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This is Alyssa.


Alyssa May Day

If you read my diaries you might remember Alyssa from this account.

Alyssa also used to write Haiti diaries here on Daily Kos as allie123. She's had multiple sclerosis for many years now, and eventually it got bad enough that she couldn't write them any more. But she can still tweet! Now she is Occupy Oakland's unofficial official tweeter.

Alyssa needs medication that costs $30,000 a year to allow her to keep going strong. Her insurance company, PacificCare, is supposed to handle that.

This is PacificCare.


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This is how PacificCare operates.

California regulators are seeking fines of up to $9.9 billion from health insurer PacifiCare over allegations that it repeatedly mismanaged medical claims, lost thousands of patient documents, failed to pay doctors what they were owed and ignored calls to fix the problems.

In court filings and other documents, the California Department of Insurance says PacifiCare violated state law nearly 1 million times from 2006 to 2008

This is PacificCare's profit for the year: $5,000,000,000 (that's right, billion).

Despite (or because of) this, PacificCare has multiple assholes in it. They play the same game with Alyssa every three months, denying her a prescription refill, hoping she'll give up in frustration. After days of persistence on Alyssa's part, calling and holding, calling and holding, they ultimately give her what she is entitled to by law -- her medicine. And they've been playing this cruel game for years.

Below is Alyssa's latest story. It took place over the span of about four hours two days ago, and like all of Alyssa's stories nowdays, it is a tale told in tweets.

Woven through it, though, is a much bigger lesson than simply one of persistence. It a lesson of why health insurance companies like those that exist in America are a plague on society, a horrible cancer on the economy, a pyschological nightmare to millions of Americans, and the real death panel to hundreds of thousands, if not millions, of others.  And why they need to go away.

Let us begin.

Alyssa @alyssa011968
yesterday I spent over 10 mins on hold w/specialty pharmacy for Avonex http://www.nationalmssociety.org/... -- then gave up. I'm trying again on hold 8min now

Alyssa @alyssa011968
I know insurance companies (CrimeFamilies) have caused a lot of people not to take it. Saves insurer money #ObamaCare gives them more power

Alyssa @alyssa011968
No controversy in med com about the med. I don't know of a neurologist who doesn't recommend treatment 2 slow multiple sclerosis progression

Alyssa @alyssa011968
I've been on hold for 12 minutes now. And this is just the beginning of process of trying to get prescriptions refilled

Alyssa @alyssa011968
ok I finally got thru. I'm making them ship it overnight just to fuck w/them.

Alyssa @alyssa011968
ok now the asshole says insurance won't cover it. refused to give his name and Say's have to wait 10 min on hold to speak 2 his sup.

Alyssa @alyssa011968
I should have known it was too easy at first.

Alyssa @alyssa011968
So I've been on phone over 22 minutes today, 10 min yesterday. Annoying but no big deal when not working (I'm sure AT&T appreciates it)

Alyssa @alyssa011968
Now supervisor said he see's that it is covered but has to figure out why not going thru and will call back. All while I don't get my treatmnt

Alyssa @alyssa011968
Now the pharmacy is just one of 3 or 4 places that has to authorize & reauthorize every 3months even though need it forever since no cure 4 ms

Alyssa @alyssa011968
When I was working this was a lot 2 deal w/esp considering Pacific Care denies everything at 1st hoping people 2 sick or sick of them 2 appeal

That's right. If you goal is to squeeze every last dollar out of your "customers" then there is no sense in providing them with the medicine they need if it costs more than the premiums they pay. Better to hope they continue to pay their premiums while you deny them treatment and tie them up in endless appeals. Or better yet that they drop their coverage. Or better yet that they just up and die so they can't sue you at some point in the future.
Alyssa @alyssa011968
And MS symptoms change, sometimes frequently. So get prescribed diff med 2 treat diff symptom & have 2 fight 4 everyone 2 get covered

Alyssa @alyssa011968
And you guys, I've had ms since 4/2000 and have been prescribed Avonex since then. So almost 13 years of this same fight.

Alyssa @alyssa011968
I can't tell you how many times I've been reassured that the "problem" is solved and won't have problem getting it again - but it never ends

Alyssa @alyssa011968
The thing that pisses me off the most is that ms not of progressed so much, if I had gotten treatment reg-it is supposed2 slow progression

Alyssa @alyssa011968
AS PacificCare denies treatment legally required to give, I wold like to know @whitehouse where are the riot police now?

Alyssa was arrested twice for absolutely no reason during Occupy protests, once on October 25th, 2011 and once on January 28th, 2012. But when insurance companies kill people because they deny claims where are those who motto is 'protect and serve' to either protect the people or serve them? Where are the federal and state regulators?
Alyssa @alyssa011968
insurance claims i'm moving in2 different phase of coverage frm dough-nut hole to catastrophic. I was told to call insurance co. here we go.

Alyssa @alyssa011968
So now I get to call Pacific Care.usual pattern is after waste bunch of time w/them they tell me2 call medical grp that tells me 2 call pharmacy

Alyssa @alyssa011968
The thing is what about the people who are too sick to do this? Or already struggling to manage ms while maintaining full-time employment?

Alyssa @alyssa011968
thing is w/ multiple sclerosis have to choose what I do/ how spend energy cuz don't have that much. How much should go 2 fight insurance?

Alyssa @alyssa011968
When I talked w/CA insurance reg agency &they said insurance co have 2 cover this. The women told me people w/cancer get denied chemo regularly

The answer to Alyssa's and my question as to where the people are who are supposed to prevent this insanity is that they are nowhere to be found. If anything they are protecting the insurance company executives who make the decisions that make people suffer and die so that their profit margins can go up.

What possible sense does a health care system that creates massive incentives for those at the top to kill the people it is allegedly trying to serve make?  Why does no one understand, even otherwise sensible progressives, let alone wingnuts, that profit and health care are a deadly combination?

In every other industrialized nation on this planet health care functions reasonably and more equitably -- and less expensively -- without a profit motive.

Alyssa @alyssa011968
back on hold for Pacific Care. I know these tweets r somewhat boring but this is what I go thru all the time. Rep just got on phone.

Alyssa @alyssa011968
Welcome to ObamaCare. Only reason for profit insurance companies exist is to deny, delay treatment. Lets see how long they delay this time

Alyssa @alyssa011968
I"m on hold. And remember I've been taking this med for over 12 yrs!

Alyssa @alyssa011968
with all pacific care's "incompetence," they have no trouble taking $424.83 premium out of check every month +medicare takes $125

Alyssa @alyssa011968
phone over 10 min w/Pacific Care.O hold again. Told don't know what happened? 12yrs of this shit & Obama calls riot police on me when I protest

Alyssa @alyssa011968
Right now people to sick to do this shit are being denied medicine/like chemo that could save their lives.

Alyssa @alyssa011968
Insurance say's I have to pay since I've reached the catastrophic level. WTF. This is bs. Now I'm on hold again. Asked to speak to sup.

Alyssa @alyssa011968
I hung up on the Pacific Care supervisor. couldn't stand it anymore. Now this is normal. may not seem like big deal but it wears on u.

Alyssa @alyssa011968
And when you are really sick you just can't do it. Now I just have to call my Doc after lunch.

Alyssa @alyssa011968
I think I'm going to let Pacific Care win this one. But just know when CEO gets mills$ bonus, @ least $2000 came from denying me treatment

When I saw this I tweeted her back: "WTF???"
Alyssa @alyssa011968
@jpmassar I just started feeling better and don't feel like spending the time calling dr and insurance to deal w/it.

Alyssa @alyssa011968
@jpmassar And I know I'm going to get real sick when I take it cuz of the break in treatment. But I hate that they r allowed 2 do this.

Alyssa @alyssa011968
And as ObamaCare gets into full force, insurance companies will grow much stronger and it will only get worse.

Yes!! PacificCare wins! Time to Celebrate!

Wait. Hold on! What? That isn't how the story is supposed to end... The heroine slays the dragon one more time. The greedy corporate executives are forced to cough up a minute fraction of their profits for the greater good, and all of us reading this far get to feel that the world is just a tad better than it was a few minutes ago.

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Except this time the race did go to the swifter, the battle to the stronger... or at least the more diabolical.

The battle to create a health care system that does not depend on profit -- call it single payer, call it Medicare, call it -- GASP! -- socialized medicine, is just beginning anew, rising up from its ashes at the birth of Obamacare. As Alyssa tweets, Obamacare still leaves us all at the mercy of insurance companies. It will help many people, and I'm positive millions of lives will be saved because it will go into effect. But we can do better. If we are willing to keep fighting -- for the sake of those who can no longer continue to fight in their despair and frustration, for the sake of those who have yet to get sick, for the sake of those yet unborn, we can do better.

As I understand it, Alyssa will be able to get this particular prescription again starting January 1st. But she may still have to undergo a similar battle for the other medicines that she needs from now until then. And meanwhile her MS gets worse.

Thanks for listening to her story.

Originally posted to jpmassar on Thu Nov 29, 2012 at 07:17 AM PST.

Also republished by Invisible People, Single Payer: The Fight for Medicare for All, Single Payer California, and Healthcare Reform - We've Only Just Begun.

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Comment Preferences

  •  In "Private Healthcare" (31+ / 0-)

    the inclusion of the word "care" is not intended as a factual reference.

    The Class, Terror and Climate Wars are indivisible and the short-term outcome will affect the planet for centuries. -WiA "When you triangulate everything, you can't even roll downhill..." - PhilJD

    by Words In Action on Thu Nov 29, 2012 at 07:29:45 AM PST

  •  So if I understand this correctly (8+ / 0-)

    you think that with Obamacare the problems Alyssa has will get worse not better? Because the insurance industry has a stranglehold? Geez. That isn't what we hoped for. It feels that in spite of our diligent efforts to get Obama re-elected (not discounting the brilliance of his geeks and team) we now are stuck with bupkis?

    American Television is a vast sea of stupid. -xxdr zombiexx

    by glitterscale on Thu Nov 29, 2012 at 07:43:09 AM PST

    •  Well, they won't get better. (13+ / 0-)

      They will get worse in the sense that since more people will be insured, and many that do will be poorer, less healthy and less able to fight the insurance company, then more people will start to have problems like Alyssa is having.

      The insurance companies still have the incentive to "deny first, deny again, and deny some more."

      •  Access to insurance has never, ever, ever (5+ / 0-)

        necessarily meant access to care.

        And if AHIP and PhRMA could effectively shut out/down  single payer, bulk drug negotiations and the pub opt during our health insurance reform debate, what are they capable of now that their lethal business model is propped up by the ACA with tens of millions of new tax-payer subsidized, mandated customers?

        What a fine, fine capitalistic nation we are, never missing the chance to profit off the infirm.

    •  There doesn't seem to be... (7+ / 0-)

      ...anything in ObamaCare that forces insurance companies to actually provide care to their customers. They are not allowed to drop customers, on pain of fines that may actually cost them less than providing care would to that customer (which is to say, they will still make a profit should they chose to drop their very expensive customers, they will just profit less), but there is no provision for punishing health insurance companies which simply deny all claims. And there is nothing that prevents them from requiring binding arbitration, which means that you can't take them to court, but instead go before an arbitrator whose livelihood depends entirely on health insurance companies, and who often decides ten or more cases per day. (One of them has been known to decide upwards of 40 cases per day, and in his case his record is more than 95% decided in favor of the company and against the individual.)

      In some states, there is recourse. For her, there is the California insurance board. But it doesn't help much, because every time she's denied care she'd have to go to them and contest that specific denial. Can take months, and is exhausting even if you win. And they can't say 'stop doing this in the future', they can just work on what has happened before.

      This is not to say that Obamacare is all bad. Health insurance companies don't have the incentive to deny very many people care this way, because it is (ironically) expensive to do so. It takes a lot of time and effort on the part of customer service, managers, etc to sit on the phone. So the equation is: if your health care for the year costs more than your premiums for that year, plus the amount of money that it would cost them to deny you coverage, then you might be in danger of this happening.

      Since mostly the health insurance industry is a huge profit center, and the vast majority of people who are signed up for it are just making them money, then this doesn't apply to those people. But once you do get really sick, watch out.

    •  I think you understand correctly (1+ / 0-)
      Recommended by:
      jpmassar

      And it isn't what most of us hoped for.  In fact the will of the American people was denied. In poll after poll, a strong majority of us consistently said we wanted (still do) a real (not fake) public option at the very least (and that was a huge compromise on our part).  We didn't even get that.  Instead we got the biggest piece of corporate welfare pork at our expense ever passed over on a misinformed and misled public.  PPACA was literally written by the health insurance industry for its benefit including every loophole it could possibly want to make every "protection" for us virtually meaningless.  It is analogous to letting ther KKK write Civil Rights reform.

  •  Time for a National Health Service (23+ / 0-)

    that combines single payer (like Medicare) with publicly owned clinics and hospitals like the VA, only on a larger scale.

    •  And don't get me started on the insanity of (11+ / 0-)

      having a separate VA, Medicare, and Federal health clinics and probably other systems.

      •  jpmassar: not insanity: specialization (8+ / 0-)

        because, seriously, you want the docs to be that good at treatments.

        It's a different ballgame for a guy like Max Cleland, who's been living with three amputations for more than 40 years, than it is for a guy who just woke up in Landstuhl last week. Lots more acute, not to mention the counseling and psych aspects of whether "living like this is worth doing".

        That's a different ballgame from a 12-year-old who's pregnant.
        Both are different ballgames from Alyssa.
        Both are also different ballgames from a 70-something stroke patient.
        All these are different from a housecleaning worker who needs a mammogram / cervical cancer screening, or a school janitor who needs a prostate exam.

        I remember going WTF when the President started talking about health insurance reform instead of health care access, and having a really bad feeling.

        Looks like I was, as usual, underestimating the scope of the craptasticity.

        LBJ, Lady Bird, Anne Richards, Barbara Jordan, Sully Sullenberger, Ike, Drew Brees, Molly Ivins --Texas is no Bush league! -7.50,-5.59

        by BlackSheep1 on Thu Nov 29, 2012 at 09:04:33 AM PST

        [ Parent ]

        •  The NHS in the UK seems to do fine without such (4+ / 0-)
          Recommended by:
          allie123, weck, elwior, WheninRome

          specialization.

          Obviously specialization is very important in terms of treatment, but in terms of administration?

          •  ?? I bet even the UK NHS doesn't expect (4+ / 0-)
            Recommended by:
            jpmassar, weck, charliehall2, allie123

            an ob/gyn to also be a bone surgeon and / or Alzheimer's specialist.

            Insofar as the paperwork, looks to me like the US has its own solution: administer it like SS/Medicare. That's got the lowest overhead of any gov't program going ... which may be why the GOP so hates it.

            LBJ, Lady Bird, Anne Richards, Barbara Jordan, Sully Sullenberger, Ike, Drew Brees, Molly Ivins --Texas is no Bush league! -7.50,-5.59

            by BlackSheep1 on Thu Nov 29, 2012 at 09:16:54 AM PST

            [ Parent ]

            •  They don't BUT (5+ / 0-)

              all the forms are the same. The records are centralized. The specialists talk to each other, and to the patient's GP. Who, by the way, is often at a clinic no more than 15 minutes away.

              They don't live in their own little sphere and do the same tests over because they'll make more money that way, or do test a today and then wait 3 days for test b because the insurance company won't let you do test and and b on the same day, or let you do just test b without test a.

              And the care is, for the vast majority of cases, light years better than what you get here.

              It also includes mental health. And physical therapy. And family counseling. And home visits, by nurses, doctors, or therapists, when needed. Excellent prenatal and well baby care, including home visits from a nurse during the first few weeks.

              For EVERYBODY. FOR FREE (well, covered by taxes).

              I want it. Now. Increase my taxes, I wouldn't mind.

          •  Here's a link to their data. (5+ / 0-)
            Recommended by:
            jpmassar, weck, elwior, allie123, bluedust

            I diaried about this a few days ago.  Apparently last week 3000 people had to wait approximately 4 hours for treatment.  Shocking!

            http://transparency.dh.gov.uk/...

            I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

            by detroitmechworks on Thu Nov 29, 2012 at 09:21:31 AM PST

            [ Parent ]

  •  $5B profit (16+ / 0-)

    off of the health misfortunes of Americans (or is that just Californians?).

    That is what Tea Party is fighting so hard to preserve: a for-profit model of health care.

    Because socialism is such an awful alternative.

  •  Excellent post JP Massar! (20+ / 0-)

    Yes, what the citizens in the US need is socialised health care, like what we have in the UK. Healthcare is accessed by everyone irrespective of income, irrespective of historical conditions. We pay far less for our healthcare, which is far more comprehensive through taxation and those that do not pay taxes are also covered. This is what healthcare means, no interference by insurance companies based upon profitability. It is healthcare based on need, this is what the right to healthcare means.

    Thank you for this piece, the discussion on universal health care became subsumed to a political agenda. We need to revive it and explain exactly its benefits. Diary tipped, rec'd and shared with gratitude and also thank you for highlighting allie123 here; perhaps humanising the discussion will get people to fight for the right to healthcare in the US.

    "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

    by NY brit expat on Thu Nov 29, 2012 at 07:53:42 AM PST

  •  hope springs eternal.... (4+ / 0-)
    Recommended by:
    jpmassar, paradise50, allie123, dharmasyd
    11/9/12....The health-care industry will change its focus from expanding the insurance market to reining in medical costs now that the U.S. presidential election has been decided, said Karen Ignagni, chief executive officer of America’s Health Insurance Plans.

    The re-election of President Barack Obama, who campaigned to preserve his health-care system overhaul of 2010, gives the industry certainty that implementation of the Affordable Care Act will proceed, Ignagni said in an interview with Bloomberg Television’s Peter Cook for “Capitol Gains” airing Nov. 11.

    “When we look at health reform we look at it through the prism of affordability and disruption,” said Ignagni, whose organization is the main Washington-based lobbying group for health insurers. It means “making sure that care is affordable a year from now and making sure that employers who are providing coverage and individuals who are buying are not disrupted.”

    http://www.bloomberg.com/...

    "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

    by MartyM on Thu Nov 29, 2012 at 08:34:09 AM PST

  •  public option? (6+ / 0-)
    10/27/12....WASHINGTON — The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

    These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

    The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

    Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

    http://www.nytimes.com/...

    "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

    by MartyM on Thu Nov 29, 2012 at 08:36:17 AM PST

    •  not public option (3+ / 0-)
      Recommended by:
      allie123, MartyM, WheninRome

      It's a private insurance companies that treats the fed as a big group plan.

      It's a different mechanism.

      A Medicare public option has its coverage determined by the federal government, and has something like 5% overhead.

      This is just a big insurance company, with the 15% overhead/profit and usual big insurance games.

      It's more like a big group insurance like for a big company, the gov't has huge leverage as the biggest and most important customer, which is more leverage than an individual customer.

      So more like insurance working for GM than insurance you buy yourself.

  •  Don't worry about it. The ACA ensures..... (4+ / 0-)
    Recommended by:
    jpmassar, paradise50, allie123, blueoasis

    ....that everyone can enjoy the same level of service that Pacific Care is efficiently delivering to Mellisa.

    Companies like Pacific Care are going to LOVE the ACA. Not only will the ACA's individual mandate force many Americans to join companies like Pacific Care, but if someone can't afford to pay the premiums, then the American Taxpayer will pay the Pacific Care premiums for them.

    For the first time in history: the Individual Mandate effectively creates a tax that will be paid directly to companies like Pacific Care. When you look at it from that perspective, then it is very easy to understand why Chief Justice Roberts ruled in favor of the Individual Mandate.

    Pull yourself up by your Mittstraps: borrow a few million dollars from your parents!

    by xynz on Thu Nov 29, 2012 at 09:02:58 AM PST

  •  Every time they talk about cutting, I scream NHS (6+ / 0-)

    Because they want to play "Be reasonable".

    Fine by me.  Give me Half of what I want, which would be single payer.

    We'll get back to the NHS next year.  Bwaahahahaha!

    I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

    by detroitmechworks on Thu Nov 29, 2012 at 09:15:17 AM PST

    •  Also keep in mind that Canada's system (2+ / 0-)
      Recommended by:
      jpmassar, allie123

      does NOT include coverage for drugs, unless they are administered in a hospital (chemotherapy drugs, etc).

      But Canada's drugs do, on average, cost less to begin with.

      You may not be able to change the world, but at least you can embarrass the guilty.
      - Jessica Mitford

      by Swampfoot on Thu Nov 29, 2012 at 11:56:43 AM PST

      [ Parent ]

      •  I didn't know that until now. (3+ / 0-)
        Recommended by:
        allie123, plooto, Swampfoot
        Pharmaceutical medications are covered by public funds for the elderly or indigent,[6] or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs.
        http://en.wikipedia.org/...

        What happens when someone needs drugs that cost far more than they can pay and are not employed?

        •  Good grief. Canadians are almost as crazy (0+ / 0-)

          as Americans.  E.g.

          http://www.drugcoverage.ca/...

          What is the point?  Why not just provide it as part of basic health care single payer insurance?

        •  Answer precedes the question (2+ / 0-)
          Recommended by:
          allie123, jpmassar

          An unemployed Canadian who cannot afford medicine almost certainly meets the definition of indigent. That doesn't mean there aren't people who lack insurance for Rx, struggle to afford it out of pocket, and don't technically meet the government definition of "indigent", but it is a dramatically smaller scale and less severe problem than our situation in the US. It's a helpful reminder that when we discuss universal health care, it's important to be nuanced about the generosity and scope of coverage, not just a raw percentage of who has nominal coverage.

          •  Universal healthcare in Canada (1+ / 0-)
            Recommended by:
            jpmassar

            covered the biggest expense for Canadians, that is medical care.  The thinking was that it would be easier and cheaper for employers to offer group drug plans and to establish group plans independent of employers for people who are self employed.  In addition, the government holds down the price of prescriptions and allows generics to come on the market faster.  By and large that has worked. In addition, seniors (age 65) have full or almost full prescription coverage under most provincial plans.  As a result, most Canadians are covered by a drug plan either through their employer, an independent group plan or as seniors.  In addition, provincial plans have a provision for catastrophic drug requirments in such cases.
            It's not perfect and some Canadians are left without a drug plan.  Most of us would prefer to include prescription drugs in the universal single payer system.  I suspect that this is something the Liberals will be including in their policy platform for the next election.k

            •  Yeah, I don't think anyone has a perfect (0+ / 0-)

              health service.  Here in Iceland we have drug coverage but not dental (there's lots of push to fix that, though). But the thing is, it's orders of magnitude better than what the US has.  Once you've lived in a country with a NHS for a while the more absurd the US system looks.

  •  Insurance execs (4+ / 0-)
    Recommended by:
    jpmassar, allie123, mollyd, FindingMyVoice

    should be made to carry, 24x7, the corpses of the people they kill.

    "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

    by nosleep4u on Thu Nov 29, 2012 at 09:35:15 AM PST

  •  We Should Also Knock Down (6+ / 0-)

    the latest Republican lie about Medicare (repeated by Mitt in the first debate)- that doctors en masse are deserting the system and leaving patients high and dry because of inadequate reimbursements.  I have an aged Mother in Arizona, supposedly an epicenter of Medicare desertion, and see no such denials in her treatment.  And my wife and I have taken our Medicare to many, many doctors in the NYC Metro area and Philadelphia, and never have been denied treatment.

    In fact, an NJ thyroid doctor we saw last year won't even accept private insurance, because of all the bullshit and bad faith.  And I have heard that is widespread among NYC doctors.

  •  San Francisco has universal healthcare right now (8+ / 0-)

    Don't know if this helps and it is only open to SF residents, BUT.  Healthy SF offers great universal health care to all human residents.

    It is cheap - max $440/qtr., I pay $60/qtr. Sliding scale based upon income.

    It is full coverage - no pre-existing exclusions, no deductibles, $10 co-pays, no limits (annual or lifetime caps), and doctors, not some insurance company (remember single payer), make the care and drug decisions.

    You only must be a resident (yes, that means you could be living in your car or with friends in SF for one day, there is no waiting period) and not have existing insurance coverage (that means ditching Pacific Care). They are happy to sign you up as SF wants everyone to be covered - really.  The website has the docs list you need and you just need one of each and it is very basic stuff.

    Believe me I know from very personal experience what it means to have healthcare after you have been denied by an insurance company (Yeah, for HealthNet) in the middle of your treatment.

    Not to toot SF's horn, but it is important to aware of your healthcare options when you are fighting these battles with the bad guys just to get care.  So Healthy SF is a real and viable option for you.  Keep it in mind.

    •  SF's horn *should* be tooted (4+ / 0-)
      Recommended by:
      allie123, jpmassar, elwior, FindingMyVoice

      for this!

    •  Just bear in mind... (2+ / 0-)
      Recommended by:
      elfling, allie123

      ... that Healthy SF is NOT health insurance.

      If you leave San Francisco, it doesn't cover you. If you are hiking in the North Bay, and fall and crack your skull, and are taken to a hospital in Sebastopol, you pay the full rate. And as soon as you're not an SF resident you get dropped.

      Also, and this is important at least up through 2014, if you have a condition and you are covered by Healthy SF, and then you need to move or otherwise need to get actual health insurance, you can be denied insurance based on that preexisting condition, or denied coverage of that preexisting condition even if you do get health insurance, because you are not considered to have continuity of insurance.

      Healthy SF is a hell of a lot better than nothing, but it isn't a substitute even for health insurance (as long as it's GOOD health insurance, which seems to be getting rarer these days), let alone a substitute for a good single-payer system.

  •  Hoping with a supermajority... (8+ / 0-)

    ...here in California our legislators will deliver single payer to Governor Brown to sign.

    Hoping... for Alyssa and everyone.

    Then, as goes California, goes the nation.

    Hoping, agitating, advocating.

    Connecticut, Iowa, Maine, Maryland, Massachusets, New Hampshire, New York, Vermont, Washington, Washington D.C. and California (pending)

    by cooper888 on Thu Nov 29, 2012 at 10:20:50 AM PST

  •  I wonder if we could find a creative lawyer (4+ / 0-)
    Recommended by:
    jpmassar, allie123, elwior, WheninRome

    There must be some angle that she could use to get around the binding arbitration here.

    E.g., she's effectively working as an unpaid part of their billing department, since she is in effect required to spend hundreds or thousands of hours per year correcting their billing problems. I wonder if we could go after them for not paying her minimum wage?

    Could denying someone medications that you have a contractual obligation to be supplied, and without which you will be in extreme pain, be considered assault? (Probably not, but attempting to poison someone is assault, in California.)

    Could there be a ADA case here? (I am not sure whether you can waive your right to sue under the ADA with a binding arbitration clause, so it would be better if we could find something criminal to charge them with.) Forcing someone to go through tens of hours of exertion that they are unable to perform in order to get a necessary medication seems like something that should be covered under the ADA.

    Surely there are some creative lawyers out there who could come up with something in a case as obviously abusive and wrong as this one is.

    •  I told them that (3+ / 0-)
      Recommended by:
      jpmassar, side pocket, JamieG from Md

      Pacific Care also sometimes says I owe thousands of dollars and threatens to (maybe they have) report to credit people, sue etc... And they have no problem calling then. They called my job about a $2000+ bill I'd already spent hours clearing up. So I told them I already handled it and it was their job, not mine to figure it out. But it definitely is a job to get things covered. Now I have a choice whether to fight it or not, so I'm basically ok, but the people who r too sick too fight r dying. And nobody, or very few people, see what's happening to them on a systematic level.

    •  oops I guees it was my (1+ / 0-)
      Recommended by:
      jpmassar

      medical group that was billing me, not technically Pacific Care.

  •  1. Don't get sick. (3+ / 0-)
    Recommended by:
    jpmassar, allie123, elwior

    If you do:

    2. Die Quickly!

    Thank FSM for Grayson!

  •  Pacificare now belongs to United Health Care (8+ / 0-)

    I saw a dramatic decline in the quality of their service and coverage when the takeover happened.

    I've had the same go-round a few years back, with Advair, an asthma med. I was picking up the prescription ..  a regular refill for a family member ... and was told I had to call the insurance company, that there was an issue. I was told that we had to use the generic. I reminded them there was no generic. Then they said there was another less expensive med we had to use. I was in tears of frustration by this point, 40 minutes in, and I invited them to tell me what drug that might be. They wouldn't tell me: my doc would have to change it. Change it to what? I said. They couldn't tell me.

    I spent an hour and a half on a cell phone, so freaking frustrated.

    This wasn't a nurse or a medical professional, just a clerk, making medical decisions for my family.

    And then the next day... poof. The med went through. We have no idea what happened, to this day.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Thu Nov 29, 2012 at 11:34:22 AM PST

  •  Market Values vs Morality (0+ / 0-)

    There is a fascinating new book out by Harvard Professor Michael Sendel (creator of the course "Justice") called "What Money Can't Buy: The Moral Limits of Markets."

    He points out that "Market Values" are devoid of any morality and that this is inherent in any market-based system.  

    The 800-lb gorilla is the mistaken idea that the only way to distribute goods and services for maximum "social utility" is the market mechanism. All of the free-market cultists out there believe (as do most economists - who are not, after all, interested in morality, but in the mechanisms of supply and demand, profit and loss, cost/benefit ratios as motivators) that the "market mechanism is the best - indeed, the only - proper mechanism for determining how goods and services can best be distributed to those who have shown they want them the most - hence "social utility."

    However, the only mechanism that the market uses to make this determination is the willingness of people to pay the most for the goods and services.  If you have 100 widgets to sell, you set the price high enough so that there are 100 people willing to pay it to get one of your widgets.  Any higher price costs you sales, while a lower price point costs you profit per sale.  This is the entirety of the market philosophy of decision-making on the "optimal" distribution of goods and services in a society.  It doesn't even concern itself with the inability of customers to pay the price - only the willingness.

    There are many other ways to determine who is most in need of goods and services besides the market mechanism (degree of need, in the case of health care, not willingness to pay all the market can bear).  This is a higher moral means of deciding the most worthy recipients, and, therefore, of no interest to economists or market producers and suppliers.

    The question of whether you buy a new or used car this year, or what price you are willing to pay, is essentially a market decision, based on cost/benefit ratio and is (almost always) not subject to any higher moral element.

    In the case of health care, education, community policing and fire protection, and thousands of other examples, there ARE higher moral elements that are undermined by the market mechanism that says everything has a price and only those who can pay the freight are entitled to the resource.  

    In the past 30 years or so ('coincidentally' starting with Reaganomics), economists have been expanding their market theories and trying to explain ALL human decision-making in terms of purely market-type cost/benefit analysis.

    We can see in market-based for-profit healthcare how this dollars and cents calculation undermines and thus degrades any and all higher moral issues, and is ultimately destructive to the morality and values that define a society.

    Take the unrelated case of queueing up to get into the gallery to see a Congressional committee hearing.  Our government workings are open to all citizens on a first come/first serve basis.  The willingness to spend time (as opposed to money) waiting in line is the deciding factor in distributing this access.  As the market mentality spreads, there are a growing number of line-holding companies that, for a fee, will hire a jobless or homeless person to wait in line overnight to secure a seat for a wealthy lobbyist able to afford the service (which might cost $1,000 a person).  Today,  almost all seats are taken by lobbyists using line-waiters and are denied to the ordinary people who have come to D.C. to see how their government works.  An economist would say that this is evidence that the Congress is undervaluing (underpricing) the seats, and the private companies are simply correcting that.  Their answer is that Congress should charge $1,000 a seat instead of taking people queue order.

    The market solution is oblivious and unconcerned with the point that the democratic value of first-come/first-served and the right of ordinary people to view the public workings of government outweighs the market value of putting a price on the opportunity.   Thus, the market devalues the superior moral values.

    Healthcare can be "moralized" using one of two mechanisms.  At best, we as a society decide that we all pay into a common fund that will, in turn, provide each participant with the money necessary to obtain medical care as needed.  Only a minority will use it in any year, but, all subscribers will know that it is available to them in their own time of need, perhaps years or decades in the future.  When this is structured as a single-payer, tax-funded, government-administered system, it replaces the willingness to pay the most with the higher moral measurement of common need.  This can also be accomplished, though not as effectively, in the way we did it before Nixon's 1973 law on HMOs, when all private insurers were non-profit or not-for-profit services.  Then we had several shared-risk pools instead of one, but they essentially worked like a single-payer system.

    If those who can afford it want extra "boutique" or "concierge" services, they can pay out of their own pockets, but at least everybody has a baseline of good medical care at the best possible price - and at least a third to a half of the money we now spend on for-profit care can be used to improve medical care in general or put toward some other worthy goal, like free public college education.

    The worst thing that economic conservatives have done to this country in the past 30 years, and are continuing to expand today, is the idea that we can replace all democratic institutions, driven by higher moral values, with a cold and calculating market calculus.  It's why you can pay extra for linejumping tickets at airports, theme parks, even the elevators at the Empire State Building ($22.00 a person with a 2-hour wait, or $44.00 a person and you get the next elevator).

    We have become a country that knows the price of everything, but the value of nothing.

    "When plunder becomes a way of life for a group of men living in society, they create for themselves, in the course of time, a legal system that authorizes it and a moral code that glorifies it." --Frederic Bastiat, French writer and economist, 1850

    by Beartooth Bronsky on Mon Dec 03, 2012 at 04:31:22 PM PST

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