Sunday, September 09, 2007


As regular readers of the Oread Daily know, I usually give my two cents worth especially in this on going series of posts and articles about issues affecting everyday Americans. That won't be the case today. Someone else has sort of done that for me.

A couple of months back a friend of ours, whom we affectionately refer to as "Ellie Mae," wrote a little something about the movie SICKO and the what the screwed up American Healthcare "system" has meant to one hard working Alabama woman.

"Ellie" tells me she is no longer sure that she still holds to the section she wrote critical of the movie, but because I think the commentary in general catches the reality of the "system" at its most basic level I'm reprinting the entire dang thang as an introduction to a post I found at another blog site (see further on down). That second post details another problem with the system to which, I must admit, I had given virtually no thought.

Anyway, here is what our friend down in 'bama wrote (Note the name of the person involved and the town have been changed to preserve some form of anonymity).

Lights, Camera, NO Action: Will Michael Moore’s, ‘Sicko’, Derail Healthcare Reform?
If so, what happens to Janice?

Well, unless you have been living under a rock you have at least heard about Michael Moore’s new movie, ‘Sicko’. It focuses on how the healthcare industry is ‘broken’ and insurance companies fail to pay for procedures, which in some cases are lifesaving, or at least restorative. In addition, there is discussion about our nations’ 46 million uninsured rolls which increases exponentially as more and more businesses cut or eliminate benefits for employees – creating a significant group of people who are now called the, ‘working poor’. The final concept explored in the movie discusses the benefits of what is characterized as socialized medicine or universal healthcare which would be a government managed system, and how a nation like the United States should adopt such a program like other industrialized countries in order to provide basic healthcare access to all people living in our country.

Now, most individuals who have studied the problems within the industry must admit the people Moore presents in the movie make a compelling argument that we are at the brink in regards to our system of ‘sick’ care that is the most costly of any industrialized nation and yet finds us ranked at 37 in terms of patient outcomes (Commonwealth Fund, 2007). Most agree that something should be done… so, what’s the problem with a movie like Sicko? Plenty!

Now, before anyone says I am a Right-Winged fanatic and Michael Moore basher that is simply not the case. I am a registered Democrat and have been since I could vote in 1976. Michael Moore seems like someone I would love to have dinner or drinks with. He seems like a barrel of laughs with an extremely sharp mind. And for those of you who may say, as a NURSE, I should be supporting movies that expose these atrocities – and rally with the nurse collective like those in California who came out into the streets to support his movie. But, in all good conscience I can not.

The issues and consequences are deeper than Mr. Moore’s right to entertain or provoke – the issue is that this will only fuel the fire of the debate that had started to become a reasonable dialogue that crossed party lines… NOW, lines in the sand will again be drawn and the discussions will deteriorate to derail the healthcare reform we so desperately need in this country. It will be ‘us against them’. In fact, it has already started. You can not turn on the television, pick up a paper or read news online without being bombarded with editorials, face time with Michael Moore himself or expert commentators and not find an article or segment about the topic that does not have that feel that we are sinking again into a debate on the virtues of either a) capitalism or b) access to healthcare for all. It is one way or another – there is no in between or middle ground. And, now on the campaign trail of the 2008 elections the candidates will be drawn into the debate. Unfortunately the debate will not include intelligent discourse about tangible solutions to a genuine crisis; a crisis that impact real people. Instead the American people will be subjected to pandering to their base and snarling talking points at each other about what was right or wrong with the movie like a bunch of silly children. Thanks (NOT), Mike!

So, just like in 1992 when the healthcare agenda was buried in partisan politics – mostly fueled by those who hated the appointed spokesperson for this reform; Hillary Clinton. We were closer to a reasonable chance of reform than we had been in years and yet in spite of the need to do so our elected officials – who, by the way, have really great insurance, reduced the discussion to such a state that it died a miserable death on the cutting floor of congress – mostly because they just hated the messenger. Now, as political jabs hurl from the left and right, sparked by those who use the Moore film to make their case on both sides of the issue – here we go again! And, who will suffer from the polarizing effects of this debate framed in such a manner? Well, my friend, Janice and her children for starters. They are the losers in this game of repartee and pithy sound bites.

Janice who lives in my small rural town, Piedmont, Alabama, cleans houses, boats and anything else she can for a living is a friend of mine. Her children attend school with my daughter and she is one of the most delightful individuals I have ever met. Even though she cleans my house twice a month I count her a very close friend and just marvel at her resourcefulness. Her kids are on the state healthcare plan, but Janice doesn’t have health insurance even though she probably works more hours and definitely harder than I ever have.

She grew up in a small town in Indiana and left high school to marry a man who was in the Army who promised to love, cherish her and take care of her. He did too. Well, up until the time he left her after impregnated another woman and quit working so he wouldn’t have to pay child support after the Army discharged him for mental health and anger issues. So, Janice, only 33 years old, lives in a trailer with 3 bright children as she struggles to put food on the table.

By now some of you are reading this and may be thinking that Janice needs to get a job with healthcare benefits – even if it is a menial job since she doesn’t have formal education or any technical training. But, there are two problems with that bright idea. First, Janice has a child with special needs. He needs constant medical care and she juggles numerous doctors’ appointments that simply would not jive with holding a traditional full time job. Ask anyone with a child like hers and they will tell you that making sure they get the therapy and care they need is, in and of itself, a full time ‘job’. Cleaning other people’s houses and boats can be done at odd hours and provides the flexibility she needs; however, none of her clients can offer her health insurance.

The second problem facing Janice and the other thousands of people who live in this area of the country is there are only a handful of industries and employers who provide benefit packages to their workers. So, Janice herself falls into the ‘doughnut hole’ where the working poor find an unsettling resting place with very few ways in which to climb out – and who, in essence, no one of consequence seems to care about. In fact, although this particular story highlights my friend Janice, over half of my daughter’s classmates are in the same predicament. There are hundreds of Janices – and, Jims for that matter and their stories are just as tragic.

The last time Janice was at my house she looked so tired. She just was not her bright and bubbly self. Her eyes were tired and dull. When I asked her what was wrong she said she needed a hysterectomy because she was diagnosed with endometriosis, but couldn’t afford it. Endometriosis is an extremely painful condition. It produces severe menstrual cramping and bleeding almost constantly and many women pass huge clots of blood on a regularly basis. But, in and of itself it is not life threatening. Endometrial tissue can actually attach itself to other internal organs like the intestines which increases the pain ten-fold. I had the same diagnosis 5 years ago, but of course I just scheduled and had my surgery and went about my life (I have great insurance too) - but, Janice can’t do that. She said she had contacted all of the local physicians about performing this surgery only to be directed to the office manager about how they would need about $10,000 down and there would be a similar bill and process when she set up the procedure at the local hospital. It might as well be 1 million. So, Janice will not get to have her hysterectomy that can restore her health so she can continue working 80 hours a week cleaning other people’s stuff and, so she can feed her children and put gas in her run down van in order to take her special needs child to his doctor visits and to and from school.

What happens if Janice can’t continue her cleaning work at her current pace? Well, she may have to go on government assistance to include getting a Medicaid card; something she has never done before and is tremendously proud of. But, there are limits on the amount of time someone can be on Medicaid, so it would only be a temporary fix. The irony is that if she did have Medicaid she could probably have her surgery and go on her merry way. So, not working so hard could actually help her situation. Interesting, and sadly true.

I do not know what will happen in Janice’s case, but there are thousands of more individuals like Janice who are forever falling in the ‘doughnut hole’ of our healthcare system. And because of a polarizing, yet factually true movie, the politicians and pundunts will reduce the debate to the lowest common denominator again and nothing will happen, again. Maybe it is not our lawmaker’s fault. Maybe they do not know someone like Janice in their district. Oh, wait – of course they do – she cleans their houses and boats!

We can send men and women into space, we can build bombs that will destroy the world as we know it, but Janice can’t have her surgery, and no one who can do anything about that seems to care – or, if they do care, they are doing little about it – now, that, my fellow Americans, is what I call, SICKO!

The following is from The Stiletto which granted permission to re-print this piece. This is, by the way, a self-described conservative web site and I appreciate the author (who has quite an interesting bio) granting me permission to post her article.

Why Middle Class Americans Can’t Afford Health Insurance

A new Census Bureau report shows that even though median household income rose to $48,200 in 2006 - a slight increase from the year before - the number of people without health insurance also increased to 47 million, or 15.8 percent of the population.

The uptick in the uninsured is due to workers losing employer-provided or privately purchased health insurance.

An article in The Wall Street Journal advises scrutinizing your medical records as closely as your credit report, as mistakes can affect your insurability or your premium:

Savvy consumers know to check their credit score before applying for a loan. What is less well known is that consumers can improve their chances of getting insured -- and of paying lower premiums -- by checking that medical information held by doctors, hospitals and pharmacies is accurate.

Errors in medical records aren't uncommon. "They happen all the time," says Joy Pritts, research associate professor at Georgetown University's Health Policy Institute.

Mistakes can arise from a mistyped diagnosis code or transcription error to an inaccurate diagnosis or a diagnosis that is out-of-date, say because a patient has gotten his or her cholesterol under control. And, if you have a common name, other peoples' records can end up in your file, says Ms. Pritts. Part of the problem is that the U.S. health-care system relies mainly on paper records, which make it harder to coordinate care and spot errors.

Even if your medical records are complete – and completely accurate – there is stuff in there that an insurance underwriter will zero in on to assign you to a higher risk pool – which could mean that your monthly premium could be higher than your mortgage or rent – even if you are in good health. Consider this scenario:

A 35-year old divorced woman is going over the results of her lab tests with her doctor. The patient has two tween-age children, and took her widowed mother into her home two years earlier after a stroke left her unable to live on her own – though still able to walk, dress and bathe herself

The patient is a non-smoker and within 10 pounds of a weight her doctor considers optimal. However, her blood pressure is borderline and her cholesterol is a bit high. The doctor tells her that both conditions can be managed without medication, if she exercises at a moderate level of intensity for 30 to 45 minutes a day.

She looks at the doctor incredulously, and launches into a plaintive protest:

"Are you kidding me? Do you know what my life is like? I have a 45-minute drive each way to work, and that’s after I drop the kids off at school and leave my mother at a daycare program for seniors. I’m lucky that my neighbor brings the kids home from school, but I have to leave work at the crack of 5:00 to fetch my mother. If a late afternoon meeting is running long, I’m eating my heart out thinking I’m not going to get to the senior center in time. My mother is as independent and healthy as can be expected, but she’s very demanding and critical of everything I do. Not only I have no time to exercise, I feel like I am constantly late for something. My social life has dwindled down to zero – I have no time for my friends, and it’s been ages since I’ve been out on a date. I often feel trapped, which depresses me no end."

If you think this is a private exchange between this patient and her doctor you’re wrong. The doctor has been taking notes the entire time, and the details of this conversation are immortalized in the patient’s medical records.

Should this woman lose her health benefits, because her company can no longer afford to insure its employees or the company goes belly up and she’s out of work, underwriters at all the insurance companies from which she will try to purchase individual coverage will look at the doctor’s notes and conclude she is a high risk.

Despite being a normal weight non-smoker she will be deemed a heart attack waiting to happen, because of her cholesterol and blood pressure readings. Her reference to depression will also be flagged as a potential suicide. Every health insurance company she contacts will offer her coverage – as they are required to under HIPPA – but they will want to charge more than $1,000 a month just for her, never mind the kids. (The American Sleep Apnea Association Web site has a great explanation of why people get "rated" and how underwriters determine how much to charge you for health care coverage.)

The moral of the story: Don’t give your doctor any extraneous information about your life. Anything you say can and will be used against you by an insurance underwriter when you try to get healthcare coverage.

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