Friday 31 March 2017

The Problem Isn’t Obamacare…It’s The Insurance Companies

Primary Care Doctor Explains:

“The Problem Isn’t Obamacare…It’s The Insurance Companies”

With premiums increasing for those with coverage through the ACA marketplace, a lot of people are criticizing Obamacare. But many doctors and healthcare professionals are saying that isn’t really the problem.

Cathleen London is a primary care physician in Milbridge, a rural town in Maine. She claims the problem isn’t Obamacare itself, but rather, the entire health insurance system and insurance companies are to blame.



Writing for the Portland Press Herald, London explains she is a a primary care physician who is on the front lines every single day, as  her town is very remote, which means it takes 30 to 40 minutes to get to the emergency room, which is why her office operates as an urgent care facility as well as a family medical practice.

It’s takes an ambulance about 20 minutes to get to her clinic and specialist care about 2 hours away, so Dr. London is trained to handle about 90 percent of medical problems.


DR. LONDON EXPLAINS THE FOLLOWING, WHICH WILL SHOW YOU EXACTLY WHAT’S WRING WITH HEALTH CARE:
One evening I was almost home after a full day’s work. Around 7:30, I got a call on the emergency line regarding an 82-year-old man who had fallen and split his head open. His wife wanted to know if I could see him, even though he was not a patient of mine.

 Instead of sending them to the ER, I went back to the office. I spent 90 minutes evaluating him, suturing his wound and making sure that nothing more sinister had occurred than a loss of footing by a man who has mild dementia. When I was sure that the man would be safe, I let them go.

 I billed a total of $789 for the visit, repair, after-hours and emergency care costs. Stating that the after-hours and emergency services had been billed incorrectly, Martin’s Point Health Care threw out the claims and reimbursed me $105, which does not even cover the suture and other materials I used.

 I called them about their decision, said that it was not right and let them know they’d lose me if they reimbursed this as a routine patient visit. They replied, “Go ahead and send your termination letter” – which I did.

 The same day, Anthem Blue Cross kept me on the phone for 45 minutes regarding a breast MRI recommended by radiologists on a woman whose mother and sister had died of breast cancer. She’d had five months of breast discharge that wasn’t traceable to anything benign (and it turns out the MRI is highly suspicious for cancer).

 Anthem did not want to approve the MRI unless it was to localize a lesion for biopsy, even though the mammogram had been inconclusive! This should have been a slam-dunk fast track to approval; instead, dealing with Anthem wasted a good part of my day.

 Then Aetna told me there is no way to negotiate fees in Maine. I was somewhat flabbergasted. I do more here than I did in either Brookline, Massachusetts, or New York. The rates should be higher given the level of care I am providing. I have chosen not to participate with them. This only hurts patients; however, I cannot keep losing money on visits.

 I do lose money on MaineCare – their reimbursement is below what it costs me to see a patient. For now, that is a decision that I am living with.

 I had thought those losses would be offset by private insurance companies, but their cost shifting to patients is obscene. I pay half of my employees’ health insurance, though I’m not required to by law – I just think it is the right thing to do.

My personal policy costs close to $900 a month for me and my sons (all healthy), and each of us has a $6,000 deductible. This means I am paying rack rate for a policy that provides only bare-bones coverage.

Something is wrong with the system. In one day, I encountered everything wrong with insurance. I am not trying to scam the system. I am literally trying to survive. I am trying to give care in an underserved area.

This is not the fault of Obamacare, which stopped the most egregious problems with insurance companies.

Remember lifetime caps? 

Remember denials for pre-existing conditions? 

Remember the retroactive cancellation of insurance policies? 

Returning to that is not an option.

Indeed it is not an option, Dr. London.  If Republicans get their way eventually by repealing Obamacare, it may be where we end up again. If Republicans really get their way, it’ll be even worse than it was before.

Minda Wilson

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Thursday 16 March 2017

Jordyn 21 Year Old Boy Killed by His Insurance Company

This is a true story.

Due to the fact that their son's death is so recent and raw, I have changed some of the details so protect the family.

"The story you are about to read is true, the names were changed to protect the innocent."

On the morning of Sunday, March 5th, at 4 am, Jordyn Smith died.  Jordyn was 21 years old.  While he didn't know exactly what he wanted to do with his life, he was working on it. He was handsome, over 6 feet tall, strapping, and athletic. He had a close group of friends that he had known since kindergarten.  Each one spoke at his funeral and told a story about how special he was to them and how much they meant to each other.

Jordyn liked to go to parties and, admittedly, had a drink or two with his friends before he turned 21.  The thing is, he never smoked.  He was passionate about music, loved rap.  He loved his sports teams and rooted passionately for the Rams.  You could never say a bad thing about them. He was a typical boy from a relatively small suburb growing up and finding his way.

Eighteen months ago, he was diagnosed with lung cancer.  For over a year, he was in and out of the hospital. First chemotherapy, then surgery.  They removed a good section of his lung.  This made him so sad because he was worried about whether he would have the wind to keep up with his friends when he was well.  Everyone told him that, once he got done with his treatments, and started exercising, his lungs would expand and he would be able to play soccer and basketball, two things he loved.

After the surgery, he had a lot of pain, which never really got better.  Worse, more treatments followed.  He had more radiation, more chemo.  His skin hurt from the radiation.  Through it all he was stoic and silent; complaining little and keeping up a strong front for his family.

After New Year, it looked like we were out of the woods.  Several months had passed since his last treatment.  There was talk of another round of chemo, but his tests were clear and he was recovering.  He felt so good that there was a big celebration party at his house and he started going to football games to see his beloved team.  And then it happened . . . .

Jordyn got a cold; a cold!  Because of the vulnerability of his lungs, it turned into pneumonia.  He couldn't breathe.  Within a week of getting sick, he was back in the hospital, hooked up to a breathing machine.  It took several weeks to get him off the machine and to stabilize him.  This last Friday, it looked liked he was finally going to be transferred out of the hospital to a rehabilitation facility.  The hospital required to test for infection prior to transfer.  When the blood tests came back, he had tested positive for infection.  Thirty-six hours later he was dead.

How could Jordyn have gone from able to be discharged to full blown pneumonia, 
without it being detected?  

 Jordyn was another victim of the Affordable Care Act, and the power it imbued our insurance companies.  Insurance companies, not doctors, now dictate how often blood can be "routinely" tested or chest x-rays taken for a patient like Jordyn in order for a hospital to be reimbursed.

If more frequent testing is recommended by the doctor, to get paid approval is required.  If no approval is forthcoming, who gets stuck with the bill?  The delay, deny, die mantra of insurance companies let you know right away how long it will take to get and answer and the law gives them up to 90 days to respond.  For Jordyn, it led to his death.

Minda Wilson
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Tuesday 7 March 2017

Minda WIlsons Response to Republican Proposals



President Trump said that healthcare is complicated. It is complicated;
but fixing healthcare is not.



The solution is simple and comes in 3 parts:

1)            True health insurance coverage, by a licensed entity, ie insurance company, gifting program, MEWA, or other legally approved entity, will provide catastrophic coverage, only.  This means that preventative care will not be covered.  Those costs should be paid individually by money set aside in your Health Savings Account, see below.

2)            In the aggregate, the price an insurance company charges for its policies should be no more than 1.4 times the money paid out by that insurance company for medical related services.

3)            All Americans should be able to set up Health Savings Accounts for themselves and their family members.  Contributions can be made by both employers, employees, and individuals.  Caps for these accounts should be set no lower than the cost of a family deductible, today about $10,000.




This proposal ties policy prices to money actually paid out for care.  If they spend more on care for your fellow policy holders your policy price will go up.  If they spend less, your policy price will go down.  The money they get for administration will be directly tied to the cost of care.  They less they spend on care the less they receive for administration.  It is just that simple.  You will be responsible for your individual healthcare needs.  If you don't take care of yourself, you will pay more.

Fixing healthcare only becomes complicated when you stop thinking about what a viable solution would look like and start thinking about how you can satisfy the insurance companies needs to continue using funds that are supposed to be used to pay for customer's healthcare needs, but instead are used to pay for health insurance company expenses.

The legislative proposals call for more health "insurance".  Allowing insurance companies accesses to more insureds and relying on them to agree to reduce costs makes no sense.  As a business person, if someone said, "I'll send more customers your way and let you decide whether or not your think the extra business is enough to make you consider lowering your prices!" , the odds of me lowering those prices is slim and none.

Affordability seems to be off the table.  Policy costs will continue to be negotiated at the state level.  Since all insurance companies typically have to do to raise rates is show more losses than anticipated or more expenses than anticipated, the odds of rates going down any time soon are non-existent.  Interstate insurance will allow companies incorporated in the most advantageous states to out compete those who are incorporated in states with higher levels of consumer protections.  While tax subsidies and/or tax credits are being considered, lower income families, and families that do not file itemized returns will receive little or no benefits.

Americans seem to have confused health insurance with health care.  Health insurance is supposed to spread the risk so that everyone who participates pays a little so that no one person has to pay a lot if they get sick.  Health insurance companies have become an investment vehicle to enrich senior executives.  As long as we continue to allow them to spend only 10% of what comes in to pay for the actual care part of their policy holders , there won't be much care there.

"The answer to our problem is to hold our insurers accountable; not promise them more business with no consideration for how much we will be charged"

Minda Wilson
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