Health Care

Dear Hilary,

Please wade through this long letter. I am a forty-two year old former public high-school history & math teacher who's been as good as disabled for the last six years, due to a chronically-dislocating right shoulder from a 1978 auto accident that was not my fault. I am an educated (Masters in International Relations) woman whose extensive experience with our country's health care system, I feel, qualifies my long-winded views to be seriously considered. I'm sorry I've waited so long to write, but my chronic pain has made a succinct, coherent letter very difficult.

First, my preferences, hopes, warnings, & suggestions; then my explanations & discussions:

1. single-payer Canadian-like system
2. no malpractice cap
3. standardization of forms & paperwork
4. national computerized data bank on the prices, qualifications, background, history, patient evaluations, etc. of all health care providers (hospitals, physicians, psychiatric personnel, clinics, emergency crews, etc.)
5. price controls & reform & reorganization (and/or elimination) of hospitals, insurance companies, & drug companies --- the real villains in outrageous costs
6. provision for rural & poor access to preferred doctors, rather than only HMOs or clinics
7. eliminating possibility of being turned down for insurance due to pre-existing conditions
8. no "GP gateway"requirement before seeing specialists
9. long-term HOME health care
10. "Dr. Kevorkian" possibility of ending one's life if no longer viable lifestyle possible
11. progressive income-tax for payment; certainly not taxes on benefits OR on legal substances like cigarettes & alcohol (some people, especially poor & those with pain & other problems, are already hooked: go at the "sin" substances another way --- through early childhood education & certainly no subsidies to manufacturers)
12. last & most important --- compassion, & refusal to make "judgement" calls --- a person who's never been seriously sick just can never understand what others have had to, & continue to have to, go through.

The small letter on unconscionable insurance company profits is probably the most important! The writer reiterates my previous point, & gives statistics on Prudential & Nationwide. Another example is Zoe Baird's salary of $500,000 at Aetna, as well as a recent clip from the AP that says this company paid enough to buy her house in Connecticut in order for her to realize a $100,000 profit. There's no excuse for an insurance company to pay an executive such outrageous sums --- more than twice what your husband makes as leader of the free world?

The horror stories I could relate if I were writing a book to you concerning wasted costs incurred due to insurance companies has made me adamant that you're on the wrong track with "managed competition" instead of a "single payer" scheme. I congratulate you for taking on the drug companies, but that's no excuse for letting the insurance companies continue to "rape" us! Suffice it to relate just one of many drawn-out experiences in the last several years (and something happens in every dealing with my insurance companies ---- previously Lincoln National, & now John Hancock [ I've also in the past had problems with Blue Cross & J.C. Penney]). I was supposed to pre-certify a costly procedure when I was desperately in pain & having to travel 3 hours away by car for the specialized care I needed. I called the number & reached a voice-mail system. The girl I finally discussed my case with didn't understand, so I was told to call a supervisor. I called --- voice mail again --- another poorly-trained girl said the supervisor would call me; she didn't. I called again --- voice mail again --- a 3rd girl after a 3rd 10 minute wait & 3rd long explanation. Finally, I received a "not approved" letter in the mail which was unintelligible, & based on faulty & incomplete information. After 2 or 3 more calls similar to the above, I finally reached the supervisor, & complained about the absurdity & unbearability of the above process. She vowed to correct, & did, AFTER I was under medical care that I had no choice but to undergo, whether it was paid or not. Think of all the pain for my doctor & myself & all those workers having to call & recall, write & rewrite, read & interpret, reread & reinterpret, calculate & recalculate over a period of several weeks: the absurdly wasted costs --- and for one item! Multiply this by all the medical procedures performed each day in this country.

The last newspaper clipping concerns information Ralph Nader has compiled in opposition to a possible "blackmail" deal with the AMA on malpractice caps. Very easily I can add 5 stories from my own acquaintances where people did NOT sue, even though the practices by doctors were outrageously incompetent & harmful to the individuals:

1. A teacher of foreign languages I know went to her doctor for a routine physical; she ended up with a punctured eardrum & a year of reduced hearing due to an aide who was improperly trained in probing. Prior to this, she was in excellent health.
2. My father was wheeled into surgery by his long-time doctor & given anesthesia which caused his heart to almost stop. The doctor had "forgotten" that, without all his blood pressure medicines which had been withdrawn for the surgery, there would be an interaction with the anesthesia to cause this symptom. When my dad awoke, he discovered he hadn't been operated on. He had to return home, reschedule time off from work, & go into the hospital a second time 2 weeks later.
3. My sister, a dietician, went to see her doctor with severe nausea and pain, saying despite her "slight" scientific training compared to a doctor, she thought she might have a kidney stone from her symptoms. The doctor sent her home, saying it was "all in her head". Later that night, she was rushed by ambulance to the hospital where, for 4 days, the doctor continued to try to convince her it was "all in her head". Just before her dismissal, she passed the kidney stone.
4. My housekeeper's sister was recently admitted to our local hospital for 10 days with serious vomiting & pain. After an unexplained delay that turned out to be an MRI machine that had caught fire (after being less than a year old) her family was informed that she had 6-8 months to live due to pancreatic cancer. Her daughter couldn't believe the poor treatment she'd suffered form an inattentive doctor & so had her transferred to a big city hospital an hour & a half away. There, a different doctor said he saw no cancer, but would have to schedule a 4-hr. operation to remove & "cleanse" & replace her pancreas that was all blistered & infected, along with a swollen liver, from complications due to a long-ago diagnosed case of diabetes!
5. I first seriously dislocated at 4 A.M. in October of 1986 when I rolled over in bed. The ambulance crew stood in my bedroom for 2 hrs. "waiting for me to get dressed" --- an impossibility due to the pain --- and obviously due to their lack of training. I, years later, discovered that they should have immediately given me a morphine drip & immobilized me & rushed me to the hospital. When I finally arrived, I was understandably distraught (maybe even hysterical), but the emergency room doctor said he wanted X-rays 1st, & "wasn't I overdoing it?", which almost caused me to go "mad". Who would be so insensitive to think I was "play-acting"? I guess he was overworked &, because of my obesity, couldn't visually determine whether or not I was dislocated.

   When I eventually had surgery for this condition, the nurse wanted me to sign a "release" form that said they were doing the wrong operation on the wrong shoulder. When I refused, she said, "Oh, honey, the doctor knows the right information --- just sign." I refused & the operation was delayed a half-hour while they rounded up the doctor.

1. What was touched on above --- insurance companies "pre-certifying" costly procedures --- this adds an entire new layer of costly bureaucracy, creates untold expense & time loss better-directed to more useful activities, & pain to both doctors & patients --- as well as hospitals. Insurance companies are not even trained properly, or close enough to individual cases, to do this correctly.
2. lack of standardization of forms: hospitals, insurance companies, & doctors all have multi-farious forms (gov'ts, too), for which much time & money is wasted by all in attempts at interpretation: ABSURD, COSTLY, & PAINFUL --- as well as DANGEROUS to the old, seriously ill, drugged, or uneducated!
3. outrageous hospital bills that are impossible to interpret by patients &, therefore, are seldom questioned; often wrong; & as stupidly expensive as the horror stories at the Pentagon. Included under this heading is a "Pain Center" (at Jewish Hospital in Cincinnati) which I attended three weeks this past summer that was essentially a SCAM; it merely created new health problems for me due to the bureaucratic, "run-up-the-bill" mentality of many of its workers.
4. One of the most important is the IMPOSSIBILITY of making an informed choice of doctors, hospitals, or psychologists due to lack of information. Since I moved from Cincinnati, my home town where I had access to & choice of long-term great care, I've been to almost 10 different doctors & five psychologists, AND NOT DUE TO HYPOCHONDRIA! First, I had an old M.D. who was behind the times even though good; he sent me to a D.O. specialist who gave me every test on earth, but still couldn't diagnose a persistent pain in my side. He was sicker than I, himself, & so when I needed him & he was off work, a substitute would fill in --- of course, not too informedly. Then I tried getting a new doctor when he retired, was referred to a total "nut case" who told me I was depressed without examining me physically, & prescribed anti-depressants. I spent a year, as a result of this, going to a psychologist to find there was nothing wrong with me. A complaint was lodged with the head of the osteopathic clinic; the doctor in question retired that year --- probably as a result of my complaint. Two more doctors were specialists in orthopedics --- one, the only one in Athens at the time, was overworked handling 3 counties in this rural area; he made me wait over 2 hrs. in his office, required unnecessary X-rays which I refused, & caused me to go to the 2nd practitioner in my hometown --- 3 hrs. away. This 2nd one ALSO kept me waiting over 2 hrs --- I was to see him for the next 5 yrs., though, despite his total lack of bedside manner. I eventually required 2 other psychologists to overcome the results of his bizarre care, since, because I had a desperate & extremely painful & debilitating physical problem, I required a specialist in joint care --- any specialist if I couldn't find a good one. More patient torture & wasted expense! After 6 years of all this, I have a satisfactory, not great, orthopedist, GP, & psychologist.

   *IF I had to go to an HMO-type group under "managed care", I still would not even have these men because NONE of them belong to the main osteopathy clinic here in town & don't know each other, so wouldn't team up (and . . . one is not even in this town).

   The whole point of all this is: we need a health care data bank for patients! Rural areas need more choices, & GOING TO A GP first every time a person like me needs specialized care is TORTURE, & a WASTE of MONEY & TIME!

5. Hospital and nursing-home care for people who could either be treated at home more cheaply (like my 88 yr. old grandmother, who was lucky enough to tap into a home-nursing program to teach her about & monitor a case of adult-onset diabetes) OR are so sick that their worthwhile life is over (such as the people Dr. Kevorkian has helped or Karen Quinlan, etc.). Just as in abortion, in a free country like the U.S. is supposed to be, a person who is dying should have the right to be helped out of this world with dignity if that is one's preference --- BEFORE all medical insurance, life's savings, & family compassion is used up!

1. taxing health-care benefits
2. outrageously-high "sin" taxes
3. rationed care
4. lack of choice of provider.

I smoke --- a dumb thing to do but, hilariously so far, NOT the cause of even 1 penny of my health problems. You have no idea of the hell I've been going through the last 6 years, partly due to my health problems, partly due to all the problems in U.S. health care: if I had to give up smoking right now on top of everything else, I would be seriously suicidal. People who've not been through true health crises that are long-term CANNOT POSSIBLY KNOW how serious I am about this or whether I'm just a complainer who could easily quit with a little help. When, for periods of over a year, I've been unable to move from a chair to do anything worthwhile and, even in the chair, have been unable to read or knit or whatever, smoking has been my saving grace. The "yuppie" tendency in the last couple of decades to legislate morality & life-choices for others, in a "we-know-better-than-you-do-what's-good-for-you-and-our-country" attitude is FASCIST! $1-a-pack more tax on cigarettes maybe can be justified, but $2? This stems from a disgusting "superior" attitude. In the same vein --- how about $2 per burger & fries tax on the McDonald's products since they help cause myriad cases of heart disease? Lay off! (By the way $200,000 a yr. people "just don't get it" when they try to understand what the average Jane & Joe are going through in their daily lives as $10-20-30,000-a-yr. employees, parents, & citizens --- witness the flap over "nanny care").

Did you make it through all this? If so, thank-you sincerely for considering my views. They're born of painful experience and, if carefully analyzed between the lines of emotional overkill, offer many worthwhile suggestions for COST SAVINGS & IMPROVEMENTS in health care delivery!

Again sincere thanks,

Barbara V. Smith

A HERO

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re the Kevorkian Verdict - Mar 27, 1999

I find it absolutely outrageous that this courageous doctor has now been subjected to his FIFTH trial on this issue in a supposedly FREE country where, apparently, individual citizens do not have the right to choose whether or not they wish to die in dignity --- without being subjected to a medical community that, in addition to forcing them to submit to possible tortures of the damned, often takes all their monetary assets as well, before they are permitted to be "released"!

We have "Humane" Societies for our pets, to put them out of their misery when they have reached the ends of their lives worth living, but we cannot be "permitted" to choose when OUR OWN lives worth living are over? When my father ran out of money after 5 months, all the doctors & hospitals & nursing homes & insurance companies were perfectly willing to allow him to die of poor care & pneumonia contracted in one of their "health-care" establishments. Previous to that, did they give him excellent care to first avoid, & then alleviate, the permanent effects of a major stroke? Hell, no!

Why should someone else's religious or moral beliefs be stuffed down MY throat? I have suffered for 13 years from the after-effects of a major automobile accident that was NOT my fault; my pain has been NOTHING compared to what some of the individuals Dr. Kevorkian has helped have had to endure. Still, I have spent years of suffering the indignity & pain of paying money to a series of mostly incompetent doctors who made me worse with all their pills lightly thrown my way, which were not monitored & often caused new problems (as well as rarely first giving me the time of day, much less looking into a proper history-taking, diagnosis, treatment plan, or follow-up); physical therapists who were so gung-ho that they caused new injuries; hospitals that didn't hire enough nurses to give adequate care, in order to pad these institutions' financial bottom lines; and ambulance crews who weren't properly trained enough to prevent excruciating pain, inordinate waits, & improper handling.

On top of this, when I got home, I had to fight revolving-door insurance companies who wanted, from offices half-way across the country from me, to tell my health-care team what I needed or didn't need --- without ever having met me! Then, after one's mental health was sapped, one was subjected to another round of MENTAL "health" care even more inadequate, for which one's health insurance was even less likely to approve payment! If you're rich, in the right part of the country, curable, or happen to have found good medical care, don't deny that others have not had such good fortune.

I am now 48; I just love to think on how long I will have to endure this hell here on earth. Am I depressed? Yes! Do any of the myriad anti-depressants prescribed to this three-year "guinea pig" work? No! I truly pray to God that none of you self-appointed national health-care arbiters out there, or any members of the jury that convicted for second-degree murder today, ever, in a wink of an eye, come to suffer a similar unexpected fate. The lack of compassion of some healthy people for the plight of many of the chronically or incurably ill makes me puke! If some wish, or feel they need to, suffer --- let them; but if others wish, or believe it's O.K. or necessary, to end their suffering --- let them, too!

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