How healthcare is rationed in the US: an example

Mark Kleiman tells the story of what happened when he was diagnosed with cancer:

That process took just about one full month, a month during which my chances of survival were dropping fairly steadily and the intensity — and therefore the side-effect profile — of the treatment that would be required if we ever got the damned thing figured out was rising in parallel. It would have taken longer — quite possibly fatally longer — if Al Carnesale, whom I’d known when we were both at the Kennedy School, and who by then was the Chancellor of UCLA and thus at some ethereal level responsible for both me and the hospital, hadn’t sent a note to the guy who runs the entire UCLA medical area (hospital and medical school). The note politely hinted that it would be at least marginally preferable if my department didn’t have to go through the hassle of recruiting a replacement. After that, things speeded up somewhat.

What absorbed that month? Mostly waiting.

After the chest X-ray, I needed to see an oncologist. I couldn’t make an appointment until I had the approval of the insurance company for the referral. That took a few days. Getting on the oncologist’s schedule took a few more days.

After the oncologist saw me, he wanted a bone marrow sample to send to the pathologists to figure out what the cancer might be. I couldn’t make an appointment for the bone marrow procedure until the insurance company approved it. Then I had to wait for the bone-marrow extractor to have time on his busy schedule.

When it turned out that there wasn’t enough marrow to test, I needed a lymph-node biopsy. More waiting for an insurance approval and more waiting for an appointment.

Having seen the head-and-neck surgeon who was going to do the biopsy, I couldn’t have the biopsy right away because the insurance company wouldn’t approve it as an in-patient procedure and there was queue for outpatient biopsy operating room time. Anyway, the guy who had seen me didn’t have any time free on his dance card for the next several weeks, so he sent me to another surgeon to actually do the procedure.

When I showed up for the outpatient biopsy, the anaesthesiologist took one look at my chart and flatly refused to put me under for the procedure except in an in-patient setting, on what seemed like the reasonable grounds that otherwise I could easily die on the table. That meant, of course, more waiting for another approval and another appointment.

All this, let’s recall, with the Chancellor breathing down the neck of the boss of the medical area on behalf of a full professor at the university that owns the hospital. So my experience with the system was probably about as good as it gets except for corporate executives using places like the Mayo Clinic or family members of people on the boards of directors of hospitals. (Apparently it’s generally understood that if you stump up enough in the way of contributions to get on the board of the hospital, you’re entitled to priority care; that’s how not-for-profit hospitals raise capital.)

Not that the Dutch system is perfect by a longshot, but this simply could not happen here. Once you need this kind of medical help, you’re going to get it and the insurance companies will pay out, as they’re obliged to do by law. Basic health care insurance is mandatory by law, provided by commercial insurers who however cannot refuse to insure you. At the moment we’re paying roughly 200 euros a month for the two of us to be insured, which includes some additional coverage; it could be cheaper, it could be more expensive. It’s an awkward, cumbersome system supposed to bring healthcare costs down by increased competitio, which hasn’t happened, but at the very least it leaves the majority of people free not to worry about their ability to pay for cancer treatments…

RIP Jim and To Hell With Sensible Liberals

Susie Madrak has a terrific post up at the Huffpo (yes, I know, but where better to get to the sensible liberals and smug parlour pinks?

Do I have your attention? Good.

I would like to point out the utter injustice of a Democratic political system that is very, very happy to take the money and volunteers the blogosphere sends its way, and in return, we get… um….

Invitations to appear at places most of us can’t even afford to travel, with no way to pay for a hotel — unless you’re an A-list blogger.

Oh, and awards. Yay!

A small handful of top bloggers gets some help: Fellowships, stipends, consulting gigs. The rest of us? Bubkis.

There is not even a little doubt in my mind that, if The Rittenhouse Review’s Jim Capozzola had remained a Republican, he’d be alive right now. He would have been in a well-paid think tank job, living the high life. (He did, after all, have a masters degree in foreign policy.) Most importantly, he would have had health insurance for the past six years.

And what did his talent and dedication get him on the liberal side of the political noise machine? Some free books. A life that, as intellectually stimulating as it was, reduced him to living on the charity of strangers.

People saying really kind and thoughtful things about how important he was to the cause – after he’s dead. Isn’t that ironic?

Yes. It should make any leftist livid .

As sick as I’ve been the one thing I don’t have to worry about now is that it will cause us a total financial meltdown – our income is lessened, surely, but it’s not disastrous. Because of European socialised health insurance I’m exceedingly lucky – and don’t I know it.

20 years ago in the US multiple emergency admissions for an acute kidney infection and complications cost me a total of $40,000 and that just was my 20% share, despite having had Blue Cross/Blue Shield insurance. I dread to think how much it would cost now – and that’s if I could get affordable cover to begin with. Yeah, right.

The bill collectors even then were rapacious. they don’t give a damn if you’re sick. The only way out was Chapter 8; but now even that relief from the crippling weight of medical debt has been taken away from sick people with mounting medical bills.

Many now die rather than incur the cost of treatment because familiy budgets are so precarious and insurance unavailable or unaffordable. Many lives are severely shortened too by the burden of stress that medical debt causes.

I was lucky – if my parents hadn’t come and fetched me back to the much-maligned NHS, I’d’ve been dead in my early twenties. As it was I could never return to the US because I’d never get insurance again. Too risky. But I was lucky enough to be born British. For Americans with no insurance – well, not to be mealymouthed about it, they’re fucked. Health is where inequality really bites.

Because of socialised medicine and welfare system of national insurance and sickness benefit, when I’ve been too ill to work outside the home (and I have whenever possible; everyone should work) I’ve still been able to be politically active and engaged and maintain some degree of independence, . I’ve even managed to stay online, albeit intermittently (Food or phone bill? Food.) and that has kept me in touch with the world.

Not so for American bloggers :

Jim’s death has made me realize that, despite the yes, millions of dollars and untold hours of volunteer support the left blogosphere has thrown the way of the Democratic party, they will never, ever, ever give us anything more than a pat on the back. “Isn’t that cute? They think they’re special.”

I don’t know what it is about liberal groups whose leaders assume you should live on air while you give your life to the cause. Has it even occurred to them how much harder it is to get a “regular” job when you’re publicly and politically active? I guess not. After all, they’re already employed.

Exactly. They are the hereditary political elite: they are entitled to make a living from their minds. Us, the physical defectives – generally not white and not male – with the dangerous anti-elite ideas, not so much. Nothing we have to say could possibly be important. But why should their voices, and the voices acceptable to them, be the only ones to be heard?

One of the reasons disabled people and those with chronic illnesses get involved online is because online you can be judged, not by your physical illness, but by what you actually say. We tend not to advertise our infirmities: who wants to be known as “Oh, so and so, the Huntingtons blogger” for example? Illness is also an intensely personal thing you don’t always want to share – and admitting to struggling with debts too, however necessarily incurred, is shaming in a society where you are your credit rating. But it doesn’t mean we’re not here:

You may not even know that Jim’s case wasn’t unusual. I can name at least a dozen well-known bloggers off the top of my head who are in dire straits financially. I know several with health conditions that could become critical at any moment, and like me, they’re living without health insurance, the Sword of Damocles dangling over their heads.

Even though there have been times when I’ve been desperately poor – sickness benefits were never generous, they’re totally inadequate now, but at least we have them, unlike in the US – nevertheless I’ve known that my absolutely necessary medical care, the long hospital stays, the past and future surgery, the radiotherapy I had, the huge amounts of drugs I still need; they’re all paid for.

The sword of Damocles has been removed from above my head and the relief from that particular worry that that gives is unimaginable.

I often rail about the insular competitiveness that’s been developing with US liberal blogs, but then I have luxury to be able to do it; our livelihood is not entirely dependent on blogging and thus on links and traffic. For America’s bloggers it’s different, and lthere are those whose continuing health (like Jim’s did) depends on blog income, So no wonder, that despite the surface collegiality, that the kool kidz are so jealous of their status as top ad-earners. A glass cieling has developed, either by design or by evolution, it’s hard tell which.

Buit as regular commenter bjaques pointed out recently the internet has a tendency to route around obstacles. Susie Madrak has a plan:

And so I am talking to lawyers about putting together a non-profit to help progressive bloggers. Not, as some groups offer, to help them organize for the Democratic party — to help them personally, with things like electric bills and health insurance. I plan to recruit every blogger I can for the effort. One local blog proprietor is working right now to put together a concert benefit with a big name.

We should at least have our paperwork filed by the end of the summer. And if you, the blog reader, wants to be part of it, great. Hold a bake sale, even — every little bit helps.

I know a lot of us aren’t all that thrilled with the Democrats right now. So, until we get this foundation set up, you can directly support the people who do keep standing up to the Republican regime — bloggers, the ones who aren’t making a living off this insane labor of love. Go hit those donation buttons!

And for those of you who want to help this foundation — if you have a business, and want to donate either money or computers, great. If you’re a musician, and want to volunteer for a benefit, cool. (Anyone who has something to offer can email me at suburbanguerrilla AT comcast.net.)

This is something that every progressive blogger should support. We cannot continue to expect the people we’re figjhting against – the Washington insiders, the sensible Leiberman ‘liberals’, the thinktanks funded with corporate money – to fund progressive blogging. Neither can we expect support from a blogging elite that’s fast becoming, if not another wing of mainstream media, at least a group that follows the news agenda set by the mediia and essentially plays by its rules.

The kind of effort Susie is proposing is where self-organisation begins – weren’t the first embryo modern political parties mutual aid societies? What Susie is proposing is collective action of the most basic kind and something anyone who considers themself a leftist should get behind, provided that it’s open, accountable and democratically run and I have no reason to beleive it won’t be.

Well done, that woman, and RIP Jim Capozzola.

There’s Been Times When I’ve Been Tempted, Too

You know what it’s like in hospital: bang, bang, crash, wallop, wail, rattle hum. The chances of actually getting any healing sleep are virtually nil.

So I’ve got some sympathy with this youing German lad, as reported by Ananova:

Teen unplugged ‘noisy’ life support machine

A teenager in intensive care unplugged his neighbour’s life support machine because the noise was keeping him awake.

Frederik Moelner, 17, said he had been trying to sleep as he recovered from a car crash but the noise of the life support machine as it helped 76-year-old Hermann Berghof breathe kept waking him up.

A police spokesman from Landshut in southern Germany said: “He told us the noise was getting on his nerves and he thought this was the best way to make sure he got peace and quiet.

“Luckily the medical staff acted promptly and reconnected the life support machine. If there had been any delay the old man could have died.”

Moelner is now being questioned by police.

You Shall Know Them By The Company They Keep

[UPDATE: Ann Winterton’s bill was defeated yesterday, but there’s two more coming right along behind. This is not over by a long chalk.]

The Catholic church in Britain, buoyed up by the rise of the religio-fascist Pope Ratzo, the presence of some prominent Catholics in the UK giovernment and the huge influx of Catholic migrants, is getting way too big for its boots: it’s threatening, the 70 Catholic MP’s who don’t toe the church’s anti-abortion line with excommunication (though they insist not, that’s effectively what it is) and worse, should they even so much as abstain from voting on new legislation tightening abortion rules. Catholic MPs include Ruth Kelly, the Communities and Local Government Secretary, and John Reid, the Home Secretary. The head of LifeLeague, James Dyson, said the pressure group would “out” Catholic MPs who took communion and abstained on abortion measures.Aiding them in this profoundly undemocratic exercise are some of the most rabid rightwing nutjobs British politics can produce.

The leader of Scotland’s Roman Catholics yesterday questioned whether politicians who backed abortion should remain full members of the church, and also compared Scotland’s abortion rate to “two Dunblane massacres a day”. In a sermon marking the 40th anniversary of the 1967 Abortion Act, Cardinal Keith O’Brien attacked both the practice of abortion and pro-choice members of the Scottish parliament.

[…]

“I think it’s far beyond time that the present Abortion Act of 40 years ago was re-examined,” he said. “We are killing, in our country, the equivalent of a classroom of kids every single day. Can you imagine that? Two Dunblane massacres a day in our country going on and on. And when’s it going to stop?”

The Dunblane reference was just gratuitously unpleasant and ill behoved a cleric – but it proves that this is about poitics and power, not conscience. That a priest would commit such an offence to common decency as to use a tragedy and parents’ grief to make a political point says he is a political, not a spiritual man. But then the anti-abortion movement has never been spiritual or about the sanctity of life but about the subjugation of women – and that goes double for the Catholic church.

British Catholics are in an invidious position. Allegiance to the Pope is required for Catholics as a matter of doctrine and this allegiance extends to the Vatican, it’s cardinals and all of their doctrinal instructions. Those instructions are infallible as they come from God directly, Catholics are told: the church’s position is that temporal powers are are strictly limited by God and God’s instructions trump the state’s. The Pope speaks directly to God, ergo the Pope’s instructions trump the state’s because abortion is considered a spiritual, not a temporal matter.

However, I suspect that should anyone else from any other religion give their primary allegiance to another city-state and its leader ahead of their own nation and compatriots they’d be called traitors, with prominent Catholics like Ruth Kelly in the forefront of the name-calling, especially so if they were Moslem.

The church can obsfuscate about liege lords and loyalty as much as they want, but their own statements of doctrine say it’s so.

This puts many British Catholics in a very delicate and ambiguous position: their loyalty has been constantly historically suspect and this has more than once resulted in bigotry and violence, so much so that the church has had to become an underground, secret, and dare we say it, even a terrorist organisation at times. This state of affairs has formed the basis of much of the long history of anti-Catholic bigotry in England but we had begun to get over it, at least until the ascendance of Ratso to the papal throne and the subsequent empowerment of the worst of the right wing of the church.

Read More

I told you so

Dutch kidney reality TV show a hoax:

which a supposedly dying woman had to decide one of three contestants to whom she would donate a kidney was a hoax, the programme makers have said.

The Big Donor Show, which the programme makers had said was intended to focus on the shortage of donor organs, had sparked controversy worldwide.

Identified only as “Lisa”, the 37-year-old woman who had been said to have a brain tumour was to base her selection on the person’s history and conversations with the candidates’ families and friends.

At the last minute, she was revealed as a healthy actress.

The contestants were also part of the deception.

It may have been a hoax, but it served its purpose: organ donation is back on the political agenda, both in the Netherlands as in the EU. Me, I’ve downloaded a organ donor form and will sent it in on Monday.

And you?