The Two Patients

 

During his speech, President Obama told two heartwrenching stories of medical patients who had had their health insurance unfairly ripped away from them with devastating consequences. The first is as follows:

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it.

This is infuriating, if true. But is it? Unless Obama is talking about a case other than that of Otto Raddatz, whose sister Peggy testified before Congress on his behalf, then, no. It isn't. On June 16, 2009, CNN wrote this about the Raddatz case:

Peggy Raddatz testified on behalf of her brother, who was diagnosed with stage four non-Hodgkin's type lymphoma. In the midst of his chemotherapy treatment, his coverage was rescinded and he was not able to receive the stem cell transplant needed to save his life.

Raddatz's brother was told his coverage was canceled for failing to disclose that, unknown to him, a doctor had once noted in his file that a CT scan showed a small aneurysm and some insignificant gallstones.

But this is not where the story ends. Indeed, according to the CNN article:    

Peggy Raddatz worked with the Illinois attorney general's office and eventually was able, after two appeals, to get her brother's coverage reinstated.

But if Otto Raddatz had had his coverage reinstated, why did his sister have to testify in his behalf? Did he die, as Obama said? Well, yes, he died - three years later. Was it because of the problem with his insurance? No. Peggy Raddatz asserted that his insurance had been "reinstated without any lapse." Furthermore, according to the hearing transcript:

The company relented and Otto received his stem cell transplant. He was able to live 3 more years before passing away earlier this year.

So Obama's tale isn't exactly true. What about the other story? Here's how Obama tells it:

Another woman from Texas was about to get a double mastectomy when her insurance company cancelled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.

Interestingly enough, a case identical to this one appeared CNN article. I rather suspect that it is the one Obama is talking about. Here's what it says:

Robin Beaton found out last June she had an aggressive form of breast cancer and needed surgery -- immediately. Her insurance carrier precertified her for a double mastectomy and hospital stay. But three days before the operation, the insurance company called and told her they had red-flagged her chart and she would not be able to have her surgery.

The reason? In May 2008, Beaton had visited a dermatologist for acne. A word written on her chart was interpreted to mean precancerous, so the insurance company decided to launch an investigation into her medical history.

Well, that sounds pretty bad. But CNN also says the following:

Beaton had listed her weight incorrectly. She also didn't disclose medication she had taken for a pre-existing heart condition -- medicine she wasn't taking when she originally applied for coverage.

So was Beaton's insurance really just rescinded because she had acne? No. It was rescinded because it looked like she had failed to report precancerous acne and when the insurance company launched an investigation of her medical history; they found out that she hadn't reported information about a pre-existing heart condition. According to CNN, she hadn't been taking that medication when she applied for coverage. Perhaps that is why Beaton was able to, with help from her representative, have her care reinstated.

In any case, it is important to note that both patients had their problems resolved in the Status Quo. And in the Status Quo, if someone has a problem with their insurance company, they can go to the government for help. But let's say the government is your insurance company. What is your recourse if it wrongs you? Where does a patient go then?

Comments

[Trudy]

good for you. you cannot trust a single word from our Liar in Chief.

[A.I.]

KB: "Where does a patient go then?" has nothing to do with what is proposed. There would be no rescission for pre-existing conditions. There would be no wondering if you could get treatment as the appeals process went on or whether you would be bankrupted if you went ahead with treatment anyway--assuming someone would provide it.

I won't bother to vet your vetting of Obama's anecdotes. Whether or not every detail was related accurately by either of you, the fact remains that people who had been paying for insurance were threatened with rescission for conditions having nothing to do with the malady needing treatment at the time. That is obscene. It is no way to finance a health care system. People buy insurance for security, but even a small, honest mistake in the application process means coverage can be denied. That is not security, it's a crap shoot.

Even if there were something to appeal however, that does not mean there would be no process within the administering agency. Some borderline cases are turned down initially when applying for Social Security disability, for example. There is an appeals process within the Soc. Sec. Administration and people often receive a disability designation upon appeal with back benefits paid in full.

[Miranda]

I am disappointed in you A.I. You have been quick to don your fact-checking hat every time I have made a mistake and I have admired you for your commitment to truth and accuracy. It is a pity that that commitment disappears when someone of your political alignment is on the hot seat. Absent are the accusations of fear-mongering that you so quickly applied to the other side. Suddenly, accuracy is not important. What a shame.

I know that Obama plans to limit exclusions based on pre-existing conditions. But the problem is broader than that issue. It involves every aspect of the system.
Your phrasing is interesting, because you don’t claim that there will be such a process, only that there might be. The bill is already written, A.I. We are not discussing what might be put into it, we are talking about whether or not the current bill should pass. Which section of the bill details the sort of process you are referring to?

Finally, it is not comforting to me to think that the organization which administers the program would also be in charge of settling disputes.

[Miranda]

Trudy, I missed your comment before. Thank you for your support.

[A.I.]

Actually Miranda, four bills have been written that have made it through relevant committees, three in the House and one in the Senate. A fifth may soon get through the Senate Finance Committee. In terms of "the bill" you reference, there is no such thing.

If I thought exacting accuracy was necessary in the anecdotes cited, I would attempt investigation. I didn't and won't bother because the lesson to be taken away from the examples had nothing to do with your dispute of Obama's accounts. If he or you erred on a detail or three, the fact remained undisputed in both renditions that attempts were made to rescind coverage on bogus grounds. Had you questioned that portion of his account, I would have fact checked. Or had you said successful rescission never occurs, I would have called you out.

What is important is your intimation that there would be no way to appeal a government determination that might negatively effect someone in some way--although just what or how is unspecified. Since there is no final bill to discuss, you can not say there will be no process to appeal whatever it is you imagine may need appealing. It is the norm in government that an appeals process is included if there is some basis for needing one. What plausible reason is there to conclude health care reform will be different?

You stir up dust with regularity because you are uncomfortable with this or that proposal emanating from this administration. You imply that Democrats are anxious to take over health care so people will have no choice but to acquiesce to some nefarious motives they might have. That's absolutely ridiculous. There is no indication of sinister motives and your accusations have no discernible basis I can imagine other than your own paranoia or cynicism. Is there some other explanation?

[Miranda]

There is the hat! I figured I’d see if it was still in working order and, behold, it is!
I understand that there are different versions of the bill being floated about, but they are essentially the same bill. And it isn’t quite fair, A.I. to say that anything MIGHT still be slipped into it, because those on your side of the debate have all claimed unequivocally that certain things are absolutely not in the bill. Death panels, for instance, are absolutely not there. Neither is coverage for illegal aliens.

Well, alright. That’s fine. But if it’s final enough for your side to make such claims, well, it’s final enough for my side to do the same and, supposedly, the major components of the plan have already been decided upon. According to Obama, there are only a “few wrinkles left to iron out.” Well, devising a whole new system of arbitration seems like more than a wrinkle to me. Of course, perhaps that wasn’t an accurate statement. I keep forgetting that accuracy is only required if a Republican is speaking.

Now, you say that accuracy isn’t important in Obama’s “anecdotes.” I disagree. Obama claimed that a company cruelly and wrongfully caused a man’s death, when in fact, that is probably not the case. If Obama was referring to Otto Raddatz, and he probably is, then he has slandered that insurance company. That is a major error. It is also fear-mongering.
As for your other comments, and in particular this one, “You imply that Democrats are anxious to take over health care so people will have no choice but to acquiesce to some nefarious motives they might have.” I’m not quite sure which of my comments inspired them. I’d be happy to respond if you care to specify.

[A.I.]

You promoted in earlier posts the notion that free, voluntary end of life counseling was a back door means of offing old people. You are now saying OMG, there is no way to arbitrate a dispute with the government. I would say offing someone and offering no avenues of appeal would be nefarious activities on the part of government. You have asserted Democrats want to enact such preposterous things. Those are the comments/accusations that led me to question whether you are paranoid, cynical or something else.

Now it's your turn. What specifically might need an appeals process. We know it isn't rescission, denial of coverage for pre-existing conditions, increased premiums for chronic ailments, annual and lifetime caps, etc--all things being done by private insurers now that would not be allowed in the public option or, as I understand it, in private plans included in an insurance exchange. So just what would need appealing?

[Miranda]

A.I.: I did not, in fact, mention end-of-life counseling. I mentioned Ezekiel Emanuel’s writing on end-of-life care (allocating medical resources based on age) and I also took issue with Cass Sunstein’s view that we should focus on a healthcare system that saves the young at the expense of the elderly. But, since you’re not a Republican, close enough!

[A.I.]

Point taken, but you still have not explained what aspects of the reform bills need an appeals process.

[Miranda Flint]

A.I.:
Alright. Here's the problem will arbitration from my standpoint. The bill does not really create any sort of system for arbitration. Instead, it gives the power to do that
to a commissioner. This is the same commissioner who is responsible for deciding how premiums may vary, how exclusions are to be defined, and really, most of the issues in the bill that require judgment.

There are a lot of phrases throughout the bill that end in "as the commissioner sees fit," or similar wording. I like the idea of a separation of powers. I don't think that the same people who decide how premiums go up or who should be excluded from them, should be the same people in charge of appeals. There should be, not only an internal system of appeals, but an independent system of appeals and I see nothing like that in the bill.

If you have a grievance with a private insurance company, you can sue the company. You cannot sue the federal government without its permission and it has a history of denying the right in medical situations.

Now, here are some situations that I think might arise and some of the reasons I think so.
One can get an idea of how government healthcare works by looking at some of the existing programs.

Medi-cal is one of these - run by the government of California. I used it briefly, when I was pregnant with my son, before deciding to take up extra employment so that we could afford private insurance. Here are some of the problems I had with the system.

Case workers lost my file twice. That file included my social security number, my husband's social security number, the balance and account numbers for my bank account, as well as my husbands, and some of my medical history. Neither file ever appeared again and shortly after, my husband had his identity stolen. It's possible that someone unconnected with medical stole it, but nevertheless, nothing was done to protect our information.

I was bounced around among different case workers in a matter of months. One would tell me one thing, another would tell me another. One would give me paperwork to fill out, the next would say I hadn't filled out the correct paper work, and then would have me fill out the exact same form I had before.

Sometimes, I would be temporarily disqualified from the program, because "I hadn't filled out the right paperwork." When I disputed that claim, it took weeks for me to reach the appropriate workers. No one returned my calls. Eventually, after weeks of calling, I was able to reach a supervisor who verified that I had, indeed, submitted the correct paperwork and reinstated my coverage.

In the mean time, I had to skip prenatal doctor's visits, because my benefits card would not work. Even after reinstatement, the card occasionally would stop working and the doctor's office would have to spend time contacting the Department of Health and Human Services to try to fix the problem. Sometimes I would just have to go home. Now, in my case, things worked out alright. My son was healthy and he was born without any major complications. But what if there had been a problem? What if the delays had put his life in danger?

These things could happen very easily under Obama's plan. A caseworker might lose a patient's paperwork, and the patient might be disqualified. Or, under the plan, a patient can be fined and disqualified for falsifying information or omitting relevant information. Suppose someone makes a mistake in his or her paperwork. He or she could be disqualified while depending on the system. So you might get the same sort of story Obama told under his system. The difference is, Raddatz or his family could have sued the insurance company in the Status Quo. Under the new system, Raddatz could have only done so if the government gave him permission to do so.

But even if I couldn't think of any scenarios, that does not mean they wouldn't arise. Usually, no one thinks of every problem that could occur. There should
be an independent system of arbitration. It isn't smart or safe not to have one.
I suppose if you think that the government is flawless and that there isn't any way they would make a mistake, then you wouldn't need one. I have enough experience government-sponsored care to know that that is not the case.