Friends,
Because "Sicko", Michael Moore's new documentary about the health care industry does not open until June 29th, I have not seen it yet, but I have seen the trailer and watched online an Oprah interview with Moore that showed some clips. I got angry just watching the trailer. It featured a Dr. who used to work for one of the insurance companies, testifying to Congress how her job was to routinely deny payments to insured clients, many of whom were cancer patients, in order to increase profits for the company. Insured patients died as a result of the denials.

When I was diagnosed with Stage IV base of tongue SCC in 2002 and was scheduled for the routine treatment plan of 5 weeks of radiation concurrent with 4 chemo treatments (cisplatin and taxotere) at M.D. Anderson (the number 1 or 2 cancer hospital in the world) I was shocked to learn that my insurer was attempting to deny paying for part of my treatment by characterizing the chemo portion of the treatment as "experimental" (which, according to the Moore interview, is one of their common tactics).

M.D. Anderson and my insurance agent battled them for me and eventually the insurer did approve payments for the chemo. This was not the kind of aggravation that I needed as I was preparing to go through treatment to save my life. Fortunately I am a lawyer and have lawyer friends and was in a position to protect myself, although at the time, treatment was imminent and I did not have time to screw around.

The moral of the story, is to keep fighting these people and get a lawyer if you need one. All the insurance companies care about is the bottom line and the best way to insure their profits is to pay you less. They also know that if one of these cases ever gets before a jury, they will lose. I was fortunate to have disability insurance as well, but dealing with two disability carriers was no pleasure either. A fraud investigator, who "just happened to be in my part of the country" wanted to come by and meet me so he "could put a face with the name". One of my former partners represented me for free and instructed the guy to meet me at his office and did most of the talkiing for me. By this time I was already beginning to feel badly from the radiation and might have already been on the feeding tube.
Later on the other company sent its former cop, fraud investigator, and then accountants to go through my records. Their medical staffs were constantly picking over the required monthly reports that my doctor and I were required to fill out, suggesting, then alleging that I was fully ready to go back to my work in my specific occupation as a "trial lawyer." Sure I was ready.... 20 pounds underweight, living on a liquid diet, with a sore throat, fatigue and a very hoarse voice, taking vicodin, concentration lacking, wondering if I was going to survive, I was ready to go pick a jury and begin a murder trial! Fortunately my health improved eventually and I quit receiving the disability payments, but not until I was ready to begin doing trial work again.

Just remember, the nice guy that you grew up with or the friendly neighbor down the street who sold you an insurance policy is not the same guy or lady that you have to deal with when the time comes to make a claim.

Give 'em hell!

Danny G.

Hello Danny

It all comes down to money. Our whole stinking existance is about money. You are programed to go get in your tin coffin and drive everyday and go make money for someone else.

In the 50's & 60's I man could work 40 hours and the wife could stay home and raise a fine family and you would live a modestly comfortable life.

Now both husband and wife MUST work just to SCRAPE by. And the kids are programed for the $150.00 sneakers.

The illegal immagrants here in S. Fla. won't work for less than $10.00 cash. And don't let anyone fool you. They are stealing valuable jobs. $10.00 an hour is $20,800.00 a year.

Minimum wage is $5.15 hr. it will go up .70 cents every July for the next three years. 5.85 07', 6.55 08', 7.25 09'.

If it were 2009 now and your making 7.25 @ 40 hrs. = $290.00 wk. = $15,080.00 yearly.WTF! You could just get by if you were single and alone and very boring with no interests.

Damn, did I just describe the perfect spouse?

Money, money, money. THE ROOT OF ALL EVIL!

I wish I could just go to Montana and live off the land. Now that's good living!

Or move to Canada!

C'mon up! we've got lots of space, some of the most beautiful mountains you'll ever see, and pretty damn good health care that's not costing us a thousand bucks a month in insurance premiums.

Plus, we Canadians are really friendly !:^)

Yes us Canadian's are very lucky to have our health care system. Everyone is treated equally; rich or poor, young or old. Yes there are pro's and con's to everything; however we really can't complain.

Best wishes to you all!
LisaB

It is a money issue. You have to constantly fight with the insurance company. My significant other has a cancer policy. It has been a month since we submitted a claim to get the cash, and nothing yet.You can never talk to the same person and all they say is that it is being processed. I call every week to no avail. This company, United American out of McKinney, Texas is downright terrible. They have a website, but no toll free number to call. I had to call the Texas Insurance Commission to get a phone number. Dealing with cancer is frustrating enough, then componded by dealing with these idiots. What's a person to do?

Hi junklady

I found that with my Cancer policy, it took about 5-6 weeks to get things processed and checks out the door. As more claims were submitted, it seemed to get somewhat better.

Hang in there, but don't let them get the best of ya.

Kevin

So far, and I mean SO FAR, I have had no trouble dealing with the insurance company, but then i havent had my surgery yet of course so we will see!!

Being originally from England (been in USA since '99) I still find it hard to reconcile that you have to pay (even with insurance) a quite large chunk of money to get treated!

I couldn't agree more that our health care system is badly broken and it's because we allow the companies paying the medical bills to make a profit. In fact, they are contractually obligated to try to make as big a profit as they can for their shareholders. That is just fundamentally at odds with receiving good quality care. And we should all be up in arms about it. There are a lot of people that think things would be worse if health care were run by the government but the fundamental difference is there wouldn't be that root-level conflict of interest between profit and good care. Yes, government programs can be messed up, but they could hardly be more messed up than our system is right now.

That said, my insurance company has been remarkably good, so far, about paying for everything, including out of state second opinions on things. Maybe it's because I was diagnosed with two cancers at once and they know if they mess up with me I could become a really good newspaper story about the heartlessness of insurance companies, I don't know. But I have really not had to do much fighting with them about coverage. And for that I am *extremely* grateful!

Nelie

Here in the Uk we are lucky in that it's possible to pay for 'Private Treatment' or go with the National Health Sevice where everyone is treated the same and drugs are a reasonable price if you can afford them, free if not!

However, i went to the dentist with first symptoms in January, referral to Maxillo-facial surgeon was scheduled for April 19th, took til May 15th to get MRI and was June before final diagnosis!

And not really any choice of specialists or cancer treatment centres, and we've to 'fight'--and wait for--'second opinion'
That said, having finally 'got into the system', my team is absolutely wonderful--thorough, caring and providing extra support emotionally when needed--nothing is too much trouble.

I don't know how we'd cope here if we had to go through what you Americans have to organise and pay for!
Brenda

Dear Brenda

You and many others know how hard it was for me, and many others to get treatment because of no insurance.

It took me a long time to figure it out and it is one of the US Governments most guarded secrets, but so simplistic in form to get if you have it. It is almost a

While I realize that our health care system needs alot of work to fix all in it that is broken, you would find many in other countries that would feel fortunate to have our level of health care. I have tons of relatives that live all through Canada, I go there every year and my mom lives about two miles from the border. My Canadian relatives will tell you that they laugh every time they hear someone say how Canada has "free" health care. Are any of you aware of the tax rates in Canada? Last time I was in Prince Edward Island the tax rate was over 16% on everything I bought. Some territories, like Quebec and Ontario, charge an Employer Health Tax and require prescription insurance. And some of the nightmares we hear of here in the US you can hear about in Canada, most of them concerning horrific wait times for treatment.
With that said, I'm not putting down Canada's health care in any way, shape or form. Simply trying to say that while our system here in the US isn't perfect, it's not perfect anywhere else either.
From what I'm hearing, the Moore movie misrepresents more than a few issues here in the US.

I think Minniea's correct to a point about our health care system...it's not "free" in the sense that someone else pays the complete cost. Of course, the same is true for any service provided by any Government, regardless of the nation.

All Government services are funded by the citizens at some level, and the same is true for the Canadian health care system.

I think the biggest fundamental difference is that situations like Petey's are almost unheard of in Canada, regardless of what Province. I live in Alberta, arguably the economic powerhouse in Canada, and the only Province with no sales tax. While I have participated in private health care insurance for my entire working life, I received the same level of care as I would have had I been an indigent street person...that level being extraordinarily high.

My health care insurance provides "added extras", "nice to have's"...complete dental care..prescription drug coverage, etc.

That said, were I unemployed, or otherwise without funds, I would still be provided with treatment, medications, etc. through a variety of publically funded programs.

Sure, it's folks like me that pay the freight in that situation by paying taxes, and God knows, Canadians are VERY familiar with paying taxes.

I'm pretty OK with that; overall I have nothing but the highest praise for our imperfect system. It needs work in a lot of ways, but it's certainly far from broken.

As for Mr. Moore, I haven't seen his latest, but that's how he made BAGS of money on his first two movies; mis-representing certain elements to better suit his own agendas. Some of it I agree with, some not, but you can't argue he's good at what he does!
Wayne

There are so many problems with health care in the US today, and I have seen the best and the worst, as both a caregiver (RN), someone who works in the area of health informatics to provide technology to help with some of this, and as a patient and family member of patients... As stated by Wayne, Michael Moore has made a lot of money by sensationalizing known issues to suit his own agenda. Here is what I think is a more balanced view of his latest movie, if you care to see the other side. http://www.mtv.com/movies/news/articles/1563758/story.jhtml

"the tax rate was over 16% on everything I bought. "

I pay 20% of the costs of my health insurance. That 20% comes out of my paycheck--my employer plays the rest. That 20%, last time I checked, costs me over $1500 a year (this is not for a family policy--just for me). If they taxed me 16% on everything I bought it wouldn't cost me much more than that, and since my employer would not be paying the other 80%, I'd probably have larger salary increases to cover it!

I would encourage everyone to see Sicko. It is Moore's most balanced and accessible movie. Just listen to the stories of people in there, including many who have worked for insurance companies and know accrately how the business of denyong the claims of others works. People are dying in our country, even people who HAVE insurance (in fact, that's who he focuses on, not people like Petey who didn't have any coverage) because instead of treating medical care like having pilcemen and firemen we treat it as a for-profit business.

Nelie

Here We Go!

Nelie- You rule!

Since I love to criticize things I do not know about, I'll stand in the middle of the road on this one. I've only read excerpts from Sicko, but I have also read from movie critics.

It's the same crap all over. The majority who thinks it's false are republicans and the believer

I was simply making observations so that we all realize that it's not always greener on the "other side". I LOVE.....let me re-state that.......LOVE....Canada. Considered moving there when I was much younger as I spent so much time there when I was young. Wayne makes excellent points in his post. I just know that their system also has it's downside, as does the US. Canada simply doesn't have some grossly overweight, unkempt man making millions off of mis-representing all that is bad in a situation. (Can you tell that I have zero respect for Moore?) And YES, I PROUDLY state that I am a Republican. With all of that said........

HAPPY 4TH OF JULY AND GOD BLESS AMERICA.

Happy 4th of July, Minnie. I am not a Republican--more of an independent like Petie I suppose (though I couldn't disagree more with the idea of a flat tax). But I honestly believe that fixing the health care system is something that Republicans and Democrats need to work together on and I intend to hold my representatives responsible for that regardless of which party they belong to.

I'm all for free enterprise but there are some things that should not be for profit and one of those is the health of our nation. The current system is hurting not just individuals who can't afford insurance, and individuals who pay for insurance and then get screwed by their insurance companies (because otherwise they might not make huge profits), it is hurting our businesses, especially smaller ones, who can't really afford to pay for health insurance benefits. And we all pay anyway when so many are uninsured because by the time they end up getting care, at public hospitals that have to take them, they are sick in major ways that could be prevented if they had gone to a doctor earlier. Where does the money needed to care for them at these public hosptials come from? From us, in the long run (both in higher insurance rates for those of us who are paying for insurance and from public funds).

It just doesn't work to have health insurance be something that has the primary goal of making a profit. The primary goal should be care of people who need it--preferably preventative care which will save billions of dollars in costs overall in the long run. As Moore pointed out in his movie (and I tend to be impatient with people who dismiss his movies without seeing them, though I do agree that he does gimmicky things), if we don't start thinking like a "we", as people DO think in most other Western Democracies, this will never happen. And that means we have to get beyoind derogating someone because they have different party allegiances and looking for areas of common agreement.

OK, I'll get off my soapbox now!

Nelie

By the way, one of the things I like about this forum is we have all sorts of different political views and yet we love and care for each other because we are all fighting this horrendous disease. I wish there were more of that in America. We may have different perspectives on the war, we may have different perspectives on whether it is more patriotic to protest the current policy or support it. But there are things we still have in common and e should look at those things when we can.

Moore points out the British developed their National health System right after WWII, when the country was in an economic shambles BUT people felt very united from being under attack by the Germans for so long. They felt like caring for each other was a big part of patriotism. I mean, during the war, people in the cities sent their children to strangers in the country to keep them out of the way of bombs. And people in the country with any place to put someone up at all took them in.

It's too bad it takes being under attack by a human enemy or a disease to realize we are all human should have some common sense of caring for one another. But I guess that is a part of being human.

Nelie

I give up, Petey! What is it?

Petey:

well perhaps that was too subtle:

Nothing

Re politics, please lets tread carefully here. This is a Cancer board and while griping over funding and govermental waste are understandeable, I do not think that this is the right place to advocate shooting or bombing people.

M

Nellie, well said and I AGREE with all that you have said. Anyone, Republican or Democrat, should agree with you on this.

Markus

You are correct on both counts. I agree.

Sometimes we get caught up in our "friendly" disagreements.

Markus solved the riddle. Answer: "NOTHING"

If you can show that you possess less than $2,000.00 in cash and assets (not including 1 house & 1 car) "you

Does anyone really think that U.S. Govt. provided healthcare is the answer, the same govt. that operates Social Security? Look now at how so many truly disabled folks have to fight tooth and nail just to receive SSDI. I have seen battles of folks trying to get SSDI as bad if not worse than trying to get a private insurance company to cover issues.

Our politicians can't even (should read won't) control our borders for fear of losing votes. Votes and continued power is the only thing that interests them and the same goal would foremost in their minds while formulating a healthcare plan.

Government, both federal and local, are one of the reasons for so many problems and costs with private healthcare. To give one simple example, in GA as well as in many other states, the state insurance commission (may have different name in other states) dictates to insurance carriers what they can and cannot offer in the way of coverages. Individual consumers cannot pick and choose the coverages they wish to pay for to where they can essentially customize their coverage plan. This would have a major effect on the cost of coverage with the consumer having the freedom of picking and choosing. For instance, why should a man or woman 60 years old be forced to buy health insurance that provides for maternity benefits? Why should a devout non-drinker or drug user be forced to pay an insurance premium that includes coverage for substance abuse treatment? Such examples go on and on but this is just one area that could be looked at. You may have wondered the same thing as to why insurance companies can't sell something closer to what you want as an individual. The answer is that such issues are dictated by state government.

The train wreck known as healthcare is a mess but who can really straighten it out who won't be addressing their own agenda in the process?

Bill D.

Bill, I and everyone in my company are "forced to" buy insurance that provides maternity benefits and coverage for substance abuse treatment. As I am "forced to" pay for the cost of public education though I do not have any children. And I don't mind because other people are "forced to" pay for insurance that covers cancer care, a benefit that I have used and they never will.

I also don't mind because things like maternity care, education for all, and treatment for people with substance abuse problems, cost taxpayers MUCH less in the long run than the costs of care for infants born with lifelong birth defects, people chronically unemployed due to no job skills, and years in jail for a substance abuser. You are spouting a party line that just makes no SENSE when it is examined at all closely. It's a short t4emr view that benefits just one grop of people-stockholders in insurance companies.

Nelie

Nelie

I have no clue what you are speaking of by saying that I am "spouting a party line". The mess that our healthcare system is in is a bipartisan problem regardless of any "party" preference. I was simply giving one example of how individual healthcare coverage could be tailored for one's specific anticipated need. If you think that government is the answer for our healthcare needs then so be it. Also, you cannot compare the funding of public education with private healthcare coverage. Public (government) education is funded by tax monies collected where the payors have no choice in the matter but to pay. Private health insurance is an option for a consumer to purchase or not to purchase and as such, there is nothing offensive about the consumer being able to buy the coverage desired. We are offered coverage and limits options for auto, homeowners, life, and other forms of insurance made available to us as consumers.

My intent was not to turn this into some form of political argument as that is not the purpose of this site.

Bill D.

I have no objection to a basic level of coverage available to all and then also the option of paying for private care--as exists in the UK. But the whole purpose of health coverage should be you get covered for what you need. If you give people too many "options" of what is insured, they will fail to insure themselves for things they end up needing and that doesn't help anyone.

In my opinion we should have no choice but to pay for health insurance as we are able (and this is regardless of whether you think a private or state run system is best). It shouldn't be an option. People who can afford to pay if they budget but don't pay because they think they won't get sick, and then do, end up costing everyone else. And I have to admit I was one of those folks for a while (I was putting myself through grad school and I was very poor) but if I ahd gotten really sick, I would have had to get "charity" care and the cost of that care gets passed on to everyone in higher medical costs!

Nelie

The whole health care issue is very complex. In the US there are 2 basic types of health insurance PPO's and HMO's. The PPO's tend to be tougher to get decent coverage out of although you can typically "see your own doctors". The HMO's, like Kaiser Permantente tend to give complete care services with focus on prevention. My wife and I pay almost $1,500/month for our small group plan with Kaiser. We have been totally satisified with our doctors and have a very good plan that even covers eye care and dental. $5 doctor visits, $5 prescriptions, $10 lab tests, etc.

Socialized (or so called "universal") health care will never work in the US. For one thing would you want the government running the health care system? This is not to state that there isn't a need for a more accessible health care system for the uninsured and underinsured. People of means will refuse to give up the access to health care that they have enjoyed for many years - this is why Hillary went no where when she attempted health care reform during the Clinton sdministration. Even in communist countries, like China, there is a multi-tiered system of health care and the better, newer hospitals are where the top paid workers go for their health needs.

Further complicating things is that the main cause for the increase in costs is also tied to the pharmacuetical industry. It costs a lot of money to test and bring new drugs to market. Are there huge profits to be made? Of course but we do embrace a capitalist system here don't we? And companies are also in business to make a profit both for them and their investors.

Another dark side is that countries having socialized medicine typically have huge tax liabilities on their citizens.

Bill is absolutely correct about the state governments having their fingers in the pie as well. Arizona, for example won't allow HMO's, hence no Kaiser.

Again, I will just say this. I would MUCH rather have the government running my health care than a company whose main obligation is to make as large a profit as possible for their shareholders. That goal is fundamentally and basically at odds with good health care.

By the way, my health insurance is a PPO, not an HMO, and I have had excellent coverage from them so far. No hassles whatsoever. Whereas I know of people who have had real problems with HMOs (you can chose an HMO plan if you want at my workplace) so I'm not sure it's the distinction between the two that makes the difference.

One thing that obviously does make a difference is whether you are covered under a group plan or are buying your own individual plan. When I started my current job, I was still covered by my old insurance plan and was trying to figure out how long I needed to hang onto it. Right before my job started I had a case of abdominal problems, which they thought was diverticulitis, and I was concerned that if I needed further treatment the new plan would exclude it as a pre-existing condition. But I found out that because my plan was a group plan, the contract disallowed that. They had to take me pre-existing conditions and all.

People like us, cancer survivors, who lose their insurance for some reason (like loss of their job--unfortunately not uncommon) who can't get onto a group plan like that are really screwed. And that's one reason for the number of people who are ininsured (who,again, end up costing us all in the long run. Just read an article in the NY Times of health care policy in PA where they did research that showed that 6% of the insurance costs of those who have insurance in PA bascially went to cover the costs of eventually treating the uninsured, usually when they were really critically sick--and their percent of uninsured is quite a bit lower than the nation's--I think they said only 7%).

Nelie

Like anything else in life you only get what you pay for. Some PPO's are very tight like BC/BS and others are more fairly run.

Your facts aren't totally straight. There is COBRA for people leaving their jobs for whatever reason and it can extended in the case of a serious pre-existing condition. See http://cobrainsurance.com/information/?source=google_adwd&gclid=CPTpgLDcnY0CFQGlQAodggZHzQ

If you can qualify for your own small group plan (i.e. you are self employed) Kaiser, at least anyway, has a "no questions asked" policy. That's how I got coverage. I had NO insurance going into this. Kaiser also paid for me to be treated at UCSFCCC - I didn't even have a $5 copay!

There are many ways around the system. Publicly funded institutions are required to take a certain amount or poor and indigent cases.

The injustice is the middle and lower middle classes that own some property or have some assets. Those will be taken away to pay the bills. Especially if you are in a state run program like Medical.

I know people with no assets however, who have recieved state of the art medical care through the County healthnet, so anything is possible if you are willing to do the legwork.

Further complicating this are the changes that have ocurred in business today. Outsourcing of jobs, weakening of the labor unions, acquisitions and mergers, no more career opportunities that our parents enjoyed, no loyalty between companies and workers - the list is endless.

One only has to look at the VA or military hospital system and juxtapose that this is how a Federal government universal health care program would be implemented. Thank you but NO thank you.

This whole issue to on the brink of a biblical catastrophy as the boomers start lining up. Kaiser is scurrieing, as we speak, to build cancer centers around the country just to handle the influx.

You ain't seen nothing yet - and they think that Social Security is at risk!