Socialist healthcare "horror story"

allnurses Guide · Dec 27, 2008

Calif. teen's family sues Cigna over transplant

http://news.yahoo.com/s/ap/20081226/ap_on_re_us/teen_liver_transplant

rph3664 · Dec 27, 2008

Nataline Sarkisyan was not killed by her insurance company. She was killed by the cancer she had battled for some time.

Had she received a new liver (no guarantees about that), the operation itself would probably have killed her, and giving immune suppressants to someone on chemo is adding to the ticking time bomb.

allnurses Guide · Dec 27, 2008

I don't know what the outcome would have been. I cannot imagine anyone does.

Being pro life I would not choose to deny the chance her physicians requested.

...four doctors from Mattel Children's Hospital at UCLA Medical Center appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent....
http://news.yahoo.com/s/ap/20081226/ap_on_re_us/teen_liver_transplant

HM2VikingRN, RN · Dec 28, 2008

The Kos story was a well written piece.

Not_A_Hat_Person, RN · Dec 29, 2008

I've had CIGNA. They're horrible.

lamazeteacher · Dec 30, 2008

I'm offering the following history in the interest of giving information that might explain (not approve) of the lowered medical circumstances occurring now.

Cigna arrived on the scene in Los Angeles about 30 years ago, it seemed to have been designed for "blue collar" workers, with mostly foreign trained and speaking physicians as the only covered ones. When the communication problems became acute (just a few years after its inception), some effort was made to have interpretors intervene.

It was commonly known in the '80s that if your employer provided Cigna coverage, it wouldn't be an ideal place to work (to put it mildly). However, that time was the last "recession", and you were lucky to have a job. So "the band played on". If you had a choice of Cigna or Kaiser (as teachers did), you chose Kaiser and felt lucky to have that. My best friend, a teacher, had 3 young boys then and a sister-in-law who is a dermatologist.

So when chronic illness occurred, for 2 of the children, the aunt would coach the family about what they needed for good medical care (which was expensive, and not suggested by physicians in Kaiser's system). My friend's husband is an attorney and he would negotiate with Kaiser for the care his sister told him was needed. They got the expensive care.

I was away from L.A. for about a decade and was chagrined to find Cigna had grown tremendously during my absence, with clinics of their own and more English speaking doctors, with even more clients (employers). It seemed to me that the populace had settled for mediocrity or worse in health care.

It seems to me that statistics should be available to indicate comparisons various health care insurers have. That is, stats on lengths of time before correct a correct diagnosis is made and appropriate treatment begun, with patients' compliance in the package. However, no public agency seems to be interested in doing that and the insurance companies themselves have no interest in that project (why should they?).

Instead patient advocacy centers on children and the elderly (mostly helpless, health care dependant individuals). That scratch on the outer membrane of health care has produced much outcry and less solutions. What is it about the USA's population that prevents effective intervention? Well, you might site the money hemorrhage into various battles, fraudulent practitioners who more slowly syphon off more tax money, and a generally healthy milieu whose people have limited energy/interest, due to their other personal battles. Politicians have turned their heads away from growing, mountainous medical costs (not at all consistant with inflation, but more in tune with "what the traffic will bear"; and mounting health care insurance premiums.

Michael Moore's voice of conscience in exposing the shortfall of public medical services, in comparison with other countries' wealth of them was received by doubting, unbelieving Americans. I don't know how much more clear the desperate situation of those lacking insurance (for various reasons) has to be made, to inspire a sense of responsibility of all, for the few who need their tax dollars spent on public health care for all.

I came from a health care system in Canada in the '50s and '60s wherein the responsibility was placed on physicians to bridge the money gap and provide care for the public clinics held by all (private and public) hospitals. In order to achieve a place on the medical staff of any hospital, they had to staff its public clinics.

Hospitals in turn, absorbed the cost of care during admissions of those without funds to pay for it, I don't know if any of it was tax deductible. Finally, with hospital costs rising and physicians claiming that they needed to spend all their time in their own (private) practises, it was foreseen in the early '60s, that more government responsibility was needed. And it happened.

When I arrived in the USA in 1963 and learned about Public "County" hospitals' desperate conditions for the poor, I was appalled, then outraged. I was told that those poor people "deserved" the poor treatment they got. Then it was discovered in Los Angeles (I don't know if it happened elsewhere, but I suspect it did), that surgeries creating infertility (tubal ligations) were being performed without patients' consent (or knowledge of English).

At the same time, public outcry against the hopeless war in Viet Nam was becoming a groundswell effort, and political activism had general approval, when it worked to prevent further loss of life in a war that wasn't ours. Then it was turned on negative reception of those soldiers who survived, as they returned home. The dicotomy of the warm welcome given those Vietnamese who entered our lives at the same time (many of them settled in Orange County in CA, as close to Disneyland as they could) was missed.

What did become evident, was their acceptance of squalid living conditions as natural, our love for their food, and need to compensate for the helpful deeds they performed for our side in their homeland. Many women here became closer to the Vietnamese individuals who gave their manicures, and sympathized with their lowered circumstances. So it almost escaped notice that a whole industry (manicuring services) was taken over by them, due to their ability to make do with less income. There was no complaint from former manicurists, who may have gone on to better themselves (?) in the impending technology revolution.

And "the band plays on", but not tunefully as doctors demand higher and higher incomes, bolstered by the powerful industrious companies that now own many medical practises and require that more patients are seen/day. (I get a picture in my malicious mind of future wretched physician rowers - like the essence of hell in comic books, of multi manned boats, that hopefully will not be physicians' "just desserts").

Health insurance companies have assumed greater and greater influence on life/death decisions and use of procedures that would give greater quality of life; and formed alliances with employers (clients) and providers of newer medical equipment, and pharmaceuticals. Talk about political machines' influence on a society! They will be dictating seniors' eligibilty for joint replacements, heart valves, stints, and other replacements......... and let's not forget penile function.

So now we have the "recession"/depression that dictates scrabbling activities, as those who are employed do whatever it takes to preserve their jobs (usually keeping minds and mouths shut to inequities in working situations). So it's up to baby boomers who have established some form of future support for themselves, to do the work they've been so successful with - protest! Then help create a health care system that works for us all.

We boomers have more time and the realization of being duped by health care providers (health insurance companies) and - yes, our own crazed need for more, more, more. If you are close to one, please inform those individuals that it's time to pay up, with their spare time (after bridge and computer games, of course, or whatever recreation they now feel is their due) for all that their gain has wrought.

Thank you for following along in this ramble.

Lois Klein, R.N., P.H.N.

OC85 · Dec 30, 2008

Michael Moore's voice of conscience in exposing the shortfall of public medical services, in comparison with other countries' wealth of them was received by doubting, unbelieving Americans. I don't know how much more clear the desperate situation of those lacking insurance (for various reasons) has to be made, to inspire a sense of responsibility of all, for the few who need their tax dollars spent on public health care for all.

I'm not really a huge Michael Moore fan, but I was honestly shocked at how so many people could just dismiss this movie. I have to say, there were certain parts that literally had me in tears, and thats something that almost never happens. How anyone can watch this movie and not be moved enough to even admit that there is a serious problem is completely beyond me.

[The rest of your post was excellent, as well.]

patrick1rn, MSN, RN, NP · Dec 30, 2008

If we are going to raise taxes so people can have decent health insurance, so be it. On the other hand, I am opposed to so called socializing medicine in the USA. It is funny, liberals love to bash the VA hospital system and say that it does not take care of our veterans, that it is a failure, but yet liberals then look to the VA healthcare system as a model of socialized medicine that would work in the USA.

Every American citizen should have access to affordable healthcare, I agree with that, we live in the most prosperous country in the world. I dont have the solution to the problem, a mix of liberal and conservative ideals would be the best thing, it always is.

allnurses Guide · Dec 30, 2008

My story is simple, the VA takes care of me.
They do a good job for me including my vision and dental, besides my physical. They prescribe medicines for me . They even give me travel pay to help my transportation expenses.
I've often thought everyone should have this same level of medical expertise just for being a citizen.
Thank you and good luck,
Rocky
USMC
http://www.guaranteedhealthcare.org/your_story/i-have-it-and-it-good

Rocky clearly likes his VA care. My beloved uncle received excellent care too. I credit the vA with his living into his late eighties.

Yes I am aware that some VA hospitals and clinics are better than others and that some veterans have trouble accessing needed care. We can and, I think, will improve.

However I'm not in favor of socialized healthcare in the United States. I think single payer, such as improved Medicare, will be better. We could choose our primary provider, specialists, and hospital.

The single payer would negotiate prices and pay the providers.

lamazeteacher · Dec 31, 2008

However I'm not in favor of socialized healthcare in the United States. I think single payer, such as improved Medicare, will be better. We could choose our primary provider, specialists, and hospital.
The single payer would negotiate prices and pay the providers.

Please explain how you see the difference between "socialized medicine", Medicare, and single payer. I see some confusion in the vision you stated of single payer negotiating prices and paying providers. That is the same as Medicare, except that medications aren't covered in Medicare. The payments made toward Medicare come as a % of individuals' paychecks, so those who earn more, pay more. However trhe return on that money is the same for all, in terms of payment for services. Single payer programs, such as Canada's, means that the government (the single payer), acts only as cashier, taking in money from employed persons, and paying medical bills - without being responsible for negotiating costs (of pharmaceuticals, medical equipment) or determining appropriateness of planned extensive treatments. The latter functions are the responsibilities of committees of paid professionals.

In any 2 tier delivery of health care there's duplication of resources, so having VA hospitals and clinics seems to tax any health care delivery system unnecessarily, to me. I felt that way about "county" hospitals and clinics. They served only to separate the poor from the moneyed folks, until medicaid programs came into being. Some doctors chose not to accept medicaid patients, claiming to dislike the remuneration given for their care. Usually that group of " hoi polloy" doctors didn't take Medicare patients, either. There's something reprehensible about that, I think, yet others would call it "free enterprise". Yet I don't think of myself as a "socialist". As I've said in other threads, the only true socialism in place today, is practised voluntarily by those wishing to exist in Israeli kibbutzim.

What's wrong with having military patients treated in the same facilities as civilians? They could still have military physicians - or others, stateside. Are we concerned about civilians seeing the carnage exacted by war?

allnurses Guide · Dec 31, 2008

Please explain how you see the difference between "socialized medicine", Medicare, and single payer. I see some confusion in the vision you stated of single payer negotiating prices and paying providers. That is the same as Medicare, except that medications aren't covered in Medicare. The payments made toward Medicare come as a % of individuals' paychecks, so those who earn more, pay more. However trhe return on that money is the same for all, in terms of payment for services. Single payer programs, such as Canada's, means that the government (the single payer), acts only as cashier, taking in money from employed persons, and paying medical bills - without being responsible for negotiating costs (of pharmaceuticals, medical equipment) or determining appropriateness of planned extensive treatments. The latter functions are the responsibilities of committees of paid professionals.
In any 2 tier delivery of health care there's duplication of resources, so having VA hospitals and clinics seems to tax any health care delivery system unnecessarily, to me. I felt that way about "county" hospitals and clinics. They served only to separate the poor from the moneyed folks, until medicaid programs came into being. Some doctors chose not to accept medicaid patients, claiming to dislike the remuneration given for their care. Usually that group of " hoi polloy" doctors didn't take Medicare patients, either. There's something reprehensible about that, I think, yet others would call it "free enterprise". Yet I don't think of myself as a "socialist". As I've said in other threads, the only true socialism in place today, is practised voluntarily by those wishing to exist in Israeli kibbutzim.
What's wrong with having military patients treated in the same facilities as civilians? They could still have military physicians - or others, stateside. Are we concerned about civilians seeing the carnage exacted by war?

I think eventually when all have the same excellent standard of guaranteed healthcare the current government hospitals and clinics will compete for people to choose them as their provider. Private practice providers would as well.

There would no longer be a need for the many entities mentioned because ther would be a SINGLE payer.

Several decades of planning have preceded the current bill HR 676 The national Health Insurance Bill:

http://www.pnhp.org/docs/nhi_bill_final.pdf

HR 676 establishes an American-styled national health insurance program.

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories.

The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of ones employment, income, or health care status.

With over 45-75 million uninsured Americans, and another 50 million who are under insured, it is time to change our inefficient and costly fragmented health care system.

Physicians For A National Health Program reports that under a Medicare For All plan, we could save over $286 billion dollars a year in total health care costs. http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php

We would move away from our present system where annual family premiums have increased upwards to $9,068 this year.

Under HR 676, a family of three making $40,000 per year would spend approximately $1600 per year for health care coverage.

Medicare for All would allow the United States to reduce its almost $2 trillion health care expenditure per year while covering all of the uninsured and everybody else for more than they are getting under their current health care plans.

In 2005, without reform, the average employer who offered coverage contributed $2,600 to health care per employee (for much skimpier benefits).

Under HR 676, the average costs to employers for an employee making $30,000 per year would be reduced to $1,155 per year; less than $100 per month.

Who is Eligible?

Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and identification number once they enroll at the appropriate location. No co-pays or deductibles are permissible under this act.

Health Care Services Covered!

This program will cover all medically-necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. Medicare will be improved and everybody will get it.

Conversion to A Non-Profit Health Care System!

Private health insurers shall be prohibited under this act from selling coverage that duplicates the

benefits of the Medicare for All program.

Cost Containment Provisions/Reimbursement

The Medicare for All program will annually set reimbursement rates for physicians, health care providers; and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then administer the program. Payment to health care providers include fee for service, and global budgets. Doctors will be paid based on their current reimbursement rates. The conversion to a not-for- profit health care system will take place over a 15 year period, through the sale of U.S. treasury bonds;

Administration

The United States Congress will establish annual funding outlays for the Medicare for All program through an annual entitlement, to be administered by the Medicare program. A U. S. National Health Insurance Advisory Board will be established, comprised primarily of health care professionals and representatives of citizen health advocacy groups.

Proposed Funding

Maintaining current federal and state funding of existing health care programs! A modest payroll tax on all employers and employees of 3.3% each. A 5% health tax on the top 5% of income earners. A small tax on stock and bond transfers. Closing corporate tax loop-holes, and repealing the Bush tax cut for the highest 1% of income earners.

Of course there will be ammendments, hopefully improvements.