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American healthcare

Gadfly | September 27th, 2017

A mixture of despair, extortion, life-saving treatments, and inequality

Fifty-four-year-old Antony Marino of Wise, Virginia keeps a pair of needle-nosed pliers handy so he can pull out a rotting tooth that’s bothering him. He has never been to a dentist. Forty-nine-year-old Joyce Bays tenderizes the meat she eats with a hammer, and cuts it into small pieces because she has no teeth.

Forklift driver Robin Neal has had Type 1 diabetes since age 10 and has pancreatitis, but her medication costs $500 for 70 pills, so she has gone two years without the drugs.

At a free vision clinic held in a Virginia tent, a patient admitted he couldn’t see the largest letters on the chart. Before he got his glasses he admitted he had driven several miles to get to the clinic.

In August The Food and Drug Administration approved a gene-altering treatment for leukemia. It’s a one-shot deal called Kymriah that may or may not work. If it works it will cost you $475,000.

American hospitals keep a secret list of charges in what is often called the Chargemaster. It contains often-inflated charges promoted by insurance companies so they have some bargaining room. That’s where an uninsured patient will be charged $154 for a $20 neck brace, or $137 for an IV bag that costs less than a dollar to make. I remember being charged $17 by a Fargo hospital for a box of Kleenex years ago. I raised holy hell and it was dropped.

Before ObamaCare a Harvard University study indicated that 45,000 American adults died a year because they did not have health insurance. The Affordable Care Act added over 20 million people to the insurance roles, but we still have about 30 million without any insurance.

Every two weeks Ian Milhiser injects over $2,200 worth of drugs into his leg to prevent his digestive fluid from leaking into his abdominal cavity. It costs $55,000 a year to keep him alive. He has good insurance.

Humira, the most profitable drug made by AbbVie, costs $4,539.21 for a box of two 40 mg. shots. The company sold $12.5 billion worth of Humira in 2014.

Doctor: “I watched my patients die of poverty for 40 years. It’s time for single payer”

In an article published in The Washington Post, Dr. David Ansell has a fascinating line: “In nearly 40 years as a doctor, I witnessed time and again how inequality kills.” He uses the example of Sarai, a patient of his who died at the age of 25, of Wilson’s Disease, an inherited disorder that causes liver failure. She was uninsured and couldn’t afford the necessary treatments. Dr. Ansell signed her death certificate indicating she died of liver disease, but he writes that she actually died of inequality because she could have been saved if we had had a Medicare-for-all type insurance system.

He practiced medicine at Cook County Hospital and became chief of General Medicine. There are about 12,000 inmates at the Cook County jail, most uninsured, with almost a third with serious mental problems. While at Cook County he never saw a colonoscopy or hip replacement. In 27 years at what are called safety-net hospitals not one of his patients received an organ or bone marrow transplant. Too expensive for the poor.

In these hospitals an insurance card was the difference between life and death. In a survey conducted by the Chicago Medical Society, 56% of the doctors surveyed said single-payer would provide the best care to the greatest number of people. A national organization of doctors, medical students, and health professionals have formed a 21,600-member group called Physicians for a National Health Program that supports a single-payer plan.

For the first time in American history less than half of doctors own their own practice. They are employees of hospitals and other health care institutions. Merritt Hawkins of a doctor recruitment firm says: “Physicians long for the relative clarity and simplicity of single-payer. In their minds it would create fewer distractions taking care of patients—not reimbursement.”

In a single-payer system, a public entity such as the government, would pay all the medical bills for a certain population rather than insurance companies working on a 20% commission basis.

Will the Republicans achieve their goal of repealing and replacing ObamaCare?

We should know by the time this column is published. They have been trying to get rid of Medicare and the Affordable Care Act (ACA) since the Democrats passed it. They have been trying to dump ObamaCare for eight years without having an idea how to replace it. The Affordable Care Act has dramatically decreased the number of uninsured and has brought health care to millions who have had none.

Even business leaders are questioning why we should pay private insurance companies a 20% extortion rate and hire millions of “agents” to try to reduce coverage.

Oh, there is real money to be made in the health insurance business. In the last eight years the Wall Street stocks of the five largest investor-owned health insurance companies--Aetna, Anthem, Cigna, Humana, and United-- increased between 387% and 748%--and the salaries of health care CEOS have skyrocketed to many millions.

Private health care administration runs about 20% while Medicare administrative costs are about 2%. People should ask why.

The Catholic Network lobby, sponsored by 7,150 Catholic nuns who generally work in hospitals and schools, has come out against Graham-Cassidy by quoting Pope Francis: “Health is not a consumer good, but a universal right, so access to health services cannot be a privilege. To cut Medicaid and take health care from millions is not a pro-life stance.”

Pew Research: “Sixty percent have lost faith in private insurance”

One business leader decided to support single-payer plans when his company paid $260,000 in treating just two employees with Hepatitis C. He is very disturbed that The Best Congress Money Can Buy (TBCMCB) has made no attempt to control hospital and drug costs, has prevented Medicare and Medicaid from negotiating drug prices with big Pharma, and has outlawed Americans buying drugs in Canada and overseas at drastically reduced prices.

Pew Research Center polls indicate that 60% of the American people have lost faith in private health insurers and want the government to do more in health care. Senator Bernie Sanders’ single-payer plan of “Medicare for All” is gaining momentum.

The Graham-Cassidy bill that Republican conservatives and free-marketers are trying to get through TBCMCB is a return to the 19th century idea that doctors would accept eggs and bacon slabs from patients.

A return to free markets? Horse apples! They are shrieking “socialized medicine” again in another attempt to keep health care a privilege, not a right. We already have quite a number of “socialized” services in this modern country—including that socialist Bank of North Dakota in Republican North Dakota.

We all defecate and urinate so society has determined we need sewer systems. That’ssocialism. We all need roads, ditches, bridges, airports, and interstate highways so we can travel. That’s socialism. We all need water to survive, so society pays for water plants, dams, river care, wells, and pipelines. That’s socialism. It’s efficient.

I suppose somewhere in this country there is an 80-year-old who has never needed dental or medical care. Please send me his name. A healthy society is a necessity according to Otto von Bismarck and Winston Churchill. Health care should be a right, as it is in most of the civilized world.

In some hospitals the rich are told, “You’re on the list”

In his article “Keeping the Wealthy Happy -- and Everyone Else Waiting,” writer Rex Weiner promoted his thesis that we have one health care system for the one percent and another one for everyone else. A doctor friend of his said he should call it “Wealth Care.”

He based some of his article on an NBC-TV production called “Not Fair: Insiders Say Hospitals Favor Rich and Famous.” A concerned doctor at the beginning of the report, said: “If rich people had to wait in line for an MRI like everyone else, the American healthcare system would be changed overnight.”

Testimony from hospital union heads and from nursing and maintenance unions all confirm that wealthy people in the Los Angeles area and across the country often “jump the line” for health care.

Several hospitals give wealthy patients colored blankets to carry so that all employees know this person is a rich possible donor. Other richies go ahead of roomfuls of waiting patients because they are “on the list.”

After such deluxe treatment they are often invited to dinner by hospital administrators and asked if they would be interested in making a sizeable donation to the hospital, hinting that the next time they need care, they will be well taken care of.

Sometimes by breaking into the line, the rich caused the death of a waiting patient.

We are beginning to see doctors forming “concierge care” or “retainer care” or “boutique medicine” organizations to serve only the rich. They often double their incomes by dropping low-end patients and charging the rich a fee well above the established insurance rates.

These doctors are always on call. The practice of concierge-type medicine amounts to triage (the system of who goes first), so the rich will live longer and healthier lives—while poor people get sicker and die sooner.

Even public entities get in on the take care of the rich first” program. As an example, the University of Texas Southwestern Medical Center maintains a list of 6,400 “preferred patients” (people worth saving!). The list includes politicians, sports team owners, hedge fund managers, publishers and editors of prominent newspapers, and assorted billionaires.

In the meantime, why don’t we try to take care of this citizen?

Lucas McCulley of Nampa, Idaho has a huge tumor growing on the side of his face, distorting his jaws and eyes and disrupting the functions of nearby organs. A victim of lymphangioma, Lucas has a fluid-filled cyst of massive proportions. The cause is still unknown.

He has endured 24 surgeries as a child but he is now 22 and has no insurance. He would like to have the tumor removed so he could join the Army. He says, “Surgery would make my life a lot better in every aspect of the day, just so I don’t have to worry about it. I don’t have to wake up hurting or anything like that and just be normal. So far he has collected $74,000 toward the operation to remove the tumor. Doctors have not given him an estimate of the final cost-yet.

By the way, “Christian” David Meade has forecasted the world is going to end tomorrow on the 23rd. See you on the 24th.

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