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Larry Gellman

Larry Gellman

Posted: November 23, 2010 05:48 PM

A few weeks ago, our dog Kiva was bitten on the nose by a baby rattlesnake. Kristen was walking him on a bike path near our home in Tucson and Kiva pounced on a bush, hoping to feast on a lizard but got much more than he bargained for.

She took him to our vet whose office was fortunately just a few blocks away and she was told that the situation was serious. Kiva needed at least one vial of antivenim serum ($900 a vial) along with numerous blood tests, IVs, and other treatments if everything went well. Within an hour, Kiva's head looked like a pinata after a wild party but he was lucky and made a full recovery in just a few days.

But this is not an article about my wonderful dog or our good fortune. It is about the epiphany I experienced during the 24 hours that he was in the doggie hospital.

Actually, it is about the check-in process. Before the hospital would agree to accept Kiva as a patient, we had to go into a special room to make financial arrangements. We were told that his treatment would cost between $2,500 and $4,000 and that they wouldn't admit him unless and until we gave them a credit card up front and let them charge us up front for $2,400 -- 60 percent of the high estimate. If we didn't have the cash, we could take Kiva home and take our chances.


They then told us that unless we signed an agreement to pay them an additional $600 (minimum) up front, they would take no action to resuscitate him if he suffered a heart attack or some other crisis in the middle of the night.

We agreed to their terms and, happily we picked up our very valuable canine son the next day -- well on his way to a full recovery. The treatment was a complete success. Everyone at the doggie hospital was delightful and responsive to our calls and treated Kiva and us wonderfully.

But it got me thinking.

Our dog is alive today because we had $4,000 that we were willing and able to pay to keep him alive. I'm pretty sure that he received a higher level of care than the vast majority of humans in the world and most in our own country.

In the U.S., no hospital would turn away or refuse to treat an accident victim or someone whose life was in imminent danger. But follow up care, treatments for life-threatening conditions, and cutting-edge surgeries are often only available for those who are willing or able to pay up front.

As a type-1 diabetic with a fake hip, no thyroid, and spots on his lung, I am not unfamiliar with doctors' offices. In recent years, the biggest change in their decor are the many signs prominently announcing the types of insurance that are not accepted and other declarations that the physicians understandably want to make sure that they will get paid before treatment is dispensed.

Let's be honest. About health care.

We live in a country where we pay several times what residents of other nations pay for health care and by any objective measure our outcomes are much worse. There are still more than 35 million Americans who lack any insurance coverage at all and where those of us who are insured have been paying more and more each years for less coverage, higher deductibles, and co-pays that have gone through the roof.

As a candidate for president, Barack Obama accurately identified health care reform as a top priority and most Americans agreed with him. After dozens of incarnations and versions (each of which was labeled "Obamacare" by his political enemies), an inadequate but important first step was passed and signed into law this year.

The response of the Republican leadership and and their media promoters has been to convince Americans that this undefined Obamacare has made us worse off today than we were a couple of years ago. That we are being charged much more (we aren't) for coverage that will somehow be worse (it won't) -- even though most of the provisions of the bill haven't even kicked in yet and really haven't been set in stone anyway.

They have convinced millions of Americans that we are being bankrupted by a health care system that caters to dark-skinned people who pay nothing and get everything for free -- Mexican immigrants and black welfare freeloaders -- at the expense of the rest of us.

But let's be honest.

All those people really get is the assurance that if they walk into an emergency room bleeding to death or with some other pressing ailment that they will be treated whether they have insurance or not.

Beyond that, tens of millions of Americans who are too young for Medicare deal with the health care system in the same way that Kristen and I dealt with Kiva's vets. If you have a long-term chronic condition or symptoms of something seems like it might be serious, you'd better be covered by insurance that your doctor accepts (an ever shrinking list) or come up with a whole bunch of cash up front. Otherwise they face the choice that we did with our dog. Find the money or go home and hope you don't die.

All of the fact-free ranting about Obamacare has mainly succeeded in distracting Americans and keeping many of us from coming to grips with what a total disaster our current health care system has become. A comparison with Canada (which has socialized medicine) shows that we spend about 60 percent more per capita on health care than they do. And yet, our infant mortality rates and life expectancy is far worse than theirs.


Washington Post columnist Richard Cohen cites a CIA study that shows the U.S. ranking first in the world in health care costs and 49th in life expectancy and 47th in infant mortality. His piece on the subject is well worth reading.

On top of that, about half of all personal bankruptcies in the U.S. -- millions a year -- are due to health care costs. People who don't have the money choose to spend it anyway to save their loved ones or themselves. Who do they think they are?

To make matters worse, most of them have financed those life-saving treatments by maxing out multiple credit cards which has only hastened their slide into bankruptcy.

Meanwhile, in Canada there are zero bankruptcies due to health care costs.

Reasonable people can disagree about how to best fix our broken system. But right now, Republicans seem to be only focused on undoing Obama's efforts to make things better -- and undoing Obama altogether.

Let's be honest.

Our health care system is one of many things that are driving us broke -- not because of freeloaders or illegals or whatever your definition of Obamacare might be. It's because the rest of us are living much longer than we were supposed to. The whole system was financially based on the assumption that we would work until we were 65 or so and live a few years after that before succumbing to old age and/or diseases. Today, many of the members of my golf club are over 80 and some of them can beat me scratch. We all have relatives who are in their 90s and are doing just fine.

They paid in a little and are taking out five and ten and twenty times as much in benefits. Many of them are retired and been net takers for almost as long as they worked and paid into the system. A bipartisan committee has just recommended that benefits to retirees be cut significantly in the future as part of our effort to get out of debt but polls show that most of us and our elected officials just don't want to go that route.

We'd apparently rather get angry and outraged at blacks and Mexicans and single mothers and poor people. And, of course, Obama.

I tried to explain this all to Kiva but he just licked my face and begged for a treat. I'm not giving him anything until he learns to bark at Glenn Beck.

 
A few weeks ago, our dog Kiva was bitten on the nose by a baby rattlesnake. Kristen was walking him on a bike path near our home in Tucson and Kiva pounced on a bush, hoping to feast on a lizard but g...
A few weeks ago, our dog Kiva was bitten on the nose by a baby rattlesnake. Kristen was walking him on a bike path near our home in Tucson and Kiva pounced on a bush, hoping to feast on a lizard but g...
 
 
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01:29 PM on 11/28/2010
Why? Why would honesty have ANY PLACE in the health care debate. We see every day on Fox News that the most OUTRAGED/ANGRY people about the health care bill have never even read it...and they are PISSED OFF about issues not even found in the bill

Being angry, annoyed, etc...is what the GOP wants because it makes them feel better
07:54 AM on 11/25/2010
That was very close to being blackmail when they forced you to pay (too much) before they would touch your dog. The charges were legal, but they had you over a barrel.

Our health care system is a lot like blackmail too, especially health insurance.

I have to disagree about people living longer. It is mostly only the higher earners who are living longer. The average worker is only living about 2.5 years longer. The government adjusted Social Security for that age increase in 1983 by changing full retirement age to 67 from 65. The higher earner lives 6.5 years longer and draws the highest benefits. The average worker should not have to pay in more, but the higher earners should pay more without an increase in benefits. Raise the cap until it takes care of them and let them pay it.

Also you have to figure the buying power of the dollar when figuring if people are drawing more than they paid in. That is why we adjust for inflation.

Don't forget the employer matches what workers pay into FICA for Social Security and Medicare, too. Also when there is a surplus there is interest earned on that.
08:27 PM on 11/24/2010
It is actually an arguments. As for me, whatever the proposal would be as long as the people will benefit on it, I will give my full support.

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Dental Implants in Orange County
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The Lone Stranger
Yes, I am a lousy typist. OK!
01:02 PM on 11/24/2010
90% of the population of Canada live within 200 miles of the US Border, and our lifestyles are very similar. Canadians live an average of eight years longer than we Americans. And it is not accidental that their healthcare is cheaper and more effective.

The number one issue causing our system problems is that we have to pay not just for healthcare, but for a useless bloated bureacracy known as private health insurance that operationally has entrenched, systemic goals diametrically opposed to the public it ought to serve. Two basic things can be done to increase profitability for private health insurers: they can over charge their customers and they can withhold funds needed for treatment. In many cases, it is more profitable to let the patient die and given the choice, insurers are more than happy to work towards this end.

If we paid the same exact amount we pay now for healthcare we could have universal single payer healthcare for all americans and no families would ever go bankrupt here ever again over medical bills, but this would mean the end of private insurance as the main delivery mechanism. Other nations have made the switch and now live longer than we do. Why can't we do likewise?

Since Obama has failed to resolve this issue, choosing instead to enact so-called reforms that indeed make the problem worse, the best route to reform may be class action lawsuits that seek to dismantle private for profit health insurance.
08:05 AM on 11/25/2010
I pay more for Medicap insurance than I do for the original Medicare. The Medicap insurance pays what Medicare approves of but doesn't pay. They say Medicare pays 80% of what they approve of. Then the Medicap pays the other 20% of what Medicare approves of.

There were changes made to the medicap insurances for 2011 and they don't help pay for home health care and most don't cover what they did before. If people already have a supplemental medicap policy it may not be changed, but I am not sure. People could check with Medicare to find out.

The elderly aren't any sicker than they were but the costs are a lot higher for health care and insurance.
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Salukeitis
08:18 AM on 11/25/2010
With Obamacare we're all going to pay more. The Private Healtj Ins COs are in charge, and you know what they will do. If the POTUS doesn't FIGHT for single payer in the next two years all is lost. I find O's behavior very peculiar as of late. Say nice things to the Repubs and Business. No Progressive leanings at all, Steer the ship to the right and the big boys will be happy. They'll never say that though.
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Selina Spence
12:55 PM on 11/24/2010
My last job was taking mail order pharmacy drug orders and helping professionals to get drug claims to process. Medicare itself is much worse than you think because of the coverage gap. Nobody understands it. I do simply because I am 39 and have been the chosen one to help relatives with medical insurance issues of any sort so I am self educated about this whole mess. Most people on medicare have no concept that unless they stay UNDER a certain amount of drug spend per year they are going to have to pay for medications out of their own pocket until they have paid enough to qualify for catastrophic coverage and then they usually pay 5 or 10 percent on a drug depending on the plan. I not only had to educate everyone (including professional healthcare providers) that I spoke to on the phone about how medicare was set up, I had to educate every single person I worked with including the operations manager. Even medicare doesn't work well for anyone that doesn't understand our system of medical insurance. Most people including professionals also don't know that medicare claims must be filed electronically within 60 days or by paper within 30 days so many healthcare providers who don't understand and prioritize medicare claims for ANYTHING don't get it filed in time, don't get paid, and then decide to not take medicare. Most private health plans accept claims for up to a year. I worked getting claims filed for both.
12:40 PM on 11/24/2010
"Let's Be Honest -- About Health Care Reform"

Okay. How do we rewind the clock and get the Democrats to be open and honest about what was in HCR?
12:22 PM on 11/24/2010
Unfortunately, I think your dog is more likely to understand all this then the average conservative. Arguments for socialized medicine just make so much irrefutable sense, and the evidence for its superiority to our system is so decisive, that the only explanation for why a bigger majority of Americans don't support it is that ideology is preventing them from acknowledging the facts. For some reason, they would rather let their countrymen and women suffer sickness and death than change their worldview. How patriotic!
08:17 AM on 11/25/2010
They try to say that people use their insurance when it isn't necessary. Some in the government and some of the insurance companies want to raise co-pays and deductibles to $5,000. They would have a happy profitable time if that happens. It probably will make most of people quit seeing a doctor except during an emergency. A thousand dollar deductible is a lot of money and will discourage most people from going to the doctor when they don't need to.

Most people even like going to the doctor. There is no way to shop costs either.
12:17 PM on 11/24/2010
I'm guessing that part of the huge cost in the US is that the doctors and hospitals have to submit an incredible amount of paperwork to the insurance companies which results in huge admin costs. Why can't the individuals submit their own paperwork?
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shryock
It never is what it is anymore
12:48 PM on 11/24/2010
individuals could, but it would not reduce the paperwork doctors and hospitals have to do.
if you are an individual, the doctor must produce some kind of paper for you to submit to your insurance company, so where is the savings?
insurance submissions from doctors and hospitals are computerized now, and the doctor or hospital does not have to produce paper copies. they click a button and the insurance company is billed. you, as an individual, do not have access to that computer network to submit your own bills.
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MJinCanada
Safe from zombies until my 2nd cup of coffee
01:34 PM on 11/24/2010
In Canada, 3 people and an answering service can cover reception and billing submission paperwork for a practice of 5 to 7 doctors. All citizens are pre-approved for a long list of treatments and tests, so billing the government is mostly quick and routine.
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Selina Spence
01:02 PM on 11/24/2010
I an assuming you don't live in the US. I will tell you why not. Let's start with Medicare and Medicaid. You must file a paper claim within 30 days to expect the claim to be paid. If the provider files electronically, they have 60 days and don't have to submit as much paperwork to justify the claim. Now, covering all types of insurance in the US, if you file a claim yourself you must fill out a form and submit proof that you needed the care and received it form a participating provider. This means that you must know medical billing and I went to school for it. Trust me, it is complicated enough that when people finish school for learning medical billing, they specify in ONE type of billing such as cardiac, orthopedic, or a general practiconer. Seriously, we live in a country where insurance companies have DENIED claims for lifesaving ER visits because the ER was not in network. If you are filing your own insurance claim you might as well assume the claim will not get paid.
12:17 PM on 11/24/2010
Larry Gellman is right. Life expectancy is higher and infant mortality is lower in Canada. We pay higher sales and individual income tax, but I would rather pay higher rates knowing that basic health care is available to all. We pay out-of-pocket or have private insurance for therapies, prescriptions, eyecare, dental care, private hospital rooms; doctor's visits, pre-natal care, hospital stays and surgeries are covered. For those who believe the negative ads regarding Canada's health care system, I can attest that this is not the norm, but the exception. I nor my family have ever had to wait for surgeries (we have had a few), to wait an excessive time for appointments with specialists and we choose our own doctors. We submit our own receipts to our insurance companies and don't worry about being rejected or dropped. The issues with our health care system is related to inefficiencies that need to be addressed and mis-management. Each province is responsible for budgeting and supporting the health care system; revenues from sales tax fund it, so the employed, unemployed, rich or poor pay into it. Why can't each state increase sales tax by 1 or 2 percentage points and use the increase in revenue to pay for basic health care for all, at the very minimum doctor visits, obstetrician visits and emergency room visits? You might have fewer people walking around with illnesses that can be passed on and the infant mortality rate might improve.
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TheIndependenceParty
Cranky yankee and a rehabilitated ex-Republican
11:59 AM on 11/24/2010
Our demographics are scarcely different from almost any industrialized nation, ... that is, the average length of life is increasing there as here.

What causes American Healthcare to cost so much is the "Middle Man" Insurance companies, their high administrative expenses and marketing costs. In addition, because people are not turned away, the costs for caring for the uninsured get shifted to those who have insurance and can pay.

HCR did very little to reform costs, and only a part of what needed fixing in access to healthcare. For all the whining on the Right, ... HCR was mainly a huge boon to the Insurance companies.
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GunnyJ
I do my best every time.
10:37 AM on 11/24/2010
In my state/city I read an article yesterday that a 37 yera old woman with HMO was denied several times a liver transplant and died from liver failure. This was with insurance!

Let me start by saying I'm a Democrat. Had the Democratic senate majority given the President the votes for the PO, much of our anger and frustration would be mute. We blast the President when we probably should have identified and pressured as a concerned nation the Democratic senators who refused to vote for the PO. As hindsight is always 20/20, I hope we all learned from this experience. The failure to gain the PO was not an Obama problem, not a will it work problem, not a funding problem, it was a Democratic Party problem! Bottom Line.
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ArtVandelayGA
10:57 AM on 11/24/2010
The failure to gain the PO absolutely was an Obama problem because he signaled early on in the process that he was willing to drop it in order to get something -- anything -- passed. The fact of the matter is that the Obama administration, for whatever reason, chose to negotiate with itself and make compromises before the Republicans even came to the table. He knew (or SHOULD HAVE known) that no matter what the bill ended up looking like, he'd get no Republican votes (which is exactly what happened), yet he continued to give in to pressure from the right anyway. The net result is a bill that falls well short of what is needed; to absolve Obama of blame for that is to simply turn a blind eye to his failure to understand his opponents.

Had Obama and the Democrats had the courage to stand up for what he campaigned on (e.g. a public option and a healthcare plan that truly covered everyone instead of being a handout to the insurance industry), they would have likely kept their majority in the House and maintained a healthy majority in the Senate. Instead, they've been neutered by their own hesitance and uncertainty, and have come dangerously close to losing their progressive base as well.
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GunnyJ
I do my best every time.
11:28 AM on 11/24/2010
1. Obama didn't campaign on the PO.
2. He found out early on from Nelson, Lincoln and Landrieu to name a few that their votes would not be cast for the PO.
3. He formed the best strategy he could as he allowed congress to try as he should to make something happen like he did.
Is this the best plan? Hell no! But it is a start and we never had a start before...
12:21 PM on 11/24/2010
GunnyJ stole my thoughts, .. I'll reiterate them.

Blanche Lincoln, Ben Nelson and Lieberman (among others) are the reason the PO didn't pass, not Obama. And because he signaled early on that he was willing to negotiate bears no correlation to the failure to gain the PO, .. using your words.

Obama's failure to understand his opponents?? Health care is a difficult issue, and has been before Obama was born. Many other Presidents tried but couldn't. The difficulty of the problems is not a character defect of weakness in our President. The simple fact is that there were not 60 votes for the PO, nor could 60 votes be garnered in the particular climate we found ourselves in.

Stop blaming Obama and drill down into the facts and details. He's only human, he makes mistakes like us all, yet he is considerate, thoughtful, courageous and pragmatic. Attempts to paint him otherwise will come out in the wash of history.
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BBackSoon
Hello, I must be going.
10:22 AM on 11/24/2010
The name of your article must be some kind of a joke. There is one side that is willing to be honest, and another side that will do anything and everythign to muddy the waters.

You get that side to settle down, I say we give you some kind of a peace prize.
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jmpurser
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10:54 AM on 11/24/2010
Tragically, the side that is willing to be honest doesn't have a political party to represent them just now...
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The Lone Stranger
Yes, I am a lousy typist. OK!
01:15 PM on 11/24/2010
"I belong to no organized party. I am a Democrat." - Will Rogers
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jmpurser
See My micro-bio
09:53 AM on 11/24/2010
Sigh.

"Let's be honest!"

Okay, good place to start.

"...an inadequate but important first step was passed and signed into law this year."

And so much for being honest.  The health insurance regulatory tweak and industry welfare act was NOT an "important first step" in health care reform.  It not only didn't TRY to fix ANYTHING about our current system it actually REQUIRES citizens to prop up the system that is killing and bankrupting them both by directly buying the insurance industry product AND by having their tax dollars ($100,000,000,000 a YEAR) go to pad the bottom line of the insurance industry.  Hardly either a first or important step.  Just another step down the road to selling Americans wholesale to corporate interests.

"Reasonable people can disagree about how to best fix our broken system."

Perhaps.  But so far I have not seen "reasonable people" disagreeing over how BEST to FIX our broken system.  I see reasonable people agreeing on a rather narrow range of obvious solutions and then I see 99% of the noise which is how to best prop up our current failed system at the expense of ANYTHING except corporate profits.

IMHO we're so broken as a nation we can't even begin to fix what's wrong with us.  Health care is a good example of that. 

Glad your dog made it.
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The Lone Stranger
Yes, I am a lousy typist. OK!
01:16 PM on 11/24/2010
Republicans would blame the dog for being lazy and making someone else pay.
09:49 AM on 11/24/2010
As long as there is a profit motive involved in the delivery of health care, costs will continue to rise and quality of care will continue to fall.
The rest of the industrialized world figured this out a long time ago.
Ask the Conservative government in Britain if they would like to turn the National Health Service over to private hands. Hell no. They know it works.
09:30 AM on 11/24/2010
If the members of your golf club are living 10 and 20 times a typical human life span that would explain why they would they would draw a like share of benefits. But they're not and it doesn't. An ASSERTED decimal-fraction increase in the average life span on individuals born NOW does not apply to you or me. And actuaries didn't leave for a long lunch after tossing off an initial assumption a century ago. Furthermore, the increases in average life span are largely the result of improved child mortality rates--not because you or I are necessarily doomed to a longer life. The "increase" is statistical. We're not living longer so much as more of us are living--period.

Cost--wildly and eternally escalating cost outside any frame of reference recognizing its necessity--is the only arithmetic that can explain or address the phenomenon.

If people dying from want in the land of the plenty is the problem, I personally would be disinclined to see increasing that number as a solution. On the other hand, for instance, if drug makers were limited in this country to the percentage of profit that is sufficient for their prosperity elsewhere in the industrialized world, we would all come much closer to being able to afford that extra .x year in the nursing home.
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10:40 AM on 11/24/2010
While it is true that much of the increase of life expectancy at birth has resulted from the decline in infant mortality, remaining life expectancy for older Americans has also increased. According to the Centers for Disease Control, in 1966 the average life expectancy of a 65 year old American was 14.6 years; in 1999, 17.7 years; and in 2006, 18.5 years. So older Americans are living 26.7% longer than they did 40 years ago.
http://www.cdc.gov/nchs/products/life_tables.htm