One More Stinkin' Example of Why We Need Universal Healthcare

Yes, I know that national health programs have their drawbacks (a Canadian reader wrote me with a bunch of horror stories just this week) but removing the profit motive should take care of many of the problems we have now:

Eric Simpson was strangely calm when the insurance company called last week, saying it was sending a man for his right arm.

The woman on the phone told him he should have known he had only $2,000 of coverage through Aetna for artificial limbs. And the arm, which he'd just received that week, cost more like $37,000.

But, he protested, he'd been preapproved.

Angelo Russello had the job of taking Simpson's arm. He works for Allied Orthotics & Prosthetics in Northeast Philadelphia.

All week he'd been visiting Simpson at Moss Rehab in Elkins Park, fitting the device, teaching the 32-year-old Germantown man how to flex his muscles to move the thumb and fingers.

"I felt like a fool," says Russello. "I've got to tell you, this has never happened before."

Simpson read his face and said, "Just take it."

And yet, in that odd way that often happens when major media calls an insurance company, it was all a big mistake!

"A miscommunication," Aetna spokesman Walt Cherniak said yesterday.

Aetna officials had mistakenly considered his new arm medical equipment rather than a prosthetic, which is covered in full. They called Simpson to apologize.

And the next day, Friday, Russello returned the arm.

"Honestly, I didn't think it would be back so soon," Simpson said Tuesday in his room. The new arm will make it easier to dress himself, to support his weight, as he tries to recover from his spinal injury. Doctors give him hope he'll walk again.

As we spoke, it was hard not to hear the man in the next bed talking with a rehab specialist.

"The wife just gave me the bad news," he said. "The insurance company just called and said we don't have approval for the procedure."

Sounds like it's going around.

Comments

[antirepublocrat]

My 18 year old daughter received a mailing from Aetna offering her medical "insurance" in partnership with her employer, a small retailer.

The "insurance" would have cost about $20/week. However, the maximum yearly benefit for hospitalization was only $5000 and the maximum yearly benefit for surgical/diagnostic procedures was far less than that, $600 if I remember correctly.

This company is clearly preying upon the naive and inexperienced. Most teenagers being offered "insurance" supposedly through their employer are going to ASSUME the coverage is adequate.

Add to the above the concept of mandates and I think you can see where we're headed. With Massachusetts style mandates, if the employer offers medical "insurance" it must be accepted or the employee is penalized on their taxes, and because "insurance" is available through the employer, the employee may be ineligible for state-provided insurance.

Prepare to be fleeced yet again.

[dbredes]

Okay so we just bought healthcare for my husband and I in October. $340.00 a month 8,000 deductible but it does pay for 6 doctors visits a year with 20% copay that's not included in the deductible. Great!

November we get a notice - price jump to $440.00

OKay

My husband goes to the foot doctor because his feet have been bothering him..Doctor suggests inserts that you can buy at GI Joe..a local store.

Insurance refuses doctor visit because my husband has had his feet for 54 years...they are pre-existing feet


So it would appear that we have secured health insurance on any NEW body parts that we can grow.

Wonderful

Money...money...money...money...Insurance companies...and their stockholders profiting on peoples lives.

[FarmworkerLawyer]

The 'horror stories' that are referred to in the first line from Canadians no doubt come from the leadership of the Conservative Party, their equivalent of the Republicans. When you talk to Canadians, and I do so routinely, they wouldn't trade their system for ours on anyday of the week. The 'horror stories' are concocted of misinformation, disingenuiness and outright fabrication by the insurance industry.

[Kungfublood]

Why you ungrateful sheep! How dare you voice a concern for the saints at our god like righteous empire I mean institution. Just for that all of you will be getting rate hikes in the next 6 months!

[QueenMaedb]

Aetna sucks. I have to watch them like a hawk! I always send my claims in with a return receipt, and STILL they say they never got them!

Single payer. The sooner, the better.

[MJCole]

With respect to: "a Canadian reader wrote me with a bunch of horror stories just this week", I'm a Canadian, and I have seen the inside of private health care in New York state as well as public health care in Ontario.

Anyone who believes that the "system" you have in the US is remotely functional needs to have their head examined by a nerologist (I'd suggest Sunnybrook Hospital here in Toronto, but you'd have to put up with our Bill O'Rielly did not approve of "Soviet Cacnucksterism" Canadian health care.)

I won't say the Health Care system in America is broken, to say that is to acknoledge that there is a system at all. Health Care in America is a disaster.

For all the wining us Canadians do, I've got admit we did a few things right, our health care, our old age pension and our education system. Three things I'm happy to pay taxes (or Canada Pension contributions) for.

[ProudLiberalDan]

The one policy area that keeps me from rooting for Obama is health care.

Kucinich's approach is the one we need.

Edwards has the best of the top three.

Clinton's approach is better than Obama's on this issue.

I prefer a mandate to a non-mandate. We need to establish the principle of health care as a right, not a privilege and we need to establish universality.

Until we have something universal, we will not move towards single-payer health care.

I'm not willing to support any plan like Obama's that already leaves 15 million behind on paper -- which means more like 30 million left behind in reality -- which is an insufficient improvement in health care for any prospective Democratic nominee.

Fortunately, no President gets his way 100% and it is important to lobby Congress so that what eventually is proposed has 100% involvement.

While I prefer Edwards, I think Clinton's New Hampshire support is based on people looking beyond the rhetoric of hope, which is nice sounding and inspirational, to actual policies of substance. I don't like Clinton's Iraq policies or triangulation, but there is without a doubt more meat on the bones of her health care policy than Obama's.

I just wish Kucinich and Edwards were more in contention right now.

[weslenforever]

I fail to understand all the concern for insurance companies employees being put out of work if we go to single payer health coverage. No one gave 2 seconds of thought for all the factory workers when all the outsourcing began. The insurance company executives already have enough millions to see them through the rest of their lives whether they work or not and as far as their underlings go, they can go to McDonalds or Burger King or Wendy's or Taco Bell, just like the middle class factory workers have been forced to do.

[ljsfolly]

The insurance companies would like us to think the doctor is the one makin the big bucks and they must pay him/her. They also employ people who are trained to "just say no" to anything they can and hope there is no one around to explain your benefits to you so you can tell them they are wrong and you are covered. Always the person insured will be not given what they need until they come out in the media. Then mistake is what it was "a mistake". But this is also what the VA does to our soldiers and the insurance companies by denials of treatment save so much money with the denials that they could cover all of the most expensive claims but no the money goes into the money pot for the insurance. Remember the kid who died who the insurance denied the transplant until the kid was too sick for it and the kid died? That is SOP for the insurance. DENY, DENY until they DIE!1

[tompoe]

Is it that difficult to say, "Single payer healthcare"? Sadly, folks have the same trepidation when the appropriate phrase for describing our present administration calls for using "war criminals" occurs, it's always "the administration".

[Anym]

insurance companies are without a doubt scum.

I'd rather have UH.

[swift_goat_pet_for_truth]

UHC ex-CEO William McGuire made $124.8 Million a year, not to mention other stock options.
How many sick people were denied care and died to give him his bonus? Who cares?
America is for the rich.

[angryoldman]

Doctors are now trained to relieve you of your money not your suffering. Not for profit is the only civilized way to go forward. We need to knock them off their god like pedestals and bring them back to earth.

[oldpotsmuggler]

We have insurance through the employer of my wife. I was refered to a cardiologist for tests after an EKG. When I showed I was told that the staff cardiologist had taken another job so I'd be seen by a substitute. When he came in I asked for the results of my cholesterol test and what other testing was scheduled. That doctor told me he didn't know how to use the system so he couldn't access my cholesterol numbers, and couldn't administer any exams because he was only a sub.

The bill came and it was large. The insurance won't pay it because I didn't have enough "out of pocket" yet. When I called to complain, the clinic told me that they made a doctor available and he had to get paid. I expected that because when I tried to complain on the day of the visit the lady in charge wouldn't get off of the phone, and I ran out of time. I can't go anyplace else because none are better. They all "practice medicine" from the point of view of the staff, and their lawyers, and I always end up feeling invisible.

I'm sure that single payer would not cure all of the ills but I'd love it if it got rid of the rock star mentality. That and allowing us to get our focus off of our family budget and back onto our health.

[Nutcase]

Part 1

We presently pay 24 cents of every healthcare dollar for administration. That includes the extra staff that physicians and hospitals must employ just to do the paperwork for the insurance companies. That also includes what we pay the insurance companies, their costs, their profits, their purchasing of politicians, etc.

The last I checked, the administrative overhead of Medicare, the largest purchaser of healthcare in the world, was 1.8 cents of every dollar. Physicians and hospitals would continue to have some costs but they would be greatly reduced by having to deal with paperwork for only one payer in a single-payer system. Let's say that the total administrative costs become 5 cents. That is a savings of 19% of our total healthcare costs.

The present costs are paid through a combination of premiums, taxes, deductables and co-pays. If you have to pay it, does it make any difference what you call it? If everyone paid the same amount as they now pay, regardless of what you call it, to Medicare, the savings would mean that everyone would be covered. You would have the right to pick your physician and hospital. Checkups could be covered. Preventive care would ultimately bring significant additional savings. Eyeglasses and dental care could be covered. And still we would save.