FREE HEALTH CARE? LIKE FREE DEFENSE IT IS IN THE CONSTITUTION

That is a picture of the original Constitution of The United States of America, as stored in the National Archives. If you have ever visited Washington, D.C. chances are your tour has included a stop to view this, the Declaration of Independence, and other documents related to our founding.

The Constitution begins with this Preamble

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.   (added color emphasis is mine)

One of the chief complaints against Medicare For All, the Bernie Sanders proposal to reform health care coverage in the U.S., or other proposals that are similar in nature including the extant Affordable Care Act (ACA), is that “free health care” is unsustainable. And, it is socialism.

But let’s take National Defense, at over $800 billion a year in all its forms,  the most costly discretionary spending in our national budget. While there is much debate over how much should be spent there is no argument made that providing free defense to each and every one of our citizens is socialism or cannot be sustained. Yes, there are millions of guns in the hands of private owners in this country but does anyone seriously believe they would be an effective deterrent to an invading horde of well-armed, well-trained, and well-supplied troops or, far more likely,  a massive air attack or simply a nuclear one? That Ak-47 won’t mean shit for you in those circumstances, Son. Hope you like Nuclear Winter.

No, we heed the admonition to “provide for the common defense” and we do that through shared responsibility by paying taxes. Our anti-missile defenses are designed to protect all, rich or poor, white or any of those horrible other colors so many whites hate. But note that “provide for the common defense” is bracketed by “insure domestic tranquility” and “promote the general welfare”, both of which can reasonably be interpreted to entail the health of our citizenry. After all, with my Medicare and Medicaid coverage I have much domestic tranquility being free of costs for my care I could not otherwise afford (I mean just being alive is pure domestic tranquility as opposed to being dead) and those programs also provide for my welfare as I am indeed part of the general public.

So if Americans do not object in general to having “free defense” and are willing to pay taxes for it, why not “free health care” with the cost burden again shared by all taxpayers?

Our founders were forward thinking enough to ensure our most basic law provided for not only defense but also domestic tranquility and  general welfare and who are we to argue with Gouverneur Morris ?

SAGA OF A ^#*;%$##%^*@ED UP MEDICAL BILL

(NOT MY BILL)

My ongoing health care problems and doctors’ visits and procedures have provided fodder for my writing for a number of years now.

I have insurance coverage under both Medicare and Medicaid. The former I enrolled in in 2006 when I was awarded Social Security Disability benefits but am now qualified for that coverage since I have been officallly an old fart for over five years. The latter coverage was obtained in 2007 and continues to the present since my income falls within the guidelines for eligibility in the state of West Virginia.

Of course that is why I tout Medicare For All as the most practical solution for the nation’s health care coverage woes.

Yet the wheels of health care justice grind exceedingly slow.

My present tale entails my bout with bladder cancer in 2014. Towards the end of June I discovered blood in my urine one Sunday morning. The following day I saw my family doctor who sent me for tests while getting me an appointment with a urologist for a few weeks hence in July. None of the tests provided conclusive evidence of any cause but there were several possibilities. For the best possible diagnosis my urologist scheduled me for a biopsy on September 11, 2014, a Friday. The following Friday I met with him to learn the results and determine any future actions. At that time he revealed I did show a malignancy but one which he was able to cauterize for elimination at the same time. The recommended followup was to have a cystoscopy quarterly for two years, then semi-annually for another two. After that period, without further difficulty I will need to undergo one only every year.

If you’re not sure what a cystoscopy is, I’ll recall how my late older brother described it. “That’s where they stick a camera up your dick”. Crude, but accurate. So I have faithfully appeared as scheduled since then for the procedure in the doctor’s office under local anesthesia. No recurrence to date though bladder cancer does have a high rate of recurrence.  By the way, the blood in my urine was the only symptom I ever experienced. I had no pain, no intrusive treatments over an extended time, and no real agonizing about my potential fate. Sadly, the vast majority of cancer patients have things much worse.

Now my urologist’s office was on the campus of one of our local hospitals, but apart from the main facility and with its own entrance, and he was independent of that ever growing conglomerate. But in 2016 for whatever reason he and his partner sold their practice to the hospital. I have continued as before with no change whatsoever. Because of my coverage I never even saw a bill from him or the hospital. That is until last week.

My last previous cystoscopy was Sept. 28 of 2017. I received a bill showing total charges of $1257.00. After payments and adjustments the total demanded of me was $1019.00.

Other than receiving any bill whatsoever what disturbed me was the area set aside for “Account Summary”. It listed my primary coverage as “Medicare Non-Patient” and my secondary coverage as “Private Pay” What “Medicare Non-patient” even means is beyond my pay grade.

One other thing of note on the bill is something that effects many Medicare patients. One of the charges was $894 for “Operating Room Services.” Funny, I didn’t recall going into an operating room within the hospital, though I admit I am far more familiar with them at this hospital than I care to think about. Indeed, last May I had outpatient surgery in one of them to correct a deviated septum. (No, other deviancies of mine were not addressed simultaneously.) As part of the check-in protocol I provided both my Medicare and Medicaid enrollment cards.

That type of charge I have learned prior to my personal adventure is perfectly legitimate. If a hospital owns a physician’s practice, no matter how remote from the hospital itself, if the doctor performs certain procedures or minor surgeries there the hospital can legitimately bill as if you had physically been on their premises.

I have also used that hospital’s services on different sites away from the main building on other occasions. Subsequent to my 2013 toe amputation I had follow up treatment at the hospital’s Wound Healing Center in rented space about two miles away. About a year ago it moved to a new building on the campus and in both June and October I visited weekly 3-5 times for treatment. One visit, and only one of the 3 in October brought a bill for about half the overall charge of nearly $400. At that time the Account Summary showed “Private Pay” for both primary and secondary coverage. I called the business office demanding, in a nice way that they update their information which was already on file. I never received another bill.

On Monday, with the current bill I called for assistance, explaining the situation and voicing my concerns. The representative saw that I was right and responded that she would make the needed corrections. I needed no more than perhaps a dozen or so cusswords to accomplish this. Yesterday another bill came in the mail. It was dated Monday so it very likely was in the works prior to me talking to Tina on Monday. It was quite different. It still had “Medicare Non-Patient” as primary coverage but now with Medicare Part B as secondary. It also showed different amounts for both payments and adjustments. Whatever Tina had done Monday could not have resulted in this. It also displayed a total due of $99.32, a great improvement, of course, but still not the zero amount I expected and which I have faced for all prior procedures.

So I called back. I got a different rep and when I explained I had spoken to someone just the day before she told me she would be transferring me to a “specialist”. (Aren’t hit men considered specialists?) Anyways after a brief time on hold a woman picked up. Within 30 seconds the call abruptly ended. I redialed immediately and I asked the person who answered to reconnect me with the specialist. Her line was busy so I left a message. When by 3 p.m. today my call had not been returned I called again. After a fairly short time on hold (Have you ever noticed that the music you so often hear on “hold” sounds distinctly like a bad ’70’s porn soundtrack? Not that the porn was bad, though it could have been, but the music used was nearly universally atrocious. At least that’s what my friends tell me.)

Lo and behold the same woman finally answered whom I was cut off from yesterday. We had a long conversation. Rather I spoke at length voicing my concerns in a number of areas of the bill I had received as well as complaining about the Andrew McCutcheon trade, the escalating price of groceries, and how my parents had sent me to live with a pack of wolves when I was 7. Every so often  she made these noises suspiciously similar to sobbing.

Bottom line is that the corrections may take 30-45 days to completely process so I may still see another uncorrected bill before then

The bright spot is that I have another cystoscopy slated for late March. Maybe Allen Funt will be there for a new episode of Candid Camera.

WALKER’S HEALTH CARE PLAN—OR TO QUOTE GERTRUDE STEIN, “THERE IS NO THERE THERE.”

Republican Presidential candidates for 2016 have one thing undeniably in common. They all pledge to repeal the Affordable Care Act (ACA) and replace it with lollipops and rainbows…er, lower premiums and lower costs and more freedom. These candidates have been asked repeatedly for specifics of their plans and sidestep the questions with more general, meaningless statements.

Well Scott Walker, Governor of Wisconsin, has finally put the pedal to the metal and produced an outline of what he proposes to do to replace the ACA.

To preface my introduction to his plan let me just assert that

1. The Affordable Care Act is not perfect, and
2. There are ways available to address any flaws without tearing the entire law apart, and
3. Any fix or replacement must be based on the facts of the current situation

Click to access Day-One-Patient-Freedom-Plan.pdf

Here is the first paragraph of Scott Walker’s plan.

Washington’s failed approach to health care is hurting the American people. Big government created a health care system built around Washington, not hardworking families. This backwards approach drove up health care costs and reduced access to medical care for far too many of our neighbors, friends, and family members.

Each sentence is a lie.

Washington’s failed approach to health care is hurting the American people

On the contrary, the uninsured rate has dropped dramatically and there have been real positive consequences of the law.

http://www.huffingtonpost.com/2015/03/22/obamacare-5-years_n_6918326.html

Big government created a health care system built around Washington, not hardworking families.

Again false, That is the equivalent of the often made claim that the ACA was a “government takeover of health care.” And that, my friends, was the Politifact 2010 Lie Of The Year And do not dismiss Politifact as a source because Walker himself takes advantage of it in support of his ideas, which you will see.

http://www.politifact.com/truth-o-meter/article/2010/dec/16/lie-year-government-takeover-health-care/

This backwards approach drove up health care costs and reduced access to medical care for far too many of our neighbors, friends, and family members.

To this I can pretty much only respond, HUH?

More lies

The list of ObamaCare failures is long. Democrats have long promised affordability with their big-government health care plans, from HillaryCare to ObamaCare. But instead of lower costs and expanded coverage, ObamaCare has caused insurance premiums across the country to spike as the cost of Washington’s new regulations and taxes are passed to the American people. The Heritage Foundation found from 2014 to 2015, average premiums for young people increased by approximately 14 percent in Iowa and 19 percent in Ohio and Minnesota. Families in Kansas and Louisiana saw increases of almost 14 percent.[1] We will likely see even higher premium increases in 2016 and beyond as ObamaCare’s insurance company bailouts phase out. Probably the most cited ObamaCare failure, and Politifact’s 2013 ‘Lie of the Year,’ was President Obama’s repeated claim that if you liked your existing health care coverage, you could keep it.[2] So while both Obama and Hillary Clinton made promises that their health plans would allow Americans to keep their existing coverage, millions of people were pushed out of their preferred health plans and restricted access to the doctors they wanted to see.[3] ObamaCare has also punished employers with costly mandates and red tape, hurting growth and job creation. Another ObamaCare failure is the way it went about expanding coverage. Where ObamaCare expanded the number of people with coverage who previously were not insured, it did so mostly by pushing people into Medicaid, a program that was already overburdened.[4] And many of the people who received insurance through the ObamaCare exchanges had in fact been previously insured, but got knocked off their private health plans. Others switched coverage because federal subsidies only flowed if they signed up for ObamaCare’s prescriptive plans. As a result, billions of taxpayer dollars have been spent on downgraded health policies.

Let me make some points here.

• The Heritage Foundation can find whatever premium increases it wants, but these increases have been predicted since day one of the law and, guess what, the average actual increase for premiums from 2014 to 2015 was ZERO

http://www.commonwealthfund.org/publications/blog/2014/dec/zero-inflation-nationwide-for-marketplace-premiums

Now, of course an average of zero does not mean there were no increases but that there were both increases and reductions. And the article cited notes the reasons behind the relative stability of health care premiums across the board including the benefits derived from the standardization of plans under the ACA. But other factors include geographical differences, the number of insurers in the market and other variations.

Likewise the predictions for hikes in 2016 are based on proposals not actualities. Again look to the Commonwealth Fund for guidance.

http://www.commonwealthfund.org/publications/blog/2015/jul/proposed-premium-rate-increases-for-2016

•  “ObamaCare’s prescriptive plans”,

I am not certain what he means. All the ACA does is require health care plans to now contain prescritption drug coverage, though not necessarily for all drugs, whereas previously they did not have to.

http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/

• Where ObamaCare expanded the number of people with coverage who previously were not insured, it did so mostly by pushing people into Medicaid, a program that was already overburdened.[4] And many of the people who received insurance through the ObamaCare exchanges had in fact been previously insured, but got knocked off their private health plans.

The Department of Health and Human Services reports that 11.7 million Americans signed up for coverage through the exchanges in the 2015 enrollment period ending in March and

As of March 2015 HHS reported a total of 16.4 covered due to the ACA between the Marketplace, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions.

So Medicaid enrollees are nowhere near a majority of the newly insured. Even if that were so, the states that accepted the expansion of Medicaid are saving money.

http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/4/29/states-find-savings-through-medicaid-expansion

However, the states that refused to expand that program are experiencing greater costs to care for the uninsured.

Nationwide, the cost of caring for uninsured people in non-expansion states between now and 2024 is projected to reach $266 billion if no new states decide to expand Medicaid, according to a report in April from the Kaiser Family Foundation. If all states decided to expand, that cost would drop by a third.

http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/6/24/not-expanding-medicaid-can-cost-local-taxpayers

• millions of people were pushed out of their preferred health plans and restricted access to the doctors they wanted to see.

First of all, the number of people who may have had policies cancelled appears to have been grossly overstated.

http://www.factcheck.org/2014/04/millions-lost-insurance/

But do you know the only group that specifically was mandated to lose their coverage under the ACA? No, you probably don’t, but it was Congress, together with certain staffers who were kicked out of the coverage they had had. And that coverage was simply participation in the same menu of plans available to all federal civilian employees. That is why, when Ted Cruz lost his spousal coverage when his wife left Goldman Sachs, he was forced to purchase coverage from one of the ACA exchanges. Yes, Virginia, there is a mandate for Congresscritters to participate in the exchanges. A mandate, incidentally, I believe to be both totally political and stupid.

Because I find the source, FOX News, to be amusing in this context I’ll present a viewpoint expressed there.

http://www.foxnews.com/opinion/2013/11/05/insurance-cancelled-dont-blame-obama-or-aca-blame-america-insurance-companies.html

But in an overall sense the ACA is a scapegoat for any cancelled policies. If insurance companies had enough introspection they would paraphrase Cassius

The fault lies not in the ACA, but in ourselves.

You see…and really this is not revelatory, simply a reminder…prior to the Affordable Care Act insurers could cancel policies for any damned reason or none at all. Just peruse this article from 2007 before the ACA was a gleam in Barack Obama’s eye.

http://usatoday30.usatoday.com/money/perfi/insurance/2007-01-28-insurance-1a-usat_x.htm

And private health care plans frequently change the providers they allow access to. See this look at the UPMC–Highmark steel cage match in Pittsburgh.

http://www.wsj.com/articles/SB10001424052702303812904577295901619123904

Now to the essence of Walker’s plan, his five points.

1. Repeal ObamaCare in its entirety.

We heard you already, Scott!

2. Ensure affordable and accessible health insurance for everyone.

A. LOWER HEALTH INSURANCE PREMIUMS

B. PROVIDE TAX CREDITS TO ANYONE WITHOUT EMPLOYER-SPONSORED HEALTH INSURANCE

C. GIVE ALL AMERICANS MORE CHOICES AND MORE ACCESS BY IMPROVING HEALTH SAVINGS ACCOUNTS (HSAs)

D. ALLOW ALL AMERICANS TO SHOP FOR INSURANCE IN ANY STATE

E. PROTECT ALL AMERICANS WITH PRE-EXISTING CONDITIONS

Part A is a pipedream and Walker’s ideas as to how to accomplish this are nebulous and sketchy at best. And it ignores the reality that in this century health care costs and premiums for coverage have seen steady, sometimes very large increases, with and without the ACA, but the rate of growth of both has slowed since the law was enacted.

Part B, A footnote accomopanying a chart showing suggested levels of subsidies states

so there would be no intrusive oversight by the IRS and no accountant needed to determine the credit amount.

Pray tell who administers or tracks these subsidies if not the IRS. And he wants to put honest accountants out of work? I have friends who would be hurt.

Part C Here’s more on health savings accounts and pros and cons.

https://en.wikipedia.org/wiki/Health_savings_account

One note I will add is that in Part B Walker claims his simplification of subsidies will lessen IRS influence, but HSA’s appear to reuire high IRS maintenance to ensure compliance with the law.

Part D This may be the only part that has some merit in that presumably there would be more competition for the health insurance premium dollar. But the same was said about permitting banks to operated across state lines and look at what Dr. Franken-deregulate-Stein has created.

Part E The devil is in the details. And these details have a strong resemblance to Satan. For, instead of simply requiring companies to insure those with pre-existing conditions, he forces them back into high risk pools with limited coverage. No thank you.

3. Make health care more efficient, effective and accountable by empowering the states.

A. RETURN REGULATORY AUTHORITY OVER HEALTH CARE COVERAGE TO THE STATES

B. REFORM MEDICAID

In this part Walker highlights Medicaid and declares it so broken only the states can fix it. Balderdash, Run by the states eligibility reuirements are set so unfairly that many desperately poor people have no chance of becoming insured, and thus will tax resources as noted above.

For instance in the U.S someone is considered to be below poverty level if their income is no more than $11,770 for one person, $15,930 for 2 persons in a hosehold and  $20,090 for a family of 3. But states that did not opt for the Medicaid expansion do not allow eligibility for those above a certain percentage of the federal poverty level. In Alabama, it is 13% for parents and 0% for other adults.

Click to access medicaid-and-chip-eligibility-levels-table.pdf

In other words In Alabama a household with 2 parents and a child, earning barely more than $2600 per YEAR means the parents cannot receive Medicaid (though the child may be eligibe for CHIP).

Think about that. Can states be trusted to take care of their own? Or only a small proportion of their own.

As to returning regulatory authority to the states, again this is a fallacy because they still exercise the majority of regulatory authority over insurance companies. Indeed, the differences between state actions in this respect are another reason why premium rates differ so greatly.

Along the way he asks that the current funding means for Medicaid, shared by the state and federal governments, remain in place with some tweaking of the formula with states getting block grants from the Feds. However, in states with no expansion, they are right now tied to the old levels of federal participation which rarely exceed 50% of Medicaid costs, whereas those falling under the Medicaid expansion get 100% paid by the feds until dropping to 90%. A much better deal than now.

4. Increase quality and choice through innovation.

A. EXPAND COVERAGE OPTIONS BY ALLOWING CONSUMERS TO POOL TOGETHER AND PURCHASE INSURANCE AS A GROUP

B. SUPPORT WELLNESS INCENTIVE PROGRAMS

C. REFORM LONG-TERM SERVICES & SUPPORTS (LTSS) PROTECTION

D. LIMIT EXCESSIVE LITIGATION THROUGH INNOVATIVE LAWSUIT REFORM

While at least A B and C have some merit on the surface, Walker’s approach is oversimplistic. As to Part A, group plans, these already are very common for members of groups like unions or fraternal organizations or even members of credit unions or those having other affinity relationships. The one basic limitation is that the persons eligible for such policies have some affiliation with each other besides the mere fact of seeking group insurance. Indeed, besides health coverage one can get auto or life insurance or pretty much any kind of insurance. Since so many Americans belong to affinity groups I would guess the extent of this type of coverage may be reliant on knowledge and desire of groups to pursue such measures.

Wellness incentives are already included in many private insurance policies. Does he want the government to mandate such coverage or merely command people to stay healthy?

Long term care coverage can be very important to individuals or even couples. But from what I can find on the topic, it does not really appear that the practice is over-regulated. In some cases there is next to no regulation. But Tax Qualified policies, because they do not tax benefits, of necessity must follow IRS regulations. Here is a good overview of such policies and practices.

https://en.wikipedia.org/wiki/Long-term_care_insurance

Part D is a complete lie. That is tort litigation is not a prime mover of medical costs. Best estimates that the total cost of the effects of medical malpractice are slightly more than 2% per year.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/

But what does that mean exactly? According to the study cited here perhaps 10% of the total figure  is for what is paid out in judgments and settlements, nearly $6 BILLION a year. But that money was paid out because doctors did something wrong.That was not mere generosity on the part of malpractice insurers. In addition defense attorneys cost those insurers almostt 20% of those payouts. But defense lawyers get paid no matter the outcome.

But the major thing wrong with this point is that it is based on myths, which are dispelled here.

http://www.medmalfacts.com/facts-and-myths/

For instance various sources put the number of yearly deaths due to medical mistakes at 100,000 or more. That is close to 4% of all deaths in the country. That’s an awaful lot of malpractice yet only 1 in 8 victims of such treatment files suit. So it is bogus to argue there is excess litigation when the opposite is true.

Now Walker and his cohorts will assert that excessive damages are frequently awarded, especially for pain and suffering, but this, like many opinions, depends on whose ox is getting gored. Rick Santorum has pushed for limits and still advocates the same but when his wife lost a baby and undoubtedly experienced pain and suffering, to which he testified on her behalf, she got an award over the limits he wants for everyone else. (Not being intimately knowledgeable about her case, I believe the award is nowhere near out of bounds.

http://www.washingtonpost.com/politics/santorum-pushed-to-limit-malpractice-awards-but-sought-larger-payout-for-wife/2012/01/19/gIQANXQeVQ_story.html

5. Provide financial stability for families and taxpayers.

Hey! Who can argue with that goal?

As a result, all of our citizens in poverty have gained access to health insurance through our state’s Medicaid plan, BadgerCare – a first in Wisconsin history. And our reforms are providing everyone in the state access to health insurance, according to the non-partisan Kaiser Family Foundation

Never dare The UMOC to check your claims of others’ approval. In fact, not everyone in poverty in Wisconsis has access to coverage but many of the ones who gained coverage through the Medicaid waiver links to BadgerCare must now pay premiums for that coverage (unlike regular Medicaid enrollees) and can lose eligibility for enrollment for a period if they fail to pay these premiums.

In 2012, Wisconsin received approval to apply premium payments to TMA adults above 138%FPL with a 12-month restrictive re-enrollment policy as a penalty for failure to pay premiums.  In 2012, the Wisconsin Department of Health Services (DHS) studied the effects of the increased and expanded premiums implemented on TMA individuals above 138% FPL. This study found that between July 2012, when the premium provision was implemented, and December 2012 over two thirds (69%) of the 18,544 individuals between 133% and 150% FPL had left the program. About one in five (21%) of that population lost coverage due to failure to pay within the initial six months.

Wisconsin’s BadgerCare Program and the ACA

Now early on in this plan Walker justifies his desire to rid the world of “Obamacare” with this statement.

It should come as no surprise that many pillars of ObamaCare can be traced to “HillaryCare,” Hillary Clinton’s 1993 health care plan. And the proposals in Hillary’s “American Health Choices Plan,” released during her 2008 presidential campaign, provide a useful link between her 1993 plan and her present-day ideas.

I smile at the irony. You can get a glimpse of Hillary’s plan here, in the assessment of the Heritage Foundation, a reliable go-to source for WAlker.

http://www.heritage.org/research/reports/1993/11/a-guide-to-the-clinton-health-plan

The Affordable Care Act does NOT resemble that at all. What it does resemble is a health care plan brewed up by that same Heritage Foundation that was introduced into the Senate in December of 1993 by 21 mostly Republican co-sponsors that also was the basis for the plan Massachusetts adopted when Mitt Romney was Governor. Now, was that 1993 plan, submitted in opposition to the Clinton plan, identical to what became the ACA? Of course not, and truth be told, it never came to a vote and other GOP Senators vehemently opposed it.

http://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/

The core part of both the Republicans HEART plan and the ACA was the individual mandate which, of course became such a point of contention in debate and in litigation when the law passed. Sure there were significant differences.

This article expounds on the genesis and evolution of the GOP plan.

http://www.forbes.com/sites/theapothecary/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/

Have I been harsh on Scott Walker? Or rather on the health care plan he has submitted for public scrutiny? Oh, Geez, I surely hope so. I’m a scrutineer from way back. But this plan is deserving of all the snark and skepticism I can muster because from the get go it fails to honestly and objectively assess what impact the Affordable Care Act has had on health care after 5+ years of implementation.

I stated at the outset that the law is flawed. However, Walker chooses to evade discussion of the real flaws and instead focus his attack on the bogeymen created by Republicans and other opponents of the law, together with the same sound bites, debunked allegations, and outright lies that have characterized this eminently debatable issue since the first inklings of what the law was to be emerged in 2009.

Do I unequivocally support the entire ACA? Hell NO! While it does some great things and millions of people are reaping its benefits, at heart is still does not achieve what its main goal purports to be, and that is ensure every American has access to health care through a system of insurance.

As Bernie Sanders and others remind us to a steady drumbeat. the United States is the only major industrialized nation without universal health care.

We can argue the best means to get to that Nirvana, that paragon, but we still waste far too much time arguing if this is a desirable goal at all.

Disappointingly far too many of our politicians would sooner have us at the mercy of private enterprise…oh, yes, that institution that has never harmed one hair on our collective chinny-chin-chins. perish the thought!

All the more dejecting because a simple solution is right before our eyes.

Once more to the ramparts exclaiming…MEDICARE FOR ALL!

AND YOU STILL DON’T BELIEVE IN SINGLE PAYER?

I have written a number of entries on health care and its costs. The United States, though experiencing a lower rate of increase of health care costs recently, still far exceeds the costs incurred for similar procedures and treatments in other industrialized countries.

This issue has been driven home for me of late in light of my own health issues which have contributed to my absence from my blog.

On this past Friday my urologist reported the results of my previous week’s biopsy to me. I had been having blood in my urine…or hematuria…since late June. My family doctor first examined me and then sent me to a specialist, the urologist. I underwent a series of exams and procedures..two CAT scans, an ultrasound, and then a cystoscopy in the urologist’s office in which a scope is inserted into the urethra in order for the doctor to examine the interior walls of my bladder. The exam showed redness/irritation and thus the biopsy.

I am happy to say that the growth was malignant—happy because during the biopsy Dr. Hall cauterized the afflicted area and removed the tumor but that means the cause of the hematuria was determined and resolved in one fell swoop.

I am also happy to say I had no other symptoms, either pain or interference with urinary function. I offer this much detail only to preach caution when one has any variance from normality in their bodies and to get to a doctor posthaste. If I had ignored the obvious blood and then, seeing my urine clear the next day I may not have seen my family doctor and the tumor may have grown. I have received ample sympathy and concern from family and friends and I’m sure my readers here would offer more but it is unnecessary. With proper followup I should be fine.

But during the interim between discovery and resolution, I got a letter from a collection agency dunning me for an unpaid hospital bill in the amount of $24.85. I called the agency and talked to a very nice lady who said all she could tell me was that this bill dated from 2010. I was hospitalized for four days at that time for severe back spasms, I received steroids and narcotics as treatment and have had no major trouble since.

But the bill troubled me. The year prior I had cardiac bypass surgery and spent a total of 18 days in the hospital and the only out of pocket expense I had was $47 as the uninsured part of a charge for the ambulance that transported me from the regular hospital to the local Health South rehab facility, a distance of about a mile.

I told the collector that I doubt I owed the bill but if she could send an itemized statement proving I did owe I would pay it. But if I fought it suing me would not be worth it, and she agreed on both counts.

I got the bill this weekend and the charges are laid out for each injection, each IV bag, each doctor consult, and each pill of my regular prescriptions I was given. It totaled around $7500 and all adjustments/payments were shown. There was one adjustment for the exact $24.85 I have now been told I owe, but adding all the charges and subtracting all the adjustments/payments leaves that balance. I will speak with the billing office tomorrow to find out why that piddling amount seemingly was not covered.

Coincidentally, last week I got another bill from the hospital which I at first thought was the one fulfilling my request. Instead it was for around $78 for the uninsured portion of treatment in July. I was puzzled as to what that could be for. As some of you know I had a toe amputated more than a year ago and the resultant wound on the outside bottom of my foot has stubbornly refused to fully close. Almost every Friday for about a year I have gone to the Wound Healing Center operated by Monongalia General Hospital but in a separate building off the main hospital campus.

When I checked with the business office I learned this $78 bill was for one of those visits, though my insurance had fully covered all of the other treatments. That office is now looking into this so I probably won;t have to pay it. But each treatment costs $1200.

I am very fortunate with my insurance coverage. I am enrolled in Medicare and since my only income is from Social Security I am eligible for Medicaid which generally covers the costs that Medicare does not.

All this is a lead in to the story I read Sunday about a man who underwent back surgery. Peter Drier had the surgery at Lenox Hill Hospital in Manhattan last December. When his bills arrived they were for $56,000 from the hospital, $4500 from the anesthesiologist, and $133,000 from his own orthopedic doctor who performed the operation. Drier was not alarmed as he had insurance through his employer, a bank, and knew that company would negotiate a lower fee and pay the bill.

But he also received a bill for $117,000 for an “assistant surgeon”, a neurosurgeon from Queens with whom he was not familiar and did not recall ever meeting. (The complete story can be found here: http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=1 )

This “drive by doctoring” has become common across the country. It is one way doctors and hospitals can maintain income when the reimbursement rates for Medicare have been lowered and private insurers have also reduced rates. What does this mean for the doctors? Well, pity them, From the article:

The average base salary for neurosurgeons decreased to $590,000 in 2014 from $630,000 in 2010, according to Merritt Hawkins, a physician staffing firm.

Probably on food stamps.

As the article further notes, along with providing tales of some other patients, very often these “assisting” doctors are out of network so do not accept the rate negotiated by insurers with in network providers.

In Pittsburgh, as many of you know, there is an ongoing battle between two health care/health insurance giants over market share. UPMC, an independent arm of the University of Pittsburgh, and Highmark Blue Cross with a similar tie in to Allegheny Health Network (AHN) are on the verge of refusing to have the providers in their system treat patients insured by the other system. This is so even though many patients have maintained the same doctors for years only to now see those practices being purchased by the system through which they do not have insurance.

That explanation does not begin to cover all the details or nuances of this dispute but just from that overview it should be clear that the patients are the losers.

Another phenomenon which has drawn attention of late in the Pittsburgh Post-Gazette is the practice of hospitals who now have doctors under their control but whose offices are in a separate building to bill patients for a hospital visit who have been no closer than their physician’s examining room, sometimes miles away. Medicare permits this and has done so for a number of years so a Medicare patient may now receive a bill for hospital care which may not be reimbursed by Medicare.

I believe my own billing woes and the tales from the New York patients together with the UPMC-Highmark conundrum provide ever more of a basis for this nation to establish a single payer health care system.That way patients would know without a doubt whether they will have any out of pocket expenses…co-pays and deductibles can be even across the board..and all these little tricks designed to increase income but which have nothing to do with patient care, successful or not, can be eliminated.

My own woes are minimal compared to the troubles reported elsewhere. If my billing is correct, it amounts to around $100, a small price to pay for the excellent and attentive care I have been the fortunate recipient of. The other patients whose tales appear here have had far more difficulties than have I.

I have advocated for single payer from this space previously. See:https://umoc193.wordpress.com/2013/02/25/single-payer-our-medical-care-costs-crisis-salvation/

My suggestion is to simply expand Medicare to include all. I’ll leave the exact mechanisms for doing so and funding it to the folks who have access to and the ability to analyze the appropriate data and formulate it into a workable system.

The alternative is to keep the status quo and that means that some patients will not have access to the care they need simply because they have the wrong insurer and can in no way afford to pay for their care from their own funds.

There is a word for how our health care insurance system now works for millions of Americans. That word is “WRONG”.

 

UPDATE

As to my debt to Mon General Hospital. I must correct myself, the amount sought is $23.85 not $24.85. The old memory just isn’t as it used to be.

But that is insignificant. I talked to a woman in the business office today and learned this. When I was in that hospital from June 24-27, 2010, I was not really there. I was an outpatient, there for observation only. The funny thing was, though I first went to the Emergency Room, by ambulance no less, I was evaluated there and told I was being admitted. I then was transported to a private room. That night and for three more days I wore a hospital gown, availed myself of a hospital toilet, was injected with a hospital provided saline solution and the alternately steroids to reduce the inflammation in my back and relax the muscles and dosed with narcotics for the pain. I ate the meals from the hospital kitchen, had nurses tend to me wearing the standard color scrubs the hospital designates for them, and had the combination call button/TV remote at my side. That was all just like my other 7-8 overnight stays in the same facility.

I can’t swear to this, but the doctor or nurse telling me I was going upstairs to a room said that I was being admitted, not held for observation.

This practice has become common as this report from the kaiser Family Foundation reveals. http://www.kaiserhealthnews.org/stories/2013/september/04/observation-care-faq.aspx

The practice also often leads to higher out of pocket costs to patients since many insurers, including Medicare, may not pay for all outpatient treatment.

How did this work in my case? During my stay, besides the medications prescribed for that event, I was provided my regular medications that I take every day at home. Since I am a heart attack survivor that includes aspirin. I buy a bottle of 300 count 81 mg aspirin at Dollar General for no more than $4.00. In the hospital I received 325 mg aspirins daily at $1.35 a pop. My other meds incurred a charge per pill of that amount up to $3.00 apiece.

Today I was informed Medicare does not cover the cost of your regular meds when not an inpatient in the hospital. My total bill for these meds was $118.15. To put this somewhat in perspective, my Medicare Part D prescription coverage is excellent. I can get a 90 day supply for a co-pay of $2.55 for generics (which all but one of mine is) to around $6 for name brand. That amount has varied over the nearly 8 years I have been enrolled, but not by much. So in those years my co-pays have amounted to approximately $700 (not all meds have been prescribed for that period).

But, strangely, even though Medicare presumably would not cover the cost of my in hospital meds for outpatient care, something happened to all but $23.85 of the $118.15 charge. The billing rep could not access the information to tell me exactly why that occurred but did point to the section of my itemized statement covering these meds where the coding indicates they will not be covered.

My other hospitalization experience leads me to believe that if the hospital had been honest with my patient classification, though Medicare rules, arcane as they are, permit this…what I would call billing abuse…I would have had no balance due.

My inclination, then is to simply not pay this. The woman from the collection agency inferred that they would not pursue the matter into court. Unless someone gives me a very compelling argument in favor of paying (and I am open to that from a moral perspective) my checkbook will remain closed.