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"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including . . . medical care . . ."
Article 25, Universal Declaration of Human Rights adopted by the UN on December 10, 1948

Another story, another reason

Save money, cover everyone and save lives with universal health care

Editor's note: While this story by Donna Smith is about the author's experience at a Colorado hospital, it could happen anywhere. Imagine an emergency room patient's dilemma upon being told by a business office representative: If you are admitted "upstairs", meaning the hospital, we do not accept your supplemental insurance. Is this right? Is this choice? Is this humane?

We can do better, here in Maine.

PS: As if to underline my "it could happen anywhere" comment, below is the December 1, 2014 Bangor Daily News editorial based on the British paper The Telegraph story by their US Correspondent David Millward: American woman in danger of bankruptcy after being taken to wrong hospital in Madison, Wisconsin. It's a financial horror story. No wonder that over 57% of Americans who declare bankruptcy are due to medical bills they cannot pay.

Theater of the Macabre: U.S. Health Care in 2014

By Donna Smith
Common Dreams
Nov. 26, 2014

Emergency

What are we doing? Really. What is it we are doing to one another? Our health care system is so dysfunctional and so profit-driven that most of us have come to accept as routine the inhumane, greedy and dangerous practices many (most) providers employ when we become their widgets.

It's a theater of the macabre, and the players on stage are you and me and every other American who finds himself or herself injured or ill and in need of medical attention. So it was last night when my husband's blood pressure soared to dangerous levels and he felt the vague ache of the chest pain that in the past has signaled an on-coming cardiac event. It took some convincing, but I got him to go to the emergency room shortly before midnight.

Exempla-St. Joseph's Hospital is a fine hospital in our area, and that's where we ended up. In the emergency room, nurses wasted no time in taking my husband, Larry, to an ER bed and starting the EKG, blood work and other assessments that would help the doctors know better what was going on. Larry was still pretty shook up but clearly a bit relieved to be in a place where if he was on the verge of a heart attack (or had already had another one), he would likely survive. It is terrifying for him to wonder when or if that next big event will come.

Once he was settled and test results were pending, a business office representative came into our room. She asked the usual sorts of questions about insurance coverage and handed us some Medicare literature and patients' rights handouts. Then she did what she probably legally is compelled to do but what ought to be illegal in any hospital. She said to Larry, "You know if you are admitted, we do not accept your Humana supplemental insurance up on the floors. Down here in the ER, we accept it, but not once you go upstairs. Our competitors at St. Luke's take it, though, so I guess you just need to know that." She went on to show her disdain for the Affordable Care Act/Obamacare, and acknowledged that she would support an improved and expanded Medicare for all, single-payer type reform. "Who wouldn't want that?" she asked as she left the room and thanked us for our time.

I watched Larry's face tense and his cheeks flush as he started worrying about what we might owe if he were admitted. He looked to me for some indication of what we ought to do. I was certain if I told him that might mean we'd owe a substantial amount to St. Joe's for his care if he became an in-patient, he'd probably had said "No way" and demanded to go to a facility that accepted both his Medicare and the Humana supplemental for which he pays more than $200 each month. We already owe this hospital for in-patient care given to me last January and biopsies in April that we are struggling to get paid off, and Larry would never tolerate owing them more. Since I didn't want him to get all stressed out again and since that stress might well exacerbate the symptoms for which we were seeking care, I worked quickly to reassure him that he should not worry. Never mind that his new cardiologist does her surgeries at this hospital, and now we find out his insurance may not provide full coverage. What a mess.

We'll figure it all out, I told him, even as internally I thought this was potentially a really bad thing. I put on such a great performance last night. I was calm and comforting and as loving as I could be. To do otherwise when someone could be suffering a heart attack or other serious heart event is unconscionable and cruel. He is my husband of 38 years. I protect him with all that I am and will continue to do so. But it's the middle of the night, and I am tired and cold. Yet there is no one to reassure me -- the fear and the worry are not helping. I turned my attention back to Larry.

This is the mission statement I found on this provider's web page (just to add a touch of irony to the tale): Mission: We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.

Two things every hospital and provider must stop doing: first, do not enter a patient's ER room and deliver potentially awful financial news when you do not yet know what is going on with that patient's medical condition and/or care and you do not know what such information might do to that patient's condition; and, second, do not expect patients and their families to fully understand that our insurances can be good on one floor or in one department of your facility but invalid or not accepted as payment for any other part of what you do within your facility. Both of those things ought to be illegal. Oh, and maybe stop lying about your overall mission?

Finally, I say it so many times, but it is true. None of these situations would arise if we provided coverage to all underan improved and expanded Medicare for all for life system. And I aim to help make it so. Only then will we stop playing our unintended roles in the theater of the macabre that is our dysfunctional, for-profit health care system.

 

Donna Smith is the Executive Director of Health Care for All Colorado and the Health Care for All Colorado Foundation.

 

A trip to the ‘wrong’ hospital shouldn’t bankrupt you

Bangor Daily News
Dec. 1, 2014

Sometimes, the best way to identify a problem is to see it through someone else’s eyes. Take, for example, the British media coverage of the plight of a U.S. woman who was taken to the “wrong” hospital when she suffered a heart attack. The Wisconsin woman now faces bankruptcy because of her medical bills.

How is this possible, the incredulous reporter for The Telegraph wonders?

Megan Rothbauer suffered a serious heart attack at work last September. The then-29-year-old was unconscious when an ambulance arrived. It took her to the closest hospital.

But that hospital was not in the network covered by Rothbauer’s insurer.

The result? Rothbauer was left with $52,531.92 in bills for her care, which included 10 days in a medically induced coma, The Telegraph’s David Milward reported. If the ambulance had gone three blocks farther to a hospital in Rothbauer’s insurer’s network, the bill would have been capped at $1,500.

This situation “highlighted the complexity of the American health insurance system,” Milward wrote. In America, you have to stay in your insurance network, even when facing an emergency and, in Rothbauer’s case, unable to speak and tell an ambulance what hospital to go to.

The hospital where Rothbauer was treated, St. Mary’s, was actually very accommodating. Its total bill for her care was $254,000. Her insurance company, Blue Cross-Blue Shield, agreed to pay $156,000, the rate it would pay to an in-network hospital. St. Mary’s then wrote off 90 percent of the remaining hospital charges. Rothbauer still has to pay bills from doctors, therapists and the ambulance — which were outside the Blue Cross network. These charges totaled more than $50,000.

An unnamed spokesperson for the insurance company said the company wouldn’t pay more “since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation,” The Telegraph reported.

Likewise, Rothbauer had little influence over where she ended up for her medical care. Yet she now bears a heavy financial burden for her care simply because she was taken to a hospital that didn’t have a contract with Blue Cross-Blue Shield. Rothbauer, by the way, doesn’t really blame anyone for what happened. Instead, she is focused on finding ways to pay her bill, including delaying her wedding and considering bankruptcy.

For Meg Gaines, head of the Center for Patient Partnerships, a consumer advocacy group at the University of Wisconsin-Madison Law School, “This brings the health care problems to a pinnacle. The question is, will we tolerate this as a society?”

That is the question. Reform work, like the Affordable Care Act, has eliminated some of the most egregious health insurance discrimination, such as denying policies to people with pre-existing conditions. Steering patients to providers with better outcomes and negotiating lower prices are important steps in reducing America’s high health care expenses.

But cases like Rothbauer’s show that reliance on a system heavy on bureaucracy and inflexible policies leaves people with health insurance vulnerable to falling into unexpected gaps in coverage when an emergency strikes.

 

Maine Health Care FACT

Maine’s uninsured population rose from 135,000 individuals in 2012 to 147,000 in 2013, an increase of 12,000 people, according to the U.S. Census Bureau’s American Community Survey. (story)

 

Maine Allcare Universal Dollar Fundraising Campaign

Small ¢ontribution$ toward a big idea — Universal Health Care in Maine

We at Maine AllCare invite you to join our Universal Dollar Fundraising Campaign. We are asking for small, recurring donations. Monthly contributions of two, five or ten dollars from many people will create a modest, but stable and reliable funding source to help pay for printing the brochures, handouts and newsletters we use at community meetings around the state. Other costs add up fast, such as theaters rentals for showing the award-winning documentary, The HEALTHCARE Movie.

Please consider making a recurring donation of any amount to support our education and advocacy for universal health care in Maine. Anyone who makes a recurring donation will receive the above “button” as a “Thank You” until our supply runs out. (We have hundreds). We are a nonprofit, nonpartisan organization. Your contributions are tax deductible. It’s easy. Simply click on the blue Donate button on the left and fill in the brief form; and don’t forget to select the “Donation frequency.” One more thing: The more donor/supporters we have, not in dollars but in numbers, the more our combined voices are heard and the closer we get toward a majority who believe that every Mainer should have affordable, quality health care! Thank you.

Dr. Philip Caper

How ACA fuels corporatization of American health care

By Dr. Philip Caper
Special to the BDN
November 20, 2014

A new Harvard study has found that Americans’ trust in the medical profession has dropped dramatically in recent years and lags behind that in many other wealthy countries. At the same time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “ Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to view our profession as just another job.

We now have a situation where patients are losing confidence in their doctors, while doctors are losing confidence in our ability to do the right thing for our patients. We have a health care system becoming more hostile to doctors and patients and more friendly to health care corporations.

These trends are collateral damage caused by another trend: our increasingly corporatized, commodified and commercialized U.S. health care “industry” that is being put into hyper drive by the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems and MaineHealth.

As we continue down this road, doctors see our clinical autonomy disappearing as more and more of us become corporate employees subject to pressure to meet corporate financial goals that often differ from what is best for our patients. Patients sense that pressure as they are rushed through exams and are subject to more tests and procedures, some of them of questionable clinical value. They can almost hear the cash registers ringing as they move through their doctors’ offices, as more wealth is transferred from patients to those selling health care goods and services.

Why is American medicine, once the crown jewel of American professionalism and a proud and respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr. John Geyman, chairman emeritus of the department of family practice at the University of Washington, explains how during the year-long Congressional debate leading up to enactment of the ACA, the interests of the public, including doctors and patients, were subverted to those of large health care corporations.

The highjacking of health care reform is paying off handsomely. Robert Pear of the New York Times recently described how the federal government and the commercial health insurance industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal Treasury to insurers each year.”

Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”

Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.

This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.

Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.

Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.

What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.

The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.

I, for one, intend to continue pointing that out. That’s where our attention should be focused.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.



What Can Maine Doctors Do?

Return medicine to its healing roots — help educate and advocate for universal, single-payer health care that covers every Maine resident

  • Join Maine AllCare mailing list, and volunteer to help, including supporting financially
  • Join PNHP — www.pnhp.org
  • Visit our websites regularly — www.maineallcare.org & www.philcaper.net for more information
  • Organize and make your voices heard through the Maine Medical Association
    • Doctors have lost influence during the past 30 years or so, but we are far from powerless – they don’t have much of a business without us!
    • Doctors are still influential – make your views known
  • Write op-eds and letters to the Editor of your local paper
  • Testify in person and in writing before the relevant legislative committees when legislation affecting health care is being considered. MAC can help organize these efforts
  • Organize speaking events directed at professions and lay audiences for Maine AllCare speakers
    • Grand rounds
    • Local and specialty medical societies
    • Community forums, church groups, Rotary Clubs, Lions Clubs, Chambers of Commerce

If you have ideas about how else we might advance the cause of universal health care here in Maine, please write to us at info@maineallcare.org and and put "Idea" in the Subject line. Thank you.