In the UK, surveys show that the way people vote is determined by three major factors: health, education and the economy. The age of the person determines what order they place these factors in.
In most advanced economies, countries have a National Health system (what the Americans rightly describe as “socialized medicine”). In the UK it was one of the main rewards provided for the sacrifices made during the Second World War.
In 1942 a large percentage of the British population wanted to negotiate an end to the war. This was understandable as we were getting a terrible beating on the battlefield and the civilian population had to endure the Blitz. Under pressure from the Labour members of his cabinet, Winston Churchill, the leader of the Conservative Party, commissioned a Liberal member, Sir William Beveridge, to write a report on future welfare provision. Given his political background, it was no surprise that is report published in December, 1942, that all people of working age should pay a weekly contribution. In return, benefits would be paid to people who were sick, unemployed, retired or widowed. Beveridge argued that this system would provide a minimum standard of living "below which no one should be allowed to fall".
It has to be remembered that before the war the British people had endured the Great Depression. This proposal played an important role in giving the people something to fight for.
In the 1945 General Election all three major parties promised to implement the Beveridge Report. However, the people did not trust Winston Churchill and the Conservative Party to deliver this pledge. They still remembered the broken promises made during the First World War (“a land fit for heroes”) and the way they were treated during the 1930s. The Labour Party won a landslide victory and its most left-wing leader, Aneurin Bevan, was given the job of implementing the Beveridge Report. In 1946 Parliament passed the revolutionary National Insurance Act. It instituted a comprehensive state health service, effective from 5th July 1948. The Act provided for compulsory contributions for unemployment, sickness, maternity and widows' benefits and old age pensions from employers and employees, with the government funding the balance.
http://www.spartacus.schoolnet.co.uk/TUbevan.htm
The government also announced plans for a National Health Service that would be, "free to all who want to use it." Some members of the medical profession opposed the government's plans. The British Medical Association (BMA) mounted a vigorous campaign against this proposed legislation. In one survey of doctors carried out in 1948, the BMA claimed that only 4,734 doctors out of the 45,148 polled, were in favour of a National Health Service. The reason for this is that they feared that their income would fall as a result of the NHS. The doctors were supported by the Conservative Party as they saw the NHS as “socialized medicine”.
This is what one Conservative paper, the Daily Sketch, said about the proposed NHS: “The State medical service is part of the Socialist plot to convert Great Britain into a National Socialist economy. The doctors' stand is the first effective revolt of the professional classes against Socialist tyranny. There is nothing that Bevan or any other Socialist can do about it in the shape of Hitlerian coercion.”
Doctors and dentists threatened to boycott the NHS. Aneurin Bevan was forced to make compromises in order to win the support of the high-income members of the medical profession (nurses and young doctors tended to support the idea of the NHS). This is what he said in a speech in the House of Commons on 9th February, 1948: “We have provided paid bed blocks to specialists, where they are able to charge private fees (Labour MPs shout "shame"). I agree at once that these are very serious things, and that, unless properly controlled, we can have a two-tier system in which it will be thought that members to the general public will be having worse treatment than those who are able to pay.”
As a result of these compromises that severely undermined the principles of the NHS, the National Health Service Act was passed in 1948. As a result people in Britain were provided with free diagnosis and treatment of illness, at home or in hospital, as well as dental and ophthalmic services. As Minister of Health, Aneurin Bevan was now in charge of 2,688 hospitals in England and Wales.
Although the NHS was extremely popular with the British people, the Labour government came under great pressure to water-down the system. In April 1951, Hugh Gaitskell, the Chancellor of the Exchequer, announced that he intended to introduce measures that would force people to pay half the cost of dentures and spectacles and a one shilling prescription charge. As a result of this measure Bevan resigned as Minister of Health. As he pointed out: “It is wrong (to impose national health charges) because it is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world.”
We now know that Gaitskell was one of those Labour leaders who was in the pay of the CIA. The money came via Tom Braden, head of the International Organizations Division (IOD) of the CIA. In this way, so-called left-wing politicians supported policies favoured by the ruling elite. See Braden’s confession in 1975:
http://www.spartacus.schoolnet.co.uk/JFKbraden.htm
The NHS has remained popular with the British people. Although Churchill and the Conservative Party were back in power in 1951, it was politically impossible to remove the NHS. Instead, they tried to undermine it with the constant under-funding of the system, tax changes to encourage people to buy into private health systems and the privatization of parts of the service. It was these actions that helped Tony Blair to be elected to office in 1997.
It is true that the Blair government has greatly increased spending on the NHS. However, they have also continued on the path of privatization and brought in reforms that favour high-paid doctors. They also have done nothing to deal with the absurd prices demanded by the multinational drug companies.
I have been blessed with good health and I have only experienced a short stay in a hospital once when I was eleven when I needed to have my tonsils out. However, my wife developed cancer seven years ago and so I now have first-hand experience of the workings of the NHS.
The main failing of the NHS seems to be that because of under-funding and the high costs of treatment, the service has to be rationed. The key to getting the best treatment concerns your ability to make your voice heard. For example, my wife was rushed into hospital on Tuesday morning. Although we had a letter from the doctor stating what the problem was (severe dehydration brought on by an infection that caused violent vomiting) it took three hours to receive the required treatment. This was much better than most people waiting in the “Accidents and Emergencies Department”. She only got treated as quickly as this because I spent the whole time advocating her case. The staff did what they could but they had too many people to deal with. It took 45 minutes before a doctor examined her. Although we had a letter from the doctor explaining what the problem was, the doctor insisted in carrying out her own tests. It therefore took over two hours before these test results confirmed that she was suffering from dehydration. However, it was now worse than that, her kidneys had stopped working.
The nurse asked to arrange for my wife to have an intravenous drip was incompetent. It was her first day in the hospital (a bank nurse) and did not know where anything was kept. She also gave me the impression that she had never done one before.
Judith was being treated in a cubicle. I could hear the young doctor pleading over the phone for a bed. It took another two hours before she was taken to a bed in the Emergency and Accidents Unit. Soon afterwards we were told by a senior doctor that she might not survive the night.
From that point on the quality of treatment has been excellent. However, I suspect that is because my daughter and I have played an active role in her medical care. This included meetings with doctors to discuss the nature of her treatment. This is vitally important as treatment is clearly rationed. For example, we were told that the only thing that could save her life was to be put onto a haemofiltration machine. During hemofiltration, a patient's blood is passed through a filtration circuit via a machine to a semipermeable membrane where waste products and water are removed. Replacement fluid is added and the blood is returned to the patient. In other words, it does what the kidneys usually do. The hospital only has one of these machines. It also needs a nurse to permanently monitor the equipment. We were told that people suffering from terminal cancer of retirement age are not usually put on this machine. We therefore had to convince them that Judith’s life was worth saving. The consultant eventually agreed that she should be put on the machine.
Judith’s treatment in the Intensive Care Unit has been superb. She spent three days on the machine and we are now anxiously waiting to see if her kidneys start working again.
My feelings about the NHS are mixed. It seems to receive the best treatment you need to negotiate your way through incompetence and an over-stretched service. Rationing is clearly taking place. The most important factor in this is not wealth or class but of education. Each patient seems to need an advocate who has researched the various different treatments available. Without one, the patient will receive second-class treatment. This to me is clearly the main weakness of the system.
However, the great strength of the system is that very expensive treatment is available to people who could not afford to pay the market price.
I am interested in hearing about other member’s experience of the health care system. Have you been satisfied with the treatment you or family members have received?
Full Version: Medical Treatment in your country
QUOTE(John Simkin @ Dec 23 2007, 12:27 PM) 
In the UK, surveys show that the way people vote is determined by three major factors: health, education and the economy. The age of the person determines what order they place these factors in.
In most advanced economies, countries have a National Health system (what the Americans rightly describe as “socialized medicine”). In the UK it was one of the main rewards provided for the sacrifices made during the Second World War.
In 1942 a large percentage of the British population wanted to negotiate an end to the war. This was understandable as we were getting a terrible beating on the battlefield and the civilian population had to endure the Blitz. Under pressure from the Labour members of his cabinet, Winston Churchill, the leader of the Conservative Party, commissioned a Liberal member, Sir William Beveridge, to write a report on future welfare provision. Given his political background, it was no surprise that is report published in December, 1942, that all people of working age should pay a weekly contribution. In return, benefits would be paid to people who were sick, unemployed, retired or widowed. Beveridge argued that this system would provide a minimum standard of living "below which no one should be allowed to fall".
It has to be remembered that before the war the British people had endured the Great Depression. This proposal played an important role in giving the people something to fight for.
In the 1945 General Election all three major parties promised to implement the Beveridge Report. However, the people did not trust Winston Churchill and the Conservative Party to deliver this pledge. They still remembered the broken promises made during the First World War (“a land fit for heroes”) and the way they were treated during the 1930s. The Labour Party won a landslide victory and its most left-wing leader, Aneurin Bevan, was given the job of implementing the Beveridge Report. In 1946 Parliament passed the revolutionary National Insurance Act. It instituted a comprehensive state health service, effective from 5th July 1948. The Act provided for compulsory contributions for unemployment, sickness, maternity and widows' benefits and old age pensions from employers and employees, with the government funding the balance.
http://www.spartacus.schoolnet.co.uk/TUbevan.htm
The government also announced plans for a National Health Service that would be, "free to all who want to use it." Some members of the medical profession opposed the government's plans. The British Medical Association (BMA) mounted a vigorous campaign against this proposed legislation. In one survey of doctors carried out in 1948, the BMA claimed that only 4,734 doctors out of the 45,148 polled, were in favour of a National Health Service. The reason for this is that they feared that their income would fall as a result of the NHS. The doctors were supported by the Conservative Party as they saw the NHS as “socialized medicine”.
This is what one Conservative paper, the Daily Sketch, said about the proposed NHS: “The State medical service is part of the Socialist plot to convert Great Britain into a National Socialist economy. The doctors' stand is the first effective revolt of the professional classes against Socialist tyranny. There is nothing that Bevan or any other Socialist can do about it in the shape of Hitlerian coercion.”
Doctors and dentists threatened to boycott the NHS. Aneurin Bevan was forced to make compromises in order to win the support of the high-income members of the medical profession (nurses and young doctors tended to support the idea of the NHS). This is what he said in a speech in the House of Commons on 9th February, 1948: “We have provided paid bed blocks to specialists, where they are able to charge private fees (Labour MPs shout "shame"). I agree at once that these are very serious things, and that, unless properly controlled, we can have a two-tier system in which it will be thought that members to the general public will be having worse treatment than those who are able to pay.”
As a result of these compromises that severely undermined the principles of the NHS, the National Health Service Act was passed in 1948. As a result people in Britain were provided with free diagnosis and treatment of illness, at home or in hospital, as well as dental and ophthalmic services. As Minister of Health, Aneurin Bevan was now in charge of 2,688 hospitals in England and Wales.
Although the NHS was extremely popular with the British people, the Labour government came under great pressure to water-down the system. In April 1951, Hugh Gaitskell, the Chancellor of the Exchequer, announced that he intended to introduce measures that would force people to pay half the cost of dentures and spectacles and a one shilling prescription charge. As a result of this measure Bevan resigned as Minister of Health. As he pointed out: “It is wrong (to impose national health charges) because it is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world.”
We now know that Gaitskell was one of those Labour leaders who was in the pay of the CIA. The money came via Tom Braden, head of the International Organizations Division (IOD) of the CIA. In this way, so-called left-wing politicians supported policies favoured by the ruling elite. See Braden’s confession in 1975:
http://www.spartacus.schoolnet.co.uk/JFKbraden.htm
The NHS has remained popular with the British people. Although Churchill and the Conservative Party were back in power in 1951, it was politically impossible to remove the NHS. Instead, they tried to undermine it with the constant under-funding of the system, tax changes to encourage people to buy into private health systems and the privatization of parts of the service. It was these actions that helped Tony Blair to be elected to office in 1997.
It is true that the Blair government has greatly increased spending on the NHS. However, they have also continued on the path of privatization and brought in reforms that favour high-paid doctors. They also have done nothing to deal with the absurd prices demanded by the multinational drug companies.
I have been blessed with good health and I have only experienced a short stay in a hospital once when I was eleven when I needed to have my tonsils out. However, my wife developed cancer seven years ago and so I now have first-hand experience of the workings of the NHS.
The main failing of the NHS seems to be that because of under-funding and the high costs of treatment, the service has to be rationed. The key to getting the best treatment concerns your ability to make your voice heard. For example, my wife was rushed into hospital on Tuesday morning. Although we had a letter from the doctor stating what the problem was (severe dehydration brought on by an infection that caused violent vomiting) it took three hours to receive the required treatment. This was much better than most people waiting in the “Accidents and Emergencies Department”. She only got treated as quickly as this because I spent the whole time advocating her case. The staff did what they could but they had too many people to deal with. It took 45 minutes before a doctor examined her. Although we had a letter from the doctor explaining what the problem was, the doctor insisted in carrying out her own tests. It therefore took over two hours before these test results confirmed that she was suffering from dehydration. However, it was now worse than that, her kidneys had stopped working.
The nurse asked to arrange for my wife to have an intravenous drip was incompetent. It was her first day in the hospital (a bank nurse) and did not know where anything was kept. She also gave me the impression that she had never done one before.
Judith was being treated in a cubicle. I could hear the young doctor pleading over the phone for a bed. It took another two hours before she was taken to a bed in the Emergency and Accidents Unit. Soon afterwards we were told by a senior doctor that she might not survive the night.
From that point on the quality of treatment has been excellent. However, I suspect that is because my daughter and I have played an active role in her medical care. This included meetings with doctors to discuss the nature of her treatment. This is vitally important as treatment is clearly rationed. For example, we were told that the only thing that could save her life was to be put onto a haemofiltration machine. During hemofiltration, a patient's blood is passed through a filtration circuit via a machine to a semipermeable membrane where waste products and water are removed. Replacement fluid is added and the blood is returned to the patient. In other words, it does what the kidneys usually do. The hospital only has one of these machines. It also needs a nurse to permanently monitor the equipment. We were told that people suffering from terminal cancer of retirement age are not usually put on this machine. We therefore had to convince them that Judith’s life was worth saving. The consultant eventually agreed that she should be put on the machine.
Judith’s treatment in the Intensive Care Unit has been superb. She spent three days on the machine and we are now anxiously waiting to see if her kidneys start working again.
My feelings about the NHS are mixed. It seems to receive the best treatment you need to negotiate your way through incompetence and an over-stretched service. Rationing is clearly taking place. The most important factor in this is not wealth or class but of education. Each patient seems to need an advocate who has researched the various different treatments available. Without one, the patient will receive second-class treatment. This to me is clearly the main weakness of the system.
However, the great strength of the system is that very expensive treatment is available to people who could not afford to pay the market price.
I am interested in hearing about other member’s experience of the health care system. Have you been satisfied with the treatment you or family members have received?
In most advanced economies, countries have a National Health system (what the Americans rightly describe as “socialized medicine”). In the UK it was one of the main rewards provided for the sacrifices made during the Second World War.
In 1942 a large percentage of the British population wanted to negotiate an end to the war. This was understandable as we were getting a terrible beating on the battlefield and the civilian population had to endure the Blitz. Under pressure from the Labour members of his cabinet, Winston Churchill, the leader of the Conservative Party, commissioned a Liberal member, Sir William Beveridge, to write a report on future welfare provision. Given his political background, it was no surprise that is report published in December, 1942, that all people of working age should pay a weekly contribution. In return, benefits would be paid to people who were sick, unemployed, retired or widowed. Beveridge argued that this system would provide a minimum standard of living "below which no one should be allowed to fall".
It has to be remembered that before the war the British people had endured the Great Depression. This proposal played an important role in giving the people something to fight for.
In the 1945 General Election all three major parties promised to implement the Beveridge Report. However, the people did not trust Winston Churchill and the Conservative Party to deliver this pledge. They still remembered the broken promises made during the First World War (“a land fit for heroes”) and the way they were treated during the 1930s. The Labour Party won a landslide victory and its most left-wing leader, Aneurin Bevan, was given the job of implementing the Beveridge Report. In 1946 Parliament passed the revolutionary National Insurance Act. It instituted a comprehensive state health service, effective from 5th July 1948. The Act provided for compulsory contributions for unemployment, sickness, maternity and widows' benefits and old age pensions from employers and employees, with the government funding the balance.
http://www.spartacus.schoolnet.co.uk/TUbevan.htm
The government also announced plans for a National Health Service that would be, "free to all who want to use it." Some members of the medical profession opposed the government's plans. The British Medical Association (BMA) mounted a vigorous campaign against this proposed legislation. In one survey of doctors carried out in 1948, the BMA claimed that only 4,734 doctors out of the 45,148 polled, were in favour of a National Health Service. The reason for this is that they feared that their income would fall as a result of the NHS. The doctors were supported by the Conservative Party as they saw the NHS as “socialized medicine”.
This is what one Conservative paper, the Daily Sketch, said about the proposed NHS: “The State medical service is part of the Socialist plot to convert Great Britain into a National Socialist economy. The doctors' stand is the first effective revolt of the professional classes against Socialist tyranny. There is nothing that Bevan or any other Socialist can do about it in the shape of Hitlerian coercion.”
Doctors and dentists threatened to boycott the NHS. Aneurin Bevan was forced to make compromises in order to win the support of the high-income members of the medical profession (nurses and young doctors tended to support the idea of the NHS). This is what he said in a speech in the House of Commons on 9th February, 1948: “We have provided paid bed blocks to specialists, where they are able to charge private fees (Labour MPs shout "shame"). I agree at once that these are very serious things, and that, unless properly controlled, we can have a two-tier system in which it will be thought that members to the general public will be having worse treatment than those who are able to pay.”
As a result of these compromises that severely undermined the principles of the NHS, the National Health Service Act was passed in 1948. As a result people in Britain were provided with free diagnosis and treatment of illness, at home or in hospital, as well as dental and ophthalmic services. As Minister of Health, Aneurin Bevan was now in charge of 2,688 hospitals in England and Wales.
Although the NHS was extremely popular with the British people, the Labour government came under great pressure to water-down the system. In April 1951, Hugh Gaitskell, the Chancellor of the Exchequer, announced that he intended to introduce measures that would force people to pay half the cost of dentures and spectacles and a one shilling prescription charge. As a result of this measure Bevan resigned as Minister of Health. As he pointed out: “It is wrong (to impose national health charges) because it is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world.”
We now know that Gaitskell was one of those Labour leaders who was in the pay of the CIA. The money came via Tom Braden, head of the International Organizations Division (IOD) of the CIA. In this way, so-called left-wing politicians supported policies favoured by the ruling elite. See Braden’s confession in 1975:
http://www.spartacus.schoolnet.co.uk/JFKbraden.htm
The NHS has remained popular with the British people. Although Churchill and the Conservative Party were back in power in 1951, it was politically impossible to remove the NHS. Instead, they tried to undermine it with the constant under-funding of the system, tax changes to encourage people to buy into private health systems and the privatization of parts of the service. It was these actions that helped Tony Blair to be elected to office in 1997.
It is true that the Blair government has greatly increased spending on the NHS. However, they have also continued on the path of privatization and brought in reforms that favour high-paid doctors. They also have done nothing to deal with the absurd prices demanded by the multinational drug companies.
I have been blessed with good health and I have only experienced a short stay in a hospital once when I was eleven when I needed to have my tonsils out. However, my wife developed cancer seven years ago and so I now have first-hand experience of the workings of the NHS.
The main failing of the NHS seems to be that because of under-funding and the high costs of treatment, the service has to be rationed. The key to getting the best treatment concerns your ability to make your voice heard. For example, my wife was rushed into hospital on Tuesday morning. Although we had a letter from the doctor stating what the problem was (severe dehydration brought on by an infection that caused violent vomiting) it took three hours to receive the required treatment. This was much better than most people waiting in the “Accidents and Emergencies Department”. She only got treated as quickly as this because I spent the whole time advocating her case. The staff did what they could but they had too many people to deal with. It took 45 minutes before a doctor examined her. Although we had a letter from the doctor explaining what the problem was, the doctor insisted in carrying out her own tests. It therefore took over two hours before these test results confirmed that she was suffering from dehydration. However, it was now worse than that, her kidneys had stopped working.
The nurse asked to arrange for my wife to have an intravenous drip was incompetent. It was her first day in the hospital (a bank nurse) and did not know where anything was kept. She also gave me the impression that she had never done one before.
Judith was being treated in a cubicle. I could hear the young doctor pleading over the phone for a bed. It took another two hours before she was taken to a bed in the Emergency and Accidents Unit. Soon afterwards we were told by a senior doctor that she might not survive the night.
From that point on the quality of treatment has been excellent. However, I suspect that is because my daughter and I have played an active role in her medical care. This included meetings with doctors to discuss the nature of her treatment. This is vitally important as treatment is clearly rationed. For example, we were told that the only thing that could save her life was to be put onto a haemofiltration machine. During hemofiltration, a patient's blood is passed through a filtration circuit via a machine to a semipermeable membrane where waste products and water are removed. Replacement fluid is added and the blood is returned to the patient. In other words, it does what the kidneys usually do. The hospital only has one of these machines. It also needs a nurse to permanently monitor the equipment. We were told that people suffering from terminal cancer of retirement age are not usually put on this machine. We therefore had to convince them that Judith’s life was worth saving. The consultant eventually agreed that she should be put on the machine.
Judith’s treatment in the Intensive Care Unit has been superb. She spent three days on the machine and we are now anxiously waiting to see if her kidneys start working again.
My feelings about the NHS are mixed. It seems to receive the best treatment you need to negotiate your way through incompetence and an over-stretched service. Rationing is clearly taking place. The most important factor in this is not wealth or class but of education. Each patient seems to need an advocate who has researched the various different treatments available. Without one, the patient will receive second-class treatment. This to me is clearly the main weakness of the system.
However, the great strength of the system is that very expensive treatment is available to people who could not afford to pay the market price.
I am interested in hearing about other member’s experience of the health care system. Have you been satisfied with the treatment you or family members have received?
John, first I'm very sorry to hear of your wife's illness. I know you are not a religious man, but if you don't mind, you both will be in my prayers.
Medical care in the US is a mixed bag. Most employers of any size offer some form of health insurance. The government of course offers Medicare to certain people. Different states offer medical coverage to certain people and of course private insurance can be purchased. In addition there are free clinics in most cities as well. Lots of choices, and of course some choose none.
My wife and I run a business as such we purchase our own health insurance. It costs us about $600 per month.
I've had some need to use my health care insurance. About 20 years ago I had major surgery to remove my colon. The total cost was about $30,000. I was required to pay $200. The time from my initial visit at my GP to having the surgery was five days.
I'm diabetic, my copay for medication is $!5. Recently after changing meds, I began having heart paints and shortness of breath. MY GP sent me to a heart guy who ran a myoview stress test, a heart sonogram and finally angiogram. All showed no heart problems, and it was in fact the meds causing the problem. But the process was two days from start to finish, there were quite a few choices of who to see and what facility and equipment to use. The total cost was about $12,000. I have a $1000 deductible insurance policy (again by choice) with a total year out of pocket of $2000. Since I had already met those limits all of the 12K was paid by insurance.
I favor choice and personal responsibility. To pay for my insurance I need to make it a priority. If it means I don't get that new car or a bigger house, that’s just how it is. I also understand that some people are going to need help since the cost of insurance is out of their reach. I support programs that help the truly needy. My problem is with those who have the means but choose to spend their money elsewhere. I'm not happy supporting those who can but don't due to the lack of personal responsibility.
Don't get me wrong. I would rather spend that 600 bucks elsewhere, but I also know that in a country as large as the US, national healthcare has the potential to be very bad. Despite the claims of others that it would be free healthcare for everyone, we all know its not going to be free. It will simply be tax supported. Choice (which is very big for me) will likely be eliminated. Services will likely be rationed (even more so that what sometimes happens with insurance companies). And I think the overall quality of the services will decline because of the lack of competition.
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
One could easily fill a book trying to describe and detail the nuances of the American health care system. I am going to use some of the statements Craig Lamson made, NOT as a rebuttal but as an opportunity to elaborate on some other aspects of the problems facing individuals seeking health insurance. Health care laws and regulations can vary from state to state and in fact that is one of the problems. I live in Florida and will be discussing health insurance in that context.
Many small businesses (Say 2-30 employees) cannot afford to offer their employees health insurance as a benefit. And if they do, the employee in most cases must pay full rates for their spouse and dependents. And those rates are significantly higher than a comparable individual plan would cost because group insurance plans generally are not medically underwritten, although the insurance company can impose a two year waiting period on pre-existing conditions if the employee or his family had no immediate prior coverage with another insurance company.
People that work on a subcontracting basis are generally responsible for purchasing their own insurance. This can include realtors, insurance agents, construction workers, plumbers, electricians, consultants, installers, etc. There is a current case in the news about how Federal Express required their delivery drivers to be subcontractors so they would not have to offer them certain benefits, including health insurance.
Large companies that once offered their vested retiring employees an extension of health insurance coverage no longer do so, meaning those employees must find insurance in the open market which can be problematical if they are under the age of 65.
Many insurance plans are not portable. If Craig were to move to Florida and his plan could not follow him (which is often the case) he would face large obstacles in purchasing health insurance here. Based on his health history, private insurers could and would refuse to cover him with a standard individual policy. Individuals are routinely rejected with any history of heart problems, any form of cancer, diabetes, and a host of other diseases. Insurance companies are particularly reluctant to insure people once they are older than 55.
A perfectly healthy 60 year old man would pay a monthly premium of $437 for a plan similar to Craig's. ($2000 deductible). This is with Blue Cross Blue Shield of Florida, a not for profit organization with the best coverage for the money in this state. A 60 year old smoker would pay $546 for the same coverage. If he was taking blood pressure medication, the rates would increase 25%. If he was taking cholesterol medication, the rates would increase another 25%. In all likelihood, the insurance company would refuse coverage. Women's rates are comparable. (These rates vary by county of residence and are significantly higher on the east coast, i.e. Miami and Fort Lauderdale.)
A person that is uninsurable for health reasons can purchase guaranteed issue coverage during August (called the open enrollment period), but they must be self-employed. The monthly premium for one person is generally around $1000, or higher. If someone was in the same circumstances as Craig, this is what he or she would have to do.
I agree with Craig statements above. Defining the truly needy may be an issue. I know many families where both parents work and they make plenty of sacrifices. Many young parents will insure their children, but not themselves. Florida does offer health coverage to children whose parents fall below certain income standards.
Of course health care cannot be free for everyone. I don't know anyone that thinks that. By and large, people on Medicare have not had their choices limited or services limited. That practice is much more prevalent with private insurance plans. Until a few years ago, seniors on Medicare had to pay for their own prescriptions. In many cases, their monthly prescription bill was higher than Craig's premium on his health plan. In 2006, Medicare-sponsored prescription plans were offered through private insurance companies. Seniors pay a monthly premium and a copay for their needed drugs. And the plans have a cap (called the donut hole), where the individual will again be responsible for the full cost of their prescriptions.
In addition, many states now offer what's known as advantage plans for those on Medicare. Instead of Medicare being billed by the doctors and hospitals, the claims are fully administered and paid for by the private insurers that offer plans based on federal guidelines. The insurance company receives copays from the insured, plus monies from Medicare to assume these responsibilities.
They do. ABC News reported this week that there was 60 billion dollars in Medicare fraud last year alone. This needs to be addressed.
Private insurance companies are not blameless. The insurance industry is heavily regulated by lawmakers, yet they have been found guilty of many practices that do not serve their policy holders or the health care system. A case in point is the story of William McGuire, former CEO of United Health Group, one of the country's largest health insurance companies. McGuire was forced to repay 618 million dollars to his former employer as a settlement for back-dated stock options that he received. In additon, McGuire was force to pay a fine of 7 million and was barred from serving as a director for a public company for ten years. He was allowed to keep stock options totalling ofver 800 million dollars.
In addition, United Health Group announced a 55 million dollar settlement with the Internal Revenue Service. Here is an excerpt from a 2006 Wall Street Journal article:
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
Medical care in the US is a mixed bag. Most employers of any size offer some form of health insurance.
Many small businesses (Say 2-30 employees) cannot afford to offer their employees health insurance as a benefit. And if they do, the employee in most cases must pay full rates for their spouse and dependents. And those rates are significantly higher than a comparable individual plan would cost because group insurance plans generally are not medically underwritten, although the insurance company can impose a two year waiting period on pre-existing conditions if the employee or his family had no immediate prior coverage with another insurance company.
People that work on a subcontracting basis are generally responsible for purchasing their own insurance. This can include realtors, insurance agents, construction workers, plumbers, electricians, consultants, installers, etc. There is a current case in the news about how Federal Express required their delivery drivers to be subcontractors so they would not have to offer them certain benefits, including health insurance.
Large companies that once offered their vested retiring employees an extension of health insurance coverage no longer do so, meaning those employees must find insurance in the open market which can be problematical if they are under the age of 65.
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
My wife and I run a business as such we purchase our own health insurance. It costs us about $600 per month.
Many insurance plans are not portable. If Craig were to move to Florida and his plan could not follow him (which is often the case) he would face large obstacles in purchasing health insurance here. Based on his health history, private insurers could and would refuse to cover him with a standard individual policy. Individuals are routinely rejected with any history of heart problems, any form of cancer, diabetes, and a host of other diseases. Insurance companies are particularly reluctant to insure people once they are older than 55.
A perfectly healthy 60 year old man would pay a monthly premium of $437 for a plan similar to Craig's. ($2000 deductible). This is with Blue Cross Blue Shield of Florida, a not for profit organization with the best coverage for the money in this state. A 60 year old smoker would pay $546 for the same coverage. If he was taking blood pressure medication, the rates would increase 25%. If he was taking cholesterol medication, the rates would increase another 25%. In all likelihood, the insurance company would refuse coverage. Women's rates are comparable. (These rates vary by county of residence and are significantly higher on the east coast, i.e. Miami and Fort Lauderdale.)
A person that is uninsurable for health reasons can purchase guaranteed issue coverage during August (called the open enrollment period), but they must be self-employed. The monthly premium for one person is generally around $1000, or higher. If someone was in the same circumstances as Craig, this is what he or she would have to do.
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
I favor choice and personal responsibility. To pay for my insurance I need to make it a priority. If it means I don't get that new car or a bigger house, that’s just how it is. I also understand that some people are going to need help since the cost of insurance is out of their reach. I support programs that help the truly needy. My problem is with those who have the means but choose to spend their money elsewhere. I'm not happy supporting those who can but don't due to the lack of personal responsibility.
I agree with Craig statements above. Defining the truly needy may be an issue. I know many families where both parents work and they make plenty of sacrifices. Many young parents will insure their children, but not themselves. Florida does offer health coverage to children whose parents fall below certain income standards.
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
Don't get me wrong. I would rather spend that 600 bucks elsewhere, but I also know that in a country as large as the US, national healthcare has the potential to be very bad. Despite the claims of others that it would be free healthcare for everyone, we all know its not going to be free. It will simply be tax supported. Choice (which is very big for me) will likely be eliminated. Services will likely be rationed (even more so that what sometimes happens with insurance companies). And I think the overall quality of the services will decline because of the lack of competition.
Of course health care cannot be free for everyone. I don't know anyone that thinks that. By and large, people on Medicare have not had their choices limited or services limited. That practice is much more prevalent with private insurance plans. Until a few years ago, seniors on Medicare had to pay for their own prescriptions. In many cases, their monthly prescription bill was higher than Craig's premium on his health plan. In 2006, Medicare-sponsored prescription plans were offered through private insurance companies. Seniors pay a monthly premium and a copay for their needed drugs. And the plans have a cap (called the donut hole), where the individual will again be responsible for the full cost of their prescriptions.
In addition, many states now offer what's known as advantage plans for those on Medicare. Instead of Medicare being billed by the doctors and hospitals, the claims are fully administered and paid for by the private insurers that offer plans based on federal guidelines. The insurance company receives copays from the insured, plus monies from Medicare to assume these responsibilities.
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
They do. ABC News reported this week that there was 60 billion dollars in Medicare fraud last year alone. This needs to be addressed.
Private insurance companies are not blameless. The insurance industry is heavily regulated by lawmakers, yet they have been found guilty of many practices that do not serve their policy holders or the health care system. A case in point is the story of William McGuire, former CEO of United Health Group, one of the country's largest health insurance companies. McGuire was forced to repay 618 million dollars to his former employer as a settlement for back-dated stock options that he received. In additon, McGuire was force to pay a fine of 7 million and was barred from serving as a director for a public company for ten years. He was allowed to keep stock options totalling ofver 800 million dollars.
In addition, United Health Group announced a 55 million dollar settlement with the Internal Revenue Service. Here is an excerpt from a 2006 Wall Street Journal article:
Today, the 58-year-old Dr. McGuire is chief executive officer of UnitedHealth Group Inc., one of the nation's largest health-care companies. He draws $8 million a year in salary plus bonus, enjoying perks such as personal use of the company jet. He also has amassed one of the largest stock-options fortunes of all time.
Unrealized gains on Dr. McGuire's options totaled $1.6 billion, according to UnitedHealth's proxy statement released this month. Even celebrated CEOs such as General Electric Co.'s Jack Welch or International Business Machines Corp.'s Louis Gerstner never were granted so much during their time at the top.
Dr. McGuire's story shows how an elite group of companies is getting rich from the nation's fraying health-care system. Many of them aren't discovering drugs or treating patients. They're middlemen who process the paperwork, fill the pill bottles and otherwise connect the pieces of a $2 trillion industry.
The middlemen credit themselves with keeping the health system humming and restraining costs. They're bringing in robust profits -- and their executives are among the country's most richly paid -- as doctors, patients, hospitals and even drug makers are feeling a financial squeeze. Some 46 million Americans lack health insurance.
UnitedHealth's main business is offering health plans to employers and Medicare beneficiaries. Bigger employers usually pay employees' medical bills out of their own coffers and hire UnitedHealth to administer the health benefit. Smaller employers pay an annual insurance premium to UnitedHealth in exchange for having the insurer take on the risk of covering employees' health care.
Healthcare is never something I worry about. As many on here know, I am in the USAF and it is paid in full for me and my spouse and children. We never pay a cent. For prescriptions, if we go on base and wait it is free(the wait is often long unless you are active duty and on duty at the time). Otherwise we can go to any pharmacy and pay only $3. Dental and vision are different. Mine is completely paid for while theirs has limits and a small fee each month for that coverage.
QUOTE(Matthew Lewis @ Dec 23 2007, 12:09 PM)
Healthcare is never something I worry about. As many on here know, I am in the USAF and it is paid in full for me and my spouse and children. We never pay a cent....
That is why Craig is right when he says:
QUOTE(Craig Lamson @ Dec 23 2007, 08:38 AM)
Medical care in the US is a mixed bag....
Like Matt, all my medical / dental is via the ADF. Difference for us is that partners / dependents are not entitled to treatment at Government expense... but since I have neither, it worries me not.
Three experiences that sum up my attitudes towards the U.S. health care system,
1. I had a girlfriend in my 20's who hurt her back while lifting an object at work. The doctor recommended by the company at first prescribed rest. When her pain persisted, he told the company she was faking, and to stop paying her disability. She then went to another doctor who suggested a chiropractor. She visited the chiropractor for months, and did not improve. Finally, she went to a doctor who theorized that lifting the heavy object had displaced some ribs and that one of the ribs was now pinching a nerve. He proposed that they remove a few inches of the rib. The company refused to pay for the operation. Eventually, the operation was performed and it worked. If I recall, she successfully sued and got the company to pay for it. The lesson I took from this was that doctors are professional guessers, and that the "science" behind their opinions was greatly exaggerated. I also saw how tempting it was for companies disinclined to pay injured employees to "trust" the one doctor who would tell them the patient was faking. This led me to believe universal health care would be an improvement. If not for her parents' money, which paid for the one doctor to actually help her, Gina would probably still be crippled by back pain, and unable to function in society.
2. My grandmother had a weak heart her whole life. Finally, in her sixties, a doctor took a look at her and decided she was a good risk for a quintuple by-pass. The operation was successful. She had a renewed energy. After about ten years, however, her other organs started failing, and she was on her death bed. She put herself on a do not code list--which meant that, if her heart should stop--the doctors were not to revive her. Her heart stopped. The doctors revived her. My mother, who'd flown out to spend these last days with my grandmother, asked the doctors why. Well, a doctor said, after overseeing her heart by-pass only ten years earlier, he wasn't about to let her cause of death be listed as heart failure. My mom was totally disgusted. She was a retired nurse, but was still working as a volunteer. After that, she stopped volunteering at her local hospital. The arrogance of this doctor had forced my grandmother--who'd said her good-byes and was at peace--to spend her last few months in a drug-induced stupor, barely able to recognize family members or make coherent sentences. This also cost the government a small fortune, no doubt.
3. Finally, an HMO horror story. When my former employer went belly-up in 2001, the employees were allowed to continue their health insurance via the Cobra plan, through which we could retain our insurance for 18 months after termination. Many of us took comfort in this and continued making our payments. In February of 2002, however, I received notice that, as of December 1, 2001, I had lost my coverage. The HMO, Pacificare if I recall, said that Cobra was only good for six months after a company was officially bankrupt, and that this had come to pass in December. I wrote them and demanded a refund for my December and January payments. No response. I called them and finally got through to someone who said they would look into it and return my payments. No response. I called up one of my former co-workers, who explained that she had been to the doctor a number of times in December and January, as she had tried to get some long-time ailments taken care of while she still had coverage. She said the HMO was now refusing to pay her doctors, and her doctors were preparing to sue her. From this, it became clear to me that someone at the HMO was monitoring the activities of my co-workers and myself. As long as we were making our payments and not actually using our insurance, they were providing us coverage. Once Diana (and possibly others) began running up the bills, however, they cut us off, RETROACTIVELY. After another phone call, and a veiled threat, I was finally reimbursed for the two months of payments wrongly accepted by the HMO (without the nine months of interest they'd collected on my money, of course). I never talked to my co-worker again so I don't know how her saga played out.
So, needless to say, I hate HMOs, and am 100% behind the U.S. getting some form of universal health care... I mean, we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED.
1. I had a girlfriend in my 20's who hurt her back while lifting an object at work. The doctor recommended by the company at first prescribed rest. When her pain persisted, he told the company she was faking, and to stop paying her disability. She then went to another doctor who suggested a chiropractor. She visited the chiropractor for months, and did not improve. Finally, she went to a doctor who theorized that lifting the heavy object had displaced some ribs and that one of the ribs was now pinching a nerve. He proposed that they remove a few inches of the rib. The company refused to pay for the operation. Eventually, the operation was performed and it worked. If I recall, she successfully sued and got the company to pay for it. The lesson I took from this was that doctors are professional guessers, and that the "science" behind their opinions was greatly exaggerated. I also saw how tempting it was for companies disinclined to pay injured employees to "trust" the one doctor who would tell them the patient was faking. This led me to believe universal health care would be an improvement. If not for her parents' money, which paid for the one doctor to actually help her, Gina would probably still be crippled by back pain, and unable to function in society.
2. My grandmother had a weak heart her whole life. Finally, in her sixties, a doctor took a look at her and decided she was a good risk for a quintuple by-pass. The operation was successful. She had a renewed energy. After about ten years, however, her other organs started failing, and she was on her death bed. She put herself on a do not code list--which meant that, if her heart should stop--the doctors were not to revive her. Her heart stopped. The doctors revived her. My mother, who'd flown out to spend these last days with my grandmother, asked the doctors why. Well, a doctor said, after overseeing her heart by-pass only ten years earlier, he wasn't about to let her cause of death be listed as heart failure. My mom was totally disgusted. She was a retired nurse, but was still working as a volunteer. After that, she stopped volunteering at her local hospital. The arrogance of this doctor had forced my grandmother--who'd said her good-byes and was at peace--to spend her last few months in a drug-induced stupor, barely able to recognize family members or make coherent sentences. This also cost the government a small fortune, no doubt.
3. Finally, an HMO horror story. When my former employer went belly-up in 2001, the employees were allowed to continue their health insurance via the Cobra plan, through which we could retain our insurance for 18 months after termination. Many of us took comfort in this and continued making our payments. In February of 2002, however, I received notice that, as of December 1, 2001, I had lost my coverage. The HMO, Pacificare if I recall, said that Cobra was only good for six months after a company was officially bankrupt, and that this had come to pass in December. I wrote them and demanded a refund for my December and January payments. No response. I called them and finally got through to someone who said they would look into it and return my payments. No response. I called up one of my former co-workers, who explained that she had been to the doctor a number of times in December and January, as she had tried to get some long-time ailments taken care of while she still had coverage. She said the HMO was now refusing to pay her doctors, and her doctors were preparing to sue her. From this, it became clear to me that someone at the HMO was monitoring the activities of my co-workers and myself. As long as we were making our payments and not actually using our insurance, they were providing us coverage. Once Diana (and possibly others) began running up the bills, however, they cut us off, RETROACTIVELY. After another phone call, and a veiled threat, I was finally reimbursed for the two months of payments wrongly accepted by the HMO (without the nine months of interest they'd collected on my money, of course). I never talked to my co-worker again so I don't know how her saga played out.
So, needless to say, I hate HMOs, and am 100% behind the U.S. getting some form of universal health care... I mean, we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED.
QUOTE(Craig Lamson @ Dec 23 2007, 01:38 PM)
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
Government systems are never perfect. However, as Pat Speer points out, somethings are too important to be left to the market: "we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED."
The problem with the market is that it is motivated by the profit motive. For example, fifteen years ago I hurt my back. I went to see the doctor who booked me in to see a consultant. The only trouble was that I had to wait a couple of weeks to see the back specialist. A friend suggested I went to see a chiropractor. There was no waiting list for him and I was invited over to his surgery straight away. Within a few minutes he had diagnosed my problem and spent twenty minutes manipulating my spine. It did not bring immediate relief. He argued that to solve my problem I would have to pay for a long course of expensive treatment. Although I could afford this treatment, I found it difficult to trust the man. After all, it was in his financial interest to promote this treatment.
I therefore decided to wait until I saw the back specialist in my local hospital. He also identified the problem. However, instead of prescribing a long course of treatment, he showed me some exercises I needed to do everyday to correct the problem. His diagnoses was correct and I still do those exercises every day. This example shows the problem with the private medical system. It is in the financial self-interest of the doctor to “over” treat the problem. The market cannot be trusted with medical care. It might be the best method for producing popcorn but health care is too important to be left to the capitalist system.
In the US, the Military and Government Employees are usually covered for their health-care; private citizens used to be much better than they are today. HMOs were a conspiracy brought to Nixon by a group*[see bottom]
who were to beneifit from them, and he ran with that ball. Only in the last 10-15 years have people started to realize the horrible problems and restrictions most HMOs bring when the illness gets catastrophic [read expensive]. I'd suggest to all, if you haven't seen it yet, to see the film 'Sicko'. And that is about those who have insurance! 40.000.000 in America can't afford it [I really doubt many are buying toys to save on the premiums!]....and are at the mercy of the 'gods' and public hospitals - which in most places offer second-class care, at best. Many who paid into healthcare programs all their lives, suddenly lost it - and all the 'accumulated' years of payments, when their employer folded, they got fired, laid-off, move, or they were accused of having had an not-previously disclosed 'pre-existing condition' [the catch-all way out for insurers to not pay anything - even on an unrelated illness due to a trivial supposed pre-existing condition]. Health [life!] is a right, not something that should be at the whim of those who only want to make a profit. There is an intersting testimony by a doctor who's job it was to find a way to NOT PAY OUT on claims. She worked for an HMO company. Her salary was based on how many patients and how many millions she found a way to deny. That is how vicious capitalism and greed has become in the USA today. They have taken the 'We' out of 'We the People'. Banks get bailouts; MIC companies get bailouts; 'we' the people are on our own.......
America is a sinking ship due to morality gone awry, only. Long ago America was secretly taken-over by the Ultra-Rich, who control the country as their own fiefdom....even now as they abandon it nearly sucked-dry in their 'globalization' quest to destroy the entire planet. One word - Greed. America's elite has found much greater profit in Thanatos, than in life and love - care and compasion. They have none. America and the World will pay a very high price for this. Note in her Congressional testimony, below, how Peeno compares the morality to that of Germany in the 1930s. I agree. This time the 'fascism' is within - as a 'cancer' - not an external enemy. Our tax money now is used to invade non-threatening nations to further enrich the already filthy-rich and their corporations; while America literally bleeds due to no universal healthcare; decaying infrastructure, and the march toward a Policestate - where only the rich and the compliant have any 'rights'. The lack of universal healthcare in America is directly related to this la
k of compassion nor any sense to share our 'wealth'!
What makes America 'great'...sadly, only the greed of those at the top.....which is
'great', indeed.
JUAN GONZALEZ: Our next guest is also featured in Michael Moore’s new documentary SiCKO. A decade ago, Dr. Linda Peeno made headlines when she appeared before Congress to talk about her work as a medical reviewer for the giant HMO Humana. Michael Moore replays part of that testimony in his new film.
DR. LINDA PEENO: I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars for this.
AMY GOODMAN: Dr. Linda Peeno, testifying eleven years ago. Following her appearance in Congress, she would go on to become one of the country’s best-known whistleblowers about HMOs and the healthcare industry. Dr. Linda Peeno joins us now also from Washington, D.C., where she also attended the premiere last night of Michael Moore’s film SiCKO, along with many legislators. Dr. Peeno, tell us your story. How did you work for Humana? What was your job? How did it change? What did you do?
DR. LINDA PEENO: Well, I started when I graduated from medical school. I took some time off out of my residency to take care of my children, and I had started working at a hospital doing something called utilization review. And one thing led to another, and I was able to get this part-time job working for Humana. And I was told it was an insurance company and that I would be doing something similar, and I would be reviewing patient charts and requests and helping make good medical decisions about them.
When I actually went to interview, I was asked if I could be tough, because I was going to be telling doctors that they couldn’t do things and that I would be expected to keep a 10% denial rate. So I didn’t really even really understand what that meant.
And then I started working, and requests started coming in. And basically what I did in that particular job was reviewed hospital requests for admission. And basically our job was to keep people out of the hospital, because, the late 1980s, that’s where the focus was. That’s where most of the dollars were being spent.
I lasted at Humana only about nine months, because I suddenly realized that my medical expertise was being used to justify economic decisions, and I also had that ethical epiphany that was the source of the testimony and was dramatized in the movie that they did about my work, where I had denied the man the heart transplant and then just within a day or so saw a sculpture being installed in the rotunda and was told at that time that it had cost about the same as the heart transplant that we had denied. And that’s when I realized that, wait a minute, the savings that we’re extracting from these denials, many of which were not legitimate and I felt that they were not legitimate, was not going to help patients. By the way, I later found out that that sculpture cost $3.8 million, so it was equivalent to eight heart transplants.
But I left Humana, and I went to a nonprofit HMO that was owned by hospitals, thinking that things would be different, that it would be more patient-centered. And it’s interesting, in the movie SiCKO, there’s actually an account of a young man who was denied, and it was through the employer, which was a hospital. And so, that was the beginning of my education about just the way in which managed care worked, that you made money to the extent that you denied, limited, substituted or obstructed care. And it wasn’t patient-centered.
So it didn’t make any difference whether you were in a for-profit setting or a nonprofit setting. And I just began to find that that was unconscionable as a physician to be doing that and to be, you know, sitting distantly at a desk, never making eye contact with a patient, never really experiencing the impact of the consequences of the decisions. So I eventually left in the early ’90s and decided to focus on trying to educate the public and protect patients.
AMY GOODMAN: Your salary skyrocketed as you spent those months at Humana. Could you explain what happened, what your salary was proportional to or, you know, how it was affected by the number of “no” decisions that you gave out?
DR. LINDA PEENO: Well, it didn’t actually skyrocket while I was at Humana, because I quit before it did, but I started out as—you know, medical reviewers were often paid, as I was at Humana, on an hourly basis. And I think I started at like $50 an hour. And there were a team of physicians, and we worked shifts, and depending on how many hours a week you worked, you got paid.
But as a result of that experience, when I went to the nonprofit HMO, they were thrilled that I had been trained by Humana, which was seen as kind of the pinnacle of the industry at that time. So then I moved into an executive position as a medical director and began actually, you know, making increasingly higher six-figure salaries. So it was—my increase in income was directly related to—you know, back to that original interview question: how tough I could be and how much money I could save.
Now, I did quit Humana just before they had implemented a system, and we were told that the medical reviewer that had the highest denial rate was going to receive a bonus at Christmas. I quit, I think, in November, before that happened. And in subsequent knowledge that I have about how the program developed afterwards, medical directors there did get bonuses that were related to their performance. I just left before I received one.
JUAN GONZALEZ: Well, and you subsequently, obviously, became a whistleblower and chief critic of the HMO industry. But I’m especially interested by your comments about there not being very much difference between the for-profit insurance companies and the nonprofit medical care companies. What then, in your viewpoint, is the fundamental or structural contradiction then? If it’s not just a drive for profit to give to shareholders, that a for-profit company would have, what then involves having the nonprofits also participate in the same kind of abusive system?
DR. LINDA PEENO: Well, I think it becomes—the whole managed care practices and strategies become a way in which to either save or make money, whichever term you use. So in a nonprofit setting, I mean, you think about Medicaid HMOs, for example, who are trying to manage a state budget. The way in which they save money is to spend it, you know, prudently and make good decisions. The problem is, is that these strategies can take on a life of their own, and so it is so easy to slip from making legitimate medical decisions that have legitimate savings to decisions in which you’re making—you’re attempting to produce more money, you know, for whatever purposes.
So in the nonprofit setting in which we were, you know, there were lots of other expenditures—I mean, physicians were being paid to be on the board; salaries, you know, for the executive employees. So you didn’t necessarily have stock that you were working toward, but there were other things. And we know that from things that—from analyses that have been done by some of the nonprofit health plans, perks that were given to executives and ways in which the resources are spent for non-medical reasons.
So the fundamental structural problem is that you—you know, the whole managed care process acts like a huge funnel. You pour the money in at the top, and you want as little money to go out at the bottom, and so you create these filters. And depending on how fair, unfair, legitimate or illegitimate those filters are, I think, is what directly impacts patients’ lives.
JUAN GONZALEZ: And we’ve been having many reports in recent months about physicians who are actually getting kickbacks, in essence, from pharmaceutical companies for prescribing certain kinds of—or certain drugs of those drug companies. Is there a sense, on your part, not only that there are structural problems, but that the entire healthcare system in America has become increasingly corrupted?
DR. LINDA PEENO: Well, I’m really glad you asked that question, because I think that, you know, this isn’t about one company, and it’s not about just the insurance industry. I think it’s about the entire corporatization of healthcare, the fact that money is driving everything. And whether it’s kickbacks to physicians for prescribing certain drugs or even decisions about how physicians organize their offices and what contracts they enter into—you know, it was interesting coming here. I sat in front, on the plane, of a physician and, from what I gathered, you know, voyeuristically listening to this conversation, some sort of executive PR person. And they were talking about how to set up this clinic in which they were going to be doing specialized surgery. And if you didn’t listen carefully, you would never have guessed that they were talking about patient care. I mean, the whole thing was centered around investment and return on investment and marketing and, you know, how many units they could produce a day. And it was as far removed from the care of patients as you could possibly get. And that shouldn’t exist in medicine.
AMY GOODMAN: We’re talking to Dr. Linda Peeno, former medical reviewer for the HMO company Humana, went on to work for a so-called nonprofit HMO, now is a physician in Louisville, Kentucky—in Washington, D.C. for the premiere of Michael Moore’s film SiCKO. This is a movie that’s supposed to launch a movement all over this country. California Nurses Association involved, MoveOn involved. Oprah is going to be doing a town hall after getting people’s stories through the summer. YouTube is asking people to post their healthcare horror stories. It goes to the issue of what can be. In Michael’s film, he shows us Britain, Canada, France, Cuba. And ultimately, he’s talking about single payer, the idea of the government being the provider of healthcare, as in these other countries, and not having the middle man, the insurance company. Dr. Linda Peeno, you’ve worked for these insurance companies, do you agree with that assessment?
DR. LINDA PEENO: Absolutely. I mean, I can see—you know, and I’ve been at this twenty years—I can see absolutely nothing that insurance companies are providing that is a benefit at this point. I mean, it’s an ingenious system that’s been devised between the money that is being spent and the care that’s being delivered that’s nothing but obstructive and even cruel, ultimately, in the way it plays out in patient lives. So however we organize it, or ultimately when we radically reform the healthcare system, I think we need to rethink seriously the whole concept of insurance in the delivery of healthcare.
AMY GOODMAN: You’re in the doctor community. Michael talks to a doctor in Britain who says, yes, you know, he has, I think it was an Audi car. He has a million-dollar home. And he says, sure, he doesn’t have two or three of those homes, but he’s quite happy, doing very well, even as he’s in the National Health Service in Britain. What about the attitudes of doctors? They are your peers.
DR. LINDA PEENO: Well, I have to admit that I don’t know directly, because, you know, most of the physicians with whom I have some association, an ongoing association, are struggling physicians who are barely holding their practices together, because they’re pediatricians and family physicians who genuinely want to practice good medicine. And I think they would be satisfied with being able to pay their mortgage and, you know, take care of their children and get their med school loans paid off.
I think the British doctor they interviewed was right. You know, there are certainly physicians currently in our system who are doing financially extremely well, and I’m not sure that they would support any kind of change. But I thought it was interesting yesterday, one of the medical students who spoke at John Conyers’s hearings said, you know, these physicians that are focused on the economics, their own personal economics, only have a few years, because there is a rising groundswell, I think, in medical students who have a different opinion about how to practice medicine and how to care for patients and what their measure of success is going to be. And I don’t think it’s going to be big houses and nice cars.
JUAN GONZALEZ: Let me ask you about the whole issue of single payer. Obviously, there are critics, conservative critics, as well as many people who are more politically moderate, who shudder at the idea of a centralized government bureaucracy that would handle health insurance. There are certainly all kinds of horror stories about Medicaid abuse and Medicaid mills and the exploitation of the Medicaid system. What’s your response to those critics?
DR. LINDA PEENO: Well, first of all, I think I’d tell them to see Michael’s film, because I think he does a wonderful job of sort of demythologizing some of the criticisms and the accusations that are made about other countries. And the single payer, I mean, you know, it’s become the S-word that’s equivalent with socialized medicine, and that’s supposed to send chills through everyone. And, you know, as he aptly points out, I mean, we socialize a lot of things in this country: our police departments, our fire departments, education. And the point that I would make, you know, based upon my experience and having seen inside the way in which insurance companies work—
AMY GOODMAN: We have ten seconds.
DR. LINDA PEENO:—is that at least with the government we have transparency and we can change the practices. Right now, we have no control over the corporations.
AMY GOODMAN: Dr. Linda Peeno, we want to thank you very much, known around the country as a leading HMO whistleblower, now a physician in Louisville, Kentucky, speaking to us from Washington, D.C., where SiCKO just premiered last night.
http://www.democracynow.org/2007/6/21/hmo_..._linda_peeno_on
Dr. Peeno's Full Testimony: http://www.thenationalcoalition.org/DrPeenotestimony.html
My name is Linda Peeno, and although the witness list does not reflect this, I am a physician. I am a former medical director and medical reviewer. I did the job that was referred to repeatedly in the first panel as a physician manager for three health care organizations. I currently, though, primarily work in medical and health care ethics.
I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death.
No person and no group has held me accountable for this because, in fact, what I did was I saved the company a half a million dollars for this.
And furthermore, this particular act secured my reputation as a good medical director, and it ensured my advancement in the health care industry;in little more than a year, I went from making a few hundred dollars per week to an annual six-figure income.
In all my work, I had one primary duty and that was to use my medical expertise for the financial benefit of the organization for which I worked and according to the managed care industry... [In the managed care industry] it is not an ethical issue to sacrifice a human being for a savings, no matter how that savings occurs. And I was repeatedly told that I was not denying care. I was simply denying payment.
I am not an ethicist whose primary background has come from the books. For me, the ethical issues were born in the trenches and pit of the pain that I have come to realize that I cause. And if I am an expert here today, it is because I know how managed care maims and kills patients.
So I am here to tell you about the dirty work of managed care and this is the kind of straight talk that I wish Ms. Ignagni [President and CEO of the American Association of Health Plans] could hear now.
Now, let me explain to you the ways that I was a good medical director. I was regularly consulted by marketing on ways to change expensive benefits or change the language to give me loopholes to make denials when requests came.
For example in one plan, we were able to structure our investigational language exclusion so that I was often able to use it to deny almost anything that was expensive, and particularly out-of-network requests.
I turned preexisting exclusions into a game as I tried to connect almost any prior medical complaint or visit as a reason to deny payment.
There are many more thing that I could tell you about, but, ultimately I was only as good&emdash;and I put that in quotation marks&emdash;as the doctors in my network, for it was their numbers that I needed to prove that I was doing my job.
That meant that I did whatever it took to control them: intimidation, hassling, humiliation, I have done it all. I have used inadequate and inaccurate data to create reports to get doctors to make their numbers better, in other words, decrease their usage.
I have used "economic credentialling" to select the best inexpensive physicians and rarely correlated these with quality factors.
I have helped design contract provisions to ensure our payment and monitoring schemes got the results we wanted at the plan, and I have threatened deselection to numerous physicians who were especially difficult or costly.
However, there is one last activity that I think deserves a special place in this list. This is what I call the "smart bomb" of cost containment and that is medical necessity denials.
Let me take you to the heart of managed care.
Even if a plan denies using all the other things that I could list, it is impossible for them to deny their use of this practice because it is vital to managed care; that is making medical decisions about access, availability, and use.
And even when medical criteria is used, it is rarely developed in nay kind of standard traditional clinical processes. It is rarely standardized across the field. The criteria is rarely available for prior review by physicians or the members of the plan. So, even if a a plan has a clear benefit package and has all the perks, like free eye exams or free screening tests for cancer, other marketing ploys, the member's physician will never be the final authority on what his or her patient will get.
This might go unnoticed for simple needs, like a regular office visit or a bout of the flu, but I can tell you that when something unexpected or expensive happens, it is like a bucolic pasture turned battlefield. The land mines will start exploding everywhere.
And somewhere in every coverage booklet for every managed care plan is a claim that establishes the plan as the final authority for medical necessity. What that means is that there is some physician at some plan doing what I did.
That person rarely is continuing a clinical practice. They are sitting behind a desk making decisions about a patient they will never see or touch, completely removed from the consequence of their decisions. They are getting paid by someone to make decisions for the benefit of the plan and not for the benefit of the members.
I would like to conclude by saying, what kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients? I became a physician to care for, not bring harm to my patients, and I am haunted by the thousands of pieces of paper on which I have written that deadly word, "denial." Thank you.
In her prepared written testimony which was long and detailed, Dr. Peeno concluded with the following statement:
I contend that managed care, as it has become, can exist only through serious ethical transgressions against individuals and society. Furthermore, I contend that a health plan's resistance to ethical correctives is proportionate to its reliance on ethical transgressions for its "success." Disclosure and exposure would present serious disadvantages in competition for cost-cutting and profit making. In summary, it is a fair assessment to claim that managed care's "success" depends upon the following:
Use of non-medical agendas to drive medical policies and practice;
Collapsing of the rights of individuals for purported greater collectivist goals;
Supersession of the care of the individual by the care of the collective;
Creation of ill relations between professional ambitions and the absence of moral inhibitions;
Reliance upon righteous ideologies about reform and societal benefits coupled with cost-cutting policies;
Disparagement of the "weaker" (i.e. costly) groups within society;
Linkage of economic imperatives and professional self-interest;
Direction of medical professionals by parameters set by health care and financial administrators;
Establishment of quotas and internal processes for control with little regard for the physical and psychological cost of their effects;
Selection of professionals who are ideological converts and "good" practitioners of its goals;
Enticement of physicians as agents of an organization, such that organizational goals are supplied with medical validation;
Facilitation of unethical professional practice by financial rewards and bonuses, as well as job security and advancement;
Generation of moral void by use of propaganda;
Degradation of moral expressions of compassion and sympathy for persons who have been designated costly or needy;
Induction of guilt into those who are made to feel a drain on resources or a threat to the collectivist goals.
The list could go on, however, there is enough here to suggest drastic needs for change. Of course, each of these would be vehemently contested by the managed care industry. If they are inaccurate, then it seems that the industry should have no reservations about supporting transparent and publicly accountable activities.
We know, though, they do object to this. Why? Because control of patients and doctors depends upon unethical practices. To this, at least, we should object. Manipulation and exploitation for any reason, even beneficence, is unethical and destructive of social good.
We have enough experiences from history to demonstrate the consequences of secretive, unregulated systems which go awry. The list above is not new. In fact, it comes from a book detailing the characteristics of a dire period of recent history.3
The last time this combination of forces worked in concert, over 200,000 individuals lost their lives in Nazi Germany (even before the Final Solution). Most of these persons were German citizens sacrificed for medical reasons set by economic and social agendas. I find the parallels chilling. One can only wonder: how much pain, suffering and death will we have before we have the courage to change our course?
Personally, I have decided even one death is too much for me.
* Dr. Peeno delivered an oral statement along with written testimony for a Congressional hearing on "Contract Issues and Quality Standards for Managed Care." Her testimony was heard on May 30, 1996 by the Subcommittee on Health and Environment of the House of Representative's Committee on Commerce. Her entire testimony can be found at the National Coalition of Mental Health Professionals and Consumers." (http://www.nomanagedcare.org/DrPeenotestimony.html).
*QUOTE
SiCKO: Richard Nixon and John Ehrlichman are heard discussing the concept of a health maintenance organization in Oval Office Recordings.
* On February 17, 1971, Richard Nixon met with John Ehrlichman to discuss the Vice President's position on health maintenance organizations, as heard in the film. The Miller Center of Public Affairs has this audio recording (conversation number 450-23. "Richard Nixon - Oval Office Recordings,"
http://millercenter.virginia.edu/scripps/d...ntialrecordings
/nixon/oval?PHPSESSID=b813e56b3017d097cd176720bc10fc74
* The next day, Nixon called for a "new national health strategy" that had four points for expanding the proliferation of health maintenance organizations, or HMOs. "Special Message to the Congress Proposing a National Health Strategy," February 18th, 1971, http://www.presidency.ucsb.edu/ws/index.php?pid=3311
* The term "health maintenance organization" was coined by Nixon advisor Paul Ellwood. Patricia Bauman, "The Formulation and Evolution of the Health Maintenance Organization Policy, 1970-1973, Social Science & Medicine, vol. 10. 1976. After Congress passed Nixon's HMO Act in 1973, HMOs in America increased nine-fold in just ten years. N. R. Kleinfield, "The King of the HMO Mountain," New York Times, July 31, 1983.
<A href="http://www.michaelmoore.com/sicko/checkup/" target="_blank">http://www.michaelmoore.com/sicko/checkup/
Witnesses from Sicko speak further of their experiences:
AMY GOODMAN: After Michael Moore spoke at Tuesday’s health care briefing at the State Legislature in Sacramento, lawmakers heard testimony from several people featured in his film Sicko. Donnelle Keyes talked about how her 18-month-old daughter Michelle died in Los Angeles in 1993 hours after being denied treatment at a hospital.
DAWNELLE KEYES: On May 6, 1993 my 18-month-old daughter Michelle became very ill. She was vomiting, had diarrhea and was having trouble breathing and a very high temperature. I called an ambulance, which took her to the nearest emergency room at Martin Luther King Jr. Medical Center in Los Angeles. The doctors believed she probably had a bacterial infection, which could be treated with antibiotics. But he didn’t conduct a simple blood culture or treat her with antibiotics because our health plan, Kaiser, told him not to. You see, Martin Luther King hospital was not a Kaiser facility. Kaiser said the simple test and treatment had to be done in a Kaiser hospital. But Michelle became sicker and sicker. She became lethargic and unresponsive. I pleaded to them. I pleaded for her treatment. And no one would give her antibiotics. Over two hours later Michelle had a seizure. Only an hour after that Michelle was transferred by ambulance to Kaiser. Within 15 minutes of arriving, she died.
I went to court to hold accountable those who were responsible for Michelle’s death. As my attorney put it, Michelle died, not because a doctor didn’t know what to do, but because of her health care coverage status. We won our case but, sadly, the jury award was cut to a fraction of what they felt was fair because of a horrible California law that caps damages in these kinds of cases called MICRA. This law has been on the books since 1975 and should be re-appealed. My case is a good example of why we need guaranteed and universal health care in California and in America. No one should ever have to go through what my family had to go through. I hope the movie Sicko, which I am proud to be a part of on behalf of my daughter, helps achieve that goal. My daughter was not treated and died because she was in the ER that was not affiliated with her health plan. This should never happen in America. Had it not happened, my daughter would be 15-and-a-half years of age and enjoying high school. Thank you.
AMY GOODMAN: Dawnelle Keyes daughter died in 1993. Andy Bales of the Union Rescue Mission in Los Angeles testified on how hospitals dump patients on Skid Row.
ANDY BALES: Unlike some unfortunate souls who are dumped or dropped off on Skid Row, I worked my whole life to end up on Skid Row, and I finally made it. I want to make sure no human being is left on the streets of Skid Row. Three years ago, my predecessors found that a woman had been dropped off by a hospital. She walked in with an IV in her arm, sat down in our guest area and died 10 minutes later from pneumonia. We set up what is now called a hospital dump can out in front of the building. And in the fall of 2005, we had a gentleman show up in a gurney, having seizures and the hospital attempted to drop him off, but the captain of the police force, Andy Smith, happened to be at our place in a meeting, he ran down, intervened, made the man—the ambulance driver–put him back in the ambulance and sent him back to the hospital. Shortly after that, in December, an undocumented day laborer showed up covered in blood. He’d just been released from a hospital in Arcadia, brought all the way to downtown Skid Row, walked in, we took him back to our guest area and shortly thereafter, he became so ill from the beating he had taken right before he went to the hospital, that we had to call the medics and haul him back to the hospital. He stayed there for several days.
That was publicized. I think eleven hospitals were documented as doing drop-offs. It was somewhat publicized. But in March of 2006, I was standing outside with the moms from the Mission, waiting for their kids to return. Their bus had been in an accident, so I was out much later than I normally would have been. I couldn’t believe my eyes as the cab pulled up and did a u-turn. And a little lady in a nightgown stepped out of the back of the cab, unassisted, was given no directions to our door. She’s several hundred feet from our door. She started walking northward on San Pedro to some of the meanest streets in the United States. Fortunately, I was there. I called the Captain, Andy Smith. I sent a staff person to rescue the lady that I later found out was Carol Reyes. Hospital document showed she had high blood pressure, a low-grade fever, had dementia so bad that she didn’t know time or place. Yet she was brought 20 miles to be dropped off on to the meanest street of our city.
Every good thing that happened to Carol Reyes after it hit the national and world news, every good thing that happened to her could have happened had she been treated like a human being in the first place. She was given a checkup by a social worker and doctors. She was deemed not to be competent. She was given a public guardian. She was given a lawyer. She was put into a group home. Today, she’s being cared for in a wonderful way. But, every one of those good steps could have been done in the first place rather than after she made the national news.
Unfortunately, there have been over 35 hospital drop-offs since Carroll Reyes made the news. One man, a paraplegic, dropped off without a wheelchair without a walker, dropped himself out of the van onto the curb with his clothes in his mouth and colostomy bag ruptured. Fortunately, one good thing that came out of this was that twelve homeless witnesses stepped forward and said enough is enough. No more of this kind of treatment for human beings.
I would like to just share a scripture from the Old Testament. As the Jewish people were heading back to set up their city, they received instruction from God through the prophet of Isaiah. It says I’ll take joy in Jerusalem, take delight in my people. No more sounds of weeping in the city, no cries of anguish, no more babies dying in the cradle or old people who don’t enjoy a full lifetime. 100th birthdays will be considered normal. Anything less will seem like a cheat. I want to steal an idea from Michael: That we need to move away from the “pull yourself up from the bootstraps”, winner-take-all, me-centered society and move to a we-centered society. That is why I am here to encourage you today. Thank you.
AMY GOODMAN: After Andy Bales of the Union Rescue Mission and Dawnelle Keys testified, Michael Moore urged lawmakers to take action against health care executives.
MICHAEL MOORE: What I would like to know is, if it is possible for a bill to be introduced. For, until we are able to eliminate these health insurance companies from making decisions like they made in causing the death of Michelle, to make it a criminal act for a health insurance company to do what they do to Dawnelle and her daughter. I would like to know why that can’t happen. I would like to encourage local prosecutors and district attorneys to consider filing manslaughter charges, premeditated murder charges, against these companies. That is really what it is, isn’t it? I would like to see the executives of these companies in a perp walk, in handcuffs, brought out. Kaiser ended up having to pay a minuscule amount of money to Dawnelle. But, really what we needed to see was the arrest of their executives. When Andy Bales and Captain Andy Smith, and eventually what the city attorney did in Los Angeles was to go after Kaiser, criminally, for dropping people off, dumping them on the street in their hospital gowns. It is a criminal act. It is exactly what should happen to them. And I just wonder how long we’re going to tolerate this as a people.
AMY GOODMAN: Finally, Dr. Linda Peeno also addressed the California State Legislators in Sacramento Tuesday. She’s a former medical reviewer for the health insurer Humana. This excerpt from Sicko features testifying before Congress in 1996.
LINDA PEENO: I am here primarily today to make a public confession. In the spring of 1987 as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this. Because, in fact, what I did was I saved a company a half a million dollars with this.
AMY GOODMAN: On Tuesday, Doctor Linda Peeno spoke about her work as a medical reviewer for Humana.
LINDA PEENO: I should say right from the beginning that when you see the film this afternoon, you’re gonna think that I’m an imposter, because when Michael’s team called me about a year ago to talk to me about the film, I was actually so despondent about health care that I couldn’t give an interview. So they had to use the old material. And so it was just so exciting for me to see all those nurses today. I just cannot tell you. After twenty years of trying to get people to pay attention to exactly what Michael said, and what shocked me into this and the thing that will be the focus in the movie is that as a young, naive physician twenty years ago, I realized that with just a flick of a pen I could condemn a person to death and did, all because he was expensive. And I have already seen references to the fact that that case is too old, it is a mere anecdote, all the things that came out when I testified eleven years ago before Congress. But, when I testified in 1996 in May before Congress about this case, I realized just the other day as I was thinking about this, I could give exactly the same testimony again, exactly, word for word, I would only have to add that things have become unimaginably worse. I think the thing that had begun to defeat me over the past couple of years is the thousands and thousands of e-mails I would get from people every week, to the point where I couldn’t even stand to turn my computer on.
I think that we’ll hear a lot about how managed care is going away, these horror stories don’t occur anymore. But they do and they occur in worse and worse forms. I think we will, for all the humor and for all the excitement, I think we have to remember that, for me, the reason why the Heart case was so important is because it is really the tip of a huge pyramid of preventable suffering and preventable death that has occurred over twenty years, really thirty years, because the HMO Act was passed in 1973. There are untold people whose lives have been affected by this.
I think when Michael said that we can’t just tinker with health policy here and there a little piece of legislation a little patient right’s protection. It is even more fundamental than that. I think that we have created a culture that devalues life and devalues the care of other people and our care for one another. I am thrilled that we are here today with nurses. I hope there are doctors here. I know there are doctors in the audience I met two that are friends of mine. But I hope there are other doctors here that are going to represent the kind of healing and caring for medicine and their work that we need. Because I think that the thing that has almost defeated me is we’re losing the heart and soul of medicine. That is a dangerous condition that we are going to pay dearly for, and are paying dearly for and maybe with some of our own lives. I read in one of the commentaries about the movie so far is that this isn’t a middle class problem. Not only is it a middle class problem, you know, I ran into somebody just a couple of months ago, a businessman, a wife who is a professional, you know, they were living the American dream, big house, private school for kids, you know, everything imaginable until one of their daughters became ill in college. They began to lose everything. So I think that at every point, anybody who feels comfortable because they think they’re protected by money, or insurance, or power, or anything else will be badly mistaken.
I think the one last thing that I would like to say with regard to the movie is that I hope it expands beyond health care. I think Michael is right. We are an individualistic society that doesn’t feel any responsibility for one another. And you know, I have spent the past twenty years seeing how health care system is a microcosm for the other systems. I hope this movie helps us to cause us to ask how we value one another in our lives, in our deaths. What values do we want to have? And why do individual human stories fail to move us? The perplexing question to me still is why did it not move people in 1996 when I, as a doctor, testified about how easy it was to cause the death of somebody? And then as I proceeded to spend ten years trying to get people to understand what was happening. So I think this is our moment in time. I don’t think we will ever have another moment. I would like to end with a quote from Abraham Joshua [unknown] a theologian that says, “Few are guilty but all are responsible.”
AMY GOODMAN: Linda Peeno. Dr. Lena Peeno is a former Humana medical reviewer testifying before the California State Legislature now and 1996.
http
://www.democracynow.org/2007/6/14/sick...ing_first_hand
Michael Moore interview on film:
http://www.democracynow.org/2007/6/18/an_h...ichael_moore_on
://http://www.michaelmoore.com/sicko/c...l_moore_on
who were to beneifit from them, and he ran with that ball. Only in the last 10-15 years have people started to realize the horrible problems and restrictions most HMOs bring when the illness gets catastrophic [read expensive]. I'd suggest to all, if you haven't seen it yet, to see the film 'Sicko'. And that is about those who have insurance! 40.000.000 in America can't afford it [I really doubt many are buying toys to save on the premiums!]....and are at the mercy of the 'gods' and public hospitals - which in most places offer second-class care, at best. Many who paid into healthcare programs all their lives, suddenly lost it - and all the 'accumulated' years of payments, when their employer folded, they got fired, laid-off, move, or they were accused of having had an not-previously disclosed 'pre-existing condition' [the catch-all way out for insurers to not pay anything - even on an unrelated illness due to a trivial supposed pre-existing condition]. Health [life!] is a right, not something that should be at the whim of those who only want to make a profit. There is an intersting testimony by a doctor who's job it was to find a way to NOT PAY OUT on claims. She worked for an HMO company. Her salary was based on how many patients and how many millions she found a way to deny. That is how vicious capitalism and greed has become in the USA today. They have taken the 'We' out of 'We the People'. Banks get bailouts; MIC companies get bailouts; 'we' the people are on our own.......
America is a sinking ship due to morality gone awry, only. Long ago America was secretly taken-over by the Ultra-Rich, who control the country as their own fiefdom....even now as they abandon it nearly sucked-dry in their 'globalization' quest to destroy the entire planet. One word - Greed. America's elite has found much greater profit in Thanatos, than in life and love - care and compasion. They have none. America and the World will pay a very high price for this. Note in her Congressional testimony, below, how Peeno compares the morality to that of Germany in the 1930s. I agree. This time the 'fascism' is within - as a 'cancer' - not an external enemy. Our tax money now is used to invade non-threatening nations to further enrich the already filthy-rich and their corporations; while America literally bleeds due to no universal healthcare; decaying infrastructure, and the march toward a Policestate - where only the rich and the compliant have any 'rights'. The lack of universal healthcare in America is directly related to this la
k of compassion nor any sense to share our 'wealth'!
What makes America 'great'...sadly, only the greed of those at the top.....which is
'great', indeed.
JUAN GONZALEZ: Our next guest is also featured in Michael Moore’s new documentary SiCKO. A decade ago, Dr. Linda Peeno made headlines when she appeared before Congress to talk about her work as a medical reviewer for the giant HMO Humana. Michael Moore replays part of that testimony in his new film.
DR. LINDA PEENO: I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars for this.
AMY GOODMAN: Dr. Linda Peeno, testifying eleven years ago. Following her appearance in Congress, she would go on to become one of the country’s best-known whistleblowers about HMOs and the healthcare industry. Dr. Linda Peeno joins us now also from Washington, D.C., where she also attended the premiere last night of Michael Moore’s film SiCKO, along with many legislators. Dr. Peeno, tell us your story. How did you work for Humana? What was your job? How did it change? What did you do?
DR. LINDA PEENO: Well, I started when I graduated from medical school. I took some time off out of my residency to take care of my children, and I had started working at a hospital doing something called utilization review. And one thing led to another, and I was able to get this part-time job working for Humana. And I was told it was an insurance company and that I would be doing something similar, and I would be reviewing patient charts and requests and helping make good medical decisions about them.
When I actually went to interview, I was asked if I could be tough, because I was going to be telling doctors that they couldn’t do things and that I would be expected to keep a 10% denial rate. So I didn’t really even really understand what that meant.
And then I started working, and requests started coming in. And basically what I did in that particular job was reviewed hospital requests for admission. And basically our job was to keep people out of the hospital, because, the late 1980s, that’s where the focus was. That’s where most of the dollars were being spent.
I lasted at Humana only about nine months, because I suddenly realized that my medical expertise was being used to justify economic decisions, and I also had that ethical epiphany that was the source of the testimony and was dramatized in the movie that they did about my work, where I had denied the man the heart transplant and then just within a day or so saw a sculpture being installed in the rotunda and was told at that time that it had cost about the same as the heart transplant that we had denied. And that’s when I realized that, wait a minute, the savings that we’re extracting from these denials, many of which were not legitimate and I felt that they were not legitimate, was not going to help patients. By the way, I later found out that that sculpture cost $3.8 million, so it was equivalent to eight heart transplants.
But I left Humana, and I went to a nonprofit HMO that was owned by hospitals, thinking that things would be different, that it would be more patient-centered. And it’s interesting, in the movie SiCKO, there’s actually an account of a young man who was denied, and it was through the employer, which was a hospital. And so, that was the beginning of my education about just the way in which managed care worked, that you made money to the extent that you denied, limited, substituted or obstructed care. And it wasn’t patient-centered.
So it didn’t make any difference whether you were in a for-profit setting or a nonprofit setting. And I just began to find that that was unconscionable as a physician to be doing that and to be, you know, sitting distantly at a desk, never making eye contact with a patient, never really experiencing the impact of the consequences of the decisions. So I eventually left in the early ’90s and decided to focus on trying to educate the public and protect patients.
AMY GOODMAN: Your salary skyrocketed as you spent those months at Humana. Could you explain what happened, what your salary was proportional to or, you know, how it was affected by the number of “no” decisions that you gave out?
DR. LINDA PEENO: Well, it didn’t actually skyrocket while I was at Humana, because I quit before it did, but I started out as—you know, medical reviewers were often paid, as I was at Humana, on an hourly basis. And I think I started at like $50 an hour. And there were a team of physicians, and we worked shifts, and depending on how many hours a week you worked, you got paid.
But as a result of that experience, when I went to the nonprofit HMO, they were thrilled that I had been trained by Humana, which was seen as kind of the pinnacle of the industry at that time. So then I moved into an executive position as a medical director and began actually, you know, making increasingly higher six-figure salaries. So it was—my increase in income was directly related to—you know, back to that original interview question: how tough I could be and how much money I could save.
Now, I did quit Humana just before they had implemented a system, and we were told that the medical reviewer that had the highest denial rate was going to receive a bonus at Christmas. I quit, I think, in November, before that happened. And in subsequent knowledge that I have about how the program developed afterwards, medical directors there did get bonuses that were related to their performance. I just left before I received one.
JUAN GONZALEZ: Well, and you subsequently, obviously, became a whistleblower and chief critic of the HMO industry. But I’m especially interested by your comments about there not being very much difference between the for-profit insurance companies and the nonprofit medical care companies. What then, in your viewpoint, is the fundamental or structural contradiction then? If it’s not just a drive for profit to give to shareholders, that a for-profit company would have, what then involves having the nonprofits also participate in the same kind of abusive system?
DR. LINDA PEENO: Well, I think it becomes—the whole managed care practices and strategies become a way in which to either save or make money, whichever term you use. So in a nonprofit setting, I mean, you think about Medicaid HMOs, for example, who are trying to manage a state budget. The way in which they save money is to spend it, you know, prudently and make good decisions. The problem is, is that these strategies can take on a life of their own, and so it is so easy to slip from making legitimate medical decisions that have legitimate savings to decisions in which you’re making—you’re attempting to produce more money, you know, for whatever purposes.
So in the nonprofit setting in which we were, you know, there were lots of other expenditures—I mean, physicians were being paid to be on the board; salaries, you know, for the executive employees. So you didn’t necessarily have stock that you were working toward, but there were other things. And we know that from things that—from analyses that have been done by some of the nonprofit health plans, perks that were given to executives and ways in which the resources are spent for non-medical reasons.
So the fundamental structural problem is that you—you know, the whole managed care process acts like a huge funnel. You pour the money in at the top, and you want as little money to go out at the bottom, and so you create these filters. And depending on how fair, unfair, legitimate or illegitimate those filters are, I think, is what directly impacts patients’ lives.
JUAN GONZALEZ: And we’ve been having many reports in recent months about physicians who are actually getting kickbacks, in essence, from pharmaceutical companies for prescribing certain kinds of—or certain drugs of those drug companies. Is there a sense, on your part, not only that there are structural problems, but that the entire healthcare system in America has become increasingly corrupted?
DR. LINDA PEENO: Well, I’m really glad you asked that question, because I think that, you know, this isn’t about one company, and it’s not about just the insurance industry. I think it’s about the entire corporatization of healthcare, the fact that money is driving everything. And whether it’s kickbacks to physicians for prescribing certain drugs or even decisions about how physicians organize their offices and what contracts they enter into—you know, it was interesting coming here. I sat in front, on the plane, of a physician and, from what I gathered, you know, voyeuristically listening to this conversation, some sort of executive PR person. And they were talking about how to set up this clinic in which they were going to be doing specialized surgery. And if you didn’t listen carefully, you would never have guessed that they were talking about patient care. I mean, the whole thing was centered around investment and return on investment and marketing and, you know, how many units they could produce a day. And it was as far removed from the care of patients as you could possibly get. And that shouldn’t exist in medicine.
AMY GOODMAN: We’re talking to Dr. Linda Peeno, former medical reviewer for the HMO company Humana, went on to work for a so-called nonprofit HMO, now is a physician in Louisville, Kentucky—in Washington, D.C. for the premiere of Michael Moore’s film SiCKO. This is a movie that’s supposed to launch a movement all over this country. California Nurses Association involved, MoveOn involved. Oprah is going to be doing a town hall after getting people’s stories through the summer. YouTube is asking people to post their healthcare horror stories. It goes to the issue of what can be. In Michael’s film, he shows us Britain, Canada, France, Cuba. And ultimately, he’s talking about single payer, the idea of the government being the provider of healthcare, as in these other countries, and not having the middle man, the insurance company. Dr. Linda Peeno, you’ve worked for these insurance companies, do you agree with that assessment?
DR. LINDA PEENO: Absolutely. I mean, I can see—you know, and I’ve been at this twenty years—I can see absolutely nothing that insurance companies are providing that is a benefit at this point. I mean, it’s an ingenious system that’s been devised between the money that is being spent and the care that’s being delivered that’s nothing but obstructive and even cruel, ultimately, in the way it plays out in patient lives. So however we organize it, or ultimately when we radically reform the healthcare system, I think we need to rethink seriously the whole concept of insurance in the delivery of healthcare.
AMY GOODMAN: You’re in the doctor community. Michael talks to a doctor in Britain who says, yes, you know, he has, I think it was an Audi car. He has a million-dollar home. And he says, sure, he doesn’t have two or three of those homes, but he’s quite happy, doing very well, even as he’s in the National Health Service in Britain. What about the attitudes of doctors? They are your peers.
DR. LINDA PEENO: Well, I have to admit that I don’t know directly, because, you know, most of the physicians with whom I have some association, an ongoing association, are struggling physicians who are barely holding their practices together, because they’re pediatricians and family physicians who genuinely want to practice good medicine. And I think they would be satisfied with being able to pay their mortgage and, you know, take care of their children and get their med school loans paid off.
I think the British doctor they interviewed was right. You know, there are certainly physicians currently in our system who are doing financially extremely well, and I’m not sure that they would support any kind of change. But I thought it was interesting yesterday, one of the medical students who spoke at John Conyers’s hearings said, you know, these physicians that are focused on the economics, their own personal economics, only have a few years, because there is a rising groundswell, I think, in medical students who have a different opinion about how to practice medicine and how to care for patients and what their measure of success is going to be. And I don’t think it’s going to be big houses and nice cars.
JUAN GONZALEZ: Let me ask you about the whole issue of single payer. Obviously, there are critics, conservative critics, as well as many people who are more politically moderate, who shudder at the idea of a centralized government bureaucracy that would handle health insurance. There are certainly all kinds of horror stories about Medicaid abuse and Medicaid mills and the exploitation of the Medicaid system. What’s your response to those critics?
DR. LINDA PEENO: Well, first of all, I think I’d tell them to see Michael’s film, because I think he does a wonderful job of sort of demythologizing some of the criticisms and the accusations that are made about other countries. And the single payer, I mean, you know, it’s become the S-word that’s equivalent with socialized medicine, and that’s supposed to send chills through everyone. And, you know, as he aptly points out, I mean, we socialize a lot of things in this country: our police departments, our fire departments, education. And the point that I would make, you know, based upon my experience and having seen inside the way in which insurance companies work—
AMY GOODMAN: We have ten seconds.
DR. LINDA PEENO:—is that at least with the government we have transparency and we can change the practices. Right now, we have no control over the corporations.
AMY GOODMAN: Dr. Linda Peeno, we want to thank you very much, known around the country as a leading HMO whistleblower, now a physician in Louisville, Kentucky, speaking to us from Washington, D.C., where SiCKO just premiered last night.
http://www.democracynow.org/2007/6/21/hmo_..._linda_peeno_on
Dr. Peeno's Full Testimony: http://www.thenationalcoalition.org/DrPeenotestimony.html
My name is Linda Peeno, and although the witness list does not reflect this, I am a physician. I am a former medical director and medical reviewer. I did the job that was referred to repeatedly in the first panel as a physician manager for three health care organizations. I currently, though, primarily work in medical and health care ethics.
I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death.
No person and no group has held me accountable for this because, in fact, what I did was I saved the company a half a million dollars for this.
And furthermore, this particular act secured my reputation as a good medical director, and it ensured my advancement in the health care industry;in little more than a year, I went from making a few hundred dollars per week to an annual six-figure income.
In all my work, I had one primary duty and that was to use my medical expertise for the financial benefit of the organization for which I worked and according to the managed care industry... [In the managed care industry] it is not an ethical issue to sacrifice a human being for a savings, no matter how that savings occurs. And I was repeatedly told that I was not denying care. I was simply denying payment.
I am not an ethicist whose primary background has come from the books. For me, the ethical issues were born in the trenches and pit of the pain that I have come to realize that I cause. And if I am an expert here today, it is because I know how managed care maims and kills patients.
So I am here to tell you about the dirty work of managed care and this is the kind of straight talk that I wish Ms. Ignagni [President and CEO of the American Association of Health Plans] could hear now.
Now, let me explain to you the ways that I was a good medical director. I was regularly consulted by marketing on ways to change expensive benefits or change the language to give me loopholes to make denials when requests came.
For example in one plan, we were able to structure our investigational language exclusion so that I was often able to use it to deny almost anything that was expensive, and particularly out-of-network requests.
I turned preexisting exclusions into a game as I tried to connect almost any prior medical complaint or visit as a reason to deny payment.
There are many more thing that I could tell you about, but, ultimately I was only as good&emdash;and I put that in quotation marks&emdash;as the doctors in my network, for it was their numbers that I needed to prove that I was doing my job.
That meant that I did whatever it took to control them: intimidation, hassling, humiliation, I have done it all. I have used inadequate and inaccurate data to create reports to get doctors to make their numbers better, in other words, decrease their usage.
I have used "economic credentialling" to select the best inexpensive physicians and rarely correlated these with quality factors.
I have helped design contract provisions to ensure our payment and monitoring schemes got the results we wanted at the plan, and I have threatened deselection to numerous physicians who were especially difficult or costly.
However, there is one last activity that I think deserves a special place in this list. This is what I call the "smart bomb" of cost containment and that is medical necessity denials.
Let me take you to the heart of managed care.
Even if a plan denies using all the other things that I could list, it is impossible for them to deny their use of this practice because it is vital to managed care; that is making medical decisions about access, availability, and use.
And even when medical criteria is used, it is rarely developed in nay kind of standard traditional clinical processes. It is rarely standardized across the field. The criteria is rarely available for prior review by physicians or the members of the plan. So, even if a a plan has a clear benefit package and has all the perks, like free eye exams or free screening tests for cancer, other marketing ploys, the member's physician will never be the final authority on what his or her patient will get.
This might go unnoticed for simple needs, like a regular office visit or a bout of the flu, but I can tell you that when something unexpected or expensive happens, it is like a bucolic pasture turned battlefield. The land mines will start exploding everywhere.
And somewhere in every coverage booklet for every managed care plan is a claim that establishes the plan as the final authority for medical necessity. What that means is that there is some physician at some plan doing what I did.
That person rarely is continuing a clinical practice. They are sitting behind a desk making decisions about a patient they will never see or touch, completely removed from the consequence of their decisions. They are getting paid by someone to make decisions for the benefit of the plan and not for the benefit of the members.
I would like to conclude by saying, what kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients? I became a physician to care for, not bring harm to my patients, and I am haunted by the thousands of pieces of paper on which I have written that deadly word, "denial." Thank you.
In her prepared written testimony which was long and detailed, Dr. Peeno concluded with the following statement:
I contend that managed care, as it has become, can exist only through serious ethical transgressions against individuals and society. Furthermore, I contend that a health plan's resistance to ethical correctives is proportionate to its reliance on ethical transgressions for its "success." Disclosure and exposure would present serious disadvantages in competition for cost-cutting and profit making. In summary, it is a fair assessment to claim that managed care's "success" depends upon the following:
Use of non-medical agendas to drive medical policies and practice;
Collapsing of the rights of individuals for purported greater collectivist goals;
Supersession of the care of the individual by the care of the collective;
Creation of ill relations between professional ambitions and the absence of moral inhibitions;
Reliance upon righteous ideologies about reform and societal benefits coupled with cost-cutting policies;
Disparagement of the "weaker" (i.e. costly) groups within society;
Linkage of economic imperatives and professional self-interest;
Direction of medical professionals by parameters set by health care and financial administrators;
Establishment of quotas and internal processes for control with little regard for the physical and psychological cost of their effects;
Selection of professionals who are ideological converts and "good" practitioners of its goals;
Enticement of physicians as agents of an organization, such that organizational goals are supplied with medical validation;
Facilitation of unethical professional practice by financial rewards and bonuses, as well as job security and advancement;
Generation of moral void by use of propaganda;
Degradation of moral expressions of compassion and sympathy for persons who have been designated costly or needy;
Induction of guilt into those who are made to feel a drain on resources or a threat to the collectivist goals.
The list could go on, however, there is enough here to suggest drastic needs for change. Of course, each of these would be vehemently contested by the managed care industry. If they are inaccurate, then it seems that the industry should have no reservations about supporting transparent and publicly accountable activities.
We know, though, they do object to this. Why? Because control of patients and doctors depends upon unethical practices. To this, at least, we should object. Manipulation and exploitation for any reason, even beneficence, is unethical and destructive of social good.
We have enough experiences from history to demonstrate the consequences of secretive, unregulated systems which go awry. The list above is not new. In fact, it comes from a book detailing the characteristics of a dire period of recent history.3
The last time this combination of forces worked in concert, over 200,000 individuals lost their lives in Nazi Germany (even before the Final Solution). Most of these persons were German citizens sacrificed for medical reasons set by economic and social agendas. I find the parallels chilling. One can only wonder: how much pain, suffering and death will we have before we have the courage to change our course?
Personally, I have decided even one death is too much for me.
* Dr. Peeno delivered an oral statement along with written testimony for a Congressional hearing on "Contract Issues and Quality Standards for Managed Care." Her testimony was heard on May 30, 1996 by the Subcommittee on Health and Environment of the House of Representative's Committee on Commerce. Her entire testimony can be found at the National Coalition of Mental Health Professionals and Consumers." (http://www.nomanagedcare.org/DrPeenotestimony.html).
*QUOTE
SiCKO: Richard Nixon and John Ehrlichman are heard discussing the concept of a health maintenance organization in Oval Office Recordings.
* On February 17, 1971, Richard Nixon met with John Ehrlichman to discuss the Vice President's position on health maintenance organizations, as heard in the film. The Miller Center of Public Affairs has this audio recording (conversation number 450-23. "Richard Nixon - Oval Office Recordings,"
http://millercenter.virginia.edu/scripps/d...ntialrecordings
/nixon/oval?PHPSESSID=b813e56b3017d097cd176720bc10fc74
* The next day, Nixon called for a "new national health strategy" that had four points for expanding the proliferation of health maintenance organizations, or HMOs. "Special Message to the Congress Proposing a National Health Strategy," February 18th, 1971, http://www.presidency.ucsb.edu/ws/index.php?pid=3311
* The term "health maintenance organization" was coined by Nixon advisor Paul Ellwood. Patricia Bauman, "The Formulation and Evolution of the Health Maintenance Organization Policy, 1970-1973, Social Science & Medicine, vol. 10. 1976. After Congress passed Nixon's HMO Act in 1973, HMOs in America increased nine-fold in just ten years. N. R. Kleinfield, "The King of the HMO Mountain," New York Times, July 31, 1983.
<A href="http://www.michaelmoore.com/sicko/checkup/" target="_blank">http://www.michaelmoore.com/sicko/checkup/
Witnesses from Sicko speak further of their experiences:
AMY GOODMAN: After Michael Moore spoke at Tuesday’s health care briefing at the State Legislature in Sacramento, lawmakers heard testimony from several people featured in his film Sicko. Donnelle Keyes talked about how her 18-month-old daughter Michelle died in Los Angeles in 1993 hours after being denied treatment at a hospital.
DAWNELLE KEYES: On May 6, 1993 my 18-month-old daughter Michelle became very ill. She was vomiting, had diarrhea and was having trouble breathing and a very high temperature. I called an ambulance, which took her to the nearest emergency room at Martin Luther King Jr. Medical Center in Los Angeles. The doctors believed she probably had a bacterial infection, which could be treated with antibiotics. But he didn’t conduct a simple blood culture or treat her with antibiotics because our health plan, Kaiser, told him not to. You see, Martin Luther King hospital was not a Kaiser facility. Kaiser said the simple test and treatment had to be done in a Kaiser hospital. But Michelle became sicker and sicker. She became lethargic and unresponsive. I pleaded to them. I pleaded for her treatment. And no one would give her antibiotics. Over two hours later Michelle had a seizure. Only an hour after that Michelle was transferred by ambulance to Kaiser. Within 15 minutes of arriving, she died.
I went to court to hold accountable those who were responsible for Michelle’s death. As my attorney put it, Michelle died, not because a doctor didn’t know what to do, but because of her health care coverage status. We won our case but, sadly, the jury award was cut to a fraction of what they felt was fair because of a horrible California law that caps damages in these kinds of cases called MICRA. This law has been on the books since 1975 and should be re-appealed. My case is a good example of why we need guaranteed and universal health care in California and in America. No one should ever have to go through what my family had to go through. I hope the movie Sicko, which I am proud to be a part of on behalf of my daughter, helps achieve that goal. My daughter was not treated and died because she was in the ER that was not affiliated with her health plan. This should never happen in America. Had it not happened, my daughter would be 15-and-a-half years of age and enjoying high school. Thank you.
AMY GOODMAN: Dawnelle Keyes daughter died in 1993. Andy Bales of the Union Rescue Mission in Los Angeles testified on how hospitals dump patients on Skid Row.
ANDY BALES: Unlike some unfortunate souls who are dumped or dropped off on Skid Row, I worked my whole life to end up on Skid Row, and I finally made it. I want to make sure no human being is left on the streets of Skid Row. Three years ago, my predecessors found that a woman had been dropped off by a hospital. She walked in with an IV in her arm, sat down in our guest area and died 10 minutes later from pneumonia. We set up what is now called a hospital dump can out in front of the building. And in the fall of 2005, we had a gentleman show up in a gurney, having seizures and the hospital attempted to drop him off, but the captain of the police force, Andy Smith, happened to be at our place in a meeting, he ran down, intervened, made the man—the ambulance driver–put him back in the ambulance and sent him back to the hospital. Shortly after that, in December, an undocumented day laborer showed up covered in blood. He’d just been released from a hospital in Arcadia, brought all the way to downtown Skid Row, walked in, we took him back to our guest area and shortly thereafter, he became so ill from the beating he had taken right before he went to the hospital, that we had to call the medics and haul him back to the hospital. He stayed there for several days.
That was publicized. I think eleven hospitals were documented as doing drop-offs. It was somewhat publicized. But in March of 2006, I was standing outside with the moms from the Mission, waiting for their kids to return. Their bus had been in an accident, so I was out much later than I normally would have been. I couldn’t believe my eyes as the cab pulled up and did a u-turn. And a little lady in a nightgown stepped out of the back of the cab, unassisted, was given no directions to our door. She’s several hundred feet from our door. She started walking northward on San Pedro to some of the meanest streets in the United States. Fortunately, I was there. I called the Captain, Andy Smith. I sent a staff person to rescue the lady that I later found out was Carol Reyes. Hospital document showed she had high blood pressure, a low-grade fever, had dementia so bad that she didn’t know time or place. Yet she was brought 20 miles to be dropped off on to the meanest street of our city.
Every good thing that happened to Carol Reyes after it hit the national and world news, every good thing that happened to her could have happened had she been treated like a human being in the first place. She was given a checkup by a social worker and doctors. She was deemed not to be competent. She was given a public guardian. She was given a lawyer. She was put into a group home. Today, she’s being cared for in a wonderful way. But, every one of those good steps could have been done in the first place rather than after she made the national news.
Unfortunately, there have been over 35 hospital drop-offs since Carroll Reyes made the news. One man, a paraplegic, dropped off without a wheelchair without a walker, dropped himself out of the van onto the curb with his clothes in his mouth and colostomy bag ruptured. Fortunately, one good thing that came out of this was that twelve homeless witnesses stepped forward and said enough is enough. No more of this kind of treatment for human beings.
I would like to just share a scripture from the Old Testament. As the Jewish people were heading back to set up their city, they received instruction from God through the prophet of Isaiah. It says I’ll take joy in Jerusalem, take delight in my people. No more sounds of weeping in the city, no cries of anguish, no more babies dying in the cradle or old people who don’t enjoy a full lifetime. 100th birthdays will be considered normal. Anything less will seem like a cheat. I want to steal an idea from Michael: That we need to move away from the “pull yourself up from the bootstraps”, winner-take-all, me-centered society and move to a we-centered society. That is why I am here to encourage you today. Thank you.
AMY GOODMAN: After Andy Bales of the Union Rescue Mission and Dawnelle Keys testified, Michael Moore urged lawmakers to take action against health care executives.
MICHAEL MOORE: What I would like to know is, if it is possible for a bill to be introduced. For, until we are able to eliminate these health insurance companies from making decisions like they made in causing the death of Michelle, to make it a criminal act for a health insurance company to do what they do to Dawnelle and her daughter. I would like to know why that can’t happen. I would like to encourage local prosecutors and district attorneys to consider filing manslaughter charges, premeditated murder charges, against these companies. That is really what it is, isn’t it? I would like to see the executives of these companies in a perp walk, in handcuffs, brought out. Kaiser ended up having to pay a minuscule amount of money to Dawnelle. But, really what we needed to see was the arrest of their executives. When Andy Bales and Captain Andy Smith, and eventually what the city attorney did in Los Angeles was to go after Kaiser, criminally, for dropping people off, dumping them on the street in their hospital gowns. It is a criminal act. It is exactly what should happen to them. And I just wonder how long we’re going to tolerate this as a people.
AMY GOODMAN: Finally, Dr. Linda Peeno also addressed the California State Legislators in Sacramento Tuesday. She’s a former medical reviewer for the health insurer Humana. This excerpt from Sicko features testifying before Congress in 1996.
LINDA PEENO: I am here primarily today to make a public confession. In the spring of 1987 as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this. Because, in fact, what I did was I saved a company a half a million dollars with this.
AMY GOODMAN: On Tuesday, Doctor Linda Peeno spoke about her work as a medical reviewer for Humana.
LINDA PEENO: I should say right from the beginning that when you see the film this afternoon, you’re gonna think that I’m an imposter, because when Michael’s team called me about a year ago to talk to me about the film, I was actually so despondent about health care that I couldn’t give an interview. So they had to use the old material. And so it was just so exciting for me to see all those nurses today. I just cannot tell you. After twenty years of trying to get people to pay attention to exactly what Michael said, and what shocked me into this and the thing that will be the focus in the movie is that as a young, naive physician twenty years ago, I realized that with just a flick of a pen I could condemn a person to death and did, all because he was expensive. And I have already seen references to the fact that that case is too old, it is a mere anecdote, all the things that came out when I testified eleven years ago before Congress. But, when I testified in 1996 in May before Congress about this case, I realized just the other day as I was thinking about this, I could give exactly the same testimony again, exactly, word for word, I would only have to add that things have become unimaginably worse. I think the thing that had begun to defeat me over the past couple of years is the thousands and thousands of e-mails I would get from people every week, to the point where I couldn’t even stand to turn my computer on.
I think that we’ll hear a lot about how managed care is going away, these horror stories don’t occur anymore. But they do and they occur in worse and worse forms. I think we will, for all the humor and for all the excitement, I think we have to remember that, for me, the reason why the Heart case was so important is because it is really the tip of a huge pyramid of preventable suffering and preventable death that has occurred over twenty years, really thirty years, because the HMO Act was passed in 1973. There are untold people whose lives have been affected by this.
I think when Michael said that we can’t just tinker with health policy here and there a little piece of legislation a little patient right’s protection. It is even more fundamental than that. I think that we have created a culture that devalues life and devalues the care of other people and our care for one another. I am thrilled that we are here today with nurses. I hope there are doctors here. I know there are doctors in the audience I met two that are friends of mine. But I hope there are other doctors here that are going to represent the kind of healing and caring for medicine and their work that we need. Because I think that the thing that has almost defeated me is we’re losing the heart and soul of medicine. That is a dangerous condition that we are going to pay dearly for, and are paying dearly for and maybe with some of our own lives. I read in one of the commentaries about the movie so far is that this isn’t a middle class problem. Not only is it a middle class problem, you know, I ran into somebody just a couple of months ago, a businessman, a wife who is a professional, you know, they were living the American dream, big house, private school for kids, you know, everything imaginable until one of their daughters became ill in college. They began to lose everything. So I think that at every point, anybody who feels comfortable because they think they’re protected by money, or insurance, or power, or anything else will be badly mistaken.
I think the one last thing that I would like to say with regard to the movie is that I hope it expands beyond health care. I think Michael is right. We are an individualistic society that doesn’t feel any responsibility for one another. And you know, I have spent the past twenty years seeing how health care system is a microcosm for the other systems. I hope this movie helps us to cause us to ask how we value one another in our lives, in our deaths. What values do we want to have? And why do individual human stories fail to move us? The perplexing question to me still is why did it not move people in 1996 when I, as a doctor, testified about how easy it was to cause the death of somebody? And then as I proceeded to spend ten years trying to get people to understand what was happening. So I think this is our moment in time. I don’t think we will ever have another moment. I would like to end with a quote from Abraham Joshua [unknown] a theologian that says, “Few are guilty but all are responsible.”
AMY GOODMAN: Linda Peeno. Dr. Lena Peeno is a former Humana medical reviewer testifying before the California State Legislature now and 1996.
http
://www.democracynow.org/2007/6/14/sick...ing_first_hand
Michael Moore interview on film:
http://www.democracynow.org/2007/6/18/an_h...ichael_moore_on
://http://www.michaelmoore.com/sicko/c...l_moore_on
QUOTE(John Simkin @ Dec 24 2007, 08:38 AM)
QUOTE(Craig Lamson @ Dec 23 2007, 01:38 PM)
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
Government systems are never perfect. However, as Pat Speer points out, somethings are too important to be left to the market: "we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED."
The problem with the market is that it is motivated by the profit motive. For example, fifteen years ago I hurt my back. I went to see the doctor who booked me in to see a consultant. The only trouble was that I had to wait a couple of weeks to see the back specialist. A friend suggested I went to see a chiropractor. There was no waiting list for him and I was invited over to his surgery straight away. Within a few minutes he had diagnosed my problem and spent twenty minutes manipulating my spine. It did not bring immediate relief. He argued that to solve my problem I would have to pay for a long course of expensive treatment. Although I could afford this treatment, I found it difficult to trust the man. After all, it was in his financial interest to promote this treatment.
I therefore decided to wait until I saw the back specialist in my local hospital. He also identified the problem. However, instead of prescribing a long course of treatment, he showed me some exercises I needed to do everyday to correct the problem. His diagnoses was correct and I still do those exercises every day. This example shows the problem with the private medical system. It is in the financial self-interest of the doctor to “over” treat the problem. The market cannot be trusted with medical care. It might be the best method for producing popcorn but health care is too important to be left to the capitalist system.
I don't think your really identified a difference between private or socialized medicine with your example but rather a difference in practice and treatment. I'll take the market any day, given that as long as I can pay I can choose who, when and where I can receive treatment. One only needs to look to Canada to see how the lack of competition due to the total socalized system reduces choice and service. You can get a cat-scan for your pet at will but try it for a human and you wait.
I would have no problem with a two-tiered system, as long as I could choose which system I prefered and did not have to pay for both. What I'm not interested in is single, government run system that locks in my choices.
Healthcare is far too important to be left in the hands of some governmental agency.
Universal public health care theoretically exists in Australia.
As John S. points out, based on personal experience with dear ones seeking important care, the care provided does have an advocacy element that is critical. Therefore those ignorant of this, or lacking in advocates do tend to get a different priotisation.
Another element is that the doctors personal liability insurance is to some extent tied to the procedures and equipment the doctor follows and uses which often may not be in the interest of the patient. EG. ultrasound scanning of foetuses, which some studies whow may harm delicate structures. A doctor that does not use this equipment may face higher premiums. I'm sure there are other similar situations.
Another example is the over use of Caesarian sectioning. A doctor that performs it, rather than waiting for nature to take its course can tend to save money. So, the procedure has soared in use, way beyond reason in the sense of what's best for mother and child. In some more rare cases a culture exists where women choose it arther than normal birthing in order to retain a certain tightness, ie the cosmetic in a sick moral sense overrides care for the future generations, and is supported by the system as it is.
So, overall one can see that it is primarily an economic problem.
It's not a question that universal health care freely (or minimally across the board tax deductions in the order of a few percents to pay for it) is desirable. The problems stem from a multitude of related economic concerns of which insurance is a prime factor, both for the patient and for the doctor in terms of liability, and similarly on a grander scale, hospital liability insurance.
Doctors are in a sense hamstrung from fulfilling their Hippocratic Oath and instead being an arm of various systemic economic pressures that forces them to prioritise treatment according to what is most economically viable.
It's the opposition that Doctors face in providing Universal, Timely, Quality care to ALL regardles of any considerations than "this person is ill and this person must and will recieve the proper treatment".
A reforming of liabiliy laws, incremental increases of across the board income deductions, a heavier taxing on the companies that actually produce the major health problems, such as tobacco, alcohol, and unsafe working conditions can, if the will only existed, go a long way to solving many of these problems. A question must always be asked "why is this person sick in this way in the first place?".
The concept of an ET, on the floor, 24/7/365 patients ombudsmen/women to argue for those who cannot argue for themselves. or do not have family and friends to do so. is also a good idea.
Private insurance companies, (who after all are really only interested in profits), must step aside and if they don't : they must be forced to do so by some carrot and stick thinking in some measure. Doctors need a guaranteed wage and a suppotive liability atmosphere. Ditto hospitals. The notion that a caring person pulling a person out of a burning car wreck and possibly facing law suits as a result must be moderated to sensibility.
Playgrounds in Brisbane have been dismantled and closed down because the councils fear lawsuits by parents whose cjildren at some point may develop melanomia. It's a system gone mad in many ways.
The previous 'government' did it's utmost to gut the public health system at the behest of private interests.
The fix is doable. It's the, across the board, will (or guts) that's questionable.
As John S. points out, based on personal experience with dear ones seeking important care, the care provided does have an advocacy element that is critical. Therefore those ignorant of this, or lacking in advocates do tend to get a different priotisation.
Another element is that the doctors personal liability insurance is to some extent tied to the procedures and equipment the doctor follows and uses which often may not be in the interest of the patient. EG. ultrasound scanning of foetuses, which some studies whow may harm delicate structures. A doctor that does not use this equipment may face higher premiums. I'm sure there are other similar situations.
Another example is the over use of Caesarian sectioning. A doctor that performs it, rather than waiting for nature to take its course can tend to save money. So, the procedure has soared in use, way beyond reason in the sense of what's best for mother and child. In some more rare cases a culture exists where women choose it arther than normal birthing in order to retain a certain tightness, ie the cosmetic in a sick moral sense overrides care for the future generations, and is supported by the system as it is.
So, overall one can see that it is primarily an economic problem.
It's not a question that universal health care freely (or minimally across the board tax deductions in the order of a few percents to pay for it) is desirable. The problems stem from a multitude of related economic concerns of which insurance is a prime factor, both for the patient and for the doctor in terms of liability, and similarly on a grander scale, hospital liability insurance.
Doctors are in a sense hamstrung from fulfilling their Hippocratic Oath and instead being an arm of various systemic economic pressures that forces them to prioritise treatment according to what is most economically viable.
It's the opposition that Doctors face in providing Universal, Timely, Quality care to ALL regardles of any considerations than "this person is ill and this person must and will recieve the proper treatment".
A reforming of liabiliy laws, incremental increases of across the board income deductions, a heavier taxing on the companies that actually produce the major health problems, such as tobacco, alcohol, and unsafe working conditions can, if the will only existed, go a long way to solving many of these problems. A question must always be asked "why is this person sick in this way in the first place?".
The concept of an ET, on the floor, 24/7/365 patients ombudsmen/women to argue for those who cannot argue for themselves. or do not have family and friends to do so. is also a good idea.
Private insurance companies, (who after all are really only interested in profits), must step aside and if they don't : they must be forced to do so by some carrot and stick thinking in some measure. Doctors need a guaranteed wage and a suppotive liability atmosphere. Ditto hospitals. The notion that a caring person pulling a person out of a burning car wreck and possibly facing law suits as a result must be moderated to sensibility.
Playgrounds in Brisbane have been dismantled and closed down because the councils fear lawsuits by parents whose cjildren at some point may develop melanomia. It's a system gone mad in many ways.
The previous 'government' did it's utmost to gut the public health system at the behest of private interests.
The fix is doable. It's the, across the board, will (or guts) that's questionable.
QUOTE(Craig Lamson @ Dec 24 2007, 03:36 PM)
QUOTE(John Simkin @ Dec 24 2007, 08:38 AM)
QUOTE(Craig Lamson @ Dec 23 2007, 01:38 PM)
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
Government systems are never perfect. However, as Pat Speer points out, somethings are too important to be left to the market: "we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED."
The problem with the market is that it is motivated by the profit motive. For example, fifteen years ago I hurt my back. I went to see the doctor who booked me in to see a consultant. The only trouble was that I had to wait a couple of weeks to see the back specialist. A friend suggested I went to see a chiropractor. There was no waiting list for him and I was invited over to his surgery straight away. Within a few minutes he had diagnosed my problem and spent twenty minutes manipulating my spine. It did not bring immediate relief. He argued that to solve my problem I would have to pay for a long course of expensive treatment. Although I could afford this treatment, I found it difficult to trust the man. After all, it was in his financial interest to promote this treatment.
I therefore decided to wait until I saw the back specialist in my local hospital. He also identified the problem. However, instead of prescribing a long course of treatment, he showed me some exercises I needed to do everyday to correct the problem. His diagnoses was correct and I still do those exercises every day. This example shows the problem with the private medical system. It is in the financial self-interest of the doctor to “over” treat the problem. The market cannot be trusted with medical care. It might be the best method for producing popcorn but health care is too important to be left to the capitalist system.
I don't think your really identified a difference between private or socialized medicine with your example but rather a difference in practice and treatment. I'll take the market any day, given that as long as I can pay I can choose who, when and where I can receive treatment. One only needs to look to Canada to see how the lack of competition due to the total socalized system reduces choice and service. You can get a cat-scan for your pet at will but try it for a human and you wait.
I would have no problem with a two-tiered system, as long as I could choose which system I prefered and did not have to pay for both. What I'm not interested in is single, government run system that locks in my choices.
Healthcare is far too important to be left in the hands of some governmental agency.
Craig, I think what John Simkin is saying , if I may be so bold, is that healthcare, which in some cases may be a life and death situation, requires at the very least strong regulatory control of the market. It can't be totally left to the market like popcorn because the lives and welfare of people are at stake. The market doesn't recognise this fact--it recognises the profit motive only. And by the way, some markets fail--with spectacular consequences.
As John and others have said, the massive profits involved in healthcare--primarily the pharmaceutical industry--have corrupted the healthcare system. Doctors are wined and dined by drug companies and kickbacks fly around like confetti. Personally, I doubt if regulatory bodies like the Food and Drug Administration are fully corrupted but I suspect that they are sometimes 'encouraged ' to drag their feet. I note the FDA last year granted permission for the drug known as Thalidomide to be used in limited cancer cases:
http://www.mayoclinic.com/health/thalidomide/HQ01507
This drug caused many cases of birth defects in the 1950's in children born to mothers who had used the drug as a treatment for morning sickness. It was banned in Australia with much controversy as the doctor who discovered the drug's role in the birth defects was an Australian, Phillip McBride. I read about this new revelation concerning Thalidomide and its potential cancer curing qualities at least five years ago. It starves cells of oxygen. So it kills cancer cells.
So why hasn't it been mass produced by the Government and rushed into service in treating terminal cancer patients, who have little to lose in taking the risk? Because 'big pharma' and its soldiers in the field would rather prescribe chemotherapy--costing the patient thousands of dollars--which has a low success rate and debilitating side effects. You'll get the wonder drug, but only when big pharma figures out a way to make a buck out of it. They're not keen to discard a juicy earner like chemo.
There is another wonder drug. Heroin. It's highly addictive but it's the most powerful pain killer ever discovered. It's used in British hospitals as we speak for a multitude of conditions. Unfortunately, Bayer's patent expired some years ago so it could potentially be mass produced generically--hence no profit for big pharma. And it would cut into the profits of synthetically manufactured alternatives--big pharma loses again. Redressing this potentially disastrous state of affairs was simple---it was rendered illegal. I know this must sound like a scary tale, but it's true.
Here is an article that appeared in Saturday's Guardian that tells a different story of medical insurance in the US.
http://www.guardian.co.uk/international/st...2231351,00.html
The family of a California teenager plan to sue her health insurer which refused to pay for a liver transplant until hours before and she died on Thursday night.
Her family's lawyer, Mark Geragos, will ask the Los Angeles district attorney to press murder or manslaughter charges against Cigna HealthCare, arguing that the firm "maliciously killed" Nataline Sarkisyan by its reluctance to pay for her treatment. The company reversed its stance after protesters called for a rethink, but the decision came too late.
The 17-year-old from Glendale, California, had been in a coma for weeks after complications following a bone marrow transplant to counter leukaemia.
After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".
Cigna's rejection on December 11 led Sarkisyan's doctors at UCLA medical centre, including the head of its transplant unit, to write a letter to protest that the treatment which they proposed was neither experimental nor unproven. They called on the firm to urgently review its decision.
In the absence of a response from Cigna, doctors told the Sarkisyan family that the only alternative would be for the family to pay. But they could not afford the immediate down payment of $75,000 (£38,000).
The family, backed by nurses, relatives and Sarkisyan's friends, mounted a protest of 150 people outside Cigna's Glendale offices. "Cigna cannot decide who is going to live and who is going to die," the teenager's mother, Hilda Sarkisyan, told the crowd.
The demo was amplified by an internet campaign orchestrated by the liberal Daily Kos website and other blogs that bombarded Cigna's HQ in Philadephia. In the middle of the rally, a note was handed to Mrs Sarkisyan saying that Cigna had decided to reverse its decision.
"Cigna HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant," it said in a statement.
The news drew cheers from the crowd, but they quickly grew sombre when they heard Sarkisyan's condition had deteriorated. A few hours later, her life support was switched off.
"She passed away, and the insurance [company] is responsible for this," Mrs Sarkisyan told the Los Angeles Daily News.
"Why did it take public humiliation for a multibillion-dollar insurance company to force them to provide appropriate medical care?" asked Charles Idelson of the California Nurses Association.
"This is what's wrong with our health system - insurers decide treatment, not doctors."
The protests over Sarkisyan's case point to growing public disenchantment with the healthcare system in America.
Politicians vying to be the Democratic candidate for the presidential race next year have prepared plans for reform to bring the 47 million uninsured Americans into the healthcare net, and to improve terms for those already insured like Sarkisyan.
The subject was given an added boost this summer by Michael Moore's documentary on the state of the American health service, Sicko.
Moore refers to the case of Sarkisyan on his website, under the simple banner: "Justice delayed is justice denied."
Following the teenager's death, Cigna issued another statement yesterday.
"Their loss is immeasurable, and our thoughts and prayers are with them," it said. "We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."
The company recently posted figures for its third-quarter performance this year, which showed profits up 22%. Next year it expects to earn an income of up to $1.2bn.
http://www.guardian.co.uk/international/st...2231351,00.html
The family of a California teenager plan to sue her health insurer which refused to pay for a liver transplant until hours before and she died on Thursday night.
Her family's lawyer, Mark Geragos, will ask the Los Angeles district attorney to press murder or manslaughter charges against Cigna HealthCare, arguing that the firm "maliciously killed" Nataline Sarkisyan by its reluctance to pay for her treatment. The company reversed its stance after protesters called for a rethink, but the decision came too late.
The 17-year-old from Glendale, California, had been in a coma for weeks after complications following a bone marrow transplant to counter leukaemia.
After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".
Cigna's rejection on December 11 led Sarkisyan's doctors at UCLA medical centre, including the head of its transplant unit, to write a letter to protest that the treatment which they proposed was neither experimental nor unproven. They called on the firm to urgently review its decision.
In the absence of a response from Cigna, doctors told the Sarkisyan family that the only alternative would be for the family to pay. But they could not afford the immediate down payment of $75,000 (£38,000).
The family, backed by nurses, relatives and Sarkisyan's friends, mounted a protest of 150 people outside Cigna's Glendale offices. "Cigna cannot decide who is going to live and who is going to die," the teenager's mother, Hilda Sarkisyan, told the crowd.
The demo was amplified by an internet campaign orchestrated by the liberal Daily Kos website and other blogs that bombarded Cigna's HQ in Philadephia. In the middle of the rally, a note was handed to Mrs Sarkisyan saying that Cigna had decided to reverse its decision.
"Cigna HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant," it said in a statement.
The news drew cheers from the crowd, but they quickly grew sombre when they heard Sarkisyan's condition had deteriorated. A few hours later, her life support was switched off.
"She passed away, and the insurance [company] is responsible for this," Mrs Sarkisyan told the Los Angeles Daily News.
"Why did it take public humiliation for a multibillion-dollar insurance company to force them to provide appropriate medical care?" asked Charles Idelson of the California Nurses Association.
"This is what's wrong with our health system - insurers decide treatment, not doctors."
The protests over Sarkisyan's case point to growing public disenchantment with the healthcare system in America.
Politicians vying to be the Democratic candidate for the presidential race next year have prepared plans for reform to bring the 47 million uninsured Americans into the healthcare net, and to improve terms for those already insured like Sarkisyan.
The subject was given an added boost this summer by Michael Moore's documentary on the state of the American health service, Sicko.
Moore refers to the case of Sarkisyan on his website, under the simple banner: "Justice delayed is justice denied."
Following the teenager's death, Cigna issued another statement yesterday.
"Their loss is immeasurable, and our thoughts and prayers are with them," it said. "We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."
The company recently posted figures for its third-quarter performance this year, which showed profits up 22%. Next year it expects to earn an income of up to $1.2bn.
QUOTE(Mark Stapleton @ Dec 24 2007, 07:47 PM)
QUOTE(Craig Lamson @ Dec 24 2007, 03:36 PM)
QUOTE(John Simkin @ Dec 24 2007, 08:38 AM)
QUOTE(Craig Lamson @ Dec 23 2007, 01:38 PM)
As bad a job as the free market can do sometimes, I shudder to think of what our government will do if they run healthcare. They have a very poor track record.
Government systems are never perfect. However, as Pat Speer points out, somethings are too important to be left to the market: "we have socialized Fire Departments, socialized Police Departments, socialized garbage pick-up in most major cities...why not socialized health care? There is no reason whatsoever beyond one reason...GREED."
The problem with the market is that it is motivated by the profit motive. For example, fifteen years ago I hurt my back. I went to see the doctor who booked me in to see a consultant. The only trouble was that I had to wait a couple of weeks to see the back specialist. A friend suggested I went to see a chiropractor. There was no waiting list for him and I was invited over to his surgery straight away. Within a few minutes he had diagnosed my problem and spent twenty minutes manipulating my spine. It did not bring immediate relief. He argued that to solve my problem I would have to pay for a long course of expensive treatment. Although I could afford this treatment, I found it difficult to trust the man. After all, it was in his financial interest to promote this treatment.
I therefore decided to wait until I saw the back specialist in my local hospital. He also identified the problem. However, instead of prescribing a long course of treatment, he showed me some exercises I needed to do everyday to correct the problem. His diagnoses was correct and I still do those exercises every day. This example shows the problem with the private medical system. It is in the financial self-interest of the doctor to “over” treat the problem. The market cannot be trusted with medical care. It might be the best method for producing popcorn but health care is too important to be left to the capitalist system.
I don't think your really identified a difference between private or socialized medicine with your example but rather a difference in practice and treatment. I'll take the market any day, given that as long as I can pay I can choose who, when and where I can receive treatment. One only needs to look to Canada to see how the lack of competition due to the total socalized system reduces choice and service. You can get a cat-scan for your pet at will but try it for a human and you wait.
I would have no problem with a two-tiered system, as long as I could choose which system I prefered and did not have to pay for both. What I'm not interested in is single, government run system that locks in my choices.
Healthcare is far too important to be left in the hands of some governmental agency.
Craig, I think what John Simkin is saying , if I may be so bold, is that healthcare, which in some cases may be a life and death situation, requires at the very least strong regulatory control of the market. It can't be totally left to the market like popcorn because the lives and welfare of people are at stake. The market doesn't recognise this fact--it recognises the profit motive only. And by the way, some markets fail--with spectacular consequences.
The problem with government is that the corruption and inept actions run deep. We have a very good track record to examine in the US where Governmental control of heathcare is concerned...Medicare. Quite frankly government has made a huge mess of it. Thanks but no thanks. Governmental oversight fails sometimes with spectacular consequences. I'll take the market and freedom of choice anyday. BTW, I'm not arguing that our system is not without problems and in need of reforms. My argument is that I have less trust in government than I do in the market
As John and others have said, the massive profits involved in healthcare--primarily the pharmaceutical industry--have corrupted the healthcare system. Doctors are wined and dined by drug companies and kickbacks fly around like confetti. Personally, I doubt if regulatory bodies like the Food and Drug Administration are fully corrupted but I suspect that they are sometimes 'encouraged ' to drag their feet. I note the FDA last year granted permission for the drug known as Thalidomide to be used in limited cancer cases:
http://www.mayoclinic.com/health/thalidomide/HQ01507
This drug caused many cases of birth defects in the 1950's in children born to mothers who had used the drug as a treatment for morning sickness. It was banned in Australia with much controversy as the doctor who discovered the drug's role in the birth defects was an Australian, Phillip McBride. I read about this new revelation concerning Thalidomide and its potential cancer curing qualities at least five years ago. It starves cells of oxygen. So it kills cancer cells.
So why hasn't it been mass produced by the Government and rushed into service in treating terminal cancer patients, who have little to lose in taking the risk? Because 'big pharma' and its soldiers in the field would rather prescribe chemotherapy--costing the patient thousands of dollars--which has a low success rate and debilitating side effects. You'll get the wonder drug, but only when big pharma figures out a way to make a buck out of it. They're not keen to discard a juicy earner like chemo.
Whats wrong with profit? Its a good part of what pays for innovation. Given the poor track record of government, whats to say any new innovation will ever come without the motive of profit driving it? Second our government is not in the business of making drugs, nor should it be. As far as I know there is no active patent on Thalidomide. It can be produced as a generic by anyone who wants. It can be ordered by any doctor who wishes, and can be requested by any patient, so whats the problem here again? That the government is not making the drug? Sorry but that simply not their job nor should it be.
There is another wonder drug. Heroin. It's highly addictive but it's the most powerful pain killer ever discovered. It's used in British hospitals as we speak for a multitude of conditions. Unfortunately, Bayer's patent expired some years ago so it could potentially be mass produced generically--hence no profit for big pharma. And it would cut into the profits of synthetically manufactured alternatives--big pharma loses again. Redressing this potentially disastrous state of affairs was simple---it was rendered illegal. I know this must sound like a scary tale, but it's true.
I don't know anything about Heroin but I do know about morphine. It IS a generic drug, and is priced as such. Why use Heroin? Morphine works and works well. How do I know? I spent a bit of time using it. If the British wish to use it, hey great for them.
QUOTE(John Simkin @ Dec 24 2007, 07:51 PM)
Here is an article that appeared in Saturday's Guardian that tells a different story of medical insurance in the US.
http://www.guardian.co.uk/international/st...2231351,00.html
http://www.guardian.co.uk/international/st...2231351,00.html
Yea I read that the other day. But you and I both know we can play match this link for days with similar stories from both sides of the pond and with both systems of health care delivery.
I'm not really comfortable going down this road right now considering your current personal situation.
QUOTE(Craig Lamson @ Dec 24 2007, 08:32 PM)
I don't know anything about Heroin but I do know about morphine. It IS a generic drug, and is priced as such. Why use Heroin? Morphine works and works well. How do I know? I spent a bit of time using it. If the British wish to use it, hey great for them.
Why use heroin?
Did you say 'why use heroin'?
Because it's more effective than morphine by many orders of magnitude (6, I think).
So what are you saying? Morphine should be legal and heroin illegal? Why? Where's the logic in that?
QUOTE(Craig Lamson @ Dec 24 2007, 08:32 PM)
The problem with government is that the corruption and inept actions run deep. We have a very good track record to examine in the US where Governmental control of heathcare is concerned...Medicare. Quite frankly government has made a huge mess of it. Thanks but no thanks. Governmental oversight fails sometimes with spectacular consequences. I'll take the market and freedom of choice anyday. BTW, I'm not arguing that our system is not without problems and in need of reforms. My argument is that I have less trust in government than I do in the market
It sounds like you're worried about Government waste and mismanagement. If so, look at the US Government Defence Budget. Those dopey wars.
There's corruption in Governments but there's also corruption in the marketplace, as demonstrated by big pharma. It comes down to how highly you value the provision of health services. The Government ostensibly answers to the people but the private sector owes nothing to the public. Which one do you want to trust if things get tough?
QUOTE(Mark Stapleton @ Dec 24 2007, 10:33 PM)
QUOTE(Craig Lamson @ Dec 24 2007, 08:32 PM)
The problem with government is that the corruption and inept actions run deep. We have a very good track record to examine in the US where Governmental control of heathcare is concerned...Medicare. Quite frankly government has made a huge mess of it. Thanks but no thanks. Governmental oversight fails sometimes with spectacular consequences. I'll take the market and freedom of choice anyday. BTW, I'm not arguing that our system is not without problems and in need of reforms. My argument is that I have less trust in government than I do in the market
It sounds like you're worried about Government waste and mismanagement. If so, look at the US Government Defence Budget. Those dopey wars.
There's corruption in Governments but there's also corruption in the marketplace, as demonstrated by big pharma. It comes down to how highly you value the provision of health services. The Government ostensibly answers to the people but the private sector owes nothing to the public. Which one do you want to trust if things get tough?
Actually the Defence Department is one of the few things that are really tasked to the US government and actually make sense.
I don't really trust either one, but I've seen far better results from the market than the government. Actually the private sector answers more to the public than the government. The government takes our money at the point of a gun while the private sector needs to earn it.
QUOTE(Mark Stapleton @ Dec 24 2007, 10:05 PM)
QUOTE(Craig Lamson @ Dec 24 2007, 08:32 PM)
I don't know anything about Heroin but I do know about morphine. It IS a generic drug, and is priced as such. Why use Heroin? Morphine works and works well. How do I know? I spent a bit of time using it. If the British wish to use it, hey great for them.
Why use heroin?
Did you say 'why use heroin'?
Because it's more effective than morphine by many orders of magnitude (6, I think).
So what are you saying? Morphine should be legal and heroin illegal? Why? Where's the logic in that?
I found morphine to be quite effective and I should know considering they gutted me like a fish.
Like I said I know little about heroin and why it was banned, nor do I really care. But an expired patent many many years ago is hardly the reason it is illegal in the US today.
My personal experience with health care in the US:
I have none. And no, it's not because I choose to spend money on other things. I have a college education but cannot find a full-time job, so I must work part-time. And no part-time jobs (at least around here) give health insurance benefits. Or any kind of benefits, actually. Like many other people in my situation, I have to work multiple part-time jobs to pay the bills (student loans, rent, car insurance, etc.) and have no money left over to pay a health insurance premium. My employer does not provide insurance for anyone but full-time employees, so I'm out of luck.
If something were to happen to me, I imagine I'd have to file for bankruptcy. Not something I really want to consider
I have none. And no, it's not because I choose to spend money on other things. I have a college education but cannot find a full-time job, so I must work part-time. And no part-time jobs (at least around here) give health insurance benefits. Or any kind of benefits, actually. Like many other people in my situation, I have to work multiple part-time jobs to pay the bills (student loans, rent, car insurance, etc.) and have no money left over to pay a health insurance premium. My employer does not provide insurance for anyone but full-time employees, so I'm out of luck.
If something were to happen to me, I imagine I'd have to file for bankruptcy. Not something I really want to consider