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"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including . . . medical care . . ."
Article 25, Universal Declaration of Human Rights adopted by the UN on December 10, 1948

Another story, another reason

Save money, cover everyone and save lives with universal health care

Editor's note: While this story by Donna Smith is about the author's experience at a Colorado hospital, it could happen anywhere. Imagine an emergency room patient's dilemma upon being told by a business office representative: If you are admitted "upstairs", meaning the hospital, we do not accept your supplemental insurance. Is this right? Is this choice? Is this humane?

We can do better, here in Maine.

PS: As if to underline my "it could happen anywhere" comment, below is the December 1, 2014 Bangor Daily News editorial based on the British paper The Telegraph story by their US Correspondent David Millward: American woman in danger of bankruptcy after being taken to wrong hospital in Madison, Wisconsin. It's a financial horror story. No wonder that over 57% of Americans who declare bankruptcy are due to medical bills they cannot pay.

Theater of the Macabre: U.S. Health Care in 2014

By Donna Smith
Common Dreams
Nov. 26, 2014

Emergency

What are we doing? Really. What is it we are doing to one another? Our health care system is so dysfunctional and so profit-driven that most of us have come to accept as routine the inhumane, greedy and dangerous practices many (most) providers employ when we become their widgets.

It's a theater of the macabre, and the players on stage are you and me and every other American who finds himself or herself injured or ill and in need of medical attention. So it was last night when my husband's blood pressure soared to dangerous levels and he felt the vague ache of the chest pain that in the past has signaled an on-coming cardiac event. It took some convincing, but I got him to go to the emergency room shortly before midnight.

Exempla-St. Joseph's Hospital is a fine hospital in our area, and that's where we ended up. In the emergency room, nurses wasted no time in taking my husband, Larry, to an ER bed and starting the EKG, blood work and other assessments that would help the doctors know better what was going on. Larry was still pretty shook up but clearly a bit relieved to be in a place where if he was on the verge of a heart attack (or had already had another one), he would likely survive. It is terrifying for him to wonder when or if that next big event will come.

Once he was settled and test results were pending, a business office representative came into our room. She asked the usual sorts of questions about insurance coverage and handed us some Medicare literature and patients' rights handouts. Then she did what she probably legally is compelled to do but what ought to be illegal in any hospital. She said to Larry, "You know if you are admitted, we do not accept your Humana supplemental insurance up on the floors. Down here in the ER, we accept it, but not once you go upstairs. Our competitors at St. Luke's take it, though, so I guess you just need to know that." She went on to show her disdain for the Affordable Care Act/Obamacare, and acknowledged that she would support an improved and expanded Medicare for all, single-payer type reform. "Who wouldn't want that?" she asked as she left the room and thanked us for our time.

I watched Larry's face tense and his cheeks flush as he started worrying about what we might owe if he were admitted. He looked to me for some indication of what we ought to do. I was certain if I told him that might mean we'd owe a substantial amount to St. Joe's for his care if he became an in-patient, he'd probably had said "No way" and demanded to go to a facility that accepted both his Medicare and the Humana supplemental for which he pays more than $200 each month. We already owe this hospital for in-patient care given to me last January and biopsies in April that we are struggling to get paid off, and Larry would never tolerate owing them more. Since I didn't want him to get all stressed out again and since that stress might well exacerbate the symptoms for which we were seeking care, I worked quickly to reassure him that he should not worry. Never mind that his new cardiologist does her surgeries at this hospital, and now we find out his insurance may not provide full coverage. What a mess.

We'll figure it all out, I told him, even as internally I thought this was potentially a really bad thing. I put on such a great performance last night. I was calm and comforting and as loving as I could be. To do otherwise when someone could be suffering a heart attack or other serious heart event is unconscionable and cruel. He is my husband of 38 years. I protect him with all that I am and will continue to do so. But it's the middle of the night, and I am tired and cold. Yet there is no one to reassure me -- the fear and the worry are not helping. I turned my attention back to Larry.

This is the mission statement I found on this provider's web page (just to add a touch of irony to the tale): Mission: We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.

Two things every hospital and provider must stop doing: first, do not enter a patient's ER room and deliver potentially awful financial news when you do not yet know what is going on with that patient's medical condition and/or care and you do not know what such information might do to that patient's condition; and, second, do not expect patients and their families to fully understand that our insurances can be good on one floor or in one department of your facility but invalid or not accepted as payment for any other part of what you do within your facility. Both of those things ought to be illegal. Oh, and maybe stop lying about your overall mission?

Finally, I say it so many times, but it is true. None of these situations would arise if we provided coverage to all underan improved and expanded Medicare for all for life system. And I aim to help make it so. Only then will we stop playing our unintended roles in the theater of the macabre that is our dysfunctional, for-profit health care system.

 

Donna Smith is the Executive Director of Health Care for All Colorado and the Health Care for All Colorado Foundation.

 

A trip to the ‘wrong’ hospital shouldn’t bankrupt you

Bangor Daily News
Dec. 1, 2014

Sometimes, the best way to identify a problem is to see it through someone else’s eyes. Take, for example, the British media coverage of the plight of a U.S. woman who was taken to the “wrong” hospital when she suffered a heart attack. The Wisconsin woman now faces bankruptcy because of her medical bills.

How is this possible, the incredulous reporter for The Telegraph wonders?

Megan Rothbauer suffered a serious heart attack at work last September. The then-29-year-old was unconscious when an ambulance arrived. It took her to the closest hospital.

But that hospital was not in the network covered by Rothbauer’s insurer.

The result? Rothbauer was left with $52,531.92 in bills for her care, which included 10 days in a medically induced coma, The Telegraph’s David Milward reported. If the ambulance had gone three blocks farther to a hospital in Rothbauer’s insurer’s network, the bill would have been capped at $1,500.

This situation “highlighted the complexity of the American health insurance system,” Milward wrote. In America, you have to stay in your insurance network, even when facing an emergency and, in Rothbauer’s case, unable to speak and tell an ambulance what hospital to go to.

The hospital where Rothbauer was treated, St. Mary’s, was actually very accommodating. Its total bill for her care was $254,000. Her insurance company, Blue Cross-Blue Shield, agreed to pay $156,000, the rate it would pay to an in-network hospital. St. Mary’s then wrote off 90 percent of the remaining hospital charges. Rothbauer still has to pay bills from doctors, therapists and the ambulance — which were outside the Blue Cross network. These charges totaled more than $50,000.

An unnamed spokesperson for the insurance company said the company wouldn’t pay more “since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation,” The Telegraph reported.

Likewise, Rothbauer had little influence over where she ended up for her medical care. Yet she now bears a heavy financial burden for her care simply because she was taken to a hospital that didn’t have a contract with Blue Cross-Blue Shield. Rothbauer, by the way, doesn’t really blame anyone for what happened. Instead, she is focused on finding ways to pay her bill, including delaying her wedding and considering bankruptcy.

For Meg Gaines, head of the Center for Patient Partnerships, a consumer advocacy group at the University of Wisconsin-Madison Law School, “This brings the health care problems to a pinnacle. The question is, will we tolerate this as a society?”

That is the question. Reform work, like the Affordable Care Act, has eliminated some of the most egregious health insurance discrimination, such as denying policies to people with pre-existing conditions. Steering patients to providers with better outcomes and negotiating lower prices are important steps in reducing America’s high health care expenses.

But cases like Rothbauer’s show that reliance on a system heavy on bureaucracy and inflexible policies leaves people with health insurance vulnerable to falling into unexpected gaps in coverage when an emergency strikes.

 

Editor's Note: More than 1 out of 5 children live in poverty here in Maine. By moving to a single, publicly funded universal health care and covering every man, woman and child, our state would achieve a number of worthy goals: improve public health and increase productivity, minimize poverty among children and families, relieve employers of the administrative and financial burden caused by today's complex insurance-based system, allow providers to focus on health and healing – all this for less money per capita than what we are paying today.

You can help by subscribing and donating to support our eduction and advocacy. Thank you.

Maine drops to 20th in healthiest state rankings

December 11, 2014
By Jackie Farwell, Bangor Daily News

Maine fell from 16th to 20th in an annual national health ranking, dragged down by poverty and low vaccination rates among children, among other factors.

The state’s finish marks its worst since the nonprofit United Health Foundation launched its “America’s Health Rankings” in 1990.

healthranking

Nearly 21 percent of Maine children live in poverty, a rate that remains largely unchanged over the last 25 years. Less than 70 percent of children between 19 and 35 months of age receive recommended vaccines, placing Maine 35th in the country on that measure. Low immunization rates may have contributed to relatively high rates of whooping cough.

The state is also home to too many smokers, though far fewer than in 1990, and ranks a depressing 40th for deaths from cancer, the rankings found.

Maine scored well in other areas, placing first nationally for our low rate of violent crime. Other bright spots were our high graduation rate (education is a strong predictor of life expectancy), low number of deaths from heart disease, and low prevalence of babies with low birthweight.

Perhaps surprisingly, given the sobering news about prescription painkiller and heroin abuse in Maine, drug deaths fell by 16 percent over the last two years.

The report also found Maine needs more dentists, ranking 35th in the country with 51.1 dentists for every 100,000 residents.

So how did the other 49 states perform? Hawaii was the healthiest state, followed by Vermont, then Massachusetts. Mississippi pulled up the rear at dead last as the least healthy state.

 

Maine Allcare Universal Dollar Fundraising Campaign

Small ¢ontribution$ toward a big idea — Universal Health Care in Maine

We at Maine AllCare invite you to join our Universal Dollar Fundraising Campaign. We are asking for small, recurring donations. Monthly contributions of two, five or ten dollars from many people will create a modest, but stable and reliable funding source to help pay for printing the brochures, handouts and newsletters we use at community meetings around the state. Other costs add up fast, such as theaters rentals for showing the award-winning documentary, The HEALTHCARE Movie.

Dr. Philip Caper

Reform health care to serve patients, not corporate medicine

By Dr. Philip Caper
Special to the BDN
December 18, 2014

When I was a kid, I liked to play a game called “connect the dots,” where I connected a series of numbered and apparently unrelated dots to reveal a picture of a person, animal or object. I still enjoy connecting dots, but I do it with apparently unrelated observations and try and understand the picture they reveal. Here are several dots I have observed lately.

The Commonwealth Fund recently released a study of the adequacy of health care for people over age 65 in wealthy countries. Even after 50 years of Medicare, seniors in the U.S. had nearly twice the rate of cost-related problems accessing care than those of any other wealthy country. Our seniors also have more chronic illness, take more medications and struggle more to pay for health care than those in the 10 other countries studied.

The difference is that in all of the other countries, everybody, not just seniors, have health care coverage. The study’s authors speculate that by the time we reach 65, we have a lot of catching up to do because of the inadequate care we received when we were younger, when preventive care could have made a real difference.

The Consumer Protection Financial Bureau recently published a report stating that about 75 million consumers in the U.S. have had bill collection problems reported on their credit reports. They found that “roughly half of all collection problems that appear on credit reports are reported by debt collectors seeking to collect on medical bills claimed to be owed to hospitals and other medical providers.” NBC News concludes that medical debt is hurting the creditworthiness of 43 million Americans, and the systems in place to collect and report this debt can be challenging.

An article appeared last week in the New York Times, headlined “ The Punishing Cost of Cancer Care.” The author, oncologist Mikkael Sekeres, puts the problem faced by cancer patients starkly.

“As the price of chemotherapy now routinely reaches $100,000 for a full treatment course, my patients are forced more and more into making the equivalent of Sophie’s Choice when it comes to treating their cancer: Spend down their savings for an improvement in survival that might amount to a few weeks, secretly hoping that they will be one of the lucky few at the ‘tail’ of the survival curve — the handful of people who live years more; or decline the therapy and in so doing ensure that their families will be provided for after they have died,” he said.

Yet another New York Times column pointed out that there appears to be a direct relationship between social status and health: the higher your social status, the better your health. Low social status engenders a chronic “fight or flight” response, a state of chronic insecurity, helplessness, fear, anger and stress. These emotions cause the secretion of adrenal hormones that, if excessive, cause high blood pressure, diabetes, heart and kidney disease, and strokes. We seem to be reaching a tipping point, where our American health care system soon may be producing more illness than it cures.

As I have written before, social factors, not medical care, are the most important determinants of illness in Americans. Early detection and timely medical care are the most important determinants of how effectively diseases can be treated and how far they progress.

So what thread connects these seemingly unrelated dots, and what picture emerges? I see a health care system that is evolving to serve primarily the financial needs of the large corporations that comprise our medical-industrial complex, not the real needs of patients and other ordinary people.

As the share of medical costs borne directly by patients continues to rise, the market for supplemental insurance policies and other gimmicks marketed to deal with those out-of-pocket costs will grow as entrepreneurs in the financial services industry scramble to exploit loopholes in the law. More and more debt will be financed with high interest rate credit cards and other consumer credit.

The winners, once again, will be the insurance companies, credit card companies and banks. The losers will be the patients and the rest of the U.S. economy.

I think we can do better than this. We need to overhaul the way we finance and pay for health care and return its focus to serving patients, not the needs of corporate America. The experiences of other wealthy nations show we can do this by expanding and improving Medicare to everyone. That is strong evidence upon which to base our own public policy.

By excising the profit motive from the heart of health care, we can reshape the emerging picture to one that works for all of us.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.



What Can Maine Doctors Do?

Return medicine to its healing roots — help educate and advocate for universal, single-payer health care that covers every Maine resident

  • Join Maine AllCare mailing list, and volunteer to help, including supporting financially
  • Join PNHP — www.pnhp.org
  • Visit our websites regularly — www.maineallcare.org & www.philcaper.net for more information
  • Organize and make your voices heard through the Maine Medical Association
    • Doctors have lost influence during the past 30 years or so, but we are far from powerless – they don’t have much of a business without us!
    • Doctors are still influential – make your views known
  • Write op-eds and letters to the Editor of your local paper
  • Testify in person and in writing before the relevant legislative committees when legislation affecting health care is being considered. MAC can help organize these efforts
  • Organize speaking events directed at professions and lay audiences for Maine AllCare speakers
    • Grand rounds
    • Local and specialty medical societies
    • Community forums, church groups, Rotary Clubs, Lions Clubs, Chambers of Commerce

If you have ideas about how else we might advance the cause of universal health care here in Maine, please write to us at info@maineallcare.org and and put "Idea" in the Subject line. Thank you.