About this blog

How do I exclude thee, let me count the ways.  

Michael Moore’s movie, Sicko, emphasized the ways that insurance companies deny coverage.  But the perversions of the American health care system extend far beyond the health insurance companies.  

If health care is not universal, there must be gatekeepers to admit people or deny people entry into the innumerable silos that offer health care coverage or offer access to other silos called networks.   

This blog will tell stories of those caught between silos, temporarily locked outside, or stranded inside. These are not heart breaking stories with tragic consequences. Rather these are stories of very deliberate, very logical and very myopic bureaucracies and the havoc they wreak.  It’s aim is to simply the system.

I hope the stories here will fuel the discussion for a more rational health care system – one that spends its money on health care instead of in health care. 

I have a day job, so my posts will be limited to Saturdays and an occasional Wednesday.

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One Response to About this blog

  1. Ed Boyle says:

    Jim:

    I am a friend of Chris Nelson of long standing.

    At almost age 70, this is the first time I have ever written a letter to a POTUS.

    May 9, 2009

    President Barack Obama
    1600 Pennsylvania Avenue
    Washington, DC 98337

    Dear Mr. President:

    Now almost 70 years of age, I was a Goldwater Republican until the Saturday Night Massacre on October 20, 1973. You were 12. The following Monday, I changed my party affiliation and have never looked back. I heartily supported you in your run for office as I do all Democratic candidates, especially Joe Sestak. I am not as visible as most campaign workers because I have a daughter with a brain tumor, just like Joe Sestak does, except Mary Beth’s was diagnosed in 1983.

    This brings me to the point of this letter. I have fought in every way possible for health care reform, going back to long before Hillary Clinton’s debacle. Over the intervening years, my daughter, my wife and I have been thoroughly abused by the system:

    1. My daughter is blind and paraplegic. The paraplegia is entirely the fault of Independence Blue Cross denials, which prevented her return to the one physician (out of network) who had treated her successfully. We were billed for $50,000 in the process.
    2. I was forced out of a high paying job when my daughter’s medical expenses got too expensive for my self-insured employer. I was eliminated from consideration by other employers in my field for the same reason. My career was over. My wife was forced out of a nursing position at a self-insured hospital. This form of bias is never discussed anywhere, least of all in Congress.
    3. Physical therapy under Blue Cross was limited to 20 sessions per year. Brain injured people need ongoing therapy just to maintain what they have. Under Medicare, she gets 12 sessions per year, approximately the same as for a sprained ankle.
    4. The appeals process in medical insurance companies is an absolute fraud. I have definitive proof that one denied appeal wasn’t actually read by anybody, but two doctors independently signed off on the denials. It took a year of dogged effort, but we finally won a reimbursement for Medicaid.
    5. Under that congressionally authorized scam, Medicare Part D, we were told by Humana Healthcare on two separate occasions, a year apart, that the Human Growth Hormone she requires to forestall osteoporosis was “Not In Our Formulary.” We were then made to jump through hoops, creating appeals that went unread by Humana. We only learned recently that the medication was always in the formulary. This was a bold-faced lie told twice over. On two occasions Humana ceased delivery a month early, conveniently moving the contracted dates forward by over a month. They insisted on sending paper work to a dead endocrinologist at a hospital we no longer go to, despite being informed in writing, many times.
    6. There is not much a man like me can do about any of the above because medical insurers have been granted de facto immunity under the ERISA law, which supersedes any and all existing state “good faith” laws. That law must be changed. If the Executive branch and the Congress won’t protect our citizens, maybe the courts will.

    With all due respect, Mr. President, healthcare related activity in both the Congress and White House is taking on the same appearance it had when Mrs. Clinton was running things. Invite all of the foxes into the hen house to divvy up the chickens and eggs. Mrs. Clinton met with health insurers, drug companies, hospital groups and administrators, physicians associations, medical device manufacturers…everybody but the sick. What is presently going on appears to be just as disingenuous.

    A few cardinal points:

    You can’t fix what is wrong unless you know what is wrong. Consult the sick.

    You can’t control costs if you have no idea of what the real costs are. The game played between hospitals, physicians, and insurers, including Medicare, is a phony numbers game where nobody has any idea of what the real cost of anything is. Double and triple billing, inflated costs, padded bills, triple ledgers, and special deals run wild. Let’s start by auditing hospitals. Let’s find out why having 7 of my daughter’s teeth extracted cost $29,000 for 45 minutes O.R. time and no overnight stay. Let’s find out why a plain vanilla CT Scan of my chest cost $7,000! Let’s determine why my brother went into the hospital with pneumonia and died from a cardiac catheterization within 48 hours of walking into the hospital.

    You say that computerization of health records will save money. We are in a world where HIPAA is useless, insurance companies know every conceivable detail about me, and share that information. Major businesses and such government agencies as Homeland Security and Los Alamos lose important data all the time.

    Taking care of a sick kid is like playing Whack-A-Mole in an amusement park. You put down one denial and another pops up. Try doing it for 27 years. Healthy people like yourself and most of Congress have no idea. When thieves like Rick Scott can testify before Congress, why can’t I?

    Sincerely yours,

    Edmund W. Boyle

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