Obama told aides that he is “really good at killing people.” according to Washington Post's Peter Hamby on November 1, 2013. I guess he's correct about the killing people part. Thanks, Obama.


Woman writes of struggle to keep the doctors who keep her alive
By Mike Krumboltz, Yahoo News Monday, November 04, 2013

The rollout of the Affordable Care Act, also known as Obamacare, has been full of snafus and politics. Less discussed are the individual people whose coverage is changing, sometimes for the better and sometimes for the worse.

Edith Littlefield Sundby counts herself among those whose coverage is taking a hit. She wrote about her case in a powerful op-ed in the Wall Street Journal on Sunday.

In her early 60s, Sundby suffers from stage 4 gallbladder cancer. According to her op-ed, less than 2 percent of people with stage 4 gallbladder cancer survive five years after diagnosis. She's had it for seven years.

Though it has become close to impossible to speak about the Affordable Care Act in a nonpolitical way, Sundby does so in her op-ed's second sentence:

"My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics."

Sundby describes herself as "a determined fighter" and "extremely lucky. "But," she writes, "this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31."

Sundby credits two things for her survival beyond expectations: her doctors (at the Moores Cancer Center at the University of California San Diego, at Stanford University's Cancer Institute and at M.D. Anderson Cancer Center in Houston) and her health care policy. She writes that since 2007, United Healthcare has spent $1.2 million "to help keep me alive."

Since receiving notice that her health care plan will end on Dec. 31, Sundby and her health care broker have searched for a comparable replacement.
They haven't found one.

Sundby writes that if she goes through the California health exchange, she will have to choose between UC San Diego and Stanford — no single plan is accepted by both — and that the UCSD plan does not allow for out-of-state care except for emergencies, meaning M.D. Anderson would not longer be an option.

What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.

Sundby's story of survival has been profiled before. In a 2012 interview with AARP, Sundby spoke about her philosophy when fighting cancer. After her doctor told her that she had a 5 percent chance of not surviving an operation to have her lung removed, Sundby said to go for it.

"The risk for me is not going for it," she says. "And who knows? Maybe with the right music or with a different attitude or by just sauntering instead of bounding up the canyon, I'll still be able to do this afterward."

Sundby's positive outlook was also profiled in a wellness blog from The New York Times in July. In the piece, Sundby, an avid walker and hiker (check out her "Mission Walk" Facebook page), wrote about why she recently walked 800 miles.

With cancer we lose control almost immediately. We become hostage to disease. It quickly takes over our life, overwhelming not only our bodies but also our emotions and eventually our spirit. For almost six years I have tippy-toed around cancer, fearful of arousing it, fearful of its rage. Each time cancer lashes out it not only wrecks havoc with my body, it terrifies my soul.

I walked to rid myself of the terror of cancer, and to overcome the fear of it coming back. It took hundreds of miles walking to just begin to rid my heart of six years of fear. That fear may never completely fade, but actively engaging life — whatever that may involve — reminds me of the joy each day can bring.

In the Wall Street Journal op-ed, Sundby writes that for cancer patients, "medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point."
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I read the Wall Street Journal letter she wrote this morning and was disheartened to see what she is now having to deal with after fighting and winning for so long.

But what I found most surprising was that I assumed that it was the ACA's fault that her coverage was no longer available due to how the law was written, but, it is her current insurance provider, United Healthcare, that is deciding to pull out of the California market completely. Hopefully there is some misunderstanding in how the market will work in California and she can continue to revive the care she has come to expect, but after reding the whole article (http://m.us.wsj.com/articles/SB100014240...mobile=y), I am pretty pissed at that company.

There are problems with the ACA (see: website roll out debacle for starters) but I would have hoped that insurance companies would not have gone the route of United Healthcare and left their customers in a lurch and scrambling to find a whole new insurer for whatever reason they did.

(11-05-2013 12:11 AM)RiceLad15 Wrote:  for whatever reason they did.

I thought the ACA was the reason. Was it not?

(11-05-2013 02:54 AM)OptimisticOwl Wrote:  

(11-05-2013 12:11 AM)RiceLad15 Wrote:  for whatever reason they did.

I thought the ACA was the reason. Was it not?

Of course everything that is happening is somehow driven by the ACA, but I was more talking about people losing insurance as a direct result from the way the law was written, like how some people won't be able to keep their current plan because they will have to upgrade it to meet the bronze minimum.

Instead, I find that insurance companies are pulling out of providing individual, non-employer healthcare because it, even though that is often a small part of their business, it would make them less profitable due to the minimum loss ratio and preexisting condition parts of the bill (http://www.usatoday.com/story/news/natio...2986795/). Now, if the decision to cover 8,000 people in California as United Healthcare does (http://www.huffingtonpost.com/2013/07/02...37396.html) would drive them into the red, then I understand. But if it just cuts into profit growth, or profits as a whole, it's unfortunate that this industry, who is meant to serve the healthcare needs of others, would "buzz off" to those 8,000 people on individual plans (United Healthcare will still remain in California for employer and large group insurance).

Color me naive, but I would think a business whose only purpose is to aid people receiving the medical treatment they need would be better about trying to provide that, even at a slight decrease in profit. But hey, that's business.

Standard operating procedure, in particular for people on the individual market. ObamaCare has completely wiped out the individual market. That is no hyperbole.

CIGNA tripled my rates and deductibles earlier this year and then announced January 1 they will no longer offer ANY plans in SC. I did a search on eHealthInsurance (go on, try it) for insurance plans ... for an individual buyer ... male ... age 28 ... in South Carolina ... effective start date January 1, 2014.

Results: ZERO

Do the same search but for December of this year? Hundreds of plans.

Much of the crap on the exchanges (nearly all Silver and many Gold and some even higher) are HMOs. HMO of course is healthcare speak for "everybody you want isn't in network".

"You can keep your plan if you like it". "You can keep your doctor if you like them". "You have to pass the bill to see what is in it". Just some of the things I can think of to get through those last 5 minutes of a grueling workout with a surge of rage.

It shouldn't be a surprise to anybody that this is the outcome. They're from the government after all ... and they're here to help.

(11-05-2013 08:10 AM)RiceLad15 Wrote:  Color me naive, but I would think a business whose only purpose is to aid people receiving the medical treatment they need would be better about trying to provide that, even at a slight decrease in profit.

Why?

And how does such a business make resource allocation decisions?

According to the account, this patient has received outstanding treatment, at a cost of $1.2 million to the insurer and presumably much, much less to herself.
Here's a question: if the ACA had been around for 50 years, how would the care she received compare in:
- effectiveness?
- cost to the payor?
- cost to the patient?

Stated more generally: if the ACA had been in place for several generations:
- Would the standard of care be higher or lower than it is today?
- Would the government's costs be higher or lower than what insurers' pay today?
- Would the patient's costs (including taxes) be higher or lower than they are today?

(11-05-2013 08:45 AM)georgia_tech_swagger Wrote:  ObamaCare has completely wiped out the individual market.

Wasn't that one of its goals?

(11-05-2013 12:11 AM)RiceLad15 Wrote:  I would have hoped that insurance companies would not have gone the route of United Healthcare and left their customers in a lurch and scrambling to find a whole new insurer for whatever reason they did.

The failure to recognize that people really do respond to incentives is one of the most repeated failures of modern policy-making.

(11-05-2013 08:10 AM)RiceLad15 Wrote:  ...I would think a business whose only purpose is to aid people receiving the medical treatment they need would be better about trying to provide that...

That performance expectation would seem to apply even more mightily to a government that has made health care its defining initiative.

More generally, one could ask the same question about many, many government initiatives, whether defense or education or fixing streets or delivering mail: why aren't they just better at it? In fact, why aren't they supremely outstanding it, unsullied as they are by the contemptible motives that infect every aspect of the private sector?

(11-05-2013 10:31 AM)georgewebb Wrote:  Stated more generally: if the ACA had been in place for several generations:
- Would the standard of care be higher or lower than it is today?
- Would the government's costs be higher or lower than what insurers' pay today?
- Would the patient's costs (including taxes) be higher or lower than they are today?

I think the obvious answer is that fewer people would go into practicing medicine because the income from the effort would be far less.

The standard of care might be higher (or might not) but that is immaterial because the availability of care would be less.
The cost of the care would probably be lower, but that too would be immaterial because the availability of it would be less.

The best example I can think of would be the post office. Something everyone needs and it basically operates 24/7. It loses money like crazy... and we're basically suggesting that we REDUCE the cost of postage and pay postal workers less with the government (taxpayers) footing the bill for the shortfall... What do you think would happen?

I think the unrealistic pricing model would put strains on Fed Ex and UPS to keep up and compete at the price, PARTICULARLY in rural areas or for heavy users, causing them to cancel all but the biggest of routes... and that business would go to USPS by default because it has no other place to go and it MUST go somewhere... but as a result of the lower reimbursement and higher demand for service, the quality must by definition decline.

Where does this analogy fail?

The thing I find perplexing is this unstated, yet implied ASSumption that "healthcare" means starting with an attachment to a doctor and the pharmacological system.

I think "Healthcare" and "Insurance" are two mostly separate things that have been co-mingled over the last 40 years to the great detriment of Americans, and their general health.

"Healthcare" functions best when it is primarily "Self-care" and starts with education and intellectual knowledge, continues to good habits and routines including primarily diet and the avoidance of bad intakes and poisons, which can and often do include many commonly prescribed pharmaceuticals as well as those obtained without prescription or illegally, and only occasionally involves the need for doctors and medicine in its more extreme cases. This is the point where "Insurance" is needed.

For the vast majority of Americans, most all that is needed is a low-cost catastrophic policy for the big diseases and crises like emergencies, a solid education in basic self-care practices, a good diet and knowledge and willingness to constantly read all food and drug labels completely top-to-bottom, and think about what one is putting in one's body, no matter who recommends it (doctor, friend, food conglomerate, insurance or pharmaceutical company).

Many of the "routine care" practices and procedures we have been erroneously sold are based on half-truths at best, and completely erroneous information at worst. Paying out of pocket for all routine care and separating it out of insurance policy costs instead of worrying about co-pays, deductibles, and all the other ponzi-scheme, shell-game crapola people assume is necessary and fail to question, along with doctors posting prices for their top 100 normal procedures and tests, would go far further in dramatically improving health of all Americans and dramatically lowering costs for everyone, rich and poor alike.

But...but Insurance Cos and Big Pharma would lose big time, and the govt would have far less control over people's lives, so that is why we are told this is a bad thing. Better to let the faceless policy makers and boards and panels make those decisions for you.

To wit: the erroneous tendency for anyone with a common cold or flu to run to their doctor for a several hundred dollar visit and then demand antibiotics which are widely acknowledged not to work for these cases, which is a complete waste of "healthcare " and insurance dollars and resources. Only the very youngest and oldest, or those who have a chronic condition generally even need to go to a doctor when they have a common cold or flu. The rest would save themselves and society a lot of wasted time and money by staying home for a few days, resting in bed in a darkened or semi darkened room with no TV, computer, smartphone, etc.., drinking lots of hot tea with honey and lemon and eating chicken noodle soup.

Of course...that means the pharmaceutical cos, doctors and insurance cos have less need to justify their exorbitant and inefficient system of delivery and would then be forced to spend their time on the really important cases that demand their attention, skill and expertise. And it would cost a lot less, as well. Makes too much sense, therefore will never happen.

GoodPost, GoodOwl.

The ACA actually doubles down on this as "patient satisfaction" is now a significant driver of reimbursement.

The guy going to the doctor for the flu who demands Tamiflu (not effective unless you catch it in the first two days or so) or a completely ineffective antibiotic will give stars to the doc that gives them the "bad" medicine and mark down the one who tells them the right thing (fluids and rest as you suggest).... and the difference in reimbursement is a TOP LINE one across the board, and not merely a case by case one or "after expenses". Meaning a doctor who falls below the satisfaction threshold doesn't just lose 10% of the $35 they were going to get from that one visit, but they lose 10% of their entire reimbursement... So a doc with 500k gross and 250k in expenses can lose 50k, or 25% of his net income. Obviously I'm being a bit extreme here, but that is how the math works. It sure doesn't encourage "tough love" and "self reliance" or "healthy living" for medicine. I sure wouldn't want to have a lot of fat patients and have to prescribe diet and exercise to all of them. I'd be better off letting them stay fat and treating their symptoms and hoping they get so sick that I can pass their care off to a surgeon or emergency room.

I WOULD point out that most "wellcare" things like annual physicals were covered by even the most basic of insurance plans... as was much catastrophic care... IMO, this should have been the model for reform because it put a direct cost/benefit to taking care of yourself. Instead, the ACA basically absolves people of their poor decisions.

(11-08-2013 03:01 PM)Hambone10 Wrote:  GoodPost, GoodOwl.

The ACA actually doubles down on this as "patient satisfaction" is now a significant driver of reimbursement.
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It sure doesn't encourage "tough love" and "self reliance" or "healthy living" for medicine. I sure wouldn't want to have a lot of fat patients and have to prescribe diet and exercise to all of them. I'd be better off letting them stay fat and treating their symptoms and hoping they get so sick that I can pass their care off to a surgeon or emergency room.

I WOULD point out that most "wellcare" things like annual physicals were covered by even the most basic of insurance plans... as was much catastrophic care... IMO, this should have been the model for reform because it put a direct cost/benefit to taking care of yourself. Instead, the ACA basically absolves people of their poor decisions.

Exactly Ham.

I've been thinking a bit, and watching some of John Stewart's thoughts on Obama's promises. While he skewers Obama, he absolutely rips the GOP for their previous stance. As much as I am against the ACA in particular, I am NOT against improving the overall health and Insurance system in America. I think the fact so many people were willing to take Obama's word and Peolsi's et al without even reading or being able to see it speaks that something did and does need to be done. We don't see the true costs of healthcare with the present system or the ACA. But what is worse, we lose even more decision making ability with the ACA. This is the most offensive thing to me about the Dems' approach.

I and many others want some changes, but WE WANT TO HAVE A REAL SAY, not just be treated like numbers or widgets. We want REAL CHOICES, and we WANT THE CHOICE TO ACT SMART and RESPONSIBLE and benefit (profit) from it if we choose and are able (and a bit lucky.) Obamacare offers NONE of those choices. It is an anti choice approach from a party that supposedly is about choices. No choices means the market can't work to lower costs. Lack of transparency and double speak, means higher costs for all. ]b]As much as some believe people don't like Obamacare because of Obama, (and many don't), more, they hate the law because the ACA TAKES AWAY CHOICE.[/b] One would think anyone who is pro choice would be offended by that one fact if nothing else.

Ironically, the Republican alternative plan (yes, folks, despite what you have heard, there has been a real, comprehensive and workable plan to save Americans bigtime money on healthcare all along, and I've linked one outline below in my signature- go read the two-page pdf summary to see what's in it (unlike Obamacare) The Republican Health Care plan OFFERS and SUPPORTS CHOICE!!!
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My point all along has been that we need to do something about health care, but Obamacare is not it. Neither single-payer nor single-provider are viable options either, particularly not for a population over 300 million. The only viable option is a Bismarck multi-payer universal private insurance system. I think that any process involving real choice would have ended up there. So why didn't we? Because there was no real choice.

(11-05-2013 08:10 AM)RiceLad15 Wrote:  Color me naive, but I would think a business whose only purpose is to aid people receiving the medical treatment they need would be better about trying to provide that, even at a slight decrease in profit. But hey, that's business.

You're mis-stating a number of things.

They aren't in business to help people, but to make money. Of course, MANY businesses and people are happy to make a living by helping people, but who would intentionally engage in a business that "costs" them real money?

If we were just talking about a reduction in profit as you allude to, they would either accept the slight reduction, or raise their prices so that they didn't lose money.

The fact that they don't should tell you something... but rather than believe that SOMEONE would step in and accept that slightly lower profit you think is there... some choose to believe that they and their shareholders are putting politics over profit and that every insurance company is headed up by partisan or even "racist" Republicans who hold controlling interest.

As Owl points out, health insurance isn't the same thing as healthcare...

and what is happening is that healthcare is being rationed... so more people have healthcare, but those that had it before now have reduced access to it... despite in aggregate paying substantially more... and the only reason we aren't paying even MORE for it, is that those evil doctors are being squeezed...

Its STATED priorities and its Effects are in complete conflict... and too many hear the statements and ignore the effects.

(11-10-2013 05:48 PM)Hambone10 Wrote:  

(11-05-2013 08:10 AM)RiceLad15 Wrote:  Color me naive, but I would think a business whose only purpose is to aid people receiving the medical treatment they need would be better about trying to provide that, even at a slight decrease in profit. But hey, that's business.

You're mis-stating a number of things.

They aren't in business to help people, but to make money. Of course, MANY businesses and people are happy to make a living by helping people, but who would intentionally engage in a business that "costs" them real money?

If we were just talking about a reduction in profit as you allude to, they would either accept the slight reduction, or raise their prices so that they didn't lose money.

The fact that they don't should tell you something... but rather than believe that SOMEONE would step in and accept that slightly lower profit you think is there... some choose to believe that they and their shareholders are putting politics over profit and that every insurance company is headed up by partisan or even "racist" Republicans who hold controlling interest.

As Owl points out, health insurance isn't the same thing as healthcare...

and what is happening is that healthcare is being rationed... so more people have healthcare, but those that had it before now have reduced access to it... despite in aggregate paying substantially more... and the only reason we aren't paying even MORE for it, is that those evil doctors are being squeezed...

Its STATED priorities and its Effects are in complete conflict... and too many hear the statements and ignore the effects.

For United Healthcare, they were currently covering 8,000 people on individual plans in California. So I'm not 100% what their decision to withdraw from the individual healthcare market in California means, but that is obviously a small portion of their revenue stream.

(11-10-2013 10:43 PM)RiceLad15 Wrote:  For United Healthcare, they were currently covering 8,000 people on individual plans in California. So I'm not 100% what their decision to withdraw from the individual healthcare market in California means, but that is obviously a small portion of their revenue stream.

Maybe I'm missing your issue then.

If that's the only event you're speaking of then the answer is obvious. They already aren't making money in the market and this just makes it harder, not easier.... Because insurance is about making a few bucks on thousands of policies... And there is a fair amount of overhead involved in it.

Your comment implied to me that you think they just don't like helping people anymore. It seems to me that they just don't like businesses that don't make money.

The ACA doesn't have to be good for business/insurance. That isn't its job... But we don't need to demonize them either. I'd point out that the government outsources it's care in the va to insurers in rural areas because they are more financially efficient in those areas... So they serve a vital purpose

(11-11-2013 12:04 AM)Hambone10 Wrote:  

(11-10-2013 10:43 PM)RiceLad15 Wrote:  For United Healthcare, they were currently covering 8,000 people on individual plans in California. So I'm not 100% what their decision to withdraw from the individual healthcare market in California means, but that is obviously a small portion of their revenue stream.

Maybe I'm missing your issue then.

If that's the only event you're speaking of then the answer is obvious. They already aren't making money in the market and this just makes it harder, not easier.... Because insurance is about making a few bucks on thousands of policies... And there is a fair amount of overhead involved in it.

Your comment implied to me that you think they just don't like helping people anymore. It seems to me that they just don't like businesses that don't make money.

The ACA doesn't have to be good for business/insurance. That isn't its job... But we don't need to demonize them either. I'd point out that the government outsources it's care in the va to insurers in rural areas because they are more financially efficient in those areas... So they serve a vital purpose

I'm not trying to demonize this healthcare company, but instead try to illustrate a point I have been trying to make on this thread since my first comment, and perhaps I should have been more clear.

When I first saw this article, it was being touted by many as basically the "Obamacare is going to kill me article." When I read it with that in mind, I was expecting to find some piece of the legislation where a specific rule had deemed the high-end insurance illegal, thus reducing the woman to finding someone else to provide her care. But what I found was an article about a company who is dropping the coverage of all individuals in California for an unspecified reason.

Instead of immediately assuming that it was unprofitable to cover those 8,000 individuals now (because Hambone, as you said, it may have already been unprofitable, and if so, why were they doing it in the first place?) I wanted to investigate and understand why the company would discontinue covering individuals, but not large groups and businesses in California.

And this is where I got confused. Ham, as you have now stated in two separate posts, businesses wouldn't engage in actions that intentionally cost them real money, but since they are now dropping the coverage, they must have been engaging in actions that intentionally cost them money. Wait, what? And since I haven't read an article that discusses the pre and post finances of United Healthcare and the rational behind removing themselves from the individual market in California, I will continue to be interested in why they made such a decision, and not make a foregone conclusion that it was because it was so unprofitable.

I'm not a gigantic fan of the mandate in the ACA (I'm all for getting rid of preexisting conditions, allowing you to stay on your parents insurance until 26, and capping the amount one can spend on insurance in a year), but I'm certainly not against it. Instead, I'm pretty much someone who better understands why the ACA was passed as opposed to why it wasn't. There are probably better healthcare alternatives out there (as Owl69/70 often points out), but perhaps I don't fully comprehend the effects of this law yet, and that's why I am not fully in one corner or the other.

Or in the end, I may just be someone who likes to stir the pot...

united Healthcare used to cover 8k people in California.
now they don't .

what changed? what is the difference between now and then?