I'm sorry to intrude on your July 4th festivities.
I have an urgent message. People are consumed with fear. They are scared. They believe our health care system is evil.
It's not broken. It's not dysfunctional. It's not being destroyed by garden variety corruption.
Our problems are far worse.
Honest doctors will tell you that the American health care system is inhumane. It is wicked. It is killing people and destroying families.
My oncologist surgeon friend wants me to observe everything and report what's going on.
I've become an official volunteer in his hospital. I had the TB screening, the medical tests. I'm certified. Now I'll discreetly trail him and see what's happening day-in-and-day-out at ground zero of the national catastrophe.
David Gill, M.D. an emergency room physician will also tell you how bad things are. He's running for Congress in the 15th CD in Illinois. He's going to change things in Washington come January 2007. Mark my words.
American health care is in a very precarious situation dear friends. For many of our fellow citizens, it's awful. You think you're beleaguered, so are the doctors, the nurses, the pharmacists--trapped inside this toxic cesspool.
Where are the politicians? Where are the leaders of the Democratic Party?
Where are more people like David Gill M.D.? Take a look at the campaign web site of this great American. I'll be telling you more about Dr. Gill in the coming days. America needs David Gill in Congress.
http://www.davidgillforcongress.com/
I spoke to him at length a few nights ago. He spoke passionately about HR 676. When is the Democratic leadership going to speak up about H.R. 676: The Expanded and Improved Medicare for All Act which was introduced by a great friend of Daily Kos John Conyers on February 8, 2005?
Most ominously Dr. Gill told me--and remember this is coming from a physician, "not a week goes by that I don't see a terrible tragedy, someone shows up in the ER too late."
"Why were they too late", I ask, knowing what he will say.
"No insurance." He answers sadly. "We treat everyone in the ER, but often it's too late."
The American people need help. We can't wait any longer.
Maybe the political class should all become hospital volunteers and see what I saw and what I will continue to write about until someone listens.
Yesterday was Day One.
My assignment was to call a New York City insurance company and attempt to get approval for Avastin for my friend's critically ill patient with metastatic endometrial cancer. I wrote about her a few days ago. You can read that diary, Looking into the eyes of a dying woman here if you'd like. http://www.dailykos.com/...
He hopes she will be well enough to be released in the next week or so. Outpatient chemotherapy is certainly less expensive than inpatient hospitalization . . .
Before I started calling I met with her. She still has a tube in her throat so speech is almost impossible. She gave me a big smile and mouthed a barely audible "thank you" when she was told that I would be working on her behalf.
Allow me to remind you first that your doctor is no longer in charge of your health care, the insurance company makes the decisions.
Does this make any sense?
The insurance company decides what medication you can take, what tests you can have, what medical procedure is appropriate, how long you can be hospitalized, etc.
Does this make any sense?
The system is structured to deny you care because every dollar that is spent on medical treatment goes against the bottom line of the insurance company. In insurance company-speak this is known as the medical-loss ratio.
Does this make any sense?
I wrote a diary about medical loss ratios Ins. Co's. medical-loss ratios plunge, harming/killing Americans, which I encourage you to read here:
http://www.dailykos.com/...
Then reality hit. . .
Have you ever wondered if your doctor is respected when he or his beleaguered staff calls an insurance company for an approval?
Have you ever wondered if they are treated better than you or me?
Have you ever wondered how you'd be treated, if when prompted by the computer-voice on the other end of the line, you hit the button for "providers". Would you quickly speak to a well trained, courteous human being instead of a loop of endless other buttons to hit?
Well, I can now tell you that your doctor is also considered the enemy. Of course he is. This is the person trying to force the insurance company to abide by the rules.
I was put on an endless loop of recorded announcements. Instructed to push various buttons. I had to punch in endless user IDs, date of birth, taxpayer ID, provider ID--on and on. Finally a human answered and I had to give all this information again.
I was initally told by this clerk that "prior authorization" for Avastin was not required.
So I dutifully asked for him name, employee ID (which he refused to provide), and quizzed him for ten minutes. I began to end the conversation and said something very efficient and secretarial like, "well I'll advise the doctor that she can be discharged and that we've obtained all the necessary approvals for her treatment going forward."
Then he murmured--as a complete afterthought-- "you'd better find out if she's "covered". Covered? "You just checked her policy and told me prior authorization is not required". I said, incredulous.
You see, my friends, prior-authorization and being covered are two entirely different beasts in our evil health care system.
Deny. Deceive. Dissemble. There is no doubt. This is what it's come to in America, the richest country in the world.
Had I not been insistent, had I not hammered this insurance company clerk, I would have obtained this dear ill woman a prior authorization for something that her insurance wouldn't even cover.
So how much time did all this take me?
I made about five calls until I got to the correct department. I didn't call the wrong people deliberately or because I was new on the job. Twice, the fucking insurance company disconnected me. Another time, I punched the wrong number and had to start from square one. Once I got a human being gave all the identifying information, reviewed the request only to be told it was the wrong department.
Time wasted: over one hour.
Patients helped: Either one or none, since the request was denied, no one was helped.
This is how doctors across America are spending their time day-after-day, 365 days a year.
Does this make sense?
We need about 100 David Gill's in Congress. David knows how bad things are. Our lives depend on electing people like him.
Toward the end of the day I told my friend what had happened. He had been in surgery since early morning. He was bone weary. I felt sad for him. I felt sad for his patient. I felt sad for our country. This fine doctor sat down and poured out his heart. "Eve, sometimes the truth really hurts, the system is evil, it's so damn evil".
There will be much more. . .