infirm and debilitated until the age of 31 yrs. or older. Beginning in my late twenties, I began suffering from the iatrogenic diseases caused by using corticosteroids. By my thirties, all hell broke loose with a series of almost fatal, disfiguring, crippling iatrogenic diseases like a perforated colon and unprecedented, extremely severe corticosteroid-induced osteoporosis of the spinal column. These iatrogenic diseases could not have possibly occurred unless I had been ingesting corticosteroids for over twenty years. Ironically, the State of Israel refused to allow me to immigrate on my own in my mid-twenties due to the SLE. And yet, the SSA claims I did not become infirm until the age of 31 yrs. or older, condemning me to a most horrific life of suffering, disfigurement, and death. I should be receiving full Medicare A & B benefits on my father’s social security retirement benefits. As you might know, SSA Commissioner Michael Astrue very recently fired or forced many doctors employed by the SSA to resign, because these doctors were forced to place those, who evidently not severely infirm and not debilitated on full benefits, while those like me were being either refused benefits or placed on inadequate benefits to prevent patients like me from receiving full benefits. The SSA is now being run like a for-profit enterprise, literally refusing to cover the truly infirm and disabled, because we cost money. And yet, the taxpayers are being forced to pay for worthless HMO policies like the ones contracted by the Governor Chris Christie, who possesses very strong connections to Wall Street. Even though I told the governor’s office and the commissioner of the dept. of HS to cancel a most gratuitous Horizon dental plan, they have not. So not only are the truly infirm and disabled being screwed and abused by the system, the taxpayers are also being screwed and abused by this current system. The taxpayers are paying for worthless pieces of paper, thinking that they are serving their civic duty by providing life-saving medical treatment to those of us, who have been afflicted with rare, atypical forms of autoimmune disease, most likely caused by contraindicated live-virus vaccines. My disease was caused by a contraindicated live-virus measles vaccine at the age of eight yrs. old. I suffered an almost fatal allergic reaction from this vaccine, plus contracted the actual viral infection from this vaccine. From henceforth, I began suffering from the ravages of a severely damaged immune and central nervous systems. There is no history of SLE or any disease, involving vasculitis, on either side of my families – although the immunosuppressive autosomal condition of selective IgA deficiency along with subclass IgG deficiency and other anomalies of the immune globulins exists on both sides. This autosomal condition eventually compensates itself by utilizing the healthy antibodies to take over the work of the dysfunctional, deficient ones as the child matures into full adulthood. Usually the only complications affiliated with this autosomal condition – that’s if the afflicted family member does not receive any live-virus vaccines – is chronic infections of the mucous tissues like chronic vaginal infections, chronic ear infections, eye infections, and chronic viral infections of the stomach and colon (causing chronic diarrhea and low-grade fevers through childhood into one’s late twenties). With the afflicted family members, who did not receive any live-virus vaccines, this autosomal condition literally and virtually disappers by the age of 30 yrs. All afflicted members are highly educated (multiple graduate degrees) with otherwise normal, healthy existences unless they foolishly subject themselves to any vaccine – whether dead or alive. Dead vaccines also cause a severe allergic reaction. I am the only member of my family to have received the live-virus measles vaccine, which is known to cause severe autoimmune diseases, involving vasculitis, like Crohn’s Disease, SLE, MCTD, IBD, and Rheumatoid Arthritis in people suffering from the autosomal condition of the immune globulins. We now give our canines preliminary antibody titer exams to preclude the onset of autoimmune disease and early onset of cancer, but we still do not render preliminary antibody titer exams to our children before turning them into pin cushions. If any truly infirm patients want to do something to bring further attention to our plight, please contact me at your earliest convenience. It’s not enough for our professional caregivers to take action. The infirm and the disabled victims must become a very visible reality for all to see and witness. During the 1980s, while I was studying at the JHU, the students and facult forced the university administration and board of trustees to divest from South Africa. Many students were spending their nights in prison cells. The same concerted divestment movement must now become a reality toward eviscerating and obliterating the private healthcare insurance industry. After the targeting the private insurance industry, the patients and their doctors and other caregivers must target the pharmaceutical corporations and the FDA for granting ridiculous patents like the patent to distribute Thalidomide by the Celgene Corp. Thalidomide was available through the year of 1997 for 75 cents per capsul. When the Celgene corp. was granted a patent to distribute this granny drug, the price of each capsule rose to over 140 dollars per capsule. (28 pills for almost $4,000 versus 100 capsules for $75 thru one of the AIDS foundations). If you are interested in organizing patients to take action – visible action to awaken the most myopic of our citizenry, please contact me at BouvierRex@aol.com
Two significant points are not sufficiently emphasized:
1, When a for-profit company gets paid only when it delivers a product, capitalism works just fine. However, when a for-profit company gets paid by a fixed premium, maximum profit is made from minimum delivery of product,
2. The need for healthcare insurance has two components. Care for the unexpected and unpredictable, that’s truly “insurance.” The other component is care for the inevitable and predictable, namely, the need for increasing medical care as one ages.
That’s why it is necessary to have a mandatory system for people to contribute money over their entire lifetime.
Donna,
I’m sorry to hear about the very difficult situation you are now in. My thoughts and prayers are with you. Through my work as an RN I daily encounter people struggling with this profit generating system that masquerades as healthcare. If only the millions of individuals struggling to have their healthcare needs met could be seen by the nation as a whole, it would be the most massive demonstration yet. But, each person becomes locked in a private struggle behind closed doors that hide the enormity of suffering that is taking place all around us. That is why we must continue the fight for a Single Payer system based on providing healthcare not profit.
Please keep telling your story everywhere you can. In time the truth will prevail. God bless you for sharing your story. Don’t quit!
I am an American living in London UK.I have used the National Health Service (our single payer ) throughout the 12 years I’ve lived here and have nothing but praise for this true health care. I was seriously ill last year and required hospitalisation, recovery, physical therapy, etc. f or months.Not once have I seen a bill. We pay taxes for this service but it is for All.It breaks my heart that my own country has no health service as we do here. In fact, because I now have a “pre exiting condition” I am forever uninsurable in the USA which means I can never return home. The For- profit criminal enterprise in the USA is obscene. Single payer works here in England and it could work there! never give up the fight!
If you haven’t already, you can help by posting this on your Facebook page and writing an opinion editorial to send to your USA home town newspaper.