Why US Health Care REALLY Sucks So Bad

These stories are true:

A middle-aged woman has Blue Cross Blue Shield (BCBS) health insurance which she has carried for many years.  Over 25 years she slowly but steadily gained weight.  Due to her obesity, she developed high blood pressure which led to impaired kidney function.  She also developed high cholesterol and type 2 diabetes.

She lost 45 pounds.  Once thin, her blood pressure and all of her blood readings returned to normal.  Her kidney function, though sill impaired, improved greatly.  She kept the weight off for two years before slowly putting it back on over the following three years.

That was ten years ago.  Since then, as she has gotten older, losing weight has become more difficult (if not impossible) and all of her bad conditions returned.  Her doctor told her that statistically, she was a candidate for heart disease and/or a stroke.  Also, because of her increased weight, she now had difficulty controlling her diabetes as well, making her prone to possible blindness and amputations in the future.

She was motivated to lose weight again, but her hunger always won out.  She tried every diet she could get her hands on, but being older, nothing seemed to work.  The she heard about a prescription medication called Phendimetrazine.

She asked her doctor for a prescription.  She was overjoyed when he agreed to prescribe it, and couldn’t wait to get started.  Her level of motivation shifted into high gear as she dropped the prescription off at her local pharmacy for next day pickup.

To make a long story short, BCBS would not approve of the medication, stating it was “not medically necessary”!

She decided to pay the US$40 a month herself.  Since then, she has lost almost 50 pounds and once again, her blood work, blood pressure, and diabetic blood sugar levels have returned to normal.  Her kidney function also has improved dramatically.

BCBS evidently believes that co-paying for a prescription to the tune of perhaps US$20 or even $7 a month is to be avoided, but having pay out tens or hundreds of dollars for a triple bypass for some chronically obese person is acceptable!?!

Then there’s the guy who, after working for the feds for 35 years, carried his federal employee health benefits (he pays 33%) into retirement.  He developed cataracts in both eyes.  During the initial pre-surgery examination, BCBS refused to pay the $30 fee for part of each exam, the pre-surgery refraction of each eye.

Each eye required a standard 12-minute procedure.  He wanted both eyes done at once, but was informed that the insurance companies only pay them half the fee for the second eye if both are done at the same time.

Although available, the man chose not to have any general anesthesia, since the eyes would be numbed up by drops and gels anyway.  Each eye was done, two weeks apart, with no general anesthesia required or given. Identically.

When the man received the “Explanation of Benefits” (EOB) from BCBS after the first procedure, there was (quite appropriately) no claim made by any anesthesiologist, and thus none paid out by BCBS.  So far so good.

When the EOB for the second surgery arrived, it showed a claim made by the anesthesiologist for US$570, and a BCBS payout of $348!!!

The man immediately called the surgical center about this.  He was informed that they have nothing to do with the anesthesiologist, who works for a different company.  He then called that company, and got nowhere.  So he called BCBS to complain.

It took a dozen phone calls to BCBS offices to finally connect with their investigative unit.  Two months later he received a formal response from BCBS.  It said that the doctor had mentioned that a topical anesthetic (eye drops and a gel) had been applied and thus the claim was valid.

It neglected to mention that the drops and gel were administered by the regular surgical center staff, just as during the initial eye examination, and not by the anesthesiologist.

Further research (not mentioned by BCBS) also revealed that doctor had requested that the anesthesiologist “stand by” in the operating room “just in case” for both 12-minute procedures as a standard precaution.  There was no mention of a fireman standing by “just in case” of a fire, or a policeman standing by “just in case” of a burglary.  There was no mention that the anesthesiologist during the first procedure ethically didn’t submit a claim (for doing nothing).

Finally, the $570 claim ($348 paid) charge for doing nothing is actually the same fee as for full administration of sedating anesthesia and constant monitoring of the sedated patient, from before surgery until waking in the recovery room.  The logic in that is…..?

No wonder the American health insurance industry and their conservative political big business protectors are fighting so hard to protect their profit margins.  With stupid financial decisions like those listed above, they really need to keep what they have going.  And what they have going, despite the penny-wise, dollar-stupid so-called “medical” decisions they make, is enormous record-broking profits year after year!

And by the way, at the rate of $348 for twelve minutes of doing nothing, the anethesiologist was earning her money at the rate of $1740 an hour!!

Hey, can I have a job like that?

If Lying was a Virtue, Some Conservatives Would be Sainted

You turn your TV and see an ad about Shona Holmes, who lives in Hamilton, Ontario, Canada.  Four years ago, she was diagnosed with a brain tumor.  The ad was paid for by a conservative group backed by Americans for Prosperity, which is a far right conservative group totally against any interference with the health insurance industry’s right to make money.  It doesn’t specifically say that Shona’s tumor is cancerous but the clear inference of Shona’s own narrative is that it is.  She claims that the Canadian health care system told her she had to wait a year to be seen by a specialist, and that she would have died by then.  She further claims that she came the USA for treatment that saved her life.

She doesn’t say who paid for her $97,000 treatment at the Mayo clinic, either.  A web search revealed that she “mortgaged her house” to pay for the treatment.

The ad announcer claimed that the Canadian government doesn’t care about its people, and that the government can deny treatment and meds, which, among many other claims in this ad, is patently false.

There is nothing more heinous than a group, any group, premeditatedly lying and misleading people through the mongering of fear for their lives, their wallets, and their families, for the sole purpose of protecting enormous profits.

It is one thing to seriously believe that one is not responsible in any way for one’s fellow citizen, and the rest of the population must be responsible for their own care.  As shortsighted as that is, at least it is a philosophical position that one can understand and acknowledge as a fundamental belief.  It is another thing altogether to use fear, lies, and purposely misleading dialogue to scare the hell out of people who, for whatever reasons, will believe the ad.

Big business and its ultra-conservative supporters/protectors are paying for these false ads to bamboozle the American people into killing health care reform in the US.  The truth about Shona Holmes is that she did not have a cancerous tumor, but instead had Rathke’s Cleft Cyst on her pituitary gland.  According to the American John Wayne Cancer Institute, “Rathke’s Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts.”

It turns out that based upon prioritizing, which also occurs in the US, she was given specialist appointments in Ontario within a few months, but she chose not to wait while patients with life-threatening conditions were treated first.  In the USA, if you’re living in a rural area, you might have to wait even longer to see your local specialist for a non-life-threatening condition, unless you’re willing to travel to a big metropolis.

The difference was that Shona chose the Mayo Clinic in the US, and as a Canadian, she didn’t have American health insurance.  But anyone with American insurance could go to the Mayo Clinic for treatment, as long as they pay for their own travel, and their insurance is accepted by the Mayo clinic.  You can read more details about all the lies here.

More lies in the ad:

– Canadian health care is socialized medicine is run by the government:  False.       Doctors are in private practice in Canada, paid by one insurer instead of 150.  This is known as “single-payer”.

– Canadians can’t pick their own doctors:  False.      Canadians can pick whomever they want, regardless of their income level.

– Canadian meds are not the same as in the USA, and the Canadian government can deny them:  False.        Canadian get their meds from the same pharmaceutical companies as the USA, and they are prescribed by doctors, not government officials.

– The senate democrats are pushing through a “single-payer” health care system, which Canada has.  False.         Sen. Max Baucus (D) Montana, Senate Finance Committee chair and one of the leaders drafting legislation, has said bluntly: “single-payer is not going to get even to first base in Congress.”

You can read more about the lies and the real truth here, here, and particularly here, where a Canadian with dual US citizenship gives a truly comprehensive report about Canadian health care.

It’s important to keep in mind that all other advanced industrialized countries on the planet have some form of universal health care.  In Europe, people are spending about half of what Americans spend per capita, and yet they live years longer than Americans.  We the PEOPLE!! has been collecting stories from actual Europeans about the quality their health care.  Is two weeks too long to wait for double knee replacement?  How about cataract surgery?  The stories are there, written by the folks who experienced them.

Again, it really doesn’t matter whether you’re for or against health care reform in the USA, as long as your reasons are based upon fact and truth, instead of lies, inuendo and purposely introduced fear.  To that end, I urge you to watch President Obama’s nationally and internationally televised news conference tonight at 8pm EDT/5pm PDT/Midnight GMT.  He will not lie, nor will he display a person who can lift cars with his teeth because of universal health care.  He will tell the truth.

If you miss (or missed), google it and watch it.  Form your opinion based on facts instead of fabricated bullsh!#!!  You owe it to yourself, and all who come after you.

When Adam & Eve Rode Dinosaurs

We, the PEOPLE!! was going to take a break this week due to the annual trek from paradise to the “north country”, where potholes grow wild and corruption is the state spectator sport of choice.  However, as luck would have it, a fan emailed a letter that just screamed to be shared right away.

Just when you thought that the promoters of “intelligent design”, which in truth is just a fancy name for creationism, had gone into hibernation until a more conservative president and congress come back into power;  and just when you thought that the science of evolution had finally taken hold, this email makes it clear that there is a museum one can visit to get the real deal about how Adam and Eve frolicked in the Garden of Eden with dinosaurs, giant sloths, and kangaroos:

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Dear Howie,

I visited the Creationist Museum the other day, you know, the one in Kentucky that tells what life was like a long time ago, about 6000 years give or take a few, when the world was first created.  It was a wonderful display which showed me how how the earth got started.

Did you know that before the Fall of Man dinosaurs were friendly, domesticated beast’s?  Yup!  There was this display depicting a dinosaur with a saddle on it.  I thought dinosaurs might have been used to help plow the fields but I forgot, and was reminded, that at that time there was no need to work.  Everything Adam and Eve needed was given to them for free.  Dinosaurs were just for fun.  I realized this when I saw depiction of a dinosaur and Adam both playing what looked to me like an early form of Frisbee.

Imagine having a pet that weighed 30 tons?!  But they were tame and friendly, and fortunately there was never a need for them to defecate.  But everything went wrong when Adam ate that apple given to him by Eve, who took it from the talking snake.  You see, that apple gave him the knowledge of what is right and wrong.  As soon as he had that knowledge, all hell broke loose, which I guess explains the origin of the saying “Ignorance is Bliss.”

There was also this great exhibit showing Noah and the ark.  As you probably know, God was angry at the world.  He hadn’t figured on them sinning, and so decided to flood the earth as punishment.  Noah was told to build an ark, and on this ark he brought a pair of every single kind of animal to save them from the water.  It must have been a really difficult thing to do, gathering them all together and feeding them, not to mention cleaning up after them or stopping them from fighting among themselves.  And I’m not sure why he brought aboard such things as fleas, flies, cockroaches and Mexican Chihuahuas, which I have never liked because they bark too much.  But God has His ways and who I to question?

Anyway, the whole world was flooded and everything was destroyed.  The ark floated around for some time.  Finally, the waters disappeared to someplace or another and they all got off on this mountain somewhere in Iran or Turkey.  From there they populated the earth once again.   I guess that must include kangaroos because how else could kangaroos be around today since there is no evolution.  Only people like Karl Marx and Adolf Hitler believe in things like evolution.  I learned that, too.

But I wondered how kangaroos could have arrived in Australia without leaving a single fossil anywhere else in the world.  I learned that there are just some things which are called “Divine Mysteries”, which are kind of like the ones you see on Law and Order Criminal Intent, only a lot more difficult, and that is probably one of them.  It’s really a test of your faith put there by God…or Satan… I’m not sure which.

I think you will really learn a lot at this museum, and don’t listen to those that say that this story is not true. They are agents of Satan;  you know, the guy with the horns and a tail and the pitchfork who whispers in your ear encouraging you to do bad, evil things like lie or steal or play with yourself.

But I know all these things to be true because God said so.  It’s in the Bible.  And the Bible is the Word of God.  It says so, right there in the Bible!  So it must be true.

I hope you visit this museum, Howie.  I think you’ll like it, and in fact, you may come away as I did, feeling…what’s the word??  Oh yeah.. blissful!

Your fan, S. Sam

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After reading this, it seemed appropriate to ascertain whether this “creationism” museum actually exists.  Sure enough, a google search proved that it does.  In fact, there are several!!  You can visit one near you!

But if creationism isn’t your thing, perhaps you would rather like to visit the Tooth Fairy Museum.  It’s located right next to the Great Pumpkin Museum and just down the street from the Easter Bunny Museum.

Imagine!  Within a short walking distance, you can visit three world-class educational museums, and perhaps learn enough to run for state governor!  And later for vice-president!  And maybe even president some day!

Knowledge is power.  🙂

Sarah Palin’s Excellent Adventure??

We all thought that republican governor Sarah Palin of Alaska, the 2008 vice-presidential nominee on the losing republican ticket in the US general election, had finally gotten the message to lay low and do some homework about world events and government 101 before attempting to run for president in 2012.  Seeking re-election as governor, or better yet yet, running for the US senate seat was what most political strategists expected her do to broaden her knowledge and experience base before any presidential attempt.  Palin would have displayed staying power, as she used her elected office to learn to fix all the things that tripped her up during the 2008 campaign.

But Palin is nothing if not interesting doing everything.  She demonstrated yet again that she can do the unpredictable by implementing the unexplainable.  Last Friday, the day before the American Independence holiday July 4th, in a speech (click for both text and video) that both democrats and republicans are still scratching their heads over, she told the world that she was resigning her position as governor of Alaska only two and a half short years into her four-year term.

She claimed she was doing it for Alaska, even though much of her speech was about how successful her administration has been for Alaska.  That begs the question:  if she was so successful for Alaska, how does resigning serve Alaska?

During the next few days many folks on all sides of the political landscape weighed in on Palin’s weird action.  Some said that she is a quitter, since she previously resigned from the city council of Wasilla, Alaska in 1996 to run for mayor, and then resigned from her position on the Alaska Oil and Gas Conservation Commission in 2004, claiming she didn’t like the ethics of some fellow republicans on the commission.  You can read all the details HERE.

Then, in an interview with the Associated Press yesterday on a trip to a remote Arctic village north of the Arctic Circle, which must have cost the Alaskan taxpayers serious money in airplane expenses for Palin to needlessly travel way up to the village of Kotzebuek, Alaska (population 3200) just to sign a state law enforcement bill into law, Palin said that all of the information requested and investigations initiated against her since her vice-presidential run had been too costly for Alaska, costing the state nearly US$2 million.  Somehow, the implication was that her resignation was to relieve Alaska of that expense.

She did not explain how resigning would mitigate the progress (or expense) of those information requests and investigations, though.

Her lawyer also weighed in, stating that contrary to rumor, there are no investigations pending against Palin at this time.  But if no investigations are pending, how does her resigning save the state of Alaska any money?

Nothing in recent memory has caused both liberals and conservative to agree as much as Palin’s seemingly inexplicable resignation as governor of Alaska in mid-term.  Most seem to agree that Palin has seriously wounded any chance of successfully running for the republican nomination for president and the general election in 2012.

But what if she’s not going to run….in 2012?   After all, basic history indicates that popular presidents win re-election most of the time, and President Obama is nothing if not popular.  And just maybe, Palin, or more likely one of her political strategists, realizes that the enormous effort required to mount a successful campaign would be wasted, and possibly fatally damaging, to any republican challenger against Obama’s run for re-election in 2012 .

Remember that Palin is only 45 years old, or fifteen years younger than Hillary Clinton during the 2008 election season.  Palin could easily sit out the next three or four campaign seasons, while she hosts a conservative (and hugely lucrative) radio/TV show on Fox, speaks on the hugely lucrative lecture circuit, and does her hugely lucrative book deal.

Then, in 2016, or 2020 or even 2024,  she could mount a more credible (and better financed) presidential campaign.  As one conservative put it, she can’t win by staying in Alaska.  And there’s not much doubt that she won’t stay in Alaska long, if she pursues this course of action.  Keep watching that one.

However, she does seem to have completely miscalculated public reaction to her resignation, just as she miscalculated public reaction to her public war of words with her ex-future-son-in-law/father of her grandchild.

Still, Sarah Palin continues surprising us with wonderfully unpredictable behaviors.  Of course, lots of people do lots of unpredictable stuff.  Somehow, that’s not a trait most people would describe as presidential.  Think North Korea…and Iran.

So stay tuned.  Considering it’s Sarah Palin, it’s going to be entertaining, at a minimum.

Hey!  Maybe NBC’s Saturday Night Live will hire her as a regular for a weekly TV segment called, “How NOT to be president!”     🙂

Why SC Governor Mark Sanford Should NOT Resign

Last week this blog fortuitously was delayed a few hours.  As a result of that delay, we were able to report on South Carolina governor Mark Sanford’s “excellent adventure” to Argentina, and all that this entailed (if you’ll pardon the pun).

The point of the article was that those conservative evangelistic folks who like to try to convince the rest of us that they have a lock on morality should keep their holier-than-thou ruminations to themselves.  Sanford, and folks like him such as Sarah Palin, are members of that group.  So when they get caught not practicing what they preach to the rest of us, the press jumps all over it.

Other well-known celebrities who have suffered similar weaknesses under similar circumstances of preaching to others include 1980’s TV evangelists Jim Bakker and Jummy Swaggert, among others.  You can read the sordid details about them HERE.  And, of course, among the most famous of cheaters is ex-president Bill Clinton, although Clinton hardly qualifies as a holier-than-thou preacher.

Of course, there are probably hundreds of millions of folks on earth (if not billions) who have engaged in behaviors that their spouses would probably would not approve of.  It is, whether we wish to acknowledge it or not, a pretty prevalent characteristic of the human experience.  As civilized people, we try to contain such behaviors in the interest of fairness to our families.  But as imperfect beings, people sometimes fail to achieve desired goals, despite the best efforts.

Welcome to the human race, where certain folks have been fighting against reality since people started to get organized.

Many residents of South Carolina consider themselves conservative christian voters.  With that in mind, consider that the GOP has been calling for Mark Sanford’s resignation with mounting urgency and insistence.  They’re not insisting that Sanford resign because he left his state leaderless for almost a week, since the Lt. Governor did not know where Sanford was and there had been no transition of power to the Lt. governor.  At least if that was the reason for the demand for resignation, it could be understandable, if a little excessive.

Nope.  The reason for the demand that Sanford resign that is coming from the GOP has EVERYTHING to do with politics.  Sanford only has a year and a half left in his term and cannot run for rel-election due to South Carolina term limit law.  The GOP wants to demonstrate their commitment to family values and religious righteousness, particularly in the bible belt.  Sanford is a GOP target of opportunity, as it were, that allows the party demonstrate to its extremely conservative base that it still cares about them.  That’s nice, although it does nothing to fix the real damage done by the Bush administration to the GOP image.  It also doesn’t do a thing to address the reality of the GOP’s misguided effort to restore credibility to the GOP.

Although the GOP has always been the first and the loudest to demand resignations over questions of marital indiscretions, particularly in Bill Clinton’s case, the reality is that many, many GOP’s have gotten caught falling off the “morality” wagon in recent years.  And whatever indiscretions are committed by a politician, the place they must be addressed is with his or her spouse.  When Bill “did” Monica, it was an issue that Hillary Clinton, first and foremost, had to deal with.  She did so in her own way, and in private.

And except for the efforts demanded by the failed GOP impeachment proceedings, Bill Clinton left office with an approval rating around 60%.  Compare that with the approval rating George W. Bush left with, around 28%.  Since we have never heard of W cheating on Laura, that should tell the GOP something.  That something is that the American people largely don’t care about a politician’s private life if that politician is doing the job he or she was elected to do.  In other word, most thinking people really don’t care about a politician’s private life.  They only care about their own.

That’s truly as it should be.  Although some ultra-extreme GOPers (but certainly not all) believe that an elected official should be passing and/or signing religious laws, most of us believe that the elected official should be judged on on-the-job performance and accomplishments, and not legal off-the-job behaviors.

We, the PEOPLE finds it both curious and amusing that this liberal blog is defending a conservative republican politician.  But then, we also question Ann Coulter’s ultra-extreme right wing credentials.  After all, until a year ago she was engaged to a liberal lawyer from New York City, and she loves the “Grateful Dead”.  But then, the GOP’s credibility just isn’t what it used to be.  🙂

So if defending a conservative republican governor is the right thing to do. it will be done.  After all, someone has to do the right thing!  🙂