I’m No Healthcare Consumer

Yesterday's New York Times contained a very sensible column by Paul Krugman. He asks a question that’s really rather obvious – so obvious, in light of our national healthcare-funding woes, it’s escaped the attention of a great many who ought to be asking it:

“Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car - and their only complaint is that it isn't commercial enough.

What has gone wrong with us?”
– Paul Krugman, “Patients are not Consumers,” New York Times, April 21, 2011.

This is more than a mere quality-of-life question. It’s got big implications for economics, as we continue to struggle through our national healthcare-funding debate:

“Consumer-based" medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most ‘consumer-driven’ health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.”

The problem is that there are an awful lot of people out there who profess an unquestioning, fundamentalist faith in what economist Adam Smith called, way back in 1759, “the invisible hand” of the market. For him, it was probably just a metaphor, but for his latter-day followers, it’s become a virtual deification of free enterprise. Attached to that invisible hand, in their fantastic imaginings, is a new Olympian god, who effortless regulates human affairs through astute transfers of capital.

That would be of little significance, were not living, breathing human beings mightily affected by such transfers.

That makes it, as Krugman correctly points out, a moral issue.

September 9, 2010 - Defensive Medicine

The headline reads, "Cost of Medical Malpractice Tops $55 Billion a Year in U.S." But it's misleading.

It's not the cost of malpractice that's the problem. It's the cost of the medical world's hyper-defensiveness in trying to stave off lawsuits.

The troubling figure, according to a recent, comprehensive study described in the article, is: 2.4.

That's 2.4 per cent of annual healthcare spending that's related to malpractice, including medical practitioners defending themselves against potential lawsuits.

Think of it - you write a check to your doctor for a $35 copay. No matter how expert your doctor is, no matter how meticulous he or she may be about leaving no medical stone unturned in diagnosis or treatment, 84 cents of what you're paying that day goes to cover the cost of other doctors who aren't so good at what they do.

Multiply that by every check written to every doctor and hospital around the country, and we're talking some really big money.

It's not so much the bad doctors out there who are the problem. Their numbers are very small. It's our fear of them that's the problem. It's a fear that leads even the best doctors to shell out big bucks for malpractice insurance, and that causes us to pay big bucks for marginally necessary tests.

They call it "defensive medicine," and it's costly indeed.

I hope the medical reform now working its way through our government includes some measures to reduce the adverse impact of this largely unreasoned fear.

It's a lot of money. It's not the whole answer to runaway medical costs in this country, by any means, but it's significant.

February 10, 2010 - Bean-Counter 1, Oncologist 0

Snowed-in today – or, to be more accurate at the moment, sleeted in. It’s a “wintry mix” out there – a real mess.

So, I have a little time to do a blog entry.

I just happened upon a link to a blog posting by a pediatric oncologist, David Loeb, who works at Johns Hopkins. It’s called “Why David Hates Health Insurance Companies.” Here’s some of what he writes about one of his patients, a young woman diagnosed with liver sarcoma:

“My patient will need a chemotherapy drug called ifosfamide to treat her tumor. This drug has a significant risk of infertility associated with it. After consultation with a reproductive endocrinologist, we decided that the best way to try to protect her fertility would be to use a drug called Lupron. Unfortunately, Lupron is expensive, so it requires prior authorization from the insurance company. I just received an email from our clinic coordinator that read, in part, ‘It won't be covered if it's for fertility reason (per her case manager).’”

“So... I have some choices to make. Do I lie and say the drug is being prescribed for another indication? Do I tell the truth and risk the family having to pay $750 per dose out of their own pockets? Or do I choose a different drug, one that will not work as well, and know that I am not providing optimal care for this young woman, and am increasing her risk of infertility?”

The rest of the blog entry indicates how hard this doctor has been working, documenting all the complexities of the case, emailing copies of medical-journal articles to insurance-company drones – trying to convince them to make an exception. Bravo to Doctor David for going the extra mile for his patient. I hope he gets someone to listen to him.

Who can put a price on a young woman’s fertility? The very notion of it boggles the mind. Yet, this is the Godlike power our broken health-care system places in the hands of insurance-company functionaries.

Think about it: an insurance-company clerk at a computer terminal vs. an oncology specialist at Johns Hopkins. The clerk is supposedly advised by a consulting physician – who’s on the payroll of the company and who receives bonuses for declining claims – who may not even be an oncologist. And who’s this “case manager,” anyway? My case manager, when I had one, was a nurse. A very capable and helpful person, but certainly not the equal of a Hopkins oncologist when comes to making treatment decisions.

This is the nitty-gritty of our present healthcare mess. This is where it gets up-close and personal. Those rageaholics at Tea Party rallies, ranting on about mythical “socialized medicine,” are perpetuating a system that forces highly-trained specialists to take precious time away from caring for patients to educate insurance-company bean-counters.

It’s not that this is an occasional aberration. This sort of Kafkaesque scene is replayed day in and day out, in hospitals across this land. It’s why our healthcare dollars buy so little patient care.

In a comment on Dr. Loeb's posting, his clinic coordinator chimes in:

"Why do physicians have to charge a high rate for service? They have to pay for me! On a daily basis, I have at least 20 cases on my desk to try and convince an insurance company to approve treatment and/or medications that will improve the patient's quality of life. This is distressing for the unfortunate loved ones who have to deal with the sometimes long wait. As if a child with cancer is not enough to deal with!"

We all know it’s a wasteful, inefficient system. Yet, there are also hidden costs, like this doctor’s and this clinic coordinator's time, that don’t show up on the usual balance sheets.

I wish every obstructionist Senator could read Dr. David’s blog entry.

This is our national shame.

October 19, 2009 - The Gloves Are Off

Today, following a Facebook link, I come across this video of the President speaking on health care reform. The gloves are off. “No drama” Obama is stepping up at last, to identify the heart of the problem with our health-care funding system. It’s the insurance companies:



The insurance companies are richer than rich. They’re powerful. They channel huge amounts of lobbying money and campaign contributions to Capitol Hill.

There’s one thing they can’t change or influence, though. As the President says in this message, a large majority of the American people is in favor of change, and elected him in order to bring it about.

The coming weeks and months will tell whether America is still a democracy, or whether it has become a plutocracy – a system in which money talks so loudly that even our democratically-elected representatives dance to its command.

Keep at it, Mr. President. A great many of us out here are behind you all the way.

3 Videos: Americas Floods, Atlanta Badly Flooded, Damage at $250 million

From Denny: Having lived in Atlanta, I knew full well this could happen one day. What this video does not say is that most of the suburban areas and high end shopping centers on the west side of Atlanta are built upon, you guessed it, a flood plain!

That's why a lot of those flooded buildings were not insured as they could not get insurance or the cost was prohibitive. At the time I lived there the flood plain of the Atlanta area had not flooded in 100 years. The builders and business people were confident it would never happen. Mother Nature had other plans.

This was 21 September when only 20 inches of rain had fallen:

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This was filmed on 22 September:

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This was when 50 inches of rain had fallen by 23 September:

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Today, as I write this post it has been raining all day. The weather systems in this part of America starts the rain in Houston, comes east to southern Louisiana and then moves on east on to Atlanta, Georgia. We may be seeing some more videos of this terrible excessive flooding in Atlanta because it's been raining here all week.

September 18, 2009 - Worse than Drunk Driving and Homicide Combined

It's worse than drunk driving.

It's worse than homicide.

It's worse than drunk driving and homicide combined.

What is it that causes more Americans to die each year than either of these two fearful scourges?

Lack of medical insurance.

So says a new study released by Harvard Medical School. If these numbers are correct - and with a Harvard cachet, most would conclude they probably are - our country's healthcare crisis is worse than nearly all of us imagined.

It's a stark number: 45,000 deaths a year. That's how many American deaths the Harvard experts attribute to lack of medical insurance. One death every 12 minutes.

About a year ago, one of our daughter's high-school classmates was struck and nearly killed by a pickup truck, while crossing the street in a designated crosswalk. She survived, but with brain damage, blindness in one eye and mobility issues that could result in lifelong disability (we continue to be hopeful for recovery). A friend who was walking beside her was knocked off balance but escaped virtually unscathed. The truck's driver - who tried to flee the scene but was later apprehended - was reportedly very, very drunk.

The community was outraged. Their outreach to the family, both in terms of fund-raising for medical expenses and simple human kindness, has been awe-inspiring. (The family does have medical insurance, by the way; it just wasn't enough. What private-insurance policy would be, for such devastatingly high bills?)

Yet, where is the outrage when another family's house goes into foreclosure because of unpaid medical bills due to lack of insurance - or even due to a policy that looked good on paper but came up lacking, once Big Insurance's casuistic cost-cutters had sharpened their knives?

Where is the outrage when a young mother, just told she has Stage IV breast cancer, admits she felt several lumps months before, but delayed going to the doctor while she was between jobs? She waited too long. The cancer had advanced.

She knew, she confided in me later, that if she received a diagnosis while still unemployed and without insurance, her treatment for a pre-existing condition would probably never be funded. Never.

Knowing breast-cancer treatment can drag on intermittently for years, she did a grim mental calculation and concluded it was worth a roll of the dice. She lost. Yet, why should a human being, a child of God, ever have to roll such dice at all?

These aren't mere statistics. These are people I know personally. What's more, such stories could belong to any of us.

Any of us. (Unless we happen to be super-rich.)

I'm not an activist by temperament. I have political convictions, but on most issues I try to keep them to myself, not wanting to limit the reach of my ministry. Yet, I'm a cancer survivor who's looked into many a careworn face on the far side of a doctor's waiting room. I'm also a pastor who's held many whispered consultations with family members at the foot of hospital beds. I'm aware of how huge this problem is, how deep its personal bite can be. The Harvard statistics confirm what I've long known, on a gut level, to be true. Some - maybe even some of my parishioners - may wish I'd remain above the political fray on this issue. But, I can't. Lives are literally at stake.

It's not that those who oppose increased government involvement in healthcare funding are bad people. They have their own convictions, their own ideologies. Some honestly believe, as a matter of principle, that the private sector can do medical insurance better than the government can (despite compelling indications that Medicare beats the average private-insurance policy hands down, on most metrics). Yet, when it comes to the large number of Americans who have reasonably good insurance and who've never faced a major health crisis, they have no idea. They simply have no idea how close they or their loved ones are to the abyss. Each and every day.

As my daughter's friend has discovered, it's as close as one second in time when stepping out into a crosswalk.

This morning I was reading an eye-opening article, "No Country for Sick Men," in the latest issue of Newsweek. The author, T.R. Reid, makes a number of telling comments:

"'You have to understand something basic about Canadians. Canadians don't mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.'

In that last sentence, [Saskatchewan Medical Society official Marcus] Davies set forth the national ethic of health care in his country: medicine is not a commodity to be sold to the highest bidder, but a right that must be distributed equitably to one and all. In short, the Canadians have built a health-care system that neatly fits the Canadian character: ferociously egalitarian, but thrifty at the same time."...

(It's a question of fundamental values, in other words.)

"But the most important influence of national culture can be seen in the most basic question facing any country's health-care system: who is covered?

On this fundamental issue, the United States is the odd man out among the world's advanced, free-market democracies. All the other industrialized democracies guarantee health care for everybody - young or old, sick or well, rich or poor, native or immigrant. The U.S.A., the world's richest and most powerful nation, is the only advanced country that has never made a commitment to provide medical care to everyone who needs it."...

(Are we really so narcissistic in this country that we think we can be so right, and so many other nations so wrong?)

"Those Americans who die or go broke because they happened to get sick represent a basic moral decision our country has made. All the other rich countries have made a different decision: they cover everybody. A French physician, Dr. Valerie Newman, explained it this way: 'You Americans say that everybody is equal,' she said. 'But this is not so. Some are beautiful, some aren't. Some are brilliant, some aren't. But when we get sick - then, yes: everybody is equal. That is something we can deal with on an equal basis. This rule seems so basic to the French: we should all have the same access to care when it comes to life and death.'"...

(Isn't that just common sense?)

"That principle seems so obvious to people in Europe, Canada, and the East Asian democracies that health officials asked me over and over to explain why it isn't obvious to Americans as well. 'The formula is so simple: health care for everybody, paid for by everybody,' a deputy health minister in Sweden told me. 'You Americans are so clever. Why haven't you figured that out?'"...

(Oh, to see ourselves as others see us!)

"In the U.S.... some people have access to just about everything doctors and hospitals can provide. But others can't even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral."

Yes, there are legal, economic and political aspects to America's bitter healthcare debate. Yet, I'm becoming increasingly convinced that the line of argument that dwarfs all these others is the moral one.

As a preacher, that's my department. And that's why I refuse to keep silent.

September 7, 2009 - Happy With Your Health Insurance?

Today I heard a phrase I’ve been hearing a lot lately in news reports about the health-insurance debate. It’s the concept of people who are “happy with their health insurance.”

Are you one of those satisfied consumers? Are you truly happy with your health insurance?

You’d think there must be an awful lot of happy Americans out there, the way Washington politicians have been spreading that phrase around, thick as manure.

I suppose there may actually be a few pleased policyholders out there. The nature of insurance, after all, is that some people need it more than others. Those who don’t submit many claims tend to be happy with their coverage. They take comfort in holding that wallet card. They feel protected.

Even if their medical safety-net is spun from pure fantasy, they feel protected. Maybe even happy.

The true test comes with hard times. I wonder how many who are happy with their health insurance have chronic medical conditions? These are the people who deal with the real world of medical insurance, not fantasy.

I’m fortunate enough to be doubly covered. The Blue Cross/Blue Shield insurance I receive through the Presbyterian Church is pretty decent. The secondary Qual-Care spousal coverage we purchase at group rates through Claire’s employer, Meridian Health, is a valuable back-up. It takes a big bite out of my 20% Blue-Cross/Blue Shield co-pay – which, when it comes to things like PET scans, can add up to a pretty penny.

Even so, I’m not happy with my health insurance. I’m not happy because I know I have to watch both insurance companies like a hawk. I know their profits are dependent on their denying customers’ claims. I know they reward their employees when they find reasons to deny or reduce payments – if not with outright bonuses, then with favorable performance reviews. I know there are so many middlemen and -women involved in the whole unwieldy process, so many paper forms, faxes and e-mails flying around, that there’s a huge potential for error. Just one omitted or misplaced pre-certification, one out-of-network service booked in error, and I could be left holding the bag for big bucks.

That unwieldy insurance bureaucracy – so complex, even the doctors’ professional claims-processors can’t make sense of it – adds as much as 30%, by some reckonings, to the cost of my medical care. Ultimately, that’s the cost of employing an army of people to push paper and tap on computer keys, not to mention squeezing quarterly dividends out of the system to keep insurance companies’ stockholders happy. It has nothing to do with the quality of my medical care.

I’m not happy with that.

Then, when I imagine the prospect of pursuing cancer testing and treatment without any medical insurance, I’m even less happy – not so much for my own sake, as for the sake of my at-risk neighbors who must do exactly that. I’m not happy being the beneficiary of a system that values stockholders more than sick people.

Dr. Len Lichtenfeld, a physician, has it right, in an August 8, 2009 blog entry on the American Cancer Society website:

“We have too many instances-and too many bankruptcies-where ‘satisfied’ people suddenly found themselves not so ‘satisfied.’ I am willing to bet that you (and me) have no idea whether or not your insurance will be a facilitator or a barrier to your care if you or someone you love becomes seriously ill with a disease like cancer. You just don’t know.

So don’t stand there and rail against your Congressman or Senator because you are ‘happy’ with your health insurance. I wonder how many of you have had a serious, prolonged illness in your family. If your experiences have been positive, terrific. But don’t discount that many others have not been so fortunate.”

Those yahoos shouting their Senators down at town hall meetings don’t seem to realize that this issue transcends any individual right to happiness. Are you happy with your health insurance, Mr. Redface Shoutington? Too bad. Your happiness can’t come at the expense of your neighbor, who worked just as hard as you did over the years, but who was either self-employed or whose employer wasn’t as beneficent as yours when it came to health benefits.

It’s a moral issue. Never before, in human history, has care of the sick been viewed as sick people’s own problem. It’s always been a community responsibility.

Some anthropologists, I’m told, date the rise of the human race according to the first skeleton they ever dug up that had a broken bone someone else had set.

We’re all in this together. That’s where true happiness comes from.

September 1, 2009 - A Little Medical-Insurance Humor

August 26, 2009 - The Passion of His Life

The death of Senator Edward Kennedy is a milestone for our nation. He was, and remains, a controversial figure – flawed like all of us, but undeniably larger than life. Not even his opponents can dispute the impact he has had in advancing a variety of populist causes.

Among Ted Kennedy’s most enduring legacies is his struggle for affordable health care for all Americans. In this video clip, he calls it “the passion of my life,” then explains some of the personal reasons why:



I can relate to many of the stories he tells. Even though I’m fortunate enough to have good medical insurance, my own experience as a cancer survivor has acquainted me with neighbors for whom illness threatens not only physical infirmity and death, but also financial ruin. This is deeply wrong. It is even more deeply wrong that wealthy corporations continue to squeeze vast profits out of this broken system. Medical and insurance lobbyists exercise such power on Capitol Hill that even the voice of the overwhelming majority of the American public may not ultimately be heeded.

The dream of universal health care is not yet achieved. Strident voices are disrupting public meetings, in ways that intimidate fair-minded people and undermine democracy.

I resonate deeply with these words of Jim Wallis, in a tribute to the Senator published today:

“On the occasion of his death, I pray that God may now move us as a nation to address the greatest commitment of Sen. Kennedy's life - the need for a comprehensive reform of the health-care system in America - as a deeply moral issue and one that calls forth the very best that is within us. May we honor the life and death of Sen. Edward Kennedy by laying aside the rancor, lies, fear, and even hate that has come to dominate the health-care debate in America this summer, and regain our moral compass by recovering the moral core of this debate: that too many Americans are hurting and suffering in a broken and highly inequitable health-care system, and that it is our moral obligation to repair and reform it – now.”

This cause was the passion of Ted’s life. May it become the passion of ours as well

Video: Obama's Prime Time News Conference Health Care Appeal

From Denny: President Obama makes his case for national health care reform of some kind, preferably by August, though it looks like that deadline is going to be pushed back to Labor Day in September or longer.

Americans continue to groan under the weight of a weak economy, now 20 million people have experienced home foreclosure, banks are still failing, health care costs are still high, and continued, though somewhat slowed, job loss. The problem is that it will take a good decade to develop new jobs to a sustainable level. Meanwhile, families are going broke trying to pay for health care that often is denied when it comes time for the insurance companies to pay out.

Did I say our economy is in a real mess because it went unattended for eight years by the previous Bush administration? :) Considering the freefall going on it's pretty amazing anyone with a rational mind would oppose health care of some kind.

The reality is that it is needed and we had better start with something basic for everyone so we can stop breaking the backs of the hospitals with the uninsured flooding the emergency rooms for standard sore throat, colds and flu care. Preventive care and education of how to handle basics at home is also required so we don't end up with a nation of hypochondriacsrunning to the doctor for every sniffle.

Amazing too that Congress thinks it's OK to waltz off on a holiday while the majority of America is groaning under the weight of rising costs from every angle: food, gas, local and state taxes as well as health care.


Barack Obama, Health care, Insurance, Health, Breaking News, Health Policy, Labor Day, United States

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July 20, 2009 - Where Not to Get Sick

If you haven’t yet read Atul Gawande’s article in the June 1, 2009 New Yorker about the high cost of health care in McAllen, Texas, you should. It’s a must-read for anyone who’s following the health care funding debate.

Why McAllen? Why should that dusty burg at the southern tip of Texas have the highest per capita health care costs in America? Gawande’s article is a detective story, chronicling his efforts to answer that question.

The answer he comes up with is that McAllen’s doctors are responsible for many of these elevated costs. They order up a whole lot of costly, high-tech medical tests, more than most other doctors around the country:

“The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.”

Remarkably, the highly-tested patients of McAllen are no healthier than patients elsewhere. Compared to some cities with lower medical costs, they actually do worse.

It’s not that McAllen’s doctors are less competent than doctors elsewhere, or that they’re morally challenged. Gawande’s explanation is that the entire medical system in McAllen is engineered – to a degree not typical of many other communities – to encourage doctors to order marginally-necessary, or even unnecessary, tests, and to prescribe costly treatments that may be no more effective than cheaper alternatives.

There are lots of reasons for this. According to Gawande, it’s a complex constellation of factors, including:

- a high rate of for-profit, physician-owned medical facilities;
- an entrepreneurial culture that sees doctors as businessmen and -women, rather than healers;
- a well-founded fear of lawsuits that leads to defensive medicine;
- comparatively less coordination of care than in other places, leading to duplication of services.

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”

It’s the system’s fault, says Gawande. This is a classic example of a systemic problem.

Gawande compares McAllen to another town that’s in the lowest 15 percent of health care costs, nationwide: Rochester, Minnesota, home of the world-famous Mayo Clinic. The most significant difference is that a high percentage of doctors in Rochester are employees of the clinic, rather than entrepreneurial owners of their own little medical businesses. Success in that setting is measured in healthy patients, not the number of patients served. The medical system in Rochester is engineered to maximize health outcomes rather than profits.

They say this article has become required reading in the White House, by staffers tasked with proposing to Congress a workable fix for the health-care funding crisis.

No wonder.

The American solution to medical cost-containment, until now, has been to rely on the insurance companies to ride herd on all this Wild West confusion. The only problem is, the insurance companies are no more concerned with positive health outcomes than physicians are. The insurance companies work for their stockholders, not for the patients.

We need to develop a health-care system that does work for the patients. Other countries (Britain, Canada, France) seem to know how do this better than we. This is a rare opportunity for our national leaders to think outside the box and develop a funding system that truly serves the greatest number of people.

Just don’t blow it, politicians. Take the lobbyists’ hands out of your pockets and pay attention to your constituents. We’re hurtin’ out here – especially in places like McAllen, Texas.

July 3, 2009 - Profits and Pain

A recent editorial in one of my favorite journals, The Christian Century, raises a pertinent question about the present healthcare-reform debate:

“The logic of putting citizens into a government-sponsored insurance pool is clear: it drastically cuts overhead, equalizes care, and meets the needs of those who can't afford or obtain coverage from for-profit insurers, who cut their costs by excluding patients with serious medical problems – precisely the people who most need the insurance and the medical care. But that logic alone will hardly slay the hardline defenders of the for-profit insurance system. The political and practical question of the moment... is whether there is any viable compromise – is there a coherent incremental step between the private system we have now and a full-fledged single-payer public plan?”

President Obama seems to think there is – which is why he’s backed away from his campaign promise to move expeditiously to a single-payer health system. Now, he’s mired in the boggy no-man’s-land between the single-payer advocates on the one hand and the insurance companies (clinging to the tattered remnants of our dysfunctional healthcare-funding system) on the other. He’s dodging rotten tomatoes being hurled from both sides.

It’s a battle of ideologies: between the free-market true-believers on the one hand – who are convinced not only that “the business of America is business,” as Calvin Coolidge famously said, but that the best marketplace regulation is no regulation – and those who believe history teaches, on the other hand, that a capitalist economy will end up eating its young if government doesn’t step in with some timely regulation.

In the same issue of The Christian Century, social ethicist Gary Dorrien makes this important observation:

“A fair amount of time has to be spent repeating over and over that single-payer is not socialized medicine, and a public option among private competitors is even farther from it. But we are approaching the point where opponents of health-care reform will start to stress the opposite concern. Their concern is not that a government program won’t work. The real worry, for all who want to keep the present system, is that a government program will work too well.”

“Working too well,” of course, means cutting into Big Insurance’s profits.

Are profits always good? That’s the essential question. Are they still good, even when the unfettered pursuit of profits causes pain for increasing numbers of people? How many of our neighbors must feel pain before the larger culture sits up and takes notice, demanding substantive change? How many uninsured and undertreated Americans is our system willing to throw under a speeding ambulance, before we’re willing to even consider following the lead of just about every other industrialized nation, implementing a national health-insurance system?

That’s the question I sigh and ask myself these days, anyway, as I scan the headlines.

May 7, 2009 - Microscope-Ready

Good news, today, in the form of a news article about government allocations for medical research. The article in Bloomberg News reports on what one researcher calls “a stunningly large number” of dollars – $10.4 billion of ‘em, to be exact – that will be devoted to curing what ails us. “Breakthrough findings on obesity, AIDS, Alzheimer’s, Parkinson’s and cancer” are on the way, the article predicts.

President Obama has included this amount as part of his $787 billion shot in the arm for the economy. There’s been lots of talk about rebuilding the nation’s crumbling infrastructure through “shovel-ready” projects like bridges and highways. It’s nice to know there are some microscope-ready projects, as well, to benefit those of us with chronic illnesses.

There are some who say that, once you have cancer, never a day goes by that you don’t think about the disease, at least once. I’m pretty sure that’s continued to be true for me, during this extended period of watch-and-wait. Some days I think about it a lot, other days it’s no more than a fleeting thought. Yet the though is always there, if only lurking below the surface.

I would a great thing, indeed, if I didn’t have to think about it anymore.

It would be a great thing, as well, if some additional billions would be used to buy health insurance for those without it – although I suppose that’s coming down the pike soon enough, along with the rest of the President’s healthcare-funding proposal.

Why is this important? Check out this 7-minute video that tells what an impossible fix a hard-working American family can get into when cancer comes knocking at the door:



Quite apart from the humanitarian factor, cleaning up our nation’s broken healthcare-funding system – that leaks dollars like a sieve – will actually strengthen the economy.

Now, that’s the sort of win-win scenario that even a fiscal conservative ought to be able to appreciate.

April 2, 2009 - Healthcare Reform Petition

Remember this guy?

The “Dean Scream,” marking the meltdown of Howard Dean’s insurgent presidential candidacy, was one of the more memorable moments in modern presidential politics. Dean has been hard at work ever since, as national leader of the Democratic Party. Now, he’s turning his efforts to work with President Obama on addressing health-care reform.

He’s looking for signatures on a petition he plans to bring to Congress, asking for a public health-insurance option. While it may not turn out to be universal health care (which I, personally, am convinced is the only way for our nation to go), the Obama plan would at least require everyone to have insurance.

A publicly-provided insurance option will likely be a cornerstone of that plan. The insurance industry is marshaling their substantial political and financial clout to try to block any such option that could compete with the products they offer.

Since private insurance has failed so abysmally, for so long, to provide affordable medical insurance options for Americans, I think we, the voters need to stand up to them and say, “Enough!”

Won’t you sign the petition?

We won’t see Howard Dean screaming about this. He’s been speaking more softly in recent years. Sign the petition, and you’ll give him (along with President Obama) Teddy Roosevelt's proverbial big stick as well.

I’m Carl Wilton, and I approved this message.

February 7, 2009 - Dumbth

Yesterday I slit open an envelope mailed to me by Care Allies (formerly Intracorp), the agency that pre-approves medical tests for my insurer, Highmark Blue Cross-Blue Shield. I guessed what it was before I opened it: a routine pre-approval for the PET/CT scan I’m having this coming Wednesday.

I usually take only the briefest of glances at these letters and put them aside. As long as I see the blessed words, “we have determined that the requested services are medically necessary,” I figure I have nothing to worry about.

This time, though, I saw something in the description of the test that concerned me. The letter reads:

“APPR: PET IMAGE W/CT, SKULL-TH 78815”

“They’ve made a mistake,” I thought to myself. “Care Allies has approved me for a CT scan of the head – not the scan of the neck, chest, abdomen and pelvis I typically have. This could be trouble, if they’ve approved me for the wrong procedure.”

I went right off and dug up the paper script Dr. Lerner had given me. That made me even more concerned, because I didn’t see anything there about neck, chest, abdomen and pelvis. The handwritten script reads:

“JSUMC, PET/CT Scan, DX: Lymphoma for restaging.”

“JSUMC,” I know, means “Jersey Shore University Medical Center.” “DX” means “diagnosis.” But it sure looked to me like Dr. Lerner had left off the list of body parts that are essential to a CT scan prescription. (Previously, I’d had problems with a Care Allies CT scan pre-certification that mentioned some body parts, but omitted the others.)

I called Dr. Lerner’s office and was put through first to someone in the billing department, then to one of the nurses. She said she’d do a little checking, and called me back a few minutes later. There’s nothing to worry about, she assured me. Everything was submitted correctly. Because this is a PET/CT scan and not just a CT scan, it’s automatically a scan of the whole body, so individual sections of the body don’t need to be specified.

“Then why does the letter I received from Care Allies mention the skull?” I asked.

“The ‘TH’ probably stands for ‘thorax,’" she replied. "It’s a PET/CT scan, skull-to-thorax.”

Mystery solved. But why, I’m led to wonder, can’t the people at Care Allies who compose these letters to patients avoid using arcane jargon and abbreviations? It seems to defeat the purpose of such a letter, which is communicating with non-medical professionals. I’m not sure, actually, that even for medical professionals “TH” would scream out, “thorax.” Clearly, this letter serves the needs of the insurance bureaucrats rather than the patients.

The late comedian Steve Allen once wrote a book called Dumbth, in which he catalogues a whole lot of misuses of the English language that are, for lack of a better word, just dumb. Its title is a word of Allen’s own invention, that describes writers’ thick-headed refusal to recognize that words they’re using just aren’t communicating. His definition:

Dumbth (pron. dumth) adj: a tendency toward muddleheadedness, or willful stupidity appearing in all segments of American life

Thank you, Care Allies, for thoughtfully seeking to communicate the details of the medical procedure for which you’ve pre-approved me. I’m afraid I have to nominate you, though, for the Dumbth Award, for your clumsy way of communicating that makes life needlessly difficult for patients like me.

December 23, 2008 - Lisa's Story

Today, I follow a link in an e-mail from the Leukemia and Lymphoma Society to “Call to Action: Health Reform 2009,” a white paper issued by U.S. Senator Max Baucus, chair of the Senate Finance Committee. I only have time to glance at it briefly in this busy holiday season, but one real-life story catches my eye – not only because it’s the story of a blood cancer patient, but also because it’s an all-too common story in America’s dysfunctional health-care funding system:

“In 2006, Lisa Kelly was diagnosed with acute leukemia. She had insurance – an AARP Medical Advantage plan, underwritten by UnitedHealth Group Inc. with a monthly premium of $185. Unfortunately, the policy had a $37,000 annual limit. And due to the flimsy coverage provided by her policy, the hospital, M.D. Anderson Cancer Center, requested an up-front cash payment of $105,000 before it would start providing chemotherapy treatment.

Ms. Kelly enrolled in a high-risk insurance plan administered by Blue Cross Blue Shield of Texas in February 2007, with a monthly premium of $633. Since her cancer was a pre-existing condition, she had to wait one year for the new plan to cover her treatment. Although Blue Cross started paying her new hospital bills earlier this year, Ms. Kelly is still personally responsible for more than $145,000 in bills incurred before February 2008, and she is paying $2,000 each month for those bills. In June, she learned that after being in remission for more than a year, her leukemia has returned.” ( “Call to Action: Health Reform 2009,” p. 11)

This kind of story really makes me angry. Here’s a person who didn’t just blow off the need for medical insurance. She went out and bought insurance she could afford. She undoubtedly thought she was covered for pretty much anything that could happen to her. A $37,000 annual limit does sound like a lot of money to a healthy person.

It's not. Anyone who’s been around Cancer World knows that cap is woefully inadequate: but most people don’t realize how rapidly and how high medical expenses can pile up, when certain illnesses come crashing down on you from out of the blue. After diagnosis, it’s even worse. You get branded as having a pre-existing condition, and then you’re up a creek without a paddle. For life.

A free-market conservative might counter, “Lisa got what she paid for: an inadequate policy. She should have shopped around more. Caveat emptor.”

All that caveat emptor (“Let the buyer beware”) talk doesn’t sit well with me. As far as I’m concerned, it’s giving unscrupulous medical-insurance companies a license to steal. If we’re learning anything as a result of the current mortgage meltdown, is that the legal sharks can devour a whole lot of victims by hiding in the fine print. What’s true for predatory mortgage loans is just as true for medical-insurance policies.

Lisa’s story is not an isolated situation. From the white paper’s executive summary:

“The U.S. is the only developed country without health coverage for all of its citizens. An estimated 45.7 million Americans, or 15.3 percent of the population, lacked health insurance in 2007 – up from 38.4 million in 2000. Those without health coverage generally experience poorer health and worse health outcomes than those who are insured. Twenty-three percent forgo necessary care every year due to cost. And a number of studies show that the uninsured are less likely to receive preventive care or even care for traumatic injuries, heart attacks, and chronic diseases. The Urban Institute reports that 22,000 uninsured adults die prematurely each year as a direct result of lacking access to care.” (p. 10)

This past Sunday, we held a Health Care Community Discussion at our church, responding to the Presidential Transition Team’s invitation to do so. The discussion went fine – a lively airing of perspectives among people of differing views. Participants completed a brief poll, the results of which we sent on to the Transition Team afterwards, via the internet.

Two church members had approached me separately, prior to the discussion, objecting that this sort of event doesn’t belong in a church. It’s “too political,” they said.

I countered that the election is over, so this couldn’t possibly be about partisan politics. Responding to an invitation from the President-Elect is different from answering the call of someone who’s still standing for election, I explained. But I doubt if either one heard me. Neither one came to the discussion, unfortunately.

I am 100% convinced that this sort of discussion does belong in the church. It probably belongs in the church more than in any other organization – with the possible exception of a hospital or other health-care provider – because we Christians follow a Lord who made healing a big part of his ministry. The American Cancer society has declared lack of medical insurance to be a risk factor for cancer (see my August 31, 2007 blog entry). If we can foster discussion that will lead, ultimately, to less people being at that kind of risk, then we – indirectly, at least – are about the work of healing.

December 16, 2008 - Cancer: The World's Top Killer

Recently I ran across an Associated Press article that began with these words:

“Cancer will overtake heart disease as the world's top killer by 2010, part of a trend that should more than double global cancer cases and deaths by 2030, international health experts said in a report released Tuesday.

Rising tobacco use in developing countries is believed to be a huge reason for the shift, particularly in China and India, where 40 percent of the world’s smokers now live.”

So, cancer’s about to become #1 in the deadly-disease sweepstakes. That, the article goes on to say, is based on estimates of 12 million cancer diagnoses per year – and, 7 million cancer deaths per year.

My diagnosis puts me in good company, evidently. Not that I want to have any traveling companions on this journey, of course.

It’s sad to read about so many smoking-related lung cancer deaths - especially in places like China and India, where incomes are so low people can barely afford the cigarettes, let alone the treatment they’re likely to need one day, if they keep on puffing. I know, from hard family experience, what that sort of death is like. My father died of emphysema and lung cancer, after a lifetime of two- or three-pack-a-day smoking. It was not a pretty sight.

“By 2030,” the article continues, “there could be 75 million people living with cancer around the world, a number that many health care systems are not equipped to handle.”

My chemotherapy treatments and the accompanying diagnostic tests cost somewhere in the neighborhood of $100,000, most of it paid by insurance. Of all the people in the world, I’m one of the fortunate – and comparatively wealthy – few who can afford this sort of treatment. Most others, faced with a diagnosis of lymphoma, or any other deadly cancer, would have to content themselves with palliative treatments.

If you’re in doubt whether the adjective “rich” can be applied to you, try comparing your income to that of most other people on this planet. You can do so in a few mouse clicks, by keying your approximate annual income into the Global Rich List calculator.

Sobering facts, indeed.

November 5, 2008 - Yes, We Can

“If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer.” – President-Elect Barack Obama, November 4, 2008

Last night, our world changed. The election of Barack Obama as President is far more than merely politics-as-usual. Even John McCain seemed to acknowledge that truth in his gracious concession speech. Americans proved last night that we are hungry for change – real, substantive change – and the rest of the world is right there with us.

Last night, I sat and watched CNN’s coverage of the election, from the very first results until the milestone moment just after the West Coast polls closed at 11 p.m., when all the networks acknowledged Obama as the winner. The CNN broadcast was punctuated by repeated (and, surely, very costly) commercials from DividedWeFail.org, an organization committed to health-care funding reform.

Here’s one:



The family profiled in the video had insurance. It wasn’t enough. When this man’s wife contracted brain cancer, it started them on a downward slide that led to bankruptcy.

Another of these commercials told the story of a twentysomething young man who also had to declare bankruptcy, after going into the hospital for emergency surgery. He, too, had medical insurance – but, he said, it turned out to be more like a supermarket cents-off coupon than real coverage.

Who is DividedWeFail.org? Some radical fringe group? Some shadowy cabal of socialists?

No way. They’re AARP!

Yes, AARP. The senior citizens’ lobby. They’ve taken on health-insurance reform with a vengeance. They paid big bucks to wallpaper the election-night newscast with commercials – on a night when it was obviously too late to influence the vote’s outcome – because they know the campaign for Americans’ hearts and minds on this issue is not over. It’s barely begun.

One piece of good news I, personally, take away from this election is that the desire for universal health care (or something very close to it) has become so mainstream in America, that we’re finally going to see some change. Blind faith that mysterious “market forces” will magically solve America’s problems is dead. “Voodoo economics” – as former President George H.W. Bush sensibly called this ruinous ideology, before changing his stripes to become Ronald Reagan’s vice president – has been repudiated, at long last.

Now, we can join the rest of the developed world in building a health-care funding system that serves clients, rather than stockholders. We can eliminate that hugely inefficient layer of middle-management that’s been slurping up so many of our health-care dollars, and apply that money to providing real medical care – and saving real, human lives.

It’s going to be a long journey from here to there. Barack’s got a hugely imposing set of challenges before him. Somehow, he and his team have got to convince everyone involved in delivering medical services – from Big Pharma to the A.M.A. to hospital administrators – that they can not only survive, but flourish in a system that guarantees health care for all.

It can be done. All the other industrialized nations of the world now have such a system. As the Johnny-come-lately, we have the advantage of being able to study the successes and failures of other nations. Then, we can apply good, old-fashioned American inventiveness and ingenuity to devise a system that’s the best in the world.

We can do it. Yes, we can.

October 6, 2008 - Got Cancer? Better Keep Your Job.

This excerpt from a recent news article tells a story that’s – sadly – all too common today, in the dysfunctional world of American medical insurance:

“Most experts acknowledge that people who have cancer or have recently beat it have a tough time finding individual coverage – a fact Angela Clay of Atlanta discovered the hard way.

Clay, 33, was diagnosed with non-Hodgkin's lymphoma eight years ago, while she was living in South Carolina. She survived, thanks to a regimen of chemotherapy, radiation and stem cell treatment, for which she was covered through her job at the time. After she moved to Atlanta in 2001, she had coverage through her job as a teacher in a day care center.

Then another center offered her an assistant manager position in 2004 – a step up with better pay but no benefits. Clay figured she'd simply buy insurance. ‘I'd go online once a month and fill out applications,’ she says. The numerous insurers she has tried turned her down, she says, and one told her she had to be in remission for 10 years to receive health insurance. ‘I've got more than two years to go,’ Clay says.

Clay still has no coverage and so must put off nonemergency medical care, including the follow-up she needs to be sure the cancer hasn't returned. ‘I'm very worried,’ she says. ‘I know I need checkups for my health. It makes me feel vulnerable.’ She sees a doctor only for emergencies, such as a severe boil she developed in January. (She's still paying off the $800 it cost to have the doctor drain it, at $20 a month.) Clay fears the stress of living without insurance will further harm her health. ‘It's hard for me to focus because I have this on my mind,’ she says.” (Jonathan Cohn, “When you are denied health insurance,” MSNBC.com, October 6, 2008)

This is a difficult position for cancer survivors to be in. You’ve gone through treatment, you’ve been declared to be in remission, you’re feeling fine – but, you’d better think twice about taking that new job, because it means switching medical-insurance carriers. You do that at your own risk – maybe even at risk of your life. Once your new employer’s insurance carrier gets wind of your medical history, they’ll drop you like a hot potato (or, they’ll accept you only if you agree to a hefty pre-existing condition exclusion – which amounts to pretty much the same thing).

Cancer survivors in remission yearn for nothing more than to get on with their lives. But, if they are in an occupation in which advancement typically happens by switching to a new employer, getting on with their work lives may be an impossible dream. Because of the pre-existing condition shell game, their cancer history has effectively doomed them to give up all hope of advancing in their profession.

It’s just one more example of the numerous cruel “gotchas” that are lying in wait for cancer survivors, in the dark recesses of our broken healthcare-funding system.

I’d love to hear the Presidential candidates respond to a case-study like Angela Clay’s story, explaining how their respective health-care plans will prevent this sort of abuse from happening.

October 3, 2008 - Onion Article: "Man Succumbs..."

Check out this article from the satirical e-zine, The Onion. It’s good for a smile or two...

Man Succumbs To 7-Year Battle With Health Insurance

September 22, 2008 | Issue 44•39

DENVER—After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life.

Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt....

For the rest of the article, click HERE.