Yet Another Example Of Private Health Care Rationing
By Justin Gardner | Related entries in Health CareAs this health care debate continues, what I find puzzling is how people seem completely fine with private insurance companies denying care because they might lose money, but if the government would ever suggest rationing, well, it’s time for a revolt!
Take the case of Shelly Andrews-Buta, who was denied treatment for brain cancer because…wait for it…she went beyond the number of tumors that a certain piece of technology was allowed to operate on.
In late April, Shelly Andrews-Buta was scheduled to undergo treatment for breast cancer that had spread to her brain, threatening her life. [...]But instead of having doctors working to remove her brain tumors on the day the surgery was scheduled, she sat in a San Francisco hotel room. Why? Because at the last minute, her insurance company, Blue Shield, decided it wasn’t going to pay for the treatment her doctors at UCSF Medical Center had recommended. [...]
Dr. Sneed, who is co-director of UCSF’s Gamma Knife Radiosurgery Program, described it as an amazing machine and the most appropriate treatment for Andrews-Buta.
But the doctor said when it came to getting Blue Shield’s approval for the procedure; she was surprised to learn that the company’s policy lays out that a patient who has more than three brain tumors, what doctors call lesions, would not be covered for the gamma knife procedure.
Do note that this was not a pre-existing condition. They simply said they weren’t going to pay for it, and that she had to settle for a procedure which has proven to be less effective and can produce incredibly bad side effects (according to her doctors).
Just remember this the next time you’re debating health care rationing.
Moving on…
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August 4th, 2009 at 5:45 pm
The key difference is that Ms. Andrews-Buta (or possibly her employer) had the choice to select this or a different insurance carrier. The ones that are more generous in their coverage tend to be more expensive. With a government program, people would have no real ability to select an insurance plan that trades off cost vs. coverage.
August 4th, 2009 at 5:46 pm
Because the scope and scale of rationing is far worse under government systems. Still puzzled?
August 4th, 2009 at 7:14 pm
Why must the only available response to defects in private health coverage be to replicate those defects in bigger form in a government system, Justin?
This is the question that arises in my mind every time of the promoters of government health care responds to concerns about problems by saying that the status quo is as bad or worse instead of by talking more productively about how concerns could be addressed in the design of the reform program. Its like you guys are intentionally low-balling the effort you put into constructing a good package.
August 4th, 2009 at 7:48 pm
Of course neither Jason or Jimmy have any evidence of their claims concerning a government system other than blind faith.
August 4th, 2009 at 8:15 pm
It’s really kind of easy: EVERY other developed country has government health care and they ALL cost far less than ours and their people live JUST AS LONG.
August 4th, 2009 at 9:16 pm
But Michael,
They all live miserable socialistic lives with 6 weeks holiday, free health care and guaranteed retirement benefits! God forbid.
August 4th, 2009 at 9:26 pm
Because the scope and scale of rationing is far worse under government systems. Still puzzled?
Do you have any evidence for this?
Because I’ve yet to see any evidence that rationing is worse in government run systems. The VA is great and it’s patients love it. MediCare is pretty good, too.
OTOH, in the US 10% are rationed out of the system from day one. Many more are rationed out when they get sick because of preexisting conditions. Others get their treatments approved, see all appropriate specialists (sometimes being put on wait lists), and then have the whole thing cancelled at the last minute.
This is the question that arises in my mind every time of the promoters of government health care responds to concerns about problems by saying that the status quo is as bad or worse instead of by talking more productively about how concerns could be addressed in the design of the reform program. Its like you guys are intentionally low-balling the effort you put into constructing a good package.
Jason, at the Universal Healthcare Access Network we tried that approach for years. It failed miserably. We tried to get MichiCare passed. Google it. You’ll get zero hits.
The problem you face when you’re talking about specific reforms is that every single one screws somebody. And most of those somebody’s are influential. “Checks and balances” mean anybody has a lot of opportunity to check or balance a new idea. Including the crazy and the greedy.
One clear problem with our system is that it’s fee for service. That means your Doctor has financial incentive to do useless procedures. Which leads to bizarre results such as Macallan, TX spending more than anybody, but having worse results. This actually exists in most medical systems, but the Brits found a fairly efficient way around it. Doctors get paid a flat amount per patient. The best US hospital systems (Mayo, the Cleveland Clinic, the VA) do the same thing.
But any attempt to fix the problem gets the Doctors real nervous. Have you ever tried getting a committee vote on a proposal Doctors oppose? Thought not.
A second obvious waste of money is medical billing. In most countries “Medical Billing” doesn’t really deserve capital letters. The nurses or office manager does it during downtime. State-side every insurance company has a different set forms, with a different set of codes. This means there’re lucrative careers available for Medical Billing specialists. Almost every Doctor has to have one, and hospitals have entire floors devoted to billing.
But you start talking about that and the insurance companies mention they’ve invested heavily in their billing systems, and that any change would be government interference in the private market. So the Chamber fights it.
You ever tried to get a committee vote on a proposal the chamber opposes?
A third obvious way to save money would be to emphasize primary medical care more. But that requires increasing payments to primary care docs, which means that you a) have to raise taxes, or b) need to cut payments to specialists. Which means specialists oppose it, as do hospitals (they make money on specialty care), and insurance companies (they’d have to change their rates too)…
So we can accept no change, and be stuck with the crappy system. Or propose a solution that’ll help some, and try to make sure that people realize that, while this bill ain’t great, our current system is worse.
August 4th, 2009 at 11:36 pm
I am a working oncologist. When the gamma knife technique was new ( about 12 years ago), it was common to limit the number of lesions considered doable. As more experience has been gained, more and more lesions have been treated. One of my patients had 11 lesions treated about three weeks ago. I’m personally skeptical about treating a large number of lesions, but more and more centers are reporting success.
Private insurance denial of coverage or putting up barriers through a complex pre-approval process is an every day affair in my world.
It is possible that the government could run medicine well, and it is possible that they’d screw it up big time. Why not shed our ideologies and look at some data? Co0st increases in Medicare are less than in private insurance. The VA runs a large health system serving millions. What kind of a job is the VA doing? I hear that it is doing pretty well.
Do any of the people who are against expanding the the role of government in health advocate the shrinking of Medicare or the VA? If not, why not?
August 5th, 2009 at 8:00 am
Rationing is better than having absolutely nothing (i.e., 50M uninsured). It’s the American character: if you have health insurance you don’t care about those who don’t (unless you have a political agenda). The Public Option fear has been brought about by conservative ideologues, who represent health care lobbyists, not their constituency.
Allow me to also mention the odd practice of private health insurance companies offering so-called “affordable” health insurance to individuals and families. I pay about $240/mo. for a plan which allows five office visits a year, a checkup, and $1000/day for hospital stays. $100 for tests, which eliminates all but the most basic. I’m 57, have some minor problems, controlled with medication. Prescription drugs are not covered, so I am forced to purchase them at Walmart. This company advertises on TV for coverage averaging as little as $6/day.
This is paying for health insurance without really having it. Do I count as uninsured? I should be. A neurologist ordered an MRI but instructed me to tell the imaging lab I had no insurance because it would cost me less that way. Could anyone say this is not absurd? There is something decidedly shady here. Comparable to predatory lending. Who if anyone regulates these types of companies? This is misrepresentation, bordering on fraud.
A public option might cost me more or less, but it remains to be seen if the quality of coverage could be any worse. I know what I have now is dreadful.
It is in the interests of wealthy conservatives to allow the system to continue as it is and people are falling for it. It reminds me of a quote by Stephen Colbert when interviewing an Indian politician: “In India, do you get people to vote against their own interests like we do here?”
August 5th, 2009 at 12:09 pm
Mike A:
I know, it’s hellish over there. The poor French are basically living like animals, staggering around the arrondissements forced to scrounge for Band-Aids in the gutter, begging neosporin off tourists. I can see why uninsured people living in mobile homes in Arkansas would be terrified of having to live like Parisians. Shudder.
August 5th, 2009 at 12:26 pm
Mike A.
Love the irony!
August 5th, 2009 at 1:11 pm
EVERY other developed country has government health care
Er, no. Unless you’re using a VERY broad definition of “government health care,” in which case we qualify as well.
Jason — the obvious observation is that people automatically equate “reform” with “better.” Would that it were so.
August 5th, 2009 at 1:13 pm
Mike A & Mike Reynolds: Yeah, we’ve seen them over there on the streets, displaying their skin lesions to shame us tourists into dropping coins or cortisone into their cups… ;-)
August 5th, 2009 at 3:01 pm
The republiclones talking points are getting a little old. why don’t you guys come up with some real to talk about?
August 5th, 2009 at 10:32 pm
Tully:
I would give them Advil, actually.
One of the annoying things about my time in Italy: standing in line to buy a dozen ibuprofen. I was reduced to loading my bags with giant bottles of OTC drugs when I’d fly back to Italy from the US. That’s right, I smuggled Advil and chlor-trimeton and and I don’t care who knows it.
On the flip side prescription drugs cost next to nothing.
August 5th, 2009 at 11:45 pm
Being originally from Moscow, Russia, I was instinctively anti-socialist. Unlike Michael Moore, I have been there and done that. The only good thing was that we could never grow as fat as he did because we just did not have enough food, plain and simple. With time, however, my outlook has changed. I would say that right now I trust private insurance companies less than I trust the government. (Do you trust Wall Street more than you trust the government?) Oh, and I am also married to a physician – in fact, have been for almost 25 years.
The system has got to change. What we have right now does not work well. We invest a lot more than other industrialized nations, and the results we get are much more pathetic. I think the myth of American exceptionalism may make some of us believe that we are the best because we just are. But you need to look at the hard facts, and you will understand that bigger and more is not equivalent of better. In fact, did you know that taking cholesterol drugs or not taking them for a vast majority of the people is not going to make any difference whatsoever in their chance of having a heart attack? There are a few excellent books which I could recommend on the subject of what is wrong with our health care (except the obvious: 25% of all healt care dollars wasted to practice defensive medicine to protect the doctors from popential malpractice lawsuits – so in other words, we definitely need to cap what lawyers can make on suing doctors, and a considerable amount of the money flowing into medical care will be saved out right). Those books are “Overdosed America” and “Worried Sick”. Both are written by M.D.s, and both are based on solid research, not influenced by special interest groups.
There are countries where universal health care is not done right, notably, Canada and the US. And then there are countries where their population generally believe that they get excellent health care, and Germany is a good example. So why can’t we follow the example of Germany?
Oh, and by the way. We should absolutely keep the private health care as a parallel system so that people would have an option. And we should absolutely NOT cover health care of illegal immigrants. Yes, I do have a heart, etc, but if we start providing free health care to them, in a year’s time we will have not 12, but 35 million of them living here illegally. Unfortunately, this great land of ours it totally incapable of sealing its borders.
August 5th, 2009 at 11:50 pm
Germany has an excellent health care system, and they have a network of many insurance plans. I think the private option should absolutely be preserved in this country, but it is a disgrace that with all this spending (and much of it wasted) into health care, our outcomes are not better, and often times worse than in other industrialized nations where they do have universal health care coverage at a much smaller cost to the citizens.
Is our mistrust of the government higher than our mistrust of the insurance industry? Maybe we should look at Wall Street and extol the virtues of free capitalist competition? I came from a communist country, and I had this faith and trust in the inherent virtues and advantages of the capitalist system. I am not so sure what is left of that trust. If America only stopped reinventing the wheel, and learned from Germany (no need to scare us with how bad things are in Canada and Great Britain – in Germany things are NOT bad, and that is who we can try to learn from)! A debate about medical care is equivalent to a debate about education. Do we think that our government does a great job educating this nation? No. But do we propose to eliminate public schools and leave it to each individual to select a private option for their child? I personally don’t. I want people to have a government option along with a private one. Meanwhile, we will notice that unlike our insurance executives, principals at private schools do not get rewarded with multi-million dollar bonuses at the end of the year. Maybe because they know their “clients†have an option to go to a public system if they feel that the tuition price is exorbitant and spent to line the top execs pockets. And this is the way it should be with the insurance industry as well. I personally do not want to take on the fight for the insurance executives bottom lines under the guise of fighting against the government control.
August 6th, 2009 at 3:13 pm
Svetlana:
It’s almost impossible to convince Americans that the government is good at anything. It’s an article of religious faith for many Americans, a theology, indifferent to reason.
August 6th, 2009 at 4:08 pm
Svetlana:
“If America only stopped reinventing the wheel, and learned from Germany…”
America has a “not invented here” syndrome. If we didn’t invent it, it will never be good enough. If may eventually be our fatal flaw, but we take the concept of “greatest nation on earth” to be inviolable. And if we consider ourselves to be the greatest nation, yet hold our government is such low regard, you can imagine what we think of other nation’s governments.
August 6th, 2009 at 5:35 pm
Actually, this opinion is limited to the American government, and is based on a wealth of experience. Speaking only for myself, it’snot an article of faith at all.I am open to objectiuve data that demonstrate otherwise.
But I aint holding my breath.
Honestly though, there are lots of things the american government is very good at. For example, borrowing money, and giving it away. Developing weapons. Making red tape. And so on.
August 6th, 2009 at 5:38 pm
If our government was that bad at things, it wouldn’t be functioning. Just because it spends more money than it should, doesn’t make it bad at everything.
August 6th, 2009 at 5:42 pm
The IRS works all too well. Medicare is efficient. VA medical is pretty good. The Marine Corps seems to work pretty well. The FBI’s a good organization. The National Park Service does incredible work with no money. The Secret Service is good.
Contrast with Enron, AIG, GM, Citibank, Bear Stearns, Lehman.
In fact a lot of business is lousy at what they do. A lot of the government works quite well.
More of it might work if Republicans didn’t do everything in their power to turn their theology into reality.
August 6th, 2009 at 9:26 pm
I’ll desist from any further cherrypicking battles. It’s a pointless argument. I’ll even go ahead and concede your point that the government excels when it comes to things like collecting revenue from its citizens, killing people overseas, invading our privacy, and so on.
If you really think that “lots” of the government works well and “lots” of businesses work lousy,OK. Because sure, It’s true that lots of businesses are lousy. Usually, those are the ones that fail. Of course, if you can just raise taxes to stay afloat, failure is no worry.
August 6th, 2009 at 9:53 pm
KK:
See, here you go again to theology. You get uncomfortable when I try to move from general religious principles (government bad, business good) to engage on specifics. It’s like closely questioning a Catholic on transubstantiation. You can’t exactly explain why you believe what you believe. You cite no evidence. When I cite evidence to the contrary you dismiss it out of hand and again, offer no counter.
You have faith, not reason.
In fact governments (and it’s plural, inevitably) sometimes do well and sometimes do poorly. But it’s not the speed of light, it’s not immutable. Simply insisting that government does nothing well is contradicted by facts. Insisting that business is necessarily better is, likewise, contradicted by facts.
August 7th, 2009 at 7:28 am
KK,
Do I believe businesses far excel government when it comes to innovation and making money? Absolutely. But their prime mission (their hypocratic oath, so to say) is shareholder’s return on investments. That mission can be achieved in part by denying care to those who desperately need it. How do businesses, who are held to quarterly growth projections, make these decisions without treating the people who need care as nothing more than expenditures?
I would make the same argument against privatizing our nation’s military.
August 7th, 2009 at 9:53 am
Michael of course has no hesitation in pimping liberal “theology.” We’re not supposed to notice that, despite his noisy cheerleading. Even though in general liberal “theology” costs more.
It should be noted over and over again that efficient is NOT the same as effective, or high quality. The Marines are both effective and high quality, but economically efficient? Heh. One suspects that Mike is having problems disinguishing effectiveness from efficiency. I’ll give him the National Park Service doing wonders with little, but note that the major reason for that efficiency is necessity — they must be efficient BECAUSE they have miniscule budgets for their tasks. So they concentrate on the very top priorities and let everything else slide. Efficient, but not effective.
Medicare is such a shining example of government efficiency that it’s got a mere $34 trillion in unfunded liabilities NOW. Their vaunted low overhead is also an open invitation to fraud, and sure enough Medicare is plagued by high levels of fraud. Medicare fraud is estimated at $68B a year, or roughly 17% of total Medicare spending. Anti-fraud spending and fraudulent claims are included in the overhead figures for insurers, but not for Medicare. So, love that Medicare efficiency! But hey, it’s all other people’s money, so that’s OK. Right?
The IRS? Concentrates on going after lower-level cheats with enough assets to pay but not enough to field fleets of lawyers. The VA? Better talk to some vets. Efficient, maybe. Like the park Service, not much choice. Effective and high quality? Not so much. The Secret Service? See above about confusing effectiveness with efficiency.
August 7th, 2009 at 11:57 am
Tully:
You’re making my point that we have no real way of comparing government to private industry. So conservative theology is just that, it is not reality-based.
By the way, the Marines actually are “efficient” by the standards of their class. They do more with less than the Army. (No dis to the Army from this Army brat.)
But I’ll take effective, Tully. I’d be very happy to have an effective health care insurance system, as opposed to the current system which has now forced me to waste thousands of dollars forming a corporation solely so I can get health insurance.
Call that inefficient, call it ineffective, or call it as my banker did yesterday, “retarded” it’s emblematic of the idiot jury-rigged system we have now.
If I were a Frenchman I wouldn’t be wasting my time and money like that. I’d be eating a charcuterie plate and a nice green salad and enjoying a glass of Sancerre. And in my fantasy there’d be a French mistress as well.
But I digress . . .
I’d be grateful for any example you can point to of me relying on theology of any kind, liberal or conservative. I would like to expunge such theological presuppositions from my thought process.
August 7th, 2009 at 12:23 pm
You misused the term, Michael, so I was merely using it in the same fashion you did. Why I put it in quote marks. I could think of many examples of your previous usages in your own sense if one only ignored your particular exclusion of “what I agree with” as not being faith-based, and have pointed some out to you previously without you altering your rhetoric in the slightest, so forgive me if I cannot give you the benefit of the doubt as to sincerity.
You’re making my point that we have no real way of comparing government to private industry.
Given that I just pointed at one obvious measure that could indeed be fairly simply cross-normalized (fraud prevention overhead cost + cost of fraud for a standardized fraud-related cost index) for direct comparison purposes of ACTUAL overhead efficiency, I would say your point was already rebutted.
I’d be very happy to have an effective health care insurance system, as opposed to the current system which has now forced me to waste thousands of dollars forming a corporation solely so I can get health insurance.
So? I sense not only a non sequitur (that the current system has open running sores does NOT mean that ANY replacement system or system “reform” will be an improvement) but also a veritable freighter-load of shaky assumptions.
For example, there’s an extremely effective health care “reform” that you would categorically prefer to the current system by your stated terms. Simply euthanize any patient whose life-threatening condition has odds of being cured through treatment of under 50%. This would free up enormous amounts of money for the treatment of others, no? After all, an enormous portion of current expenditures are in end-of-life care. (I seem to recall a European nation of the last century whose societal tab for care and treatment of the developmentally disabled was near zero. Very effective. Very efficient.)
Brings me back to a question I keep asking that very few are willing to offer an answer to. What exactly do we mean by “reform?” Because calling ANY change “reform” does not mean that the change will be either beneficial or desirable.
August 11th, 2009 at 9:27 pm
[...] written about this before recently and it still baffles me that people are completely fine with corporations making these [...]