OP-ED

Obamacare to the Rescue

I want to apologize to President Obama. But first, some background.

I found out three weeks ago I have cancer. I’m 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don’t spend it frivolously. We’re just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids’ schools and church.

We’re good people, and we work hard. But we haven’t been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment.

To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he’d worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family.

By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.

With the recession, both of our businesses took a huge hit — my husband’s income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband’s IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost.

Not having insurance amplifies cancer stress. After the diagnosis, instead of focusing all of my energy on getting well, I was panicked about how we were going to pay for everything. I felt guilty and embarrassed about not being insured. When I went to the diagnostic center to pick up my first reports, I was sent to the financial department, where a woman sat me down to talk about resources for “cash patients” (a polite way of saying “uninsured”).

“I’m not a deadbeat,” I blurted out. “I’m a good person. I have two kids and a house!” The clerk was sympathetic, telling me how even though she worked in the healthcare field, she could barely afford insurance herself.

Although there have been a few people who judged us harshly, most people have been understanding about how this could happen to us. That’s given me the courage to “out” myself and my family in hopes that it will educate people who are still lucky enough to have health insurance and view people like my family as irresponsible. We’re not. What I want people to understand is that, if this could happen to us, it could happen to anybody.

If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn’t mean that you’re better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn’t depend on luck.

Fortunately for me, I’ve been saved by the federal government’s Pre-existing Condition Insurance Plan, something I had never heard of before needing it. It’s part of President Obama’s healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.) It’s not perfect, of course, and it still leaves many people in need out in the cold. But it’s a start, and for me it’s been a lifesaver — perhaps literally.

Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the “h” on my Obama bumper sticker, so that it read, “Got nope” instead of “got hope.” I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down.

So this is my public apology. I’m sorry I didn’t do enough of my own research to find out what promises the president has made good on. I’m sorry I didn’t realize that he really has stood up for me and my family, and for so many others like us. I’m getting a new bumper sticker to cover the one that says “Got nope.” It will say “ObamaCares.”

Spike Dolomite Ward is the founder and executive director of Arts in Education Aid Council, a nonprofit organization that is restoring the arts to public schools in the San Fernando Valley. This piece originally appeared in the L.A. Times.

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  1. My husband was given three to four months to live in 2011. He was diagnosed with SMALL CELL (oat) LUNG CANCER. Oncologist said, “Get your affairs in order.” After ONE chemo treatment he said, NO MORE….I’m going to die anyway so I am not subjecting myself to this barbaric non-treatment. In the meantime our daughter had brain tumor and went to Shands in Gainesville, FL They removed the tumor size of small orange but unfortunately dendrytes had covered the brain and intertwined with blood vessels. Someone gave her a bottle of ESSIAC TEA (aka 4-herb tea) and when she went back 6 wks later, she was completely healed! She gave her dad a bottle, he started after the first & last chemo and in six weeks his stage 4 cancer was gone. That was almost two years ago. He is healthy and happy and still takes this old Objibwah native treatment l tsp a day. Our daughter is still healthy. We have shared this tea with hundreds and those who have contacted us are ALL CURED. Rene Cassie brought it to USA in l920 but the powers that be have KEPT IT FROM US AND TRIED TO DESTROY THE FORMULA which are simple weeds that grow wild. Check out Herbal Healer Academy, Inc (AZ) click on 4-herb tea and read the TESTIMONIALS. Also see: Rene Cassie Story and Google Dr. Gary Glum. You will be elated and ANGRY that the BIG BUSINESS side of cancer industry is more about making money than healing. The tea is about $30 for a bottle that lasts six weeks.

  2. State exchanges, of federal if the state doesn’t have one start in 2014.

    “So I say without apology, let’s give the new legislation a chance to work. That time is still years in the future. it can’t be much worse than what we now have.”

    It could actually be much much worse becuase it undoes so much of what is already in place. Its like taking out someone’s heart and replacing it with a liver and saying it can’t be much worse.

    For example when the Federal and State governments spend trillions and have nothing to show for it you don’t get that money back. Future generations are going to have to repay this failure which will severly strain their ability to spend elsewhere it is needed.

    When you give 30 million people(supposedly) coverage its hard to pass a bill one day taking it away. Medicare is the perfect example of this, major failure to accomplish its stated goals and the cost is thousands of times higher then it was suppose to be, but its stuck in place becuase no one wants to be the person to cancel insurance on 30 million old people.

    While MA, CGT, and VT got their waiverts Indiana was denied even though they are trying to expand a succesful proven program. The problem with waivers is it makes the process political, if your a liberal state advancing liberal agendas you get a waiver. If your conservative trying a more conservative solution you get denied. Unless you believe liberals have a monopoly on good ideas this is obviosuly a receipt for disaster.

    If enacted there will never be any going back from PPACA, the damage will be real and forever.

  3. I talk to the guy every year. We cannot find anything like this plan. You describe.

    First problem if you only talk to your broker once a year your doing it all wrong. Second maybe its time for a new broker.

    What’s your current Deductible?

    How many employees do you cover?

    Very very few cases should an employer with more then 10-15 employees have a deductible under $5000. If you do your just throwing money away 90% of the time.

  4. isn’t a $5000 deductible that will cover you if you get cancer better then no coverage at all? Your insurance needs to match your sitution, when your unemployeed you don’t eat at Morton’s every night or buy a new BMW do you? Let go of the cadillac insurance, buy a high deductibcle, and save as much as you can until your sitution improves. I would say its common sense but obviosuly it isn’t.

  5. “Employee-subsidized health insurance may have been a good idea when the Blues were created but since then, especially with the creation of for-profit hospitals in the Sixties, it has served to lead the majority of beneficiaries to have no idea about the true costs of health care until they are faced with the retail prices without the employer subsidy.”

    Compared to Medicaid and Medicare participants who have an exact idea of what their care cost? Or how about those in siocialized systems that are doing so well in Canada and Europe, they grasp the consiquences of their consumption?

    “That 18-month coverage is available but the full costs hits the newly unemployed person with a savage burden at the exact time that money suddenly becomes scarce.”

    You mean the required disclosure when they are hired doesn’t prepare them for this cost? Why don’t they save 18 months worth of COBRA premium while they are employees so when they do lose their job they are prepared? Ah becuase who in their right mind would give up cable TV and annual vacations to save.

    “It’s no wonder that a very small minority of people even use COBRA coverage. ”

    The actual reason so few people use it is so few people need it. Most people leave work already have another job lined up. A large number of people have coverage through a spouse. Even more people are willing to gamble they wont get sick before their new coverage starts, which is a safe gamble as you have 60 days from notice to go back and elect. Truth isn’t nearly compelling is it?

  6. “This started in 1910 when we didn’t create a sustainable business model.”

    What other industrialized nation is stil standing from 1910? In fact we created the only sustainable model and thats why we are still here in pretty much the same form as 1910.

    What are you paying $500 a month in co-pays for? And why aren’t you paying your expenses pre-tax?

  7. Think about this little fact, folks. These idiots in Congress can’t even work to do their f—ing jobs directly, that being come to some middle ground in handing the debt, and you lame defenders think they can fix health care!?

    Supporters of PPACA, sorry, but I hope you get screwed as much as the rest of the country if the Court cluelessly favors this garbage legislation.

  8. Have no respect for OWS crowd. Dependency is not a right, it is a weakness that only furthers destruction of a society,

    Frankly, Democrats really are enablers and codependents in the end. Not to give Republicans an out, they are equally enabling the biggest addiction in this country, that being greed.

  9. So funny, I forgot to laugh. If someone came along and ruined your profession, you really think you would enjoy others laughing at your expense?

    Exhibit A for colleagues, non clinicians making light of health care’s demise.

    Nice try.

  10. Gee, if you don’t embrace the party line that is the basis of this site, ie foster the use of EHR and other computer tech interventions, you are labeled a crack pot or annoyance or called just plain rude, even when the accusers do the accusing as rude as the dissenters. And then, when the dissenters get sick and tired of the dismissals or frank projections by the apologists and defenders of said above agenda and do get rude, then the attackers get to say “see, I told you so”.

    Give me a break, writing long posts at threads and linking to sites that are equally as long do not validate a position. Sometimes, making your point short and eloquently is impressive and appreciated. I stand by my position, there are those here who are antiphysician, they just pontificate to minimize the simple statement being said. Maybe Mr G is not frankly antiphysician, but, he can come across as such at times. Must piss off the overt ones who just want to “dispatch” us as simply as pushing off a cliff.

    Obamacare is not a solution, just some piecemeal ideas that could get us there with better full input from all the parties involved. But, do politicians want solutions, or just quick fixes. Anyone here want to be that can being drop kicked, in this case off the cliff?

  11. (Don’t worry. The day is arriving when long-term care issues will be more pressing than anything else and the problems CLASS was intended to address will make today’s unemployment look like a walk in the park. Perhaps then the political will may force action. Or maybe not.)

    John,

    Long before this could ever happen the young will have already dispatched the old off the cliff. All my young friends (30 ish) are conservative and wondering who thinks they are fool enough to pick up the tab for the senior follies.

  12. Here’s a tip, although per your writings I doubt you will be interested: making statements that basically defends someone makes you an accomplice. Had you just said the first time something similar to “here’s the clip, I don’t interpret her statement as you do” would have been a bit more neutral. And repeatedly challenging me even after I at least acknowledge she did not word for word say “pass the bill and we’ll find out what’s in it” just gets old and annoying.

    So what is my partisan bent? That I support physicians being allowed to practice providing care as trained? If that is partisan, guilty as charged. And doing my job is a crime?

    If you believe that as a yes, thanks for the validation, antiphysician!

  13. It does not follow that, because you “despise both parties equally” you are somehow loftily “non-partisan.”

    “why the hell do you defend what Pelosi basically said back in March 2010?”

    Document for me where EVER posted a defense of it. (Hint: You cannot.) I merely, repeatedly point out your misquoting her precise words (Google Pelosi pass the bill). How you construe them is your right and your problem.

    “enslaved clinicians”

    You remain utterly free to go Cash-Only Concierge.

    Seek help.

  14. Really, what defines partisan to you, I despise both parties equally, one gave us a war that enriched the military machine, and then the other gave us legislation that enslaved clinicians, and we will find out it will enrich the cronies behind the scenes. If partisan means I worship a party principle above the needs of the public, you tell us who that worship is to.

    And if you read this legislation along the way and continue to write what you write, then tell us who you worship, because I do not read your commentary as so neutral and concerned for the well being of the public. For instance, why the hell do you defend what Pelosi basically said back in March 2010?

    This is pathetically piss ass poor legislation as a whole. And it belongs in a hole.

  15. “You partisan hacks really annoy me!”

    That’s rich. Everyone but YOU is “partisan.”

    Moreover, your addiction to annoyance is by now exhaustively documented.

    I followed every PPACA draft along the way to enactment. It wasn’t difficult to do (and I made my displeasure known). So, spare us the canard that this was some mysterious law that just appeared incognito.

  16. Having followed this sausage from the time they killed the pig I only partly agree with your Left vs Right observation. It’s true there was (and continues to be) a fundamental political disagreement about how much government control over the private sector is appropriate. In the case of ACA, though, my impression is that the big players behind the scenes were corporate more than political — insurance, pharmaceuticals and powerful interest groups ranging from various physician and hospital organizations to AARP — all plowing tons of money at both political parties and all sides of the political spectrum, Left, Right and Center.

    The result has been a very uneven product, although the core insurance reforms are probably more important than anything medical. The most significant change medically has been putting teeth in Medpac, a panel of experts that has been around since 1997 making recommendations but without any real authority to execute any of those recommendations. Until ACA Congress had the final say and as we have seen recently Congress says as little as possible and won’t go near anything that looks politically risky, much less radioactive. Now that panel can make recommendations and they will be followed unless Congress pro-actively intervenes to stop them.

    Aside from that, the main corpus of what is in the legislation won’t be unrolled completely until 2017, and even then much of it will still be in a state of flux, mainly because Medicare reimbursements will be subject to go up or down for every provider depending on how closely they have followed guidelines and recommendations.

    As Dr. D. gleefully notes the famous “mandate” is up for discussion by the Supreme Court in the spring and the CLASS act, which was chucked into the bill at the last moment as a tribute to the late Senator Kennedy, was tossed out due to insurmountable actuarial problems. (Don’t worry. The day is arriving when long-term care issues will be more pressing than anything else and the problems CLASS was intended to address will make today’s unemployment look like a walk in the park. Perhaps then the political will may force action. Or maybe not.)

    And yes, this post and comments thread is a good illustration of the result of wholesale negative propaganda.

  17. Sure, the right put up a negative campaign that has it’s inappropriateness, but come on, don’t be so equally partisan and trying to jam rose colored glasses on those who want the facts. Because, and I know my peer Mr G will harp on this in a heartbeat, but she said it basically, Pelosi used as one excuse “pass it to find out what’s in it” is NOT a reason to pass legislation.

    And since it passed we are finding pretty large and ugly warts. Example, CLASS? And why is it the mandate and demand on states to have to participate is getting reviewed by the Supreme Court? Not so cut and dried were these parts, eh? But, partisan legislation has no dark side to the group that passed it, equally eh? Just like we had to buy that simple and quick war in Iraq almost 9 years ago now, eh, eh, eh?

    You partisan hacks really annoy me!

  18. While the policy was good, the Patient Protection and Affordable Care Act suffered most from a lack of effective public relations about it. While it was making its way through Congress, people didn’t understand its implications.

    The right, however, put forth incredibly effective negative propaganda against it.

    This post is a good example of the result.

  19. I am referring to all of their gov’t profligate spending of money they do not have. Their public option was to drive off the cliff much faster than we are.

  20. You cannot keep people out of the ER. Gatekeepers have been tried. Higher copays have been tried. EMTALA flies in the face of keeping people out of the Er.

    That is my place. Everyone comes to the ER. It is “free”. It is 24 hrs. It is always available.

    It will be crushed by ObamaCare.

    Your heart attack will wait behind everyone whining about crap.

    Today I saw NO ONE who needed a doctor for an emergency. My patients and those of my PAs would have been fine without us.

    i will receive if I am lucky 35 cents on the dollar.

    No other specialty gives it away (has it stolen) like the ER.

  21. MD aas Hell
    The theif is US.
    This started in 1910 when we didn’t create a sustainable business model.

    God bless all who can not afford care.

    My cost with my conditions with moderate plan 45 years diabetic, 33 years hep C, spinal stenosis = $500 mo premium + $500 mo CoPay. Lets see: $12 K after taxes since I don’t meed threshold. Most of my neighbors earn $22K-$44K.

    In my career I have watched ego kill patients
    In my career I have been asked to project an inividuals life-span to determine if their assets were sufficient to create investment opportunity in extended care.
    In my career I have been denied glucose monitoring devices, fought the fight because I am the lucky 1% of patients who are educated on how the system works, clinical guidelines and down-right stuburn.
    In my career I have watched wealthy (>= $100M net worth) people become richer by selling vapor-ware.

    My judgment: We made a mistake in 1910 when we allowed the AMA to talk us out of universal coverage which would have forced a, more efficient and still innovative healthcare system (sorry too many scientist friends in other nations who validate my points).

    See ya on the freeway with my cardboard sign.

  22. DMD at December 10, 2011 at 6:51 pm

    “Can you really look people in the eye and tell them they have the “right” to demand complete access to all care options, even if they do not have the ability to pay for the care?”
    ___

    Predictable Straw Man.

    “And, then, having codified it, we don’t lie awake nights worrying that everyone will demand a Special Forces FOB dug into his or her front yard, or an occupied Metro PD Black & White, an ambulance, and a hook & ladder truck parked at the curb 24/7.”

    Show me where I EVER argued that everyone has a “right” to EVERYTHING all the time.

    Do you have a reading comprehension problem, or is it simply an impenetrable ideological firewall?

    Again (tiresomely), none of this is exactly news. Google “Allocating Health Care Morally,” Elhauge, 1994.

  23. Wow, re reading that comment was the ultimate Freudian slip on my part:

    “we just don’t want to EXCEPT the odds, do we?” It should have read “accept” the odds. Saturday night is alright for fightin’, per Sir Elton John.

    probably catch the grief on Monday, enjoy your football games tomorrow!

  24. No one touched my comment at an earlier thread asking if third world societies have a “right” to health care. Hmm, you think silence can be validation at times? Is it really a right, or, societies like ours that are more giving and allow more opportunity create false hope and expectations? Can you really look people in the eye and tell them they have the “right” to demand complete access to all care options, even if they do not have the ability to pay for the care?

    I am not saying I have the right to say otherwise, but, let’s be honest folks, that gorilla dancing in the room eventually steps on toes, and 800 pounds sure can hurt like hell on those toes. Oh yeah, I forgot, the apologists and defenders are either clinging to the walls, or found the door to get out. Ignorance is not bliss, it is just avoiding the truth. Caring does not mean you can’t call it as it is!!!

  25. People just don’t want to accept cold hard truths. People die of unfair causes, and it sucks! But, technology has given false hope, thinking that buying a couple more months, even a few years, is worth the cost, UNTIL, others realize it isn’t the patient paying for the care as a majority of the cost this wonderful and accessible care can provide.

    Maybe it is time for some to come to the realization that this planet was not intending to have 10 Billion humans walking on the soil. Read the comment currently at the end of this thread and think about what it will mean to keep more people alive those few more years, and then who is paying those bills. Hey John Ballard, got some hundred dollar printing plates in your basement to print out all that extra cash to foot PPACA!?!?

  26. Read this article in this weekend’s Parade magazine, about a 10 year old girl, Matisse Reid, who is still alive today after being born with a congenital condition called chronic idiopathic intestinal obstruction, who managed to survive until her parents, from New Zealand, brought her to a hospital in Pittsburgh and eventually got her an organ transplant last year.

    Wonderful story to run in Parade magazine. Except one little thing that makes a story like this very unlikely to read in Parade magazine by the year 2017: you think that health care around PPACA will be able to finance situations like this? And the next comment will incense readers to the end of time, but, why is a situation like this happening? Isn’t life about limits? If one of my children had an illness of this magnitude, what would I do? Probably be angst ridden while I tried to find ways to help him/her live on, but, would I finally come to terms this was life saying this life opportunity was limited? This child will be on anti-rejection meds the rest of her life as of now. You think being on anti-rejection meds will be simple and uneventful? No iatrogenic consequences? And the literally hundreds of thousands dollar question: who paid for the care? Don’t know the details, but doubt the parents paid much. Are you happy you did as a taxpayer or fellow insured patient in their plan? And the rates go up for payments of this magnitude. Still smiling after reading the story and then considering the unmentioned details!?

    This is yet another example to me why health care is in the mess it is in. No one wants to bury a child. No one wants to bury anyone we love. But, as long as we artificially extend life beyond what the natural boundaries intend, we are faking ourselves out. The article ends with noting how the child is now enjoying the activities a 10 year old should. But what if issues go south. Did anyone ever think of how the child will think and feel to be robbed of a “normal” lifestyle if illness recurs? No, we don’t want to think of negative and detrimental futures. But, statistics don’t exist for the sake of having academic classes on it. Numbers are truth to a fair degree.

    We just don’t want to except the odds, do we?

  27. See my post “Public Optional”

    “How can we say that people have an “intrinsic right” to military defense, or to police and fire protection, (or to safe food and water, or to otherwise safe products that won’t electrocute us when we plug them in)? Well, we simply SAY it. And then we codify it. And, then, having codified it, we don’t lie awake nights worrying that everyone will demand a Special Forces FOB dug into his or her front yard, or an occupied Metro PD Black & White, an ambulance, and a hook & ladder truck parked at the curb 24/7.”

    Again, “rights” are things that societies agree to codify and defend — as, say, “obligations.”

    e.g., fundamentally, your “inalienable rights” to “life, liberty, and the pursuit of happiness” exist to the extent that your society will defend and enforce them. Absent that, you have a Tribal Warlord Might–Makes-Right ethos.

    That the definition and administration of “rights” and societal resources is an endless pain in the ass (otherwise known as “government”) diminishes the core point not one whit.

    http://bgladd.blogspot.com/2009/08/public-optional.html

  28. I think I tend to see it more as an obligation than a right, but maybe my religious beliefs influence me too much in this.

    Steve

  29. I like most of these ideas, and have suggested the same or similar elsewhere. Your end of life suggestion is not currently politically viable. It would take government action and would be demagogued. The current GOP will not allow it to take effect. I was asked to write some health policy by our (GOP) congressman. I put something very similar into my suggestions and this was a no-no.

    ER utilization is tricky. I have not read a practical way to make it work, but am open to suggestions. If people are not going to go to the ER, they need viable alternatives.

    Your co-pay idea is interesting, but already know from other research that when co-pays are high, patients often choose to forego the care that would be most helpful. Besides, the patients dont order tests, we do. Maybe the risk should be borne by the doc, but then how much do we miss?

    I like the goals idea. I know private insurers have tried it. The results, IIRC, have been mixed.

    I think my point here, if I have any, is that health care is really, really hard. It does not act like ordinary markets. And, since we started with some poor lady who has breast ca, I would note that our system really does fail people. We pay much more for similar care than other countries while covering far fewer. Rather than having Cadillac insurance, it sounds to me like this woman had insurance equivalent to what most of us carry. When she lost her job, or her husband lost his, they lost their insurance, which seems to be the norm in our country.

    Steve

  30. @Peter, Great comment!

    @John, I think you misread the little exchange above. There is no cat fighting. This is actually a very rare moment, when I believe Dr. D and I are (almost) in full agreement, and I must say that I think I see Dr. Mike’s point as well, up to a point.

    Either way, the way I see it, health care, which is only a symptom of a larger ailment, may present a rare opportunity for physicians to reassert a leadership role on behalf of all of us, instead of passively (or furiously) accepting dicta from above in the hopes of maintaining a privileged income for a little while longer.
    There is an enormous amount of largely well deserved trust that the public has in their doctors, and in this day and age when Congress approval ratings are in single digits, this trust could be utilized for the public good, which I believe is very well aligned with the profession’s long term interests.

  31. The question is not whether this lady, or the millions of other people in the same position did not make flawless decisions in their life, it is that they are employed, or were employed in jobs/businesses that did not come with the guarantee of recession proof income that would have allowed them to maintain coverage/lifestyle, or that their time to recover and continue paying premiums just ran out, along with their 401Ks and savings and maybe help from relatives and friends before the economy came back.

    The smug among you who continue to get full income, or at least income that allows for continued health coverage, are in NO position (or no smarter) to look down your nose at people who choose different careers that contribute to this economy and which support your lifestyle, but do not offer the same income protections (like doctors). Maybe everyone should take a career that has the strength of political lobbyists to maintain their cash flow, or better yet, keep the bonuses coming and no jail time for financial fraud that created this fiasco of an economy which has relied on debt for the masses and the redistribution of taxes for the wealthy for 30 years to keep the GDP chugging away on the boom and bust cycle.

    Ask the FED where Ms. Spike Dolomite Ward’s bailout is.

  32. I have been president of our corporation for quite a while. I have taken care of our insurance broker’s wife when she comes to the hospital. I talk to the guy every year. We cannot find anything like this plan. You describe. Our plan runs about what she pays. While you keep calling it a Cadillac plan, I dont really know what she has. I do know that if you have any kind of illness, individual insurance is sky high or unobtainable. Pardon my skepticism, but when I cannot find these $300 plans, I wonder. Is your wife the same age? Are you in a small business group?

    Steve

  33. So your answer is to find a situation in which an idea doesn’t work, and then claim that proves it a bad idea? Why do people have such a hard time imagining new ideas?
    Half the population below average intelligence? Yes, that would be true seeing as with large numbers half are above and half are below any mathmatical average. But your statement implies something that is not true – that the below average half are far below average and that simply is not the case. The great majority are within a few points of average.
    Here are some ideas just for starters (not proposals, just ideas. There is a difference as these are just for discussion, not being represented as having been fully thought out)
    How about a website with a video about end of life choices, presenting pros and cons. Medicare pts view the video, fill out an advance directive and health care power of atty online, and medicare waves their deductible for the year, no matter what their election was regarding EOL care.
    How about negative feedback for over utilization of the ER – is that really so hard to imagine how to implement?
    How about rewarding patients for achieving goals. It would be fairly easy to come up with a one page health inventory, score it and have that affect your medicare premium.
    It really wouldn’t be that hard to have the copay for a certain subset of expensive testing procedures be based off of a worksheet to determine pre-test probability of the condition, with the copay waived altogether if the condition sought is actually found.
    Why not reform the payment system so that patients share in the savings by choosing institutions that provide value. (What is in an ACO for patients anyway? – they get sucked up into a system they might not have choosen to participate in otherwise, just so the docs and hospitals can make more money)
    I also believe it is worth further discussion to consider somehow tying health care spending in the last 6 months of life to the tax consequences on the estate. Yes, thorny subject, but there are multiple ways to do this if you are willing to think outside the box.

  34. Thanks, steve.
    Anyone with a passing glance at Greece knows there is world-class tax evasion with the top quintile of earners paying virtually nothing in taxes. Tax evasion by high-income citizens is so widespread that helicopters are used to look for swimming pools located on property where owners claim such a small taxable income that such a luxury would be out of the question. The most recent move to cut the national debt was a thousand dollar surcharge on electric bills of property owners.

    This is from a recent Greek response to a Forbes article suggesting that a military coup is all that is left to get Greece out of trouble…

    “Ever since September of 2009, the propaganda machine has been running at full speed. The mainstream media provides Europe and America with a convenient scapegoat to exploit. Greeks are an easy target. “They are cash junkies”, “They are lazy”, “They are useless”. All these stereotypes of Greeks being lazy couldn’t be farther from the truth. Most Greeks are struggling just to survive. Yes, there are Greeks benefiting from high and early retirement. Yes there are civil servants making 4,000 euros a month without actually showing up to work and yes some of them are getting bribed. But they are an exception, not the rule.

    “Numbers don’t lie. The national blues literally kill Greeks. Suicide rates have doubled since last year. Private sector employees work endless hours for 400 euros a month. Young couples don’t have children simply because they can’t afford to while thousands want to emigrate. The majority of Greeks are not, in other words, chilling on the beach drinking frappe and ouzo.

    “But none of this matters to the leaders of the European “Union”. For them it seems that the question is always about getting their money back with maximum profit when it really should be about helping a country to recover since they are also largely responsible for its troubles.

    “Why don’t Brussels technocrats push the government to take money from those who are actually responsible for this tragedy? Why don’t they hunt down the country’s elite, the tax evaders, the corrupted politicians, the businessmen and the ship owners who made trillions at the expense of ordinary Greeks? Why is it logical that the already deprived pensioners and workers have to pay for something they have no share of responsibility in whatsoever, when those who caused it still live in Athens exclusive suburbs, drive Porsche Cayennes, have their kids in expensive private schools and when they are sick they don’t run to overcrowded public hospitals but prefer private clinics that look like five star hotels?

    “It is the same people who now have hundreds of millions of Euros in off-shores and bank deposits in Switzerland and couldn’t care less if this country is going to burn down. In fact, they would probably prefer Greece to go bankrupt and return to the drachma as they would buy everything off for peanuts!”

  35. Yes of course the deductible is high – $2250. No I am not young – 50 with 2 adult children. Can’t find details of plan online to link to – I believe they are phasing out these type of plans as a consequence of the changes coming.
    As I stated these types of plans are not (were not? if no longer available) appropriate for everyone. But keep this in mind – although not explicitly stated in the article, it appears she spent $15,000 a year over a several year period on a cadillac plan and then went bare when she could no longer afford it. My point was that a major medical plan could have been had for a fraction of what she spent, and would have been available for just such a circumstance as she ended up with. It is not entirely believable to claim that someone cannot afford a high deductible at the very time they are paying $15,000 per year out of pocket for the joy of knowing they might get some of that money back if they got sick.

  36. “The P-U-B-L-IC-O-P-T-I-O-N is why Greece, Italy and the rest of the EU are circling the drain.”

    Nope. They spend much less on medical care than we do. As to the larger picture, they had a real estate bubble, except for Germany, like the rest of the world. Germany is in trouble because of its banks.

    Steve

  37. “I believe people are in fact quite capable of making good choices if they are put in a position to experience feedback,”

    I believe half of the population is of below average intelligence. I believe most of my patients do not spend that much time thinking about health care. I believe most health care spending come in the kind of situation this writer talks about, expensive acute care, and chronic care.

    So, what exactly is this positive feedback you describe?

    Steve

  38. She has a husband and children. The only way you qualify for the $300/month program you suggest is if everyone is young and healthy. I also suspect your deductible is very high. Could you give us more details on your plan. When I try to find these things, like when Nate suggested such a thing, I could not find them or found something for healthy 20 y/o patients.

    Query- What level of deductible is viable for people? What is yours? My insurance now has a deductible of 2k.

    Steve

  39. Getting back to the original post, no one needs to buy a COBRA policy unless they are uninsurable otherwise.

    Insurance is a choice and health care is not a right. It is a commodity.

    The P-U-B-L-IC-O-P-T-I-O-N is why Greece, Italy and the rest of the EU are circling the drain.

    The hard fact is someone has to pay. Everyone with insurance prepays, creating a fund for care. For the federal programs, taxpayors prepay. If everyone is to be eligible, then call it a tax and rqaise it, eliminate private insurance and have single payor. See if you can sell it. See how long before it crushes under the weight of unbridled demand.

  40. I hate seeing professionals fighting among themselves. It does little to inspire confidence in those of us who rely upon them for advice and services. We need physicians just as we need architects and engineers competent to design and build safe multistory buildings in locations known for earthquakes. The broad-brush catfighting happening here is out of line. Please stop it.

    Way up the thread Dr. Mike posed a spate of questions—

    “Will people pay the fine or heed the mandate? Will the pre-existing clause bankrupt insurance companies or make insurance, even on the exchanges, unaffordable? Will the exchanges work – will enough young people sign up to make the plans affordable? What are employers going to do? Will the states be able to afford the medicaid burden long term? What will happen to those projected to be uninsured despite the new law? Will physicians drop medicaid to focus on the new low-paying but better paying exchange plans? Will we as a country be able to afford the continued purchase of health insurance as an inefficient stand-in for health care?”

    —all aimed at suggesting that “PPACA is not an example of quality legislation because it can succeed only under a narrow set of circumstances.”

    He’s right, you know. And it is precisely that narrow set of circumstances that should be the intent of any and all who know that unless the spiraling costs of healthcare are not brought under control all discussions about what we can afford — defense, infrastructure, social safety nets, R&D support, you name it — are moot. That cold, hard reality is the fiscal dragon we face and unless steps are taken to contain it that dystopian vision of “true revolt, which will be ugly, violent, and destructive” will no longer be the stuff of comic books and Second Life.

    Back to those questions, we have no idea what the responses will be until the time comes for them to be appropriately posed. I can imagine a similar bunch of reservations about the federal interstate highway system we all take for granted. How stupid is it that one out of every five miles can be used for landing strips in an emergency? Better yet, how stupid is it that that requirement it is an urban legend with no basis in fact? The same urban legends phenomenon is growing on the Affordable Care Act like mushrooms after a rain.

    Most of the provisions of the Affordable Care Act have yet to be enacted. The mandate being argued about doesn’t take effect until 2014. Other provisions are not scheduled to take effect until 2017, several years out.

    (Frankly, after following the whole mess going on three years now I don’t really care if the individual mandate is deemed constitutional or not. For that matter the whole damn thing can collapse for all the good it falls short of doing, and the sooner the better. Perhaps the sooner we get to that dystopian vision advanced by Determined MD the quicker we might grasp the need for a comprehensive plan such as FEMA or state civil defense resources might cobble together in its place,)
    (How do you spell P-U-B-L-I-C O-P-T-I-O-N?)

    Without the changes in the way health care is done in America we are on the way to the next generation qualifying for Medicaid before they reach Medicare eligibility. Sometime sooner than that the tax base now supporting those and all the rest of state and federal budgets will continue to atrophy as our collective net worth withers away from positive to break even to negative. Those at the top of the economic pyramid who will have acquired most of that wealth may realize, too late, that there is no longer enough tax money because the great unwashed has been sucked dry.

    So my vision of the future is not all that different from that of Determined MD. We differ, however, in how the slow motion train wreck now happening can be averted. I believe as flawed as it is PPACA (yes, a product of “tainted, polluted pools of our political system”) is the only game in town and the choice is to play or leave the field. We’re talking tax money here, so anyone who thinks the private sector is the place to be, go for it. As I have said elsewhere, let a thousand concierge practices bloom. But don’t expect any tax money when you leave that revenue stream. You can’t have it both ways. Get with the program or take your marbles and find a different sandlot.

    As I understand it the state insurance exchanges (which don’t have to be in place until 2017 (Twenty-Seventeen…you read that???) will be something along the lines of the old “alphabet plans” that defined for Medicare supplemental insurance plans (Medigap) for years, a couple of which have become extinct and others added, notably Plans G, K, L and N, all of which are nothing more than specifications that can be sold by any private insurance company that wants to enter (or NOT) any market area in the country. Nobody is forcing anybody to do anything other than wear the health insurance equivalent of a helmet or a seatbelt. (Yes, I know. If you never need it or don’t want it that’s nobody else’s business. Like nobody needs Social Security, right?)

    And even when 2017 arrives, the law makes provision for state waivers for places like Massachusetts,where the first state plan for universal health care was enacted, or Connecticut (which recently required ALL Medicaid beneficiaries to participate in one of several available insurance plans) or Vermont which has taken the first steps to become the first state to enact a single-payer system.

    Mine is a minority view. But I can live with that. I don’t mind being in a minority. I’ve been there most of my life. So I say without apology, let’s give the new legislation a chance to work. That time is still years in the future. it can’t be much worse than what we now have. And who knows, it may actually be an improvement.

    ~~~~~~~~~~~~~~~~~~~~
    Note to moderator — I’m submitting this comment without hot links so it can make it into the conversation in a timely manner. If you wish to replace it with the one awaiting moderation I appreciate it. Sorry for the inconvenience. I forgot about the hot links thing.

  41. I hate seeing professionals fighting among themselves. It does little to inspire confidence in those of us who rely upon them for advice and services. We need physicians just as we need architects and engineers competent to design and build safe multistory buildings in locations known for earthquakes. The broad-brush catfighting happening here is out of line. Please stop it.

    Way up the thread Dr. Mike posed a spate of questions—

    “Will people pay the fine or heed the mandate? Will the pre-existing clause bankrupt insurance companies or make insurance, even on the exchanges, unaffordable? Will the exchanges work – will enough young people sign up to make the plans affordable? What are employers going to do? Will the states be able to afford the medicaid burden long term? What will happen to those projected to be uninsured despite the new law? Will physicians drop medicaid to focus on the new low-paying but better paying exchange plans? Will we as a country be able to afford the continued purchase of health insurance as an inefficient stand-in for health care?”

    —all aimed at suggesting that “PPACA is not an example of quality legislation because it can succeed only under a narrow set of circumstances.”

    He’s right, you know. And it is precisely that narrow set of circumstances that should be the intent of any and all who know that unless the spiraling costs of healthcare are not brought under control all discussions about what we can afford — defense, infrastructure, social safety nets, R&D support, you name it — are moot. That cold, hard reality is the fiscal dragon we face and unless steps are taken to contain it that dystopian vision of “true revolt, which will be ugly, violent, and destructive” will no longer be the stuff of comic books and Second Life.

    Back to those questions, we have no idea what the responses will be until the time comes for them to be appropriately posed. I can imagine a similar bunch of reservations about the federal interstate highway system we all take for granted. How stupid is it that one out of every five miles can be used for landing strips in an emergency? Better yet, how stupid is it that that requirement it is an urban legend with no basis in fact? The same urban legends phenomenon is growing on the Affordable Care Act like mushrooms after a rain.

    Most of the provisions of the Affordable Care Act have yet to be enacted. The mandate being argued about doesn’t take effect until 2014. Other provisions are not scheduled to take effect until 2017, several years out.

    http://www.ncsl.org/default.aspx?tabid=14227

    (Frankly, after following the whole mess going on three years now I don’t really care if the individual mandate is deemed constitutional or not. For that matter the whole damn thing can collapse for all the good it falls short of doing, and the sooner the better. Perhaps the sooner we get to that dystopian vision advanced by Determined MD the quicker we might grasp the need for a comprehensive plan such as FEMA or state civil defense resources might cobble together in its place,)
    (How do you spell P-U-B-L-I-C O-P-T-I-O-N?)

    Without the changes in the way health care is done in America we are on the way to the next generation qualifying for Medicaid before they reach Medicare eligibility. Sometime sooner than that the tax base now supporting those and all the rest of state and federal budgets will continue to atrophy as our collective net worth withers away from positive to break even to negative. Those at the top of the economic pyramid who will have acquired most of that wealth may realize, too late, that there is no longer enough tax money because the great unwashed has been sucked dry.

    So my vision of the future is not all that different from that of Determined MD. We differ, however, in how the slow motion train wreck now happening can be averted. I believe as flawed as it is PPACA (yes, a product of “tainted, polluted pools of our political system”) is the only game in town and the choice is to play or leave the field. We’re talking tax money here, so anyone who thinks the private sector is the place to be, go for it. As I have said elsewhere, let a thousand concierge practices bloom. But don’t expect any tax money when you leave that revenue stream. You can’t have it both ways. Get with the program or take your marbles and find a different sandlot.

    As I understand it the state insurance exchanges (which don’t have to be in place until 2017 (Twenty-Seventeen…you read that???) will be something along the lines of the old “alphabet plans” that defined for Medicare supplemental insurance plans (Medigap) for years, a couple of which have become extinct and others added, notably Plans G, K, L and N, all of which are nothing more than specifications that can be sold by any private insurance company that wants to enter (or NOT) any market area in the country. Nobody is forcing anybody to do anything other than wear the health insurance equivalent of a helmet or a seatbelt. (Yes, I know. If you never need it or don’t want it that’s nobody else’s business. Like nobody needs Social Security, right?)

    And even when 2017 arrives, the law makes provision for state waivers for places like Massachusetts,where the first state plan for universal health care was enacted, or Connecticut (which recently required ALL Medicaid beneficiaries to participate in one of several available insurance plans) (http://www.hhs.gov/news/press/2010pres/06/20100618h.html) or Vermont which has taken the first steps to become the first state to enact a single-payer system.

    Mine is a minority view. But I can live with that. I don’t mind being in a minority. I’ve been there most of my life. So I say without apology, let’s give the new legislation a chance to work. That time is still years in the future. it can’t be much worse than what we now have. And who knows, it may actually be an improvement.

  42. “That means that physicians, patients, politicians, and pundits all have some role to play in reshaping they way in which we approach end of life care. ”

    “What do you hope to gain by profession bashing?”

    “I can’t control my colleagues”

    I would like to address these together, and thank you Dr. D for understanding that this is not about bashing the profession. So here is what I am driving at:

    You cannot relinquish responsibility for what is happening in medicine in general. You should not invite pundits and politicians to this table. You need to provide the leadership necessary to fix this mess. Every single player involved in health care, other than patients and clinicians, is there to take out profit (mostly financial and some political). Unfortunately, as Dr. D writes here frequently, a few doctors have succumbed to the temptation as well.
    Unless you do something about it as a profession, instead of bickering about RVUs or blaming your patients or government or whatever, you will lose the standing you now have, prestige, finance and professional autonomy included (become more like engineers).
    There are those who want this to happen because they think that elite academics, policy makers, researchers and expert economists should call all the shots anyway, while practicing doctors, or NPs or techs should just follow the blueprints.
    Personally, I cannot see how this leads to better health care for patients, so I would very much like to see “the profession” get off its proverbial behind and do something before it’s too late.

  43. By the way, I despise the picture that accompanies this post. I just do not see this man espousing care. I pay attention to the deeds, and he just does not sell care, just more selfish political interest, as did his immediate predecessor. Responsible leadership as of Dec 2011 will not come from either the Democrat nor Republican parties. They are tainted, polluted pools of our political system. And they collude to keep out real, invested alternative choice. We are headed to true revolt, which will be ugly, violent, and destructive. Which is what are species seems to practice per history!

  44. Think about one thing here people, you specifically Ms G-A since you ask the eternal question, ” that your professional ethics obligate you to always act in the best interest of your patient”. Those of us who took the Hippocratic Oath to serve the societies we work in did not repeat it whimsically or superficially, we stood there at our graduations and said it with truth and sincerity. Unfortunately, there are always some who did not embrace what being a physician is really about. There are people here, maybe not you specifically Ms G-A, who want to vilify ALL of us for the poor choices of what I believe are the minority of the population of doctors who make said poor choices or don’t really care. I can’t control my colleagues, but I challenge them at every opportunity I can in my comments, and maybe even one might pause and reflect and then do differently for the better.

    The point I have made here endlessly is this: medicine has not and never should be a business model, but, too many colleagues, even if a minority, have corrupted by their compliance and assimilation into that mind set. And those who embrace this disgusting attitude that medicine is a business are just polluting the profession further.

    And politicians have NO concept of what is the basic principle of care. I don’t even think that most politicians understand the term “care” anymore outside what it means as a doctor, but what it should be as a representative. We are doomed as is to let representation as it stands as of the end of 2011 to continue. Incumbency must figuratively die if we are to live and return to some level of function and improvement, at least in this country. Maybe words of extreme to some, but, the status quo is only the status woe as it stands now. That is why PPACA must be declared defunct by the Court. Hey, it shows that the framers had some decent idea of what is the balance of power. Three branches that can each check the other. Yeah, I listened in high school learning about the basic process that is American government!!!

    By the way, here is the question that NO non-physician can answer, but only my colleagues who took the test and passed it to become a physician: why is it that throughout the history of deeming one a doctor that so few can earn the title? Because only so few can really earn it and maintain it! Taking care of people does define a precious few, it is not arrogance that says that, it is the reality of what means being a physician. I am fortunate I have earned it, been able to retain it, and hope to finish my life maintaining the title and doing what I trained to do.

    Sorry, sometimes you have to walk in the shoes to understand the path. And others don’t want those who want to understand and respect the process to see this. Envy and greed will not tolerate empathy and care. It is that simple!

  45. What do you hope to gain by profession bashing? I could start in on engineers, but what good would it do me?
    “People have over time entrusted you with life and death decisions believing…that…you…always act in the best intest of your patient.”
    People rarely trust me with life or death decisions – they generally reserve those decisions for themselves or to their loved ones. They look to me for advice, but they make the decision.
    Act in the best interests of the patient? Yes, and those interests are determined by the patient, or their designiated surrogate. If a patient is ‘full code’ I cannot choose not to resusitate. If they say yes I want to be intubated, I cannot say no.
    Yes I can refuse to do an elective procedure. No I cannot refuse to prolong life when there exists a request to prolong it, and such a request is assumed to exist in the absence of a specific directive to the contrary. Who is ordering these expensive and unnecessary tests? Rarely does the dying patient have a say. It is their surrogate who asks for the care. And who is going to decide how much life is too little to gain? Do you have some guidelines in mind? What would be an end of life circumstance in which I should choose to act in the best interests of the patient even though the patient desires for me to act otherwise? Are you ready to relinquish complete control to the local cancer center so that they can decide who does and does not get chemo? Are you ready to let me not offer your grandmother a visit with the cardiologist for her exacerbation of end stage CHF?

  46. It is not about teaching the dying anything, it is about teaching the healthy something, and about allocating a precious resource. In our area the price of water per gallon goes up the more you use – negative feedback for accidentally leaving the hose running. There is a fine if you report a fire when there is none. The police won’t protect your stuff if you leave it in the street. Negligence bears negative consequences in most areas of life, except in health care.

  47. Perhaps, but your profession comes with different standards. People have over time entrusted you with life and death decisions believing, not that you are a saint, but that your professional ethics obligate you to always act in the best interest of your patient. There is never any caveat emptor required in the doctor’s office, right?
    Is that also right when, you crack a few ribs resuscitating a nursing home resident with maybe a couple of days/weeks left in him, all of which will be spent unconscious and hooked up to machines?

    This is of particular interest to me, since physicians seem to be able to refuse doing things which conflict with their personal beliefs (such as abortions). Who is ordering all the unnecessary, and sometimes unrelated to anything, tests on dying patients in hospitals? And why?
    http://bit.ly/trHreO

  48. I don’t believe in elites and I do believe that all people are quite competent to make their own decisions when fully informed, and one such decision may very well be to let you make the final decision.

    What I object to, is that elites get to decide on “training” feedback loops in addition to the ones already built in. If someone makes the bad decision to smoke, he/she will most likely experience the negative feedback of dying from lung cancer at an early age. I do not think that it is necessary to “teach” this lesson by imposing a $50 fine, or $500,000 fine. I can assure you that the decision to smoke or not to smoke will never be made based on the availability of chemo a couple of decades into the future, and it sounds inhumane to me to actually deliver this particular lesson.
    When someone happens to get diagnosed with a life threatening disease, there is nothing you can teach, other perhaps that we all should pay our protection money to the corporate mafia, or we will be executed when the opportunity presents itself.
    There are things that are bigger than what any of us can deal with on our own. For those, we come together as a community and pool our resources. Law and order, safe food, safe water, clean air, defense from foreign aggression, and in my opinion, defense from disease, all fall under this category.

  49. “We probably disagree about what shoud replace it”

    Only if you believe the lie that the great masses of society are too stupid to make good decisions and that instead the wise elite will design a plan which will work great as long as everyone else just does as they are told.

    I believe people are in fact quite capable of making good choices if they are put in a position to experience feedback, both positive and negative, that is directly related to the consequences of their choices. Shielding people from the possibility of negative feedback seems to be the hallmark of progressives, and of course leads to the lie mentioned above. No success in life nor in society is possible without also allowing for the possibility of failure, as success by definition is what happens when someone defeats failure.

  50. You have insisted that you are not inferring that physicians are complicit with shams and snake oil, but here you are very clearly stating that physicians are harming patients by doing the very “absurd and harmful things” they complain about.
    First, the word ‘physicians’ implies a group, so it is silly to even ask “why do you, physician (the individual), complain about what you physicians (the group) do?” I’m sure you will then try and say, “well I meant why do physicians as a group allow these things to happen?” This of course ignors the fact that any given group of non-physicians, when trained to be physicians, will in fact act like physicians. We are what society wants us to be. So therefore we must look for actual answers instead of trying to place blame squarely on the shoulders of any one individual or group. That means that physicians, patients, politicians, and pundits all have some role to play in reshaping they way in which we approach end of life care. (Yes, patients and posters to online forums are part of the problem.)

  51. I was not inferring any such thing.

    It is too often that doctors write about the absurd and harmful things done to their patients, and even things they find themselves doing because they perceive no other choice. So my question is very simple, and it is just a question, why are you guys doing these things? Why are you not refusing to do/order what essentially amounts to harming patients?

  52. “If so, why are too many physicians allowing this to happen?”, inferring that doctors are complicit with shams and snake oil? Gee, you think it is because nefarious people prey on those who have hope and faith?

    Patients want to think they have options and will be cured, and doctors equally want to think that treatment options have more benefits than risks and want to apply such interventions so they will have that positive impact.

    Jesus, people here write like all doctors are complicit in some selfish and antisocial agenda to screw everybody just for a dime. Maybe you who embrace such rigid, inflexible ideations might want to direct some attention to organizations like the FDA who are in the back pocket of pharma and med device organizations until proven otherwise, and then the alleged approvals of alleged interventions are just kickbacks, again until proven otherwise. I don’t use new meds or devices until they have been out for more than a year, just to learn what are the consequences once applied to a full population, not just a cherry picked one to get that FDA seal of approval. I bet there are people out there who would chastise me for waiting, denying them access to care options, and then would quickly accuse me of cronyism or other nefarious agenda for being so quick on the trigger to offer untested treatments should they go wrong.

    I’m on to some of you, being a doctor makes me a bad guy, whether I do what is the standard of care or just act on impulse, even with the proper focus on concerns for patient safety. MD to some people here only stands for Must Desist. Can’t have people out there watching out for the public good, doesn’t help the party line of “what’s in it for me, screw the public” that is the real mantra of Republocrats.

    Can’t wait for the next shoe to drop on exposure of more PPACA failures!!!

  53. “too many people want full court presses to the end, and there are not the resources for it,”

    Do they? Or are they just preyed upon by hospitals, pharma and device makers, raking in charges for whatever they can get away with? If so, why are too many physicians allowing this to happen?

    As to this particular post, I hope you are not suggesting that people that get cancer should go home and die unless they have the ability to sustain profits of hospitals and insurers at the levels they are accustomed to.

    I agree with Dr. Mike that this entire insurance racket should go away. We probably disagree about what should replace it though.

  54. Really, you call someone “become a smug doctor like yourself”, then write the bullcrap above to me, and I’m the ASS? That makes you the HOLE, right!? Guess the “Democrat apologists and supporters” comment hit home, eh?

    here’s an early christmas gift to all you Obama suckups:

    http://www.washingtonpost.com/opinions/obamas-campaign-for-class-resentment/2011/12/08/gIQApYDagO_story.html?hpid=z3

    Politicians do not know how to run healthcare. Period. God, they can’t even do the job they are supposed to in balancing budgets and forwarding legislation that truly helps people outside themselves and their crony legions. And the usual suspects just push the agenda.

    Times are rough, times are hard, here’s your F—ing Christmas card!

    Now that last comment does deserve the label ASS, and I accept it!

  55. By her own admission she spent at least $25,000 on health insurance just in the first two years. Why would any sane person do that if they knew there were alternatives? Why don’t they know about the alternatives? Oh that’s right, the only option for health care in America is comprehensive health insurance. If there are other options, we don’t want to discuss them – only right-wing loonies talk about those things (so say the insurance companies and the politicians whom they fund)

  56. “Hope is not a plan”

    Exactly. Which is why any legislation should not depend upon hoped for behavior from the citizenry or hoped for but as yet unknown future events or financial circumstances. The legislation should stand on its own – no matter what the legal behavior of those affected by it or events that could reasonably be expected to transpire in the future. PPACA is not an example of quality legislation because it can succeed only under a narrow set of circumstances. Will people pay the fine or heed the mandate? Will the pre-existing clause bankrupt insurance companies or make insurance, even on the exchanges, unaffordable? Will the exchanges work – will enough young people sign up to make the plans affordable? What are employers going to do? Will the states be able to afford the medicaid burden long term? What will happen to those projected to be uninsured despite the new law? Will physicians drop medicaid to focus on the new low-paying but better paying exchange plans? Will we as a country be able to afford the continued purchase of health insurance as an inefficient stand-in for health care? Way too many ifs, way too few acknowledgements of the reality that is life in the republic.

  57. It’s considered smug to point out facts and boundaries, but, when others are caught using contacts or frankly using advantages like being privileged, then the same commenters change the tune and berate the users. Can’t win with some in this crowd, eh?

    Oh yeah, we’re really immune from life’s realities, NOT! We all went to medical school and watched people be in misery and die, and those of us who have souls and compassion struggled mightily with this. But, we also learned and were reinforced to learn the two rules of medicine, well explained by the way by Colonel Blake in M*A*S*H to Hawkeye after watching a friend die in combat:

    Rule #1, people die, and rule #2, doctors can’t change rule #1.

    People outside of medicine, and even some doctors, really struggle with these premises. Letting people die is not compassionless or insensitive, it is part of life. My comment above was not at all directed to the writer of the post, I hope along with MD H she can access care and gain remission.

    I can’t speak for my colleague MD H, but I sense there would be agreement with my position, too many people want full court presses to the end, and there are not the resources for it, and not just money, but the physical elements of care, both provider time and treatment resources like medication and care products.

    Losing health insurance is indeed frightening and stressful, but, who should be granted exceptions and who is basically S O O L?

    Obamacare, PPACA, whatever the hell you want to call it, will not save the day as a whole. If the Supremes do not send the legislation back to the drawing board, we’ll find out further all those warts and dysfunctions.

    Just the privileged and well connected will be insulated from the consequences. Right, Democrat apologists and supporters!!??

  58. “Her unfortunate plight is due to bad planning first”

    “I need to take you back nine years to when my husband got laid off from the entertainment company where he’d worked for 10 years.”

    “By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.”

    With the recession, both of our businesses took a huge hit — my husband’s income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband’s IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house.”

    Yes MD, she should have had the foresight to become a smug doctor like yourself, immune from life’s reality and cushioned from impossible predictions.

  59. Hit a nerve, I see…

    I’ve had a taste of some of that “bad planning” you mentioned myself in the form of the aptly named “COBRA” coverage (which incidentally didn’t exist prior to the Eighties). Employee-subsidized health insurance may have been a good idea when the Blues were created but since then, especially with the creation of for-profit hospitals in the Sixties, it has served to lead the majority of beneficiaries to have no idea about the true costs of health care until they are faced with the retail prices without the employer subsidy. That 18-month coverage is available but the full costs hits the newly unemployed person with a savage burden at the exact time that money suddenly becomes scarce. It’s no wonder that a very small minority of people even use COBRA coverage.

    The bad planning was done by the Consolidated Omnibus Budget and Reconciliation Act of 1985. And it takes very little imagination to figure out who was fighting against even unaffordable but critical provisions even then. It’s no accident that it took yet another “reconciliation” bill to squeeze through the ACA.

    As for your hope that she does well, all I can say is what has been hurled around a lot lately…. Hope is not a plan.

  60. Grow up, John.

    Her unfortunate plight is due to bad planning first, bad luck second. That said, I truly do hope she does well.

    Once the hurricane is named, there is no buying wind and hail insurance.

  61. Even in the aftermath of this woman’s tragedy we find cold-blooded indifference to her circumstance. It’s wrapped in a gauzy veneer of superficial sympathy but the underlying meanness is transparently clear.
    Some still blame the victim.
    Unbelievable.

    I’m reminded of something I came across recently in “1493” a book by Charles C. Mann surveying the impact of what he calls the Colombian Exchange, the global impact of Christopher Columbus’ discovery of the New World.

    In the aftermath of what has been labeled the Potato Famine of 1845 literally thousands of people died of starvation. There were even reports of cannibalism in parts of Europe and the UK.

    “Examples of British callousness were indeed thick on the ground. Some politicians welcomed the depopulation, which would, one cabinet minister’s agent promised, “give us room to become civilized.” Others said that giving food to soup kitchens actually did harm…”

    We’re not there yet. But I fear we are well down that road.

  62. Great tale. i hope you do well. But I must ask just what your annual income was and what would insurance have cost? Second, you would not have entered the pre-existing plan without your misfortune. This would leave you still uninsured, paying nothing into the system which you now praise asObama’s great program.

    A thief is still a thief, no matter his or her motive.

  63. Yeah, looks great on paper, until, the “Board” decides the cost of treating certain cancers is just too high to finance, especially depending on which side you are on. You think this “Board” won’t be used as a weapon should Obama and the Democrats regain control in 2012? Equally, you think Republicans won’t come up with creative ways to punish and demean Democrats should they win out instead?

    Treatment is based on need and access to care, and let’s be honest folks, cost that is based on the coverage you have. In the past few days, I have seen patients who have good, little and no insurance coverage, and all expect to access a full court press for their health care needs. Should they all get it, sure, but, who’s paying for all this care that is finite in expense?

    And if it is going to be government controlled, you think everyone is going to get equal and fair shakes? As I wrote at another post just earlier, dream freakin’ on!

    I just want to watch and listen to the people who want to keep people who are terminally ill over a certain elderly age explain to the rest of us why these finite resources should be used while we watch the young and able with decades of potential to be potentially denied care just to keep old folks alive for a few more months or a couple of years at most.

    Man, how do all keep ignoring that big ol’ gorilla dancin’ to “Only the good die young”?

  64. Welcome to the world of way too many Americans. You get to do what others before you have done. Find an empty mayonnaise jar paste your picture and story and set it out at the gas station and collect your neighbors change and sympathy.

  65. First, I hope the auther does extremely well with treatment both medically and financially.

    It is too bad though that we as a society have come to depend on Cadillac insurance policies, as this story illustrates. My family of 4 is covered under a Blue Cross Basic plan – major medical only i.e. hospitalization and outpatient cancer care. We pay about $300/month. No, this is not the right choice for everyone, certainly not for the poorest in society, but if the auther had known about these types of policies (or maybe they are not available in her area) she could have saved tens of thousands of dollars every year. Almost every FP doc I know gives some sort of discount for cash. Everyone in a family of 4 could see me 4 times (16 visits), the wife have a mammogram, the kids have a couple of xrays and immunizations, both parents have basic lab work and one of them even get a CT or MRI and the family would still come out ahead for the year compared to paying $1300 a month for an unnecessary Cadillac insurance plan. Obviously the insurance companies don’t want you to know about this – our plan isn’t even listed in their brochures.

  66. Everyone should make these same decisions, then all health insurance will be affordable.

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