How U.S. Health System Can Fail Even the Insured

  1. colorado springs, colo. -- barbara calder lives in nearly constant pain. her limbs dislocate at the slightest movement, even when she turns over in bed at night. she wears her hair short because brushing it hurts too much.

    mrs. calder suffers from ehlers-danlos syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. but, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. now mrs. calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.
    mrs. calder's difficulties mirror those of millions of insured americans who get lost in the u.s. health-care system's giant maze. for many, the journey is frustrated by coverage limits, denied claims and impersonal service.
    http://online.wsj.com/article/sb1195...ys_us_page_one accessed today.

    video at:


    http://link.brightcove.com/services/...ctid1312314846
    Last edit by HM2VikingRN on Nov 22, '07
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  2. 46 Comments

  3. by   CRNA2007
    You mean they won't allow her to pay for the test? Please show us the millions of insured that are lost in the US health care system maze? As usual more platitiudes and less substance.


    Quote from HM2Viking
    COLORADO SPRINGS, Colo. -- Barbara Calder lives in nearly constant pain. Her limbs dislocate at the slightest movement, even when she turns over in bed at night. She wears her hair short because brushing it hurts too much.

    Mrs. Calder suffers from Ehlers-Danlos Syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. But, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. Now Mrs. Calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.
    Mrs. Calder's difficulties mirror those of millions of insured Americans who get lost in the U.S. health-care system's giant maze. For many, the journey is frustrated by coverage limits, denied claims and impersonal service.
    http://online.wsj.com/article/SB1195...ys_us_page_one accessed today.

    Video at:


    http://link.brightcove.com/services/...ctid1312314846
  4. by   HM2VikingRN
    the article clearly cites how she is uninsured and her health insurance refuses to pay for pain relief and diagnostic testing:

    she still doesn't know whether she has the vascular type of eds. she worries that if she does, then her daughter and her eldest son, who is 21 and also has joint problems, probably have it, too, putting them at risk of dying young. even though both have health insurance through their jobs as hotel employees, neither has sought a firm diagnosis from a geneticist. they fear that having a pre-existing condition on their medical record would make it hard to get individual insurance policies if they are laid off.
    in recent weeks, mrs. calder has been lobbying mr. calder and her children to move to belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. one of the leading researchers of eds is a belgian geneticist who works at the university of ghent.

    no platitudes just real people who are having difficulty accessing health care.
    Last edit by HM2VikingRN on Nov 22, '07
  5. by   rph3664
    I didn't read the stories yet, but when my sister moved to California for the first time in the mid-1990s, I told her to go without insurance before signing on with Kaiser Permanente.

    She replied that she had already heard that more than once.

    (rph3664 puts on a flameproof suit)
  6. by   ready4crna?
    Her kids may be smarter than she is. Now that they are aware she has it, they surely have done a cursory google to find out that odds are that they have it. (Autosomal dominance). And there is no cure- only supportive therapy. So....don't confirm the diagnosis, and treat problems if/as they arise. We all gotta play the hand life has delt us, or work to better it for the next generation. A decent check up every year, with the ED name drop, will raise the alertness of any provider.
  7. by   Jolie
    Your article highlights 2 frustrations that exist with every health plan known to modern man: bureaucracies, and limitations of coverage.

    As unfortunate as it may be, every member of every health plan, government or private experiences these frustrations to some extent.

    The only way to avoid them is to provide 100% free care for any and all services, no questions asked, to every person who seeks it. Obviously we can't afford that.
  8. by   CRNA2007
    But that is what the left is demanding they want the free coverage and they think everyone else should pay for it. Economic studies in this country are woefully inadequate.



    Quote from Jolie
    Your article highlights 2 frustrations that exist with every health plan known to modern man: bureaucracies, and limitations of coverage.

    As unfortunate as it may be, every member of every health plan, government or private experiences these frustrations to some extent.

    The only way to avoid them is to provide 100% free care for any and all services, no questions asked, to every person who seeks it. Obviously we can't afford that.
  9. by   CRNA2007
    if she is uninsured than how can her health insurance refuse to pay for pain relief and diagnostic testing? for every one person you can show who has this so called maze of health care hoops to jump through there are thousands who get great treatment from their health insurance plans.



    Quote from hm2viking
    the article wiote clearly cites how she is uninsured and her health insurance refuses to pay for pain relief and diagnostic testing:

    she still doesn't know whether she has the vascular type of eds. she worries that if she does, then her daughter and her eldest son, who is 21 and also has joint problems, probably have it, too, putting them at risk of dying young. even though both have health insurance through their jobs as hotel employees, neither has sought a firm diagnosis from a geneticist. they fear that having a pre-existing condition on their medical record would make it hard to get individual insurance policies if they are laid off.
    in recent weeks, mrs. calder has been lobbying mr. calder and her children to move to belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. one of the leading researchers of eds is a belgian geneticist who works at the university of ghent.

    no platitudes just real people who are having difficulty accessing health care.
  10. by   HM2VikingRN
    Quote from crna2007
    if she is uninsured than how can her health insurance refuse to pay for pain relief and diagnostic testing? for every one person you can show who has this so called maze of health care hoops to jump through there are thousands who get great treatment from their health insurance plans.
    see:

    an anthem spokesman, james kappel, says it considers celebrex a "step-therapy" drug and doesn't cover it unless other, cheaper treatments have been tried first.
    mrs. calder says she called anthem back a week later to inquire whether her policy covered genetic tests. and once again she was stymied by a misunderstanding.
    mrs. calder says a representative told her that anthem doesn't usually cover tests for diseases that aren't treatable. mr. kappel says anthem has no record of that call and that skin biopsies were in fact covered by mrs. calder's plan. "if we had received a call about a skin biopsy, we would have approved it," he says.

    these are classic examples of how benefit denial specialists interfere with appropriate patient care.



    is national health insurance “socialized medicine”?

    no. socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. doctors in the veterans administration and the armed services are paid this way. examples also exist in great britain and spain. but in most european countries, canada, australia and japan they have socialized financing, or socialized health insurance, not socialized medicine. the government pays for care that is delivered in the private (mostly not-for-profit) sector. this is similar to how medicare works in this country. doctors are in private practice and are paid on a fee-for-service basis from government funds. the government does not own or manage their medical practices or hospitals.
    the term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. that does not describe what happens in countries with national health insurance. it does describe the interference by insurance company bureaucrats in our health system.

    http://www.pnhp.org/facts/singlepaye...php#socialized
    Last edit by HM2VikingRN on Nov 22, '07
  11. by   heartrn35
    Quote from hm2viking
    see:

    the term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. that does not describe what happens in countries with national health insurance. it does describe the interference by insurance company bureaucrats in our health system.

    http://www.pnhp.org/facts/singlepaye...php#socialized
    when ever the government controls the purse strings there is going to be limitations set. you can spin this anyway you like but the government is not going to give a blank check to healthcare, that would be impossible even if the gov't wanted to. this comes back to how well the gov't runs itself...enough said?
    bush vetoed the "child care" bill, because politicians packed the bill full of garbage that had nothing to do with healthcare, trying to get stuff passed that would never pass on it own. you want these people to be in charge of all of the us healthcare, because they are going to make it better. you still beleive in the easter bunny, don't you?:trout:
  12. by   SuesquatchRN
    I dunno. I just know that we are, once again, screwed.

    DH had a TRUP done last spring. After I had been fired, while I was paying for COBRA. His company-provided insurance, Oxford, was horrible, and the prior year we had paid thousands out-of-pocket because physicians that were listed in their book had stopped accepting their reimbursements as they had simply dropped their rates without warning or negotiation. So I got coverage through work, paid for COBRA (and needed to get a lawyer to secure our benefits), and he was able to get the surgery.

    Worked solely to pay for coverage (p/t, eligible to participate, often didn't even clear gas money). Good plan. Quit to accept a position in med/surg. Was told that I "wasn't fitting in" and fired.

    We simply can't afford $1200 a month for COBRA. This has been going on, off and on, since our very good, from which we thought we'd retire, jobs were outsourced in 2001 and 2002, respectively. We reinstated the coverage for which he's eligible through work. We don't have a physician connected with the hospital he used nearer than 100 miles away.


    Mike's prostate symptoms have returned. We can't find a urologist on this plan closer than Albany, 150 miles away.
  13. by   CRNA2007
    Sounds like you might need to move to albany or closer and see if you can find work as a nurse there.


    Quote from Suesquatch
    I dunno. I just know that we are, once again, screwed.

    DH had a TRUP done last spring. After I had been fired, while I was paying for COBRA. His company-provided insurance, Oxford, was horrible, and the prior year we had paid thousands out-of-pocket because physicians that were listed in their book had stopped accepting their reimbursements as they had simply dropped their rates without warning or negotiation. So I got coverage through work, paid for COBRA (and needed to get a lawyer to secure our benefits), and he was able to get the surgery.

    Worked solely to pay for coverage (p/t, eligible to participate, often didn't even clear gas money). Good plan. Quit to accept a position in med/surg. Was told that I "wasn't fitting in" and fired.

    We simply can't afford $1200 a month for COBRA. This has been going on, off and on, since our very good, from which we thought we'd retire, jobs were outsourced in 2001 and 2002, respectively. We reinstated the coverage for which he's eligible through work. We don't have a physician connected with the hospital he used nearer than 100 miles away.


    Mike's prostate symptoms have returned. We can't find a urologist on this plan closer than Albany, 150 miles away.
  14. by   SuesquatchRN
    Quote from CRNA2007
    Sounds like you might need to move to albany or closer and see if you can find work as a nurse there.
    Yeah, that's easy to do. Just walk away from a house in a lousy housing market without a down payment.

    We want to get out of here, CRNA. But it really isn't as easy as that.

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