Private insurance isn’t perfect—but I’ll take it over the public option any day
I’ve been experiencing a tiny health care crisis myself. Sunday night, something or other happened to my knee—one of the body parts of mine that had always been A-OK till now.
I woke up in significant pain, and the pain increased day by day instead of decreasing, even though I was being very very careful. I’ve not been able to sit or exercise, and I limp rather badly. Steps are a nightmare.
Yesterday I went to the doctor, a knee specialist who fortunately had an opening so I didn’t have to wait. He initially thought I had sustained the most common knee injury of all, a tear of the medial meniscus cartilage. But when he examined me he said he wasn’t certain. It might be that; I had some signs and symptoms that indicated as much. But perhaps I had partially torn the medial collateral ligament, which can produce similar symptoms. Even though the latter is a less common injury, and usually the result of noticeable trauma (which I hadn’t experienced), he was leaning ever-so-slightly towards the ligament diagnosis. The exquisite pain I felt on the inside of the knee could be from either injury, but the location was somewhat higher than you’d expect if it was a cartilage tear.
But the only way to be certain which one it is would be an MRI. So he ordered the test, because cartilage tears almost always require arthroscopic surgery. Ligament tears, except for very major ones, almost always heal on their own, although it takes quite a few weeks. So the treatment of the two injuries would be very different.
I found out today, though, that my health insurance denied the request for an MRI. I just finished filing an oral appeal with them.
Despite the frustration of their initial refusal, I must say that my experience with the woman I spoke to for the appeal was extremely positive. First of all, she was kind and respectful. She even kept apologizing for a series of times she had to put me on hold for very brief waits. I dictated to her all the extenuating circumstances and details of why I thought an MRI was warranted, and she copied it all down and read it back to me accurately—these days, that’s a feat in and of itself. She even took the liberty of voicing her own (completely unofficial and completely meaningless, except in human terms) opinion that my reasoning made sense to her and that she thought they ought to grant my request.
Now I wait. It will take some time before they hear my plea and decide. Perhaps in those days I’ll get so much better the whole thing will be moot. Or perhaps they’ll say yes to the MRI. But perhaps not. If not, and I’m still feeling as lousy as I have been, I’ll have to decide whether to pay for it out of pocket, despite the fact that I already fork over so much money to my insurance company that they could give me a bevy of MRIs a year (perish the thought!) and still come out ahead.
But during this whole process, I’ve never for a single moment thought, “Oh, it all would have been so much better if the government were in charge!” At least with private insurance I have the threat/leverage of changing to another company. They have some sort of reason to think they must be at least a little nice to me (and millions like me) or lose my (our) business.
I can only imagine how a government employee would have handled that same phone call. I’ve had enough experience with those twin monuments to pleasantry and respect and efficiency, the IRS and the DMV, to know that it could have been far, far worse. Then there’s the passport office and the post office and various licensing boards, and almost any contact I’ve ever had with government when I want something from them and they don’t want to give it. Not good.
And I’m afraid that anyone who thinks the government would have been more likely to have allowed me to have that MRI more easily and more quickly is a dreamer. Likewise for Obama’s empty promises that of course, a public option won’t threaten private health insurance in any way. I’ve read far too much—that’s far too convincing—indicating just the opposite.
Very reasonable attitude Neo.
On the other hand, it is ironic how many folks who complain about the cost of insurance, also complain when insurance companies are careful about approving expensive tests/procedures out of hand.
I guess the insurance companies are right to be skeptical. After all the “O” has told us that Docs are not above snatching your tonsils or cutting off your foot to make extra $$s. We should assume your Doc was getting a kickback for every MRI he ordered; shouldn’t we?
Insurance companies, HMOs etc will always walk a fine line. At least you were able to reach a responsive human and were treated with courtesy. Unlike the time the IRS misfiled my check.
Oldflyer: Exactly. If they granted every MRI request, that wouldn’t be good, either.
Increasing wait times for radiology studies is certainly one of the first ways that care is rationed. Private insurers do it; government sponsored plans like the Canadian NHS certainly does it. Have you thought how Natasha Richardson would be alive today if there had been even a CT scanner at the small hospital where she was taken after her ski accident?
Ah, Neo, I hope they’ll approve it but more so that it’ll turn out a meniscus cartilage and it’ll heal itself, no operation necessary.
Keep us posted.
oops, I mean – vice versa, that it’s a ligament tear, not cartilage.
An overlooked aspect of health care, whichever side one takes, is that we have become victims of our technological success.
There is so much more medicine can do these days, e.g. the MRI, that it keeps us living longer so there is a longer window for even more medical procedures.
No matter how health care is funded it is an expensive proposition.
I just wish they would get on the stick and invent the tricorder so Dr. McCoy from Star Trek can come fix us all!
As a former Navy wife, I have some experience with government-run, monopoly health care, as does my sister a former Marine wife.
My sister survived ovarian cancer at age 18. She was instructed by the Cleveland Clinic to have follow up appointments on a rigid schedule. In the meantime she married a Marine. She could feel pain in the remaining half of her remaining ovary and her primary doctor told her to be seen by an OB/GYN right away.
In the area her husband was stationed at that time you could only call for an OB/GYN appt. on the first Tuesday of each month, between 7 AM and 8 AM. Every other woman in the entire state was calling at that same time.
When my sister finally got through, all of the appointments were taken. The woman who answered the phone said they could get her in in 6 months or so. My sister explained the situation and that she might not have 6 months. The woman said, “Well aren’t you selfish for trying to get in ahead of everyone else.” And she hung up.
Luckily our father had the means to tell her to go to a private OB/GYN, who send her to Duke for immediate surgical removal of ovarian cysts. If there had been no option other than the government, she’d be dead.
Another time I had waited 5 hours to get a prescription filled. When they gave it to me, I told him that it was not the correct drug. He said, “Well I guess you don’t get anything then.”, threw it in the trash and yelled, “Next.”
I have dozens of such stories. Like my friend who gave birth in an Army hospital, then was handed her sheets and told to go make up her bed down the hall.
Some of the military treatment was excellent, but most was a nightmare. When I got a job of my own and was able to buy real insurance, it was a huge relief.
If your insurance company is anything like mine Neo, I’ll bet you get your MRI.
Have you read Coulter’s series on the healthcare insurance issue, Neo?
Regardless, here’s what I have to say.
There is a law in existence, called ERISA, that I believe is primarily backed or created by Dems in order to benefit insurance monopolies or semi-monopolies.
As we should all know by now, the more the government regulates one part of business, the more the businesses in that part gets involved in government and the less competitive they become.
http://problemiserisa.blogspot.com/2009/08/timothy-p-carney-in-washington-dc.html
If there are problems with insurance, it is because healthcare insurance functions on a semi-monopoly, with government protections and weird contracts that go through employers, not employees. Regulation by government, just like with Fannie Mae, is code word for “lining the pockets of Dems and other corrupt pols”
Ymarsakar Says:
“Regulation by government, just like with Fannie Mae, is code word for “lining the pockets of Dems and other corrupt pols””
But, but it also has the problem that it doesn’t work right in a regular market. When neo said something about taking her business elsewhere, that’s probably fine with the current insurance company. This could end up taking a couple hundred grand… and who would pay it if she switched? A better company she switched to. So, ‘bad’ company gets out of paying and ‘good’ company pays a bill they should have…
I guess one way is for the insurance companies to get into suing each other on our behalf. If you switch companies under hippa… have the new one pay the bill (if that is their policy) and have their lawyer tell the old one to pay for it…
As an amateur athlete and self medicator, I would suggest ice as a way to promote healing and decrease pain. Also, application of any good pain salve that contains DMSO and an anti-inflammatory like ibuprofen applied at night to work on the pain while you’re sleeping. (Should be able to find such salve in any drug store.) If such measures help a quite a lot, the chances are it’s a torn ligament.
Until the insurance company comes through, training room techniques might help you with the pain.
You’re right about the contrast with private versus government insurers. We submitted a claim to Medicare in January for medical care received by my wife in Mexico. Medicare, of course, will not pay, but my Medigap insurer requires that we get a refusal in writing before they will pay. We just received our written Medicare refusal a week ago. Our Medigap insurer’s check will probably show up in a couple of months. So, we will eventually be partially reimbursed for money we paid to a Dr. in Mexico in January. The paperwork was quite extensive. About ten hours filling out forms and talking to people on the telephone. Just another anecdote from the joys of Medicare health insurance.
Megan McArdle, writing in The Atlantic
I get something similar once in a while. i usually refer to it that my knee is out. feels like there is a bubble inside and if you could just pop it it would be fine. causes me pain and i limp, in a short while it goes away… then it doesnt happen for a while long enough to forget about it.
Wouldn’t the government option be amputation? But , then you’d have to wait a year for the procedure.
/sarcasm off
Artfldgr probably has a minor meniscal tear. Transient, brief knee pain doesn’t warrant an MRI.
And as to the denied MRI, Neo, what diagnostic alternative, if any, does your insuror advise?
MRI is actually an entirely amazing and wonderful diagnostic tool. It can show 3 mm (1/8 inch) spots in the brain. It can show lesions previously only demonstrable at autopsy.
MR imaging is one of a myriad of reasons why US health care costs have risen; the machines cost a couple mill each, the yearly service contract several hundred K, and throughput is maybe 15 studies per day. But to do without it? The Ezekiels of the Left are Pol Pot equivalents.
Neo do you have any noise (crepitus) in your knee when you bend it? If so, probably the meniscus.
physicsguy Says:
“Wouldn’t the government option be amputation? But , then you’d have to wait a year for the procedure.”
And give in to the running dog surgeons doing unnecessary amputations? Clearly the consensus (and by that, I mean, political) is PUT ICE ON IT.
The proposed health care laws may take away your option to pay for a procedure out of your own pocket. Either the patient is penalized (as in Canada?), or the providers are somehow discouraged or forbidden to perform out-of-network. [The preceeding may be bull, but it’s what I’m afraid of].
MR imaging is one of a myriad of reasons why US health care costs have risen; the machines cost a couple mill each, the yearly service contract several hundred K, and throughput is maybe 15 studies per day. But to do without it?
Canada has a great lack of MRI machines per pop. THey either have to use our own or wait in line, which means their healthcare costs, on an objective standard, are actually greater they need be. I’m talking human costs, of course, as well as costs for continuous ‘treatment’ when an injury or defect discovered earlier could have been cured with a once over procedure.
Given your age, Neo, could be cartilage. You’ve said you have walked. That may have exasperated either possibilities.
Usually, however, cartilage issues occur when immense weight is put on the knee, absent any supports like muscles or what not. Obesity leads to this. But you aren’t obese.
Everyone should read this shining example of common sense. If people ignored the slick promises and slogans of the Obama Administration and just looked at facts, would they really want put their health, indeed their lives, in the hands of the folks that run the IRS, the DMV, and the Post Office? I doubt it.
One other thing to consider: Our representatives in Congress have exempted themselves from public run healthcare. Why?
stu: I’ve had crackling knees ever since I was a teenager. Ballet. Doesn’t mean a thing in my case.
Ymarsakar: Whichever injury it is, it doesn’t make a whole lot of sense. I had no traumatic event. I haven’t had knee problems in the past. I’m not overweight. And when they X-rayed my knees, it turns out I haven’t got an ounce of arthritis in either one. I was happy to hear that. But whichever injury it is, no one can figure out how I did it.
Did you ever injure it when you were younger, Neo? Maybe when you were dancing? My knee “goes” from time to time, quite painfully, and for no apparent reason — but I did injure it once long ago, in junior high, by falling off some gymnastics equipment. Tore a ligament, though I don’t know which one. It healed by itself but all these years later the occasional shooting pain or collapse is the legacy.
Funny story: my father – who has quite expensive private insurance from Aetna – suffered a heart attack some years ago. His insurance covered the operation but afterward the insurance company decided not to pay for the anesthetic because it ‘wasn’t medically necessary’ – I guess they expected him to undergo bypass surgery with a fifth of bourbon and a rag to bite on.
Luckily, sinc emy father is an expert on the American health care system, he threatened to sue Aetna and they relented, though I’m not sure most people know that suing your insurance company is an option.
Take a look around, people. The US has the most expensive health care system on the planet yet somehow we manage to provide less care and have less healthy citizens than dozens of other countries. How do you figure that one?
It also goes to why Neo’s claims of being ‘mugged by reality’ on 9/11 is totally BS. What the hell does terrorists flying into the WTC have to do with health insurance?.
His insurance covered the operation but afterward the insurance company decided not to pay for the anesthetic because it ‘wasn’t medically necessary’ – I guess they expected him to undergo bypass surgery with a fifth of bourbon and a rag to bite on.
I call bullshit.
It also goes to why Neo’s claims of being ‘mugged by reality’ on 9/11 is totally BS. What the hell does terrorists flying into the WTC have to do with health insurance?
Once you see things “as they are”, there is no going back. You should try it sometime.
“At least with private insurance I have the threat/leverage of changing to another company.”
You have another option as well; in dealing with private insurance there is also the very real threat of suing them for failure to act in “good faith.”
So, when Medicare or Obamacare (soon to be renamed KennedyCare) fails to act in good faith, can we sue?
Ac-hates:
Do some basic demographics and begin to address your own distorted rhetorical questions. As to your Dad being an expert on the American system, just what degrees does he hold, and what work does he do?
Aetna paper pushers make errors; all paperpushers do. Government paperpushers in health care wont?
You have another option as well; in dealing with private insurance there is also the very real threat of suing them for failure to act in “good faith.”
So, when Medicare or Obamacare (soon to be renamed KennedyCare) fails to act in good faith, can we sue?
Ymarsakar noted by blog (http://problemiserisa.blogspot.com/) above, which is appreciated. Rather than go into detail here I will shill it just a bit further, and suggest you take a look at it. You’ll find that your ability to sue private insurance companies, if your coverage is through your employment, is severely compromised. Bottom line — regarding employment-based coverage the insurer can commit gross fraud with no consequence.
Gosh, I have a little different insurance arrangement, one that would never deny an MRI…it’s called a high deductible. I have to pay the first $10,000 which I keep in a savings account and then pay half of the next $10,000. With this insurance, I have a wonderfully low yearly premium allows me to sock away month in the health savings account.
But here’s the best part: since I have to pay for the MRI, I negotiate the price with the billing department ON THE FRONT END. It is stunning what I pay when I tell them I am essentially a self-pay.
Once I left an x-ray department a doctor had sent me to after they quoted me the price—something like $1,200. I was shocked and called his office saying I was going to shop around and try to find a better price. I knew another radiology place and went there with the same requisition and they gave me a self-pay price of only $250….a savings of almost a thousand bucks. I had the MRI done there and went on my way without having to get anyone’s permission except the doctor’s office who had to call in the order.
When personal responsibility is put back into the equation then patients themselves will lower the price of health care immensely. Obviously in certain emergency situations that’s not always possible….however, in many, many cases it IS possible and believe me, I’m a wicked medical shopper. Most things can now be done at Minute Clinics though not MRIs.
Meanwhile, hope you get your MRI request soon and get to feeling better.
Hey, Neo: are you wearing new, or different shoes? Orthotics? Barefoot or flip-flops more?
Sometimes little thinks can cause big trouble….
Webutante Says:
When personal responsibility is put back into the equation then patients themselves will lower the price of health care immensely.
You are spot on! And when the Big Brother version of health insurance is enacted and “bought” by the majority, the customer will not be shopping for the lowest price. Why should they, “it’s free”, “the government is taking care of us.”
Webutante,
good for you! The HSA system with high deductibles would do wonders for healthcare costs in this country. Of course there are many who would not have the discipline to save that money.
I just read an article in Consumer’s Report detailing how uninsured people can negotiate costs with medical providers. I’ve even done it myself when I had a 20% co-pay and thought the hospital charge was way out of line. They didn’t want to cut me a deal, but I persisted and eventually saved $1000.
For an excellent discussion of the single payer system in Great Britain, go here:
http://www.youtube.com/watch?v=xx0ktkr9s8I
We don’t want that!
While it might be expensive, the ability to find a private pay medical procedure is an important option. Under some single payer systems the private option is outlawed to make things fair. On a related note, currently people in Canada and the U.K have the option to come to the U.S. for treatment if they can pay. If the U.S. goes national health care, we will have nowhere to run.
Basically I have a catatrophic health policy which assures routine medical procedures and illnesses/surgeries are paid out-of-pocket. So you can rest assured I negotiate, negotiate, and negotiate. I find the best price and then pay cash on the front end. I also take good care of myself.
My yearly premiums are shockingly low and I’ve never come close to reaching my $15,000 deductible ( kNOCK ON WOOD, as my grandmother used to say).
The truth is Neo could have that MRI tomorrow if she wanted to go to the trouble and expense to shop around and pay for it.
Trouble is, everyone in this country wants their insurance to pick up everything. The price we pay is a lack of flexibility and a sense of powerlessness when things like this happen. If we did auto insurance this way, we’d have an auto insurance crisis. I don’t know about you, but I pay for maintenance and lube jobs out-of-pocket and other stuff that’s no longer under warranty. What are we thinking when we really expect medical insurance to do it all. It’s a chimera to say the least and the entire country is drinking the kool-aid!
Getting off my soap box now….
Webutante: The sort of insurance you describe is not always available for a reasonable price.
The fewer choices you have, well, the fewer choices you have; Not all that complicated….
“Tore a ligament, though I don’t know which one…”
Anterior cruciate ligament, perhaps?
That may be true, Neo. However, I can’t image in my wildest dreams that if you or anyone went to their insurance company and asked to raise your deductible—and they had high deductibles, that it wouldn’t immediately lower your premiums and force you to shop for the best prices out in the healthcare market place. Because you’d be doing the job you’re now paying them to do. Your insurance company is doing your job, or the job you do shopping in other areas of your life. Why should health care be any different?
Why do we abdicate all responsibility and then wring our hands that it’s all too expensive? It more than just too expensive…it’s an unwieldy system.
BTW, what I’m describing is basically what John Mackey at Whole Foods has been excoriated about for writing it in the WSJ.
neo
What’s “reasonable”?
High deductible plans cost a hell of a lot less than the low-deductible, plans.
“available” is a matter of state law, whether a state allows high-ded plans, and since the feds started talking up HSAs some years ago, afaik, all states have the high-ded contracts.
That leaves insurability.
All states have, by fed law, an insurer of last resort who must take everybody. Whether the insurers of last resort have higd-ded plans or not ….? Probably varies by state.
Believe me, I’ve lived in many states, and always sought out high-deductible plans. The variation in price is nothing short of astonishing. This is true especially as one gets older, but is still too young for Medicare.
Webutante: I have a very high deductible and have had one for about ten years. My insurance premiums are enormously high as well. And I shopped very carefully for my insurance and got the best deal possible.
There are many variables. It depends on the rules of each state, one’s age, marital status, employment, pre-existing conditions, that sort of thing.
Our current health care debate can be summed up in one meeting Clinton had all those years ago.
He asked how many had HMO’s as their insurance and a great deal raised their hands. With a smile (some would say smirk) on his face in victory he asked how many liked it, I do not recall the exact number but less than 10 raised their hands (the group was at least 50, nearly all raised their hands at the start). Subject was then quickly changed to the next one and whatever we were to hear was not said.
This story reminds of that – who really likes that? Really, anyone who could afford better would do so. We can *all* hope to afford better and frankly we all have an equal opportunity to do so (even if many of choose not too for whatever reason). Indeed, in Neo’s case she could even go elsewhere if that treatment was bad even if she is in an HMO or similar program.
If we *all* had HMO’s, all had the same crap, then there was never any hope of doing better. Her options would be … Death Panels (dun dun duhhhh!). Well, no, not really but the idea behind that statement is pretty much accurate. You have one choice, one appeal, and outside of that oh well – sucks to be you! Even if the govt doesn’t mandate that if they set up a situation where that is the default case then it will be … the only case.
Of course, they understand this implicitly. For instance you can do whatever you want but if you go outside of our govt mandated weight limits you have to pay 1000 dollars per pound over weight or not be able to have any health care. Do not think that will happen? Well, look to what we are modeling after currently has a high likelihood to pass. I mean lets face it, how often have we all heard out govt say if they can not legislate something they will tax it out of existence?
At least in a mostly free market we all can choose who to pay and, thus, you have to convince a huge amount of people you are correct, and well, be correct. Market forces will pretty much force incorrect ideas out. In a govt run case you only have to convince 3/4 of a few hundred and 1/2 of a little over 100 you are right. In that case – oh well, sucks to be you!
Until or unless govt run health care reform solves those issues it isn’t going to fly in popular opinion. Some group may be able to get part of what they want if they were willing to give enough, but IMO to do that they loose the main part of what they want.
Further I also think that ignoring those wants/issues misses the mark by so much that any idea that *doesn’t* address them exposes so many other faults that it makes people think about the rest of your ideas. Death Panels, while a bit of a stretch, have a large kernel of truth to them and speak to the (legitimate) fears of so many, further it requires them to admit to certain parts and try to gloss over them.
Govt run healthcare will have most likely killed any “mandate” two presidencies had because of that. Maybe one day they will learn from it, but I bet not.
Gray Says:
August 27th, 2009 at 11:19 pm
Hey, Neo: are you wearing new, or different shoes? Orthotics? Barefoot or flip-flops more?
Sometimes little thinks can cause big trouble….
Good call, imo. Fwiw, I’ve seen all kinds of strange things eventuate upstream from new/different/worn out shoes, and experienced a lot of these things myself. In fact my working rule came to be, without trauma or a new kind of activity in a basically fit person, it’s always the shoes for new pain from the foot to even the low back.
And double ditto about those “little things” even apart from the shoes. I liken these little things to a blister – none or not hardly any noticeable trauma, big pain and disability later, pretty long healing time especially if in the wrong place.
Always trying to lower your health care costs, that’ll be 2 cents please.
The reason that catastrophic health insurance is unaffordable in some states is state regulation. People who argue that private insurers are rapaciously driving up their prices so they can profit are often unaware of the extreme degree to which health insurance is regulated in some (though not all) states. The state loads on all kinds of mandates as to what the insurance must cover (in my state, for example, acupuncture, chiropractic care and such — any day now they’ll add homeopathy! kidding, I hope) and that drives up the price of all insurance. I am right on board with Webutante that a combination of high-deductible catastrophic coverage, an HSA, and bargaining would solve many of our ills — but the first step is to make it possible through state deregulation and removal of the current prohibition against health insurers selling across state lines.
Mrs. W is correct: the prohibition against going across state lines needs to be lifted, among many other things…
Neo, as to insurance rates being contingent on employment, age etc….I’ll agree to some extent; however, I would bet you may be close to the same age as I and it hasn’t much affected my rates. Again what affects my rates is that I have a high deductible and pay/ negotiate, for myself in the health marketplace. It lowers cost, increases personal responsibility and expands freedom flexibility exponentially.
Don’t know which blue state you now live in—Mass or Ct, but I would consider moving to another state that allows more health insurance freedom.
In the 20+ plus years I have been dealing with group insurers at work I have learned there is a consistant method they all use to avoid paying claims. Once a year the insurer will send out notices to each member asking if they have other insurance. Most people ignore the notice and then the next time they have a claim it is denied because there was no response to the questionaire. Some people bring me their denied claims and we go through the same tedious process time and time again to reconcile the issue. I have always wondered how much money the insurance companies save each year denying legitimate claims based on non-responses to “coordination of benefit” queries.
I came across this blog by accident and was intrigued by what the contributors had to say about the health care debate. Clearly many of them need a stiff reality check. Those who blithely dismiss the Canadian health care system have absolutely no clue what they’re talking about. They’re just repeating talking points and blowing off steam. I’ve lived for decades in both Canada and the United States, and the Canadian health insurance system beats the American one hands down. I could go on for pages about why the Canadian system is superior. But here’s the supreme irony: Americans pride themselves on their lean, mean capitalist economy. And many disdain the so-called socialist Canadian system. Yet it’s the U.S. health insurance industry that’s saddled with the humongous bureacracy, not the Canadian one. But such a bloated bureaucracy is necessary in a private system where access is not universal, but carefully apportioned by a vast army of paperpushers determining who paid how much and for what plan, and then deciding who is entitled to what procedure, and who can visit what doctor, and who can visit what hospital, and whose claim can be temporarily rejected in the hopes that the claimant will be too intimidated or tired or sick or just plain disgusted with the whole hippopotamic system to dispute the rejection. If Americans were given the opportunity to be covered by the Canadian system for a year, I predict there would be a revolution in the United States and the private insurers swept entirely away.
[note from neo-neocon: to “Hugh”—I have my doubts as to whether you came across the blog by “accident.” However, assuming you did and are not a troll, it’s a funny thing that you, as a supposed Canadian, profess to be so knowledgeable about the US system. I would refer you to a previous post about my own knowledge of the Canadian system, here.
Oh, and another thing—why is your IP number from the US?]
Shoot, I’m only 26 and turning that from 25 bumped my rates up….
It is funky what will screw with other things– knew a guy who was having migraines until an old doctor told him not to pack his wallet in his back pocket. Poof! No more migraines.
If Americans were given the opportunity to be covered by the Canadian system for a year, I predict there would be a revolution in the United States and the private insurers swept entirely away.
… Right. It can’t manage basic early-term births, but we’d just love it.
Because nobody knows someone who’s had a high-risk pregnancy, right?
I came across this blog by accident and was intrigued by what the contributors had to say about the health care debate. Clearly many of them need a stiff reality check. Those who blithely dismiss the Canadian health care system have absolutely no clue what they’re talking about.
It’s a f’in form letter.
PS: Soviet Canuckistan.
Nice speech Hugh; but “speech” is exactly what it is.
I can’t help but notice that you addressed NOT ONE DETAIL of neo’s situation.
–
I’m interested in setting up some insurance along the lines Webutante suggests.
Any suggestions or web links?
Good discussion.
“If Americans were given the opportunity to be covered by the Canadian system for a year, I predict there would be a revolution in the United States and the private insurers swept entirely away.”
Punch me if I’m wrong but are Americans going to Canada for treatment? Are Americans going to Canada for test which were turned down by the bureaucrats?
I don’t want the government doing a damn thing for me.
Provide the military – do it.
Build the interstates – do it.
Provide a down payment for my car or truck – forget it.
Provide a place for me to live – forget it.
Provide my health insurance – forget it.
huxley: Don’t have time to scrape up links today; however I do have a good book suggestion:
“The New Health Solution Solution, How to Get Cheaper, Better Coverage Without a Tradition Employer Plan.” (Health Saving Accounts and other ways you can save $5,000+ every year.) by Paul Pilzer.
With chapters such as, You are One Serious Illness Away from Bankruptcy–the huge gaps in your employers health insurance plan, how to buy your own low-cost plan, HSAs, what to do if a family member has a major health problem, how to save 10-75% on prescription drugs, and on and on, I think you will mine lots of ideas that will be of use.
But just as important, we need to continue to oppose tooth and nail the travesty the government wants to foist on us from above….and now in the name of TeddyCare. If we let it happen, Mary Jo may have gotten off easy….
sorry, did I really say that??
Foxfier, similarly, I know somebody whose migraines stopped when, on a doctor’s advice, she cut off her long, heavy hair.
Hmm. I should have said headaches, not migraines. Reconsidering, I don’t know if they were migraines or not.
Thanks, Webutante!
Foxfier, Mrs Whatsit: I too have been surprised how small details in my shoes or habits can cause various pains in various joints.
Here’s hoping that neo gets to the bottom of her knee pain soon, one way or another.
Hugh better go out and talk to your neighbors
here is a case i am familiar with… Neo knows why.
Beverly Green, 45, was diagnosed with breast cancer in 2001. Initial tests indicated she would not benefit from hormonal drug treatment, but retesting at Mount Sinai Hospital in 2005 found that her initial test results were incorrect. Green testified at a public inquiry in March 2008
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080319/breast_cancerfiles_080319/20080319?hub=Canada
David Malleau, a 44 year-old truck driver suffered a devastating car accident in 2004 that forced doctors at Hamilton General Hospital to remove a fist-sized piece of bone from his skull to relieve pressure on his brain. Once the swelling subsided and he was ready for surgery in March 2005, Malleau was sent home and placed on a waiting list. Three months passed. Then six. He waited at home, a prisoner unable to leave the house for fear something would hit the exposed side of his brain – for him a potentially fatal incident. In the end, it took nearly a year before he could get skull replacement surgery.
Diane Nesenbrink, was goofing around as a teen when her jaw locked open. That incident, 27 years ago, marked the beginning of the Stratford, Ontario, woman’s lifelong ordeal with jaw joint problems. Ms. Nesenbrink jaw joint needed to be surgically replaced. But patients who need a new hip or knee have been deemed a political priority and are guaranteed joint replacements within nine months — the “medically acceptable” wait for consultation is no more than three months and the subsequent wait for surgery no more than six months. Ms. Nesenbrink’s doctor, Dr. Baker said, “The jaw joint is an important joint as well, but we’ve been forgotten.” In fact, his patients wait an average of more than two years for surgery. Even critical cases — where patients suffer excruciating pain and are unable to move their mouths — wait at least three months. “We see patients who are in dire straits: Talking, eating, chewing, smiling are all difficult, if not impossible,” Dr. Baker said.
Jeff Clarke, 34, was in a chronic state of pain for three years. The Kitchener man could stand for only 10 minutes at a time, sit for about 20 and then lie down again. The back pain, diagnosed as degenerative disc disease, travelled through his legs and often he buckled over as he tried to stand. He used two canes and a walker to get around. Then one night last November as he was watching TV, he saw a commercial about a Canadian company offering surgery in India. Clarke called the Vancouver-based business and within two days was sending his folder of medical information to the surgeon in Chennai, India. “All of a sudden there was hope, valid hope I could grasp,” he said. On Jan. 28, Clark had two titanium rods placed in his lower back, two reconstructed discs made of high-density plastic inserted, as well as screws to hold the discs together, all thanks to an Indian doctor.
Jordan Johanson, 18, died at Rockyview Hospital in late March. He died following a 12-hour wait for surgery on his appendix. Darcy Johanson, the boy’s father, said “Young kids shouldn’t be dying like this. If something can be done to fix it, they should get on with it.”
Lindsay McCreith, 66, was told he had a brain tumor but that he would have to wait four and a half months to obtain an MRI to rule out the possibility that it was cancerous. Unwilling to risk the progression of what might be cancer, Mr. McCreith obtained an MRI in Buffalo, which revealed the tumor was malignant. Even with this diagnosis in hand, the Ontario system still refused to provide timely treatment, so Mr. McCreith had surgery in Buffalo to remove the cancerous brain tumor in March, 2006. In Ontario, Mr. McCreith would have waited eight months for surgery, according to his family doctor. Eight months is enough time for a cancer to worsen, spread and progress to an irreversible stage. Had Mr. McCreith not paid $26,600 for immediate care, he might be dead today.
yup… just talking points.. .
thats waht you call em..
we call them human beings!
One other feature of Canadian law that tends to discourage parties from suing physicians for malpractice is that the Supreme Court has set out guidelines that effectively cap awards for pain and suffering in all but exceptional cases. In a trilogy of decisions released in 1978, the Supreme Court established a limit of Can$100,000 on general damages for non-pecuniary losses such as pain and suffering, loss of amenities and enjoyment of life, and loss of life expectancy.[12] The Supreme Court did state that there may be extraordinary circumstances in which this amount could be exceeded and courts have allowed the figure to be indexed for inflation so that the current suggested upper limit on awards for non-pecuniary losses is close to $300,000.[13] Nevertheless, the flexible cap on non-pecuniary losses is a major disincentive to persons considering whether they should sue a physician for malpractice and for lawyers to specialize in or seek out malpractice cases.
The Supreme Court of Canada has also limited the types of cases in which punitive damages may be awarded, although it has allowed as much as Can$1 million in punitive damages in an extraordinary case.[14] A Canadian law firm has summarized the holding in this leading case concerning punitive damages as follows:
Punitive damages are very much the exception rather than the rule;
Imposed only if there has been high-handed, malicious, arbitrary or highly reprehensible misconduct that departs to a marked degree from ordinary standards of decent behaviour.
Where they are awarded, punitive damages should be assessed in an amount reasonably proportionate to such factors as the harm caused, the degree of the misconduct, the relative vulnerability of the plaintiff and any advantage or profit gained by the defendant,
Having regard to any other fines or penalties suffered by the defendant for the misconduct in question.
Punitive damages are generally given only where the misconduct would otherwise be unpunished or where other penalties are or are likely to be inadequate to achieve the objectives of retribution, deterrence and denunciation.
Their purpose is not to compensate the plaintiff, but
to give a defendant his or her just desert (retribution), to deter the defendant and others from similar misconduct in the future (deterrence), and to mark the community’s collective condemnation (denunciation) of what has happened.
Punitive damages are awarded only where compensatory damages, which to some extent are punitive, are insufficient to accomplish these objectives, and
they are given an amount that is no greater than necessary to rationally accomplish their purpose.
While normally the state would be the recipient of any fine or penalty for misconduct, the plaintiff will keep punitive damages as a “windfall” in addition to compensatory damages.
Judges and juries in our system have usually found that moderate awards of punitive damages, which inevitably carry a stigma in the broader community, are generally sufficient.[15]
Thus, punitive damages in tort actions in Canada are relatively rare.
punitive damage tort actions are rare but actions by companies and staff that would lead to such are not.
shall i now start going into their accepting substandard doctors to make up for shortages, and how they refuse to remove doctors that have a record of hurting patients for years and years?
Hugh Says:
“If Americans were given the opportunity to be covered by the Canadian system for a year, I predict there would be a revolution in the United States and the private insurers swept entirely away.”
It’s great if you’re not sick… as low maintenance / admin costs, I do believe it. When the state owns everything you don’t need much oversight. You use formulas and wait lists rather than having someone on staff who denies your claims. But we are not proposing going to a state owned system, ergo low administration costs will be overshadowed by fraud. We’ve already seen this with US Medicare (although, the meme about it’s low administration costs are often a myth… so we have the worst of both worlds)… alas, the administration is so bad we can’t even do an accurate guess as to the level of fraud.
Anyway, I just had a major medical problem and was pretty happy with my treatment. I think the doctors are so afraid of lawsuits that they’ll go way out of their way to make sure your treated immediately (I have a few admin assistants tell me I’d need to wait a couple weeks for specialist appointments… my primary cardiologist picked up the phone, talked to the other doctor on my behalf, and bingo… I was seeing them or getting the surgery or test… the next day)…
Loyal Achates Says:
“Take a look around, people. The US has the most expensive health care system on the planet yet somehow we manage to provide less care and have less healthy citizens than dozens of other countries. How do you figure that one?”
Bogus stats….
Gray Says:
“”His insurance covered the operation but afterward the insurance company decided not to pay for the anesthetic because it ‘wasn’t medically necessary’ – I guess they expected him to undergo bypass surgery with a fifth of bourbon and a rag to bite on.”
I call bullshit.”
Might be the kind of anesthetic (he wanted something more expensive than the norm)? I had heart surgery awake with mostly local anesthesia (I may have and forgotten, but I don’t remember ever breathing from a mask… and I know I was awake).
Anyway, mine went fine. I started to un-numb up so I just told them and they gave me another shot.
Charles Says:
“You have another option as well; in dealing with private insurance there is also the very real threat of suing them for failure to act in “good faith.””
Plus, there is free step before that one that everyone really forgets. They’re regulated by the states. Write to the state insurance regulator that handles health insurance. He can overrule them without going to court / any out of pocket money.
Hugh: I have my doubts as to whether you came across this blog by “accident.” However, assuming you did and are not a troll, it’s a funny thing that you, as a supposed Canadian, profess to be so knowledgeable about the US system. I would refer you to a previous post about my own knowledge of the Canadian system, here.
Oh, and another thing—why is your IP number from the US?
Richard Johnston Says:
“Bottom line – regarding employment-based coverage the insurer can commit gross fraud with no consequence.”
Not completely true. While doing research I’ve found cases of the insurance companies loosing. Also, being a legal ‘agent’ does not protect one from fraud type charges. Also, if they win with the agent protection, you simply move up the food chain to the employer… or charge fraud (yes, the insurance company created these rules but they did so to conspire, with the employer, to avoid providing care to save money). Being an agent does not remove you from liability, the suit simply needs to treat you like an agent acting in bad faith… and keep in mind that in self financed employer health insurance… they might really be an agent / just the administrator of the employer’s cash.
Webutante: as I’ve said before, different states are as different as they can be. I have done my research, believe me. My version of health care reform would include the ability to cross state lines to get a better deal.
To all who suggest that shoes may be the culprit: Because of my back problems, I always wear shoes that (although I try to make them at least somewhat stylish) are really comfortable and really good for you. I’ve had no change in footwear recently. So that’s not it. But good try.
Many many years ago I had a foot problem that bothered me for 2 years. They were offering me surgery for it, but instead I got a pair of new walking shoes of a different brand and type. I had always walked for exercise, and I wor a type of walking shoes I had always thought were just fine. So I’d kept getting new ones of the same design. Lo and behold, when I switched, the pain I’d had for two years went away in a couple of days!
Webutante Says:
“That may be true, Neo. However, I can’t image in my wildest dreams that if you or anyone went to their insurance company and asked to raise your deductible–”
My wife is an operations manager for a small buisness and she picks the insurance options. A lot of what we have is driven by what the employees want… and what they want is often illogical.
I helped her crunch numbers and high deductable (say 5k) plans are not that much more expensive even if you do need to use $5k in insurance… The regular plan has out of pocket expences (co pays, co insurance, et cetera) and costs so much more per month… then if your not really ill in a given year and you just pay out of pocket for everyday stuff… yeah, you save a ton due to the lower premium.
I would like for them to start out with making those health care accounts carry from year to year. I need one and don’t use it because I’d lose the money if I don’t use it up in a year.
I had an infected bite of some sort. It started to look infected and I had chills and a fever. I went in on a Saturday to a same-day clinic. They eventually diagnosed a nasty form of staph. I was on antibiotics and had to have the dressing changed every two days. Was referred to a surgeon who said he would operate if it didn’t clear up. I did and I recovered just fine. My insurance company will pay for the surgeon visit (at least part of it) and the secondary visits. But for some reason, they don’t want to pay a penny towards that initial visit. I’m going to have to call in and appeal on that one.
Teri Pittman Says:
“But for some reason, they don’t want to pay a penny towards that initial visit. I’m going to have to call in and appeal on that one.”
If reason still accounts for anything I’d mention you saved them a ton of money by going to a cheapo sat clinic… not going to an emergency room.
huxley Says:
“Any suggestions or web links?”
Find a yellow pages and look up insurance agents. If someone mentions health insurance, they can probably hook you up…. just remember, you’ve never ever done any illegal drug. 😉
just remember, you’ve never ever done any illegal drug.
*laughs* I can still remember my recruiter’s response when I rattled off *every single legal drug* I’d ever taken that was stronger than baby-aspirin…. (Can’t do that anymore, but it did result in several hours of “are you SURE you’ve never used XXX? type questions.)
Thomass: I was hoping for more specific advice. I ordered the book Webutante suggested.
huxley Says:
“Thomass: I was hoping for more specific advice. I ordered the book Webutante suggested.”
“Thomass: I was hoping for more specific advice. I ordered the book Webutante suggested.”
If you go with an agent (vs. a broker website) you’ll still need to yellow page it. They are usually someone local / required to be local.
Well, I usually read up on something before shopping around and even more so before showing up in an agent’s or salesman’s office and saying vaguely, I want X. Then there’s the question of which agent.
Most of my life I have had insurance through various group plans that were available, so I haven’t thought this through at all.
Thomass said:
“’Bottom line – regarding employment-based coverage the insurer can commit gross fraud with no consequence.’”
Not completely true. While doing research I’ve found cases of the insurance companies loosing. Also, being a legal ‘agent’ does not protect one from fraud type charges.”
Thomass, you are referring ot state tort and contract law. If you have employment-based coverage, ERISA wipes all that out. It is true that the insurance company sometimes “loses,” but what they lose is meaningingless to them, and never makes the claimant whole. And in the majority of cases, if you prove they were wrong — you lose. For them to lose you have to prove they were arbitrary and capricious, i.e. that their denial of your claim wasn’t even within the bounds of reason. As you might imagine that makes it very difficult to win even when they are wrong.
Peruse my blog for more information, and of course read further to satisfy yourself I am not making this up. It’s a little-known but very important factor in health reform, IMO.
Neo, just a quick comment to your last one to me. I have no doubt that your research is impeccable and far superior to mine. And you are mostly right and only somewhat wrong. We need to clarify that I am NOT in a network. There are many reasons but mainly I want to freedom to have healthcare in TN, DC and WY etc. Being outside a network which I am guessing you are in allows me maximum flexibility and mobility at a decent cost with a high deductible and NO CO-pay bells and whistles. And I also get to negotiate. I am betting you ARE in a network. So the network has—again—pre-negotiated rock bottom prices for you and all its other members. You could leave the network if you wanted and there’s no state laws I don’t believe that would prevent that and according to my health insurance agent here who’s the best I’ve ever seen—you could most likely get the same non-network policy I have anywhere in the country….Networks DO have advantages but are more regulated.
We all have to realistically weigh our priorities and situations in health care. And I certainly don’t know all the ins and outs of others or yours. If I decided to join a Blue Cross network here, things would be pre-designated and less flexible. My premiums would be even lower, but what I would be giving up would not suit me at this time.
Again, even if you are in a network there, you could still get an MRI if you paid out-of-pocket and negotiated, but I’m sure that’s the last thing you want to do. as a network member
There’s so much more complexity to all this, but I’m not much up to anymore of it this weekend. Wonderful conversation here though. Thanks for providing it.
Richard Johnston Says:
“Thomass, you are referring ot state tort and contract law. If you have employment-based coverage, ERISA wipes all that out.”
Maybe the cases I read about were not covered under ERISA… but yeah, sounds pretty bad from what I read at that blog.
Webutante: I guess you’ll just have to trust me when I say that the type of insurance you are describing is not available to me. I have a type that gives me the maximum flexibility possible, and allows me to see virtually all doctors in any state. I have a high deductible. It is very expensive insurance, however. And it’s the cheapest of its kind in my state by FAR—about 50% cheaper than all the others of its type, including those with even higher deductibles.
huxley Says:
“Most of my life I have had insurance through various group plans that were available, so I haven’t thought this through at all.”
Generally, these high deductible plans are a great deal when your young but then decline in value as you get older (re: your the one being subsided on the group plan [old] vs. being the subsidizer [young]).
But with all the ERISA talk, maybe its worth a little extra to not be on the employer plan?
Teri Pittman Says:
“I would like for them to start out with making those health care accounts carry from year to year. I need one and don’t use it because I’d lose the money if I don’t use it up in a year.”
Or you can get a new pair of glasses, or get those wisdom teeth out finally, or just buy a bunch of over the counter stuff and put half in a charity bin (keep the other half for the next year’s home use). 🙂
Webutante: As I said, I would not be able to get a policy like yours where I live now. However, I have had that sort of insurance in other states. I had to have an ultrasound at one point when I was covered by such a policy. I paid for the test out-of-pocket, and I was able to negotiate a somewhat reduced rate for it (I think about 20% less, if I paid the same day). So I am very familiar with what you’re talking about.
But with all the ERISA talk, maybe its worth a little extra to not be on the employer plan?
I have no idea. That’s why I’m asking.
My friend Loraine is a RN and works for the city in the immunology department. She gives shots all day. Wednesday I had a message on my phone when I got home from work. She was at the emergency room of a downtown hospital because she had accidentally driven a syringe needle into her thumb and couldn’t pull it out.
When I got there they had just finished with her. The syringe needle had hit bone and bent into a hook and that was the reason she couldn’t pull it out herself.
They took an x-ray to make sure nothing was left in her thumb. Now the funny thing is they NEVER asked her for her insurance card. There was no bill for services. She was never even asked for her address and phone number.
She told me that while she was waiting one young man realized he had forgotten his ID and was turning away to go fetch it and come back but the receptionist told him there was no need and he was signed in and treated without insurance or ID. No SS card, no driver’s license … nothing.
She was in scrubs and told them she worked for the city, which of course, provides medical insurance to her but it made no difference, neither her nor her insurance was billed, yet it was obvious she HAD insurance.
Loraine is a Progressive(sigh) and has been FOR Obamacare but even she is beginning to have doubts, which she voiced on our way to get a Margarita and some good Mexican food in her. She didn’t think it was right for them to provide free medical for her and apparently others who have insurance that could have reimbursed the hospital. It has apparently gone from, “You have to provide medical for the uninsured in emergency rooms,” to FREE service to all who show up at the door, even if they have insurance..
My suspicion is that this is a widespread phenomenon.
Neo Neocon says:
“Hugh, I have my doubts as to whether you came across this blog by “accident.” However, assuming you did and are not a troll, it’s a funny thing that you, as a supposed Canadian, profess to be so knowledgeable about the US system. I would refer you to a previous post about my own knowledge of the Canadian system, here. Oh, and another thing–why is your IP number from the US?”
As I said in my post, I’m knowledgeable about the U.s. system because I have lived in the United States for decades–20 years to be exact. I’ve observed how cruel and inefficient the U.S. health insurance industry is first hand.
Why would you suspect I’m a troll, neo neocon? Because I have something to say that goes against the rigid ideological grain of this site? I truly did come across this by accident and wanted to contribute to this particular discussion because I feel strongly about this issue. I’m disgusted by the misinformation that many Americans, including the contributors to this site, repeat about the Canadian system without ever having lived in Canada. It’s not a perfect system but it’s light-years superior to the expensive, broken-down U.S. one.
OK, thanks.
Because I have something to say that goes against the rigid ideological grain of this site?
No, because you had a huge chunk of text that in no way directly commented on the topic it was posted to, which used standard boiler-plate that is nearly fact free.
Hugh: What Foxfier said. Plus, your tone of belligerence, which was already apparent the first time you supposedly come here “by accident.”
I’m not even sure what “by accident” means in that context—except that, in a sense, everyone comes here “by accident” unless it’s their business to be trolling around looking for sites on American vs. Canadian health care. So it’s a case of “I fear the man doth protest too much.”
I also referred you to another post in which I discussed one of the specifics of what I think is bad about the Canadian system. You come back, once again, very angry, and with no specific response to what I said there. In addition, although I have plenty of regular commenters here who “go against the rigid ideological grain of this site,” you immediately accuse me of intolerance of other opinions when you have already been allowed here to disagree and to insult.
I refer you here for the rules of this blog. Some pertinent ones are as follows, taken from that post:
Every now and then I decide to ban a commenter here. Sometimes it’s a no-brainer; the comment is so obscene and revolting it doesn’t see the public light of day for more than a few moments before I delete both it and the poster’s right to make more comments here.
Sometimes it’s not obscene, but so obviously of the “nah-nah-nah-nah-nah,” variety, merely insulting and taunting with no other content whatsoever. That’s an easy decision, as well; I’m not interested in that sort of discussion.
Sometimes it takes a bit longer to determine that it’s time to ban someone from commenting here. A person comes in and there’s some rudeness and taunting, but also a few substantive issues are raised. Some of these people end up staying here because, although I disagree with them and they disagree with me, in the main their comments are an attempt to engage in at least a somewhat respectful discussion of the issues.
Or there’s not a lot of nastiness, but it’s clear that the commenter is taunting in a different way: never answering a question another commenter asks, constantly moving the goalposts in an attempt to make everyone explain over and over but never listening, always misinterpreting and misrepresenting what I’ve said in a post. It’s easy to recognize, tends to emerge over time, and ultimately it often gets a person banned.
And of course, those who merely disagree with me and other posters but are here to actually debate the issues (fancy that) are always welcome.
After a while it usually becomes clear which sort of poster a person is: troll, or person truly interested in that supposed goal of so many liberals: dialogue. “Dialogue” isn’t a shouting match where you call your opponent an idiot or worse, especially when invited into what is the cyber equivalent of that opponent’s home.