Obamacare And The Cancer Survivor Who's Had Her Life-Saving Healthcare Killed
Edie Littlefield Sundby writes in the WSJ:
Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.
...But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.
You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan--a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).
So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive--but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.
For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.
I hate to say it but I'm going to: Death panels.
Cousin Dave at November 5, 2013 6:11 AM
Exactly as I have said here:
"No, ma'am, you're not being denied coverage. It just isn't available right now. Go home and wait, and we'll call you."
Sick? The clerk is not sick. Fill out this form. Is the form filled out? Okay, then the system is working perfectly. You must wait.
If you are not the one paying, you do not get to say what happens and when. No one can set aside that simple, however awful, truth.
How is that cost calculator treating you, Patrick? I seem to have missed your response.
Radwaste at November 5, 2013 6:38 AM
Radwaste touches upon something that will open up a big, Texas-sized can o' worms: when someone else is paying for your health care, they can make decisions for you in other areas of life that will have direct bearing on your health care.
For instance, eventually your diet will be regulated. For your own good. Everything you ingest will be monitored. You like partaking in high-risk "recreation"? sorry, no, too dangerous. You might get hurt, and require extensive treatment.
I R A Darth Aggie at November 5, 2013 8:57 AM
There is a bit of a furor over it being pointed out that UH stated it was pulling out of California because of "tax breaks other companies are getting but we are not." The claim is that this is totally unrelated to OCare.
It may not be directly related, but those "tax breaks" that will not be forthcoming may well be tied to Federal subsidies.
As to not finding no plan accepted by all the doctors/hospitals - yeah. Not an unknown problem. Seems each insurer "accepted" or being listed as a "provider" by medicos has associated costs, and "allowing" payouts from more than a couple often means losing even break-even income.
My own private-practice doctor's practice recently had to re-incorporate under a new name to get around something of this sort of problem, apparently because of new costs and/or insurance providers imposed on (and thus by) the hospitals where they had "privileges." Need an arterial bypass? Wait until the surgeons get the new name accepted! And yes, I strongly suspect this is OCare related. Hospitals used to get Federal funding for treating the uninsured - that is going away, which probably means having to "accept" insurance from companies not previously dealt with.
John A at November 5, 2013 9:07 AM
Most likely, her policy was a "sub-standard" one and that is, according to Obama, the reason is was cancelled.
Hey, anyone want to buy a bridge to Brooklyn? I can sell it to you real cheap!
Charles at November 5, 2013 9:42 AM
It's okay to go to death panels, but it's not okay to claim death panels do not exist now.
Under ACA death panels will be dictated by private insurers regulated by state and feds conforming to state and federal law including ACA.
And yes, people will be told there are procedures they can't get or won't be covered.
OF COURSE, THIS IS EXACTLY HOW IT IS NOW, unless you are an all cash payer.
There have always been death panels. There will always be death panels.
Right now it is impossible to appeal a death panel decision without perhaps going to the local news channel.
That may or may not be the same under ACA. You probably will die by a death panel, but you may be lucky in that your death will prompt a public outcry that will get your condition re-examined in the future for others.
jerry at November 5, 2013 1:13 PM
That's really funny, Jerry.
There have always been "death panels"? Centralized authorities that tell you that even though you are paying into a plan, it can't treat you, and you can't buy another one?
Not quite.
I wonder if you are one of the many who hooted at Sarah Palin when she used the term. Of course, no one who did will admit she was right.
Radwaste at November 5, 2013 1:31 PM
> I wonder if you are one of the many who hooted at Sarah Palin when she used the term. Of course, no one who did will admit she was right.
No, I said the exact same thing then as I am saying now.
http://www.advicegoddess.com/archives/2009/08/22/oreillylimbaugh.html
Death Panels don't need to be centralized to be death panels. How many stories have you read about people having their coverage denied by corporate bureaucrats? That is exactly the same as the government death panels except the government death panels may be a bit more transparent via FOIA.
jerry at November 5, 2013 1:38 PM
jerry,
If you were going to be denied by an HMO, etc., last year, you could buy another plan.
Here is the tough part:
NOT NOW.
-----
But of course, this is a moot point. NO ONE may say what they do with OTHER people's money. At my Federal contractor, ironically, the company MUST officially inform us of rate changes and the reasons for same - while the Feds themselves may LIE about the reasons. After all - if we lie to the Feds, it's a felony, but if they lie to us, is "just politics".
Costs are going up here. It does not matter if you are 25 or 65, working for URS/SRR: your cost is going up.
Radwaste at November 5, 2013 3:26 PM
> If you were going to be denied by an HMO, etc., last year, you could buy another plan.
I'm not sure that's true, but I have no experience with it. But I do not think if my plan had denied me coverage of say some heart procedure that I could easily find a new plan that would say, sure, we'll insure you for that once you've been denied.
It's my recollection, perhaps wrong, that one of the questions they ask you on health insurance and life insurance is "ever been denied? if so, when?"
But I don't know that for sure and will take your word on that.
jerry at November 5, 2013 6:26 PM
But of course the fact that both of you are ignoring is that health insurance is not equal to health care.
As it stands now, you can appeal to the local community to raise funds to pay for your <medical care issue>. I have seen many local groups do it including the American Legion, VFW, Fraternal Order of <group>, and friends of <someone> at the local convenience story.
Will that still be legal to pay cash in the post-Obamacare world?
Jim P. at November 5, 2013 9:30 PM
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