Healthcare Reform
The “death panels” are already here
Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they’re ready to operate, but the bureaucracy — or as Palin would put it, the “death panel” – steps in and says it won’t pay for the surgery. Despite protests from the girl’s family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent — but the patient dies before the operation can proceed.
It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama’s healthcare reform plans are. Except that’s not the future of healthcare — it’s the present. Long before anyone started talking about government “death panels” or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company’s analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn’t have saved her life.
That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. “Such a system is downright evil,” Palin wrote, in the same message posted on Facebook where she raised the “death panel” specter. “Health care by definition involves life and death decisions.”
Coverage of Palin’s remarks, and former House Speaker Newt Gingrich’s defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.
Opponents of reform often seem to skip right past any problems with the current system — but it’s rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren’t required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member’s medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren’t immune to difficulty.
“You’re asking us to decide that the government is to be trusted,” Gingrich — who may, like Palin, be running for the GOP’s presidential nomination in 2012 — told ABC’s “This Week With George Stephanopoulos” on Sunday. But as even a quick glance through news coverage of the last few years shows, private insurers are already doing what reform opponents say they want to save us from. (The insurance industry, pushing back against charges that they’re part of the problem, said last month that “healthcare reform is far too important to be dragged down by divisive political rhetoric.” The industry has long maintained that its decisions on what to cover are the result of careful investigations of each claim.) Here is a look at a handful of healthcare horror stories, brought to you by the current system. It took Salon staff less than an hour to round these up — which might indicate how many other such stories are out there.
– In June 2008, Robin Beaton, a retired nurse from Waxahachie, Texas, found out she had breast cancer and needed a double mastectomy. Two days before her surgery, her insurance company, Blue Cross, flagged her chart and told the hospital they wouldn’t allow the procedure to go forward until they finished an examination of five years of her medical history — which could take three months. It turned out that a month before the cancer diagnosis, Beaton had gone to a dermatologist for acne treatment, and Blue Cross incorrectly interpreted a word on her chart to mean that the acne was precancerous.
Not long into the investigation, the insurer canceled her policy. Beaton, they said, had listed her weight incorrectly when she bought it, and had also failed to disclose that she’d once taken medicine for a heart condition — which she hadn’t been taking at the time she filled out the application. By October, thanks to an intervention from her member of Congress, Blue Cross reinstated Beaton’s insurance coverage. But the tumor she had removed had grown 2 centimeters in the meantime, and she had to have her lymph nodes removed as well as her breasts amputated because of the delay.
– In October 2008, Michael Napientak, a doorman from Clarendon Hills, Ill., went to the hospital for surgery to relieve agonizing back pain. His wife’s employer’s insurance provider, a subsidiary of UnitedHealthCare, had issued a pre-authorization for the operation. The operation went well. But in April, the insurer started sending notices that it wouldn’t pay for the surgery, after all; the family, not the insurance provider, would be on the hook for the $148,000 the hospital charged for the procedure. Pre-authorization, the insurance company explained, didn’t necessarily guarantee payment on a claim would be forthcoming. The company offered shifting explanations for why it wouldn’t pay — first, demanding proof that Napientak had tried less expensive measures to relieve his pain, and then, when he provided it, insisting that it lacked documentation for why the surgery was medically necessary. Napientak’s wife, Sandie, asked her boss to help out, but with no luck. Fortunately for the Napientaks, they were able to attract the attention of a Chicago Tribune columnist before they had to figure out how to pay the six-figure bill — once the newspaper started asking questions, the insurer suddenly decided, “based on additional information submitted,” to cover the tab, after all.
– David Denney was less than a year old when he was diagnosed in 1995 with glutaric acidemia Type 1, a rare blood disorder that left him severely brain damaged and unable to eat, walk or speak without assistance. For more than a decade, Blue Cross of California — his parents’ insurance company — paid the $1,200 weekly cost to have a nurse care for him, giving him exercise and administering anti-seizure medication.
But in March 2006, Blue Cross told the Denney family their claims had exceeded the annual cost limit for his care. When they wrote back, objecting and pointing out that their annual limit was higher, the company changed its mind — about the reason for the denial. The nurse’s services weren’t medically necessary, the insurers said. His family sued, and the case went to arbitration, as their policy allowed. California taxpayers, meanwhile, got stuck with the bill — after years of paying their own premiums, the Denney family went on Medi-Cal, the state’s Medicaid system.
– Patricia Reilling opened an art gallery in Louisville, Ky., in 1987, and three years later took out an insurance policy for herself and her employees. Her insurance provider, Anthem Health Plans of Kentucky, wrote to her this June, telling her it was canceling her coverage — a few days after it sent her a different letter detailing the rates to renew for another year and billing her for July.
Reilling thinks she knows the reason for the cutoff, though — she was diagnosed with breast cancer in March 2008. That kicked off a year-long battle with Anthem. First the company refused to pay for an MRI to locate the tumors, saying her family medical history didn’t indicate she was likely to have cancer. Eventually, it approved the MRI, but only after she’d undergone an additional, painful biopsy. Her doctor removed both of her breasts in April 2008. In December, she went in for reconstructive plastic surgery — and contracted a case of MRSA, an invasive infection. In January of this year, Reilling underwent two more surgeries to deal with the MRSA infection, and she’s likely to require another operation to help fix all the damage. The monthly bill for her prescription medicines — which she says are mostly generics — is $2,000; the doctors treating her for the MRSA infection want $280 for each appointment, now that she’s lost her insurance coverage. When she appealed the decision to cancel her policy, asking if she could keep paying the premium and continue coverage until her current course of treatment ends, the insurers wrote back with yet another denial. But they did say they hoped her health improved.
– Additional reporting by Tim Bella
Mike Madden is Salon's Washington correspondent. A complete listing of his articles is here. Follow him on Twitter here. More Mike Madden.
Romney pal defends Obamacare
Sen. Roy Blunt supports part of the bill his ally Mitt Romney has pledged to fully repeal
(Credit: Reuters/ Jonathan Ernst) Sen. Roy Blunt, R-Mo., gave a strong defense yesterday of a portion of the Affordable Care Act that allows children up to 26 years old to remain on their parents’ health insurance plans, breaking a bit from the GOP’s hard-line opposition to Obamacare.
Blunt endorsed Mitt Romney early on and led the campaign’s efforts to recruit Republican lawmakers during the GOP primary. But his comments in an interview on KTRS radio in St. Louis may give Boston some heartburn as it tries to convince conservative voters that Romney, who enacted the predecessor of Obamacare in Massachusetts, will actually repeal the healthcare law.
Continue Reading CloseAlex Seitz-Wald is Salon's political reporter. Email him at aseitz-wald@salon.com, and follow him on Twitter @aseitzwald. More Alex Seitz-Wald.
“Birth control doesn’t matter”
A new survey reveals just how ignorant young people are about contraception and pregnancy
(Credit: restyler via Shutterstock) When it comes to sex and reproduction, even the most mind-numbingly intuitive conclusions can be politicized or disbelieved. So they bear repeating and resubstantiation. Take this recent Guttmacher study on contraceptive knowledge. Surveying 1,800 men and women ages 18–29, the authors “found that the lower the level of contraceptive knowledge among young women, the greater the likelihood that they expected to have unprotected sex in the next three months, behavior that puts them at risk for an unplanned pregnancy.” In other words, access to factual information helps prevent risky behavior.
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Irin Carmon is a staff writer for Salon. Follow her on Twitter at @irincarmon or email her at icarmon@salon.com. More Irin Carmon.
Healthcare’s foreign invasion
Obama risked a trade war with China about manufacturing -- so why isn't he outraged about medical jobs?
(Credit: gualtiero boffi via Shutterstock/Salon) Approximately 15 percent of all healthcare workers and 25 percent of all physicians in the United States were born and educated elsewhere. This means that 1.5 million healthcare jobs are “insourced,” occupied by foreign-born, foreign-trained workers brought into the United States on special visas earmarked for healthcare jobs. This number is 50 percent greater than the total number of jobs in the U.S. auto-manufacturing industry. It’s amazing to consider that in 2008 and 2009, the auto industry, which makes up just 3.6 percent of the U.S. economy, received a $97 billion bailout. If we estimate that each of these 1.5 million insourced healthcare jobs has an average wage of $60,000, that’s $90 billion a year in wages going to people brought into the United States to work rather than training Americans to do the same jobs.
Continue Reading CloseDr. Kate Tulenko is a physician with degrees from Harvard University, Cambridge University and the Johns Hopkins School of Medicine. The former coordinator of the World Bank's Africa Health Workforce Program, she currently serves as director of clinical services for a global health nonprofit. More Kate Tulenko.
Obama destroys Constitution with mild Supreme Court criticism
Conservatives and moderates declare SCOTUS-bashing to be "intimidation"
(Credit: AP) Ruth Marcus is unsettled. Maybe even queasy. There is probably some light nausea. What has her worried for the future of the nation, today? President Obama’s shameful, horrific, vicious attacks on those nice people in the Supreme Court.
Obama said that the court overturning Congress’ healthcare reform law would be a textbook example of “judicial activism” as “conservative commentators” define it: “that an unelected group of people would somehow overturn a duly constituted and passed law.” And hey, that seems like an eminently defensible and not particularly unsettling point! Conservatives made “judicial activism” into a talking point and rallying cry and defined it vaguely enough to encompass judges striking down basically any law or statute.
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Alex Pareene writes about politics for Salon and is the author of "The Rude Guide to Mitt." Email him at apareene@salon.com and follow him on Twitter @pareene More Alex Pareene.
My son’s healthcare battle
My 14-year-old has brain cancer. Without Obamacare, he would have already exceeded his lifetime insurance limit
Supporters of healthcare reform rally in front of the Supreme Court on the final day of arguments regarding the healthcare law signed by President Obama on March 28, 2012. (Credit: AP Photo/Charles Dharapak) Mason is my 14-year-old son, who is adorable and funny, and happens to have a very stubborn and large brain tumor. We discovered the tumor four years ago, and we have been monitoring and treating it with the help of some of the finest doctors around. Mason has lived a somewhat “normal” life, despite frequent MRIs and even chemotherapy. He did his homework and hung out with friends until the fall of 2010 when his headaches became debilitating. Scans revealed that Mason’s tumor had grown for the first time since we had discovered it. Then days before we were scheduled to meet with the neurosurgeon to discuss a surgery we had tried to avoid, Mason had a massive cerebral hemorrhage.
Continue Reading CloseJanine is a San Francisco Bay Area writer. She is currently working on a collection of essays about surviving her son's brain tumor and the odd reality that comes with a diagnosis of childhood cancer. More Janine Urbaniak.
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