Thursday, August 27, 2009

How Our Current Health Insurance System Denies Us Coverage

Susie Madrak, who has been trying to get her broken ankle fixed for two years after she lost her journalism job in Philadelphia. She now has the hugely expensive Cobra Insurance due to expire which President Obama has included a provision to cut this cost to two-thirds and provide a cost savings government option instead of having to pay the salary of bonuses of greedy healthcare executives.

United Heath Insurance, now called United Health Group has bought the Lewin Group so they could have "official" studies done showing the non-viability of changing the healthcare system which the Republicans have gleefully quoted to us over and over again. I have noticed that the Republican politicians quote the Lewin group word for word to get the words that the propagandist want them to say. They can do this because these fanatics has purged the Republican Party of all non-believers or compromisers in the primaries where only a few voters go to the polls.

AARP has the contradictory role of trying to "balance" pushing for United Health Insurance for seniors and supporting healthcare reform which, I think, often slips into supporting their real income source of insurance companies!

Everyone knows someone in their family who either died of cancer, diabetes, or heart disease [Fast Food] which I believe are caused in part by weak regulations of chemical and pollution and death food exposures and by our brutal economic system which rewards the aggressive and heartless corporate executives who do all that is possible to increase profits each quarter and each year to increase their stocks and options worth which healthcare insurance executives and doctors exploit for their own profit. We are all human and adjust to a system to do what is needed to survive in such a system at great personal cost to themselves and their families along with superficial rewards.

During my ten years in and out of hospitals, they made at least two serious medical errors on me and almost gave me a medication which could have killed me. They did not have time to look at my medical records! At least 200,000 patients die each year from medical and medication mistakes. Another 100,000 die taking medications in hospitals as directed.

In contrast, the Veterans Hospitals set up by the Clintons with computerization and a model similar to the Mayo and Cleveland Clinic known for their superb medical care at reasonable costs provided healthcare so superb that they were often compared favorably with the Mayo Clinic. Infections, wrong drugs, and errors by doctors is virtually absent compared to what we normally encounter elsewhere. My accountant got infected at a famous Philadelphia hospital when he went for a heart valve replacement. He was still sick and tired more than a year after the operation. I guess the infection never really went away.

Because of the Healthcare industry's concern for making profits by limiting the number of doctors, and consolidating hospitals by corporate takeovers, we are not in good shape if a mutation occurs in the Swine Flu while in Asia where pigs and people are in intimate contact. Pigs incubate the virus and can get infected with Bird Flu, Swine Flu, and Human Flu and transfer RNA segments with abandon. One of the most serious potential problem with the current swine flu virus is that it attaches itself deeply in the lungs and needs to acquire only the cell death RNA which was present in the 1918 and the 1957 Swine Flu pandemic to kill lots of Americans which attacked and killed the young as I have repeatedly mentioned.

The current Bird Flu virus did not become a pandemic because it does not have the ability to get deep into the lungs because it did not have the ability to attach to humans easily. In Indonesia Bird Flu passed easily among family members because they had receptors in their throat area that Bird Flu could attach to and reproduce using human DNA because they lack the DNA which is needed to reproduce.

I think the experts have reached the wrong conclusion that the current Swine Flu is not more infectious than the ordinary flu virus. It is simple commons sense that if a Flu is infectious when other flu virus is not, it must be more infectious. It makes sense because we all have less resistance to it except possibly for seniors over 65 who may have been exposed to the 1957 Swine Flu pandemic.

I also need to look at their conclusion that immune compromised people such as myself is more susceptible to serious illness. A pregnant women becomes immune compromised so she would not reject the fetus which is different than her genetic makeup. Why very little reports about the widespread deaths of HIV infected people. Do the drugs they are taking make them normal? Sure the numbers indicate that pregnant die more often than others who are infected, but I believe the numbers are small so their conclusions may be statistically wrong.

Jim Kawakami, August 27, 2009,

How Our Current Health Insurance System Denies Us Coverage

... Oh no, Democratic Congress! No, President Obama! Please don't throw me in that briar patch of evil socialized medicine!

I might die of happiness. ...

Madrak: Today I had an appointment with the surgeon who I expected to do the surgery on my ankle. I presented him with the second opinion from one of his colleagues, and he agreed with it.

"Yes, you really do need this surgery," he said. "But you need someone who can do an arthroscopic exam for bone fragments and a ligament reconstruction at the same time, and I can't do that. There's only a handful of people
who do."

Is there any reason why I couldn’t have those surgeries separately? I asked.

Well, no, he said. But it really didn’t make sense to separate them and the insurance company would probably dispute it. The thing is, he knows the other orthopedic group with whom I have the appointment - one of the best in the city, he hastened to add - and he knows they have a lot of restrictions about what insurance they’ll take. He said they probably wouldn’t accept the open car insurance claim in payment.

At this point, I was almost in tears. “What are my options?” I said.

There’s this one guy over at Jefferson who does both, and he might take the insurance, he said. “And there’s another guy up in Princeton, but that’s it as far as I know.” (And by way of passing, told me he had a patient that week from 100 miles away who drove to his office with a badly broken arm because he couldn't get anyone closer to accept his Medicaid.)

So I came home and called the doctor at Jefferson. The office assistant informed me they’re no longing accepting New Jersey car insurance cases. “No, no, my health insurance is Jersey. My car insurance is Pennsylvania,” I said, desperate to get a break.

Finally, I got one. The office assistant took all my information and said she had to verify my coverage and the open claim. I told her I was on COBRA, running out of money and really needed to get this surgery done ASAP.

She said she would try to help me. She called back in five minutes and now I have an actual appointment - in three weeks. (I still have another appointment I made two months ago for the week after this new one, but that's with the guy who won't take my car insurance.)

Let's recap, boys and girls. Keeping in mind the slogans of health care reform opponents (waiting lists, not getting to choose your doctor, not getting the tests you need, etc.), of course:

1) The original injury? Almost two years ago.

2) Because the original claim went through my car insurance as required by law, my health insurance company had no record of the three months of physical therapy. Because they had no record, they would not authorize the MRI until I went through physical therapy. It took me months to straighten that out.

3) Finally get an MRI authorized a year later. Former employer changes his health insurance plan (because the premiums are too high), which affects my COBRA. MRI authorization is no longer valid. Return to "Go," start over.

4) By this time, developing painful cysts in the back of my knee from hobbling everywhere. Doctor advises me to ignore it "because it wasn't in your original accident report and the insurance companies might get confused and deny payment." ...

There are five medical schools in Philadelphia and at least two of the teaching hospitals are in the nation's Top 10. I can't even count how many hospitals we have - 20 or more. Out of all those experts, four doctors perform this reasonably common procedure - and it sounds like it's for insurance reasons.

Now, picture this whole thing with single payer. You get hurt, you go get treated. They send you where you need to go - and there are no worries about whether or not they take your insurance. They order the MRI when you need it, and they locate the right specialist to do the surgery. They send someone to check you at home after the surgery, and they cover the physical therapy - without a copay. ...

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