THURSDAY NIGHT IS HEALTH CARE CHANGE NIGHT, a weekly Daily Kos Health Care Series.
Nyceve's panel, "Time for Action: How the Netroots Can Lead on Healthcare Reform" was moving, informative, thought-provoking and contentious. She provided something for everyone, drawing the audience into the timely debate.
Five speakers described their experiences with our failing health care system: a surgeon who fights for his patients' lives; a grieving mother whose daughter was denied a transplant by Cigna; a city attorney who is prosecuting insurance companies for fraud; a nurse-activist; and a progressive blogger. All agreed on one point: Health Care in America is broken and must be fixed.
It was there that paths diverged. Should we organize around Single Payer, eliminating private insurance altogether (damn the torpedoes, full steam ahead)? Or should we tack to starboard for political purposes, preserving private plans as one option? Should we prioritize politics or policy?
I have done my best to capture the language and passion of the speakers below the jump. They spoke far more quickly than I can type. I hope I have done them justice anyhow.
An Anti-Baucus Caucus
Eve Gittleson, known and loved as nyceve, moderated this exceptional panel. The speakers were: Giuseppe Del Priore, MD, MPH a New York cancer surgeon; Hilda Sarkisyan, whose daughter, Nataline, died after being denied a liver transplant by Cigna; Rocky Delgadillo, Los Angeles City Attorney, who is pursuing civil and criminal investigation into insurance practices; Geri Jenkins, RN a member of the Council of Presidents of the California Nurses Association/National Nurses Organizing Committee; and Ezra Klein, an associate editor at The American Prospect.
All of the speakers described the abuses of the insurance industry with conviction and passion. Ezra Klein cautioned the audience of Single Payer supporters that the Senate was designed from its inception to preserve status quo, and it is doing its job brilliantly today. It is difficult to push through transformative change in the Senate because of its committee structure. I am not your enemy, Klein stated. The Senate is your enemy. Max Baucus is your enemy. Unless we either remove or motivate Baucus (the powerful chairman of Senate Finance) serious change will never occur.
There is only one way to motivate Baucus to help us, asserted Klein. Elect progressives to the Senate.
Create a raucus anti-Baucas Caucus.
Either Ezra Klein is exceptionally brave, or he likes roasting on a spit.
Murder by Spreadsheet
Eve: Don’t confuse insurance with health care. We’re not talking about access to insurance. We’re talking about access to health care. The Bush legacy is abysmal. Let me frame a question. Dr. Del Priore wrote an op ed in the LA Times stating that the refusal of Cigna to cover Nataline’s care until it was too late was a page right out of the insurance playbook. Insurers never deny care, just the payment for care. Tell us what it is like to deal with insurance companies, Dr. Del Priore.
Dr. Del Priore: I get at least one phone call every day about a lab issue or a denial. I have to deal with a labyrinth of authorizations. Sometimes I order a lab test to determine whether cancer is present, but the insurer demands to know if the patient has cancer before authorizing the test. Then they ask for an additional form which has been changed three times in the past week, so I have the wrong one. This just puts off treatment. And it is blamed on me because I didn’t turn in the proper form. For some people like Nataline, the delay is too long and they die.
We send the insurer all operative notes on every claim we submit. Now they are asking for pathology on all approved surgeries. Also they want the hospital records but physicians have no way to demand hospital records. Those records belong to the hospital. Insurers can deny care if we don't provide these records. The labyrinth goes round and round until the patient gets angry and thinks the doctor is grossly incompetent.
I've learned to schedule time for a conference call with the patient. The patient calls the insurer and is told I did not submit a form. Then we put on the speaker phone. This throws the agent for a loop because its not in their memorized script. As doctor, I can produce the proof of sent forms.
The internal system is so cleverly convoluted that even when you get a sympathetic clerk, the clerk says yes, but the patient still can’t pick up the script because the pharmacist is not in the loop.
My father, who lives in Hawaii, has cancer and needs an anti-emetic drug. He can’t figure out the process even though he’s a doc and his wife is a mid-wife. We, kids can’t do it from a remote location. I tried to get his anti-emetic when I went to visit him. I spent days following every rule before I could get it.
I saw a 42-year-old patient and found advanced cancer that can easily be fatal, and she is the neice of a prominent physician. It's unheard of. This cancer can be easily found in its early stages but now, because she didn't have proper care, it can be fatal. One of my students came to me at the end of the year and said he’s going back to Mexico because he has better opportunities to practice medicine there. I have a complaint form for the Attorney General which I fill out on a regular basis with no response. I also give it to patients to fill out. Occasionsly, they get a polite response. Some of my patients are carrying tens of thousands in debt despite doing everything right, and are now taking donations.
Can we get prison sentences for insurance execs? How do I make a citizens arrest?
A Grieving Mother
Eve: Hilda please tell us about your life and what you say to others.
Ms. Sarkisyan: : I want to thank each and every one of you for praying, blogging and calling on behalf of my daughter who had leukemia. When her leukemia came back we were told to go to a certain hospital for a liver transplant. My son was a 100% match for the transplant. Everything was fine.
We are citizens and have paid taxes for 24 years. My parents brought me here for better life. It’s not a good country anymore. Insurance can’t tell us who’s going to live. We need help here. I’ve never spoken in public other than presentations. I was never an activist but I am turning into one.
John Edwards had me speak five times. The most interesting thing was when he gave me the mike I didn’t know what I would say, but my daughter is with me. This morning, my alarm went off with a song saying, "I’m smiling from above." My daughter’s here. She’s going to help. She had a dream. She had a golden life.
If we don’t change now what’s going to happen? We had insurance. We thought we were going to get a liver transplant. But the insurance company called and said, "I’m sorry Hilda. We can’t cover your daughter's transplant."
The reason I’m here today, CNA, they were there for us when we were protesting...A huge, huge protest and they reversed the decision. Thank you. But it was an exception. My daughter died that day. What about others? This happens every day. Are you going to hold a protest every time? Guess what, my daughter died. Why, as a mom, we pay insurance every month. We pay on time. The doctors said, "We have a liver but we don’t have clearance." So she died.
The war is not in Iraq. It is here. Leave the Iraqi people alone. Fix your problems here.
The Prosecutor
Eve: Rocky, why is info about how to combat insurance not on the website of every AG in the US?
Mr. Delgadillo: Thank you, Eve, for keeping up the pressure. This is a team effort. Nataline’s tragedy should stay with us every day, and Hilda is an amazing public speaker.
Everyone here knows the health care system is broken, not just the 47 million uninsured Americans who are suffering. The insurance industry has systematically adopted a system to maximize profits at the expense of patient care. Why did Dr. Del Priore have to fill out all those forms? So the company could make money! When was the last time you got a letter from an insurance company saying, "We’re lowering premiums?" Never! They are making record profits in a down economy, even not-for-profits.
A few months ago I initiated investigations into Health Net and Blue Shield. Instead of paying sick policy holders for claims, insurers are waiting for you to make a claim to do their underwriting. They have you fill out forms designed to dupe you. Health Net used to ask question 5A: about a series of twelve symptoms adding up to 300 questions, yes or no. They use this form to push risk back onto the patient. If you knew when you got really sick, at that time your application would be sent to a secret unit that gets paid a bonus to rescind your policy, would you buy insurance? And it is a secret unit for that purpose.
So we are bringing billion dollar lawsuits for false advertising. Think of Dragnet, "Just the facts, ma’am." Facts tell the story.
Just 48 hours ago (indistinguishable) of Logan Utah testified about BCBS of Utah. When they applied for insurance in 2005, Keith had recovered from prior back trouble. After discussing this with the insurance agent, Keith wrote on his form, "slipped disk in back, recovered." Then, later, Katie had an accident and fractured her neck severely. Her medical bills were over $100,000. Six months after her accident, the insurance company rescinded her policy because of Keith’s application answers about his back.
The same thing happened in our suit against Blue Shield. Doctors punctured a lung during surgery. Blue Shield checked the application. Someone from the secret unit wrote on the application, "No basis for rescinding." Wrote it right on the application. So they looked at her husband’s application. Her husband was from Puerto Rico and didn’t know much English. He didn’t report Lipitor on his application because he didn’t understand the questions, so the insurance policy was rescinded.
Regulators are being captured and are helping the industry. After I brought suit against Blue Shield, the state agency fined Blue Shield $3 million. This was far less than the $3 billion in the suit.
The agency actually said the insurance company was too powerful to regulate. That’s why we need lawsuits. We might get results in court. Go to the website http://www.protectingtheinsured.org/... Facts will tell the story. We cannot get a new system without rooting out corruption in this one.
We will get to the point of a perp walk with one of those insurance guys at some point.
The Angry Public
Eve: Our next speaker is Geri Jenkins from the heroes at CNA (California Nurses Association). They are extraordinary people. I want to know from the point of view of CNA, what the HCAN (Health Care for America Now) initiative is about. There are three initiaties on the table. What is wrong with the Wyden and Edwards initiatives?
(Eve appears to be alluding to Conyers' HR 676, a national health insurance bill; the Wyden public/private hybrid; and an HCAN campaign headlined by Elizabeth Edwards to elect Obama by throwing around anti-insurance rhetoric while supporting an undefined solution that might be the Wyden plan.)
Ms. Jenkins: Nataline’s experience is a classic example. The insurance industry has absolutely no place in health care reform in the US. We have developed a dependency on managed care in California. We are afraid to take the insurance companies on because they’re too powerful.
Insurance Companies will suck the public sector dry. What happened to Nataline happens every day. If it weren’t for the bloggers, no one would know. You can’t have a rally everytime a claim is denied. We have to eliminate the insurance industry from the equation.
Every country that has single payer has it because of a grassroots movement. In the US, we spend twice as much money on health than any other country. Women’s life expectancy is starting to slip. We can be denied insurance if we have had a cesarian section unless we promise not to have kids. There are so many smokescreens.
HR 676 provides for a publicly administered system. You would have complete choice. A Johns Hopkins study showed that people wait longer here than in countries like Canada. These stories of long waits are lies meant to divert us from reform.
I have insurance but if I lost my job, I would be uninsurable because I’ve had skin cancer. You guys are in a strategic position to get info out there on the net. CNA looks at single payer as the only viable solution.
This is a war. People live and die depending on the decisions of insurance clerks. Nataline’s doctor said she had a 65% chance of survival with surgery.
This is the difference between coverage and care, insurance and health care. In terms of economics, our system makes no sense. It’s a squandering of resources. We need to make sure people know and have right information about cost. Health care is not a commodity to be controlled by brokers.
An Unexpected Witness
Eve: Ezra, why does HCAN want to condemn Americans to this kind of system? I get confusing emails from Elizabeth Edwards and MoveOn talking about the atrocities of the insurance industry, then marginalizing the only viable solution. Can you explain this new Edwards HCAN initiative, the TV commercials, etc. . . What's it all about? What are they trying to do? It seems there are three initiatives on the table--676, Wyden and HCAN. What's wrong with Wyden and Edwards? And a follow-up...what can we realistically expect from President Obama?
I hope you don't mind that I'm sand-bagging you. I love you, really, Ezra. I just don't agree with you on this point.
Mr. Klein It's a loving sandbag, Eve.
I am not a member of HCAN. I am not employed by them. I am an associate editor of the American Prospect. HCAN would not suggest they are condemning you to this system, but would ask why will you sacrifice the better for the perfect.
Insurance companies are stupid. They are good at turning health care coverage into big money. Our enemy is politics, not eachother, politics and the US Senate. We got HR 676, we got plans, but this is a problem of politics. What we can’t do is pass the plan.
It’s not that nobody has tried. We have 47 million uninsured. Peter Milzac is a boring guy. He’s giving an Al Gore style side show about how the system is about to collapse. We are watching the red line go up and the black line go down. But we keep failing. Single payer has failed in multiple states. It has a history of repeated political failure. The correct compromise is to invade France and take their health care system.
Liberals have a tendency to be dogmatists. Right wing folks try to kill you. They run you over and they win. What they get is you got to pass their agenda. How many can name the committee chairs? How many know Max Baucus? Health care reform has to get past them. Baucus is not the guy you want there. Health care goes through Baucus. Its not a fight with the insurers. You fight with him. What do senators want more? Money or votes? If you take what's being proposed now, the American people will tell you to go fuck yourselves. They don’t trust the government.
Insurance is terrible. They’re terrible. I want you to think about how to get to 60. We can hate insurers. A world with HR 676 would be a better world. It’s been a long time since we passed transformative legislation. It’s hard. Our system is set up to screw reformers.
Eve: Why didn’t they even put HR 676 on the table?
Mr. Klein: They feel they are getting there. If you put a public plan on the choice list for people, they’ll choose it. You have tension between people trying to put politics first, and people who put policy first.
Audience Question: I’ve spent a lot of time going into union negotiations and I never start by asking for less than what we want. We are not willing to accept steps in the wrong direction. There are ways to proceed incrementally that don’t empower insurance companies. This is another case of preemptive surrender. It's disturbing that we are pretending single payer does not exist. Put it on the table.
Mr. Klein HR 676 is more similar to the health care systems in England or Canada than to what they have in Germany or France. The statement of principals for HCAN is a three pronged strategy. If you like what you have, you can keep it. If you don’t like it, you can get the same insurance as a member of Congress. There is a public option. We want to be sure folks know about the three options.
Eve: As part of HCAN, you say we can have same insurance as members of Congress. My member of Congress pays $82 per month as opposed to the $700 I would pay. Do we pay the same amount that Congress pays?
Mr. Klein Prices will go down as more people buy into it. If you put everybody in the same pool, you get a bargain. You get to do what Walmart does with crappy Chinese goods. Moving in that direction is a step in the right direction.
Audience Question: The Insurance industry created the myth that Medicare does not work and has succeeded in privatizing, so they get 12% more than Medicare for same product. We’ve lost the notion of indemnity. We have to pay larger co-pays, more and more claim rejections.
Mr. Delgadillo: What can states do justice-wise? You need to create a groundswell through lawsuits that change public opinion. Prosecutors across the land should be doing this at the state or county level. You can get a hearing and it will be a fair one.
Ms. Jenkins: We are saying it's too hard. Let's just bag it. Congress is being bought off by the insurance industry. We have to make people understand their lies.
Audience Question:: We can spend all day beating Ezra up but we need to ask how to produce better senators. What are concrete steps we can take to produce better senators and congressmen?
Mr. Klein: James Carivlle helped to elect a new representative to Congress using a health care issue. You change political incentives by running some of them out of office. I'm not talking about a rhetorical feet to fire. You need to actually change offices.