...I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care …

… sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

… So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

... you have to have some independent group that can give you guidance.

deathstroke.net...

Did anybody ever stop to ask whether it is morally defensible that a society should organize itself so that there are massive profits to be made off of the sickness, suffering and death of its members? It seems to me that that very same society could organize itself to treat those same illnesses without having to devote an extraordinary share of its capital to the profit of those involved in the undertaking.



Consider how much of our health care dollars are not going to health care. Before Judy died, I was spending over $800/month on health insurance. Where did those dollars go? Let’s examine the dollars that did not go to health care:



1) Advertising: Because my insurance company is in business to make a profit, it advertises to attract more customers. So it spends part of my $800/month on advertising. That means:

a) That it pays some of my money to an advertising firm to create ads for both print and radio/TV commercials;

b) That it pays for space in newspapers and magazines to show their ads;

c) That it pays for air time on both radio and television to air their ads.

d) Profit: Each of these entities (the ad agency, the newspapers and magazines, the radio and television stations and networks) is in business to make profit. So a sizeable chunk of my $800/month goes to pay for things that have absolutely nothing to do with health care.



2) Profit for the Insurance Company: My health care insurance company makes money for its investors. So, like every business, a very big chunk of my $800/month goes to pay for “executive compensation” (the more profit that can be squeezed out of the system, the bigger the compensation). It also goes to meet the demands for return on investment of the stockholders. Not one of these dollars goes to buy a drop of chemo drug or even a bandage.



But more ominous than this, is what it causes an insurance company to do in order to maximize its profits. It has two options: 1) it can increase premiums, and/or it can 2) reduce what it pays out for claims. I have had the unhappy experience of being on the receiving end of 2) for the past three years.



My Experience: When you are confronted with a catastrophic illness like cancer, your “full time job” becomes immersed in treating the disease. What is not well known is that your other “full time job” becomes plowing through a mountain of paper in order to find out if your insurance company is actually paying your bills.



I had an MRI to screen for the recurrence of my cancer. It was the normal course of treatment for my type of cancer. The MRI was done in January. I received an “E.O.B” (Explanation of Benefits) form from my insurance company which listed the MRI. I thought it meant that the bill had been paid (after all, it came on a document called “explanation of benefits”). But in reality, there was a code on the form that, had I understood it, would have informed me that my insurance company was denying the claim (because the MRI wasn’t performed on the same day as my doctor’s appointment — -one of the many fine print exclusions under my policy). The problem is that my insurance company didn’t inform the MRI company that it was denying the claim until the end of May. The MRI people didn’t get back to me until late July. By then, my 6 month period for appealing the denial had passed. I went ahead and appealed anyway. A year later, after two rounds of appeal, the insurance company acknowledged that they should have paid the bill, but said that since my appeal was not timely filed, they would not pay it. And to rub salt in the wound, I had to pay the bill at the full rate, whereas, if my insurance company had paid it, the MRI company would have accepted 50% of the full price.



That was just one bill. For Judy’s three year ordeal, the denials came fast and furious. One example was particularly infuriating. When Judy developed headaches (a sign that the breast cancer had spread to her brain), her doctor ordered an immediate brain MRI. Because the hospital MRI was not available, they sent her to another MRI facility across the street from the hospital. My insurance company denied the claim because the MRI was not performed in the hospital. That one took a year and a half to resolve with the insurance company. Eventually, after three rounds of appeal, the company agreed to pay the bill under duress. They sent me a letter stating that they would pay the bill but admonished me not to allow it to happen again (as though I were some sort of a criminal policy holder).



My point is this: As a society, we have turned our medical care over to a system that is based on profit. I have come to see quite clearly that this produces a system that seeks to actively reduce its payments for treatment by 1) putting a mine field of fine print exclusions in the policy language, and then 2) refusing to pay claims and then hide that refusal behind outright deception and a wall of appeals that will exhaust even the heartiest of policy holders. All of this takes place because PROFIT encourages it. Indeed, PROFIT DEMANDS IT. Without profit, there would be no incentive to cheat the policy holder or deny the payment of his or her just medical bills.



President Obama said that his grandmother spent the final months of her life locked in a battle with her health care company over bills that they would not pay. Having just spent the last three years locked in the same battle, I wonder why our lawmakers are seeking to address the health care crisis by making sure that every American can afford insurance! I believe that this is the wrong solution. You can’t solve a crisis by pouring more gasoline on the fire. Unless and until we come to grips with the real source of the problem — -that a health care system that is based on profit will devour the country that employs it — -we will never find our way out of this swamp.