Letter-writer misinformed on health-care issue

[Resident Letter in Press]

http://www.centraljersey.com/articles/2010/03/10/cranbury_press/your_views/doc4b9030777efdf270118999.txt

Guy Butterworth, Cranbury

The inherent danger in writing to the editor about some issue without having enough available and accurate information all too often results in the writer either innocently or not so innocently delivering misinformation. I have done it myself. And such was the case in a letter published on Feb. 19 in which the writer excoriated the Obama health care reforms by conflating it with the Canadian single-payer system and comparing both unfavorably with the present system here of private insurance for those under 65. To justify the attacks on both the Obama plan and the Canadian system, the writer used the news that the premier of the Canadian province of Newfoundland and Labrador flew to an, at that time, undisclosed hospital for some cardiac surgery because of the possibility the writer suggests of the waiting time of 182 days in his own province.

First, I am perplexed that the Obama plan and the Canadian system have been conflated. Although it is certainly true that cranberries and guava are both classified as fruit, I see almost no resemblance between the two plans in question except that they both have something to do with universal health care. In that sense, they are both fruit. The Canadian system is a single-payer system, which I would certainly like to see here for everyone under 65. The government program Medicare is a single-payer system for those Americans over 65, but the Obama plan has nothing of the sort, and he has even trashed the “public option” that would have allowed some folks to seek insurance through the government. Of course, as I am over 65, I enjoy Medicare’s government-provided, single-payer health insurance. Chops to me, but what about the millions of Americans without health insurance or who are losing it every day because of its cost? I suspect the Canadians don’t really care because they have universal health care already.

But the personal choice of the premier to come to the United States for treatment has caused the Canadian medical profession to express some chagrin though, at the same time, it readily endorses the right of the patient, as Mr Williams says, to choose his health care because its his health. What seems to be at dispute is whether the operation could have been done elsewhere in Canada because it was not available in his home province. The Canadian medical professionals say it could have been done in Montreal, Toronto, Ottawa, Edmonton, and Vancouver and the waiting time could not have been a consideration because, had it been an emergency or a critical case, such emergencies in Canada are treated as emergencies. Other people are not “bumped” because the emergency case happens to be a provincial premier. According to the interview he granted CTV in Canada from his luxury condominium in Sarasota, Fla., on the Gulf Coast, Mr. Williams chose Mount Sinai Medical Center in Miami because the surgeon there has performed 2,000 minimally invasive techniques. Mr. Williams neither commented on nor was asked about the fact that Miami was providentially close to his condominium. That apparently had nothing to do with his decision.

Newfoundland and Labrador have a population of about 510, 000 and a density of 3.5 persons per square mile. If we compare that with New Jersey, we find that our state has a population of 8.8 million and a density of 1,134 persons per square mile. One does not need to be a rocket scientist to appreciate that advanced health care opportunities would probably be much greater here, or in Florida, than there. Yet, Sen. Frank Lautenberg had surgery for his stomach cancer at Mount Sinai medical Center in New York City. Does that suggest that such surgery is not available here or that New Jersey hospitals have waiting lists in their emergency rooms, and, therefore, medical care in New Jersey is inferior? Of course, it does not. I really wonder if Vice President Cheney had had his heart attack at his home in Jackson Hole, Wy., whether he would have chosen the hospital there rather than George Washington University Hospital, where he had been treated previously, or the Baylor University Hospital in Houston. I seriously doubt it.
But the writer also mentions that the former prime minister of Canada, Mr Chretien, sought medical treatment in California. I couldn’t find any reference to that. He had had quadruple-bypass surgery in Montreal. It’s possible that the writer was referencing Belinda Stronach, a member of the Canadian Parliament at the time she was diagnosed with breast cancer. However, she had a mastectomy in Toronto and, subsequently, went to the UCLA Medical Center for a new type of reconstructive surgery. At the time, UCLA was the only facility performing such surgery. Now, thanks to her fund-raising activity, the same kind of surgery is available in Toronto. In the early years of heart transplant treatment, any patient in desperate need of a transplant had to travel to South Africa to have the procedure performed by Dr. Christian Bernard. Was health care in the United States so backward? No, again, and soon Baylor became famous for heart surgery.

So, the premier’s surgery could have been performed in several facilities in Canada outside his province, “bumping” would not have been an issue, but minimally invasive surgery might not have been recommended because the principal cardiac surgeon in Ottawa generally recommends it only for young women and only for cosmetic purposes. The Society of Thoracic Surgeons has expressed “caution” in the use of such surgery because the rate of complications, most particularly strokes, is higher though the procedure also has some short-term advantages.

Mr. Williams is wealthy, brash, probably arrogant, extremely popular in his province, and, on the face of it, frightfully vain. He has apparently even said he will claim any assistance that the Canadian system provides Canadians for treatment outside Canada. Talk about chutzpah (as he luxuriates in his seaside condo). Of course, I can readily understand why a man with his resources chose to travel to Miami. I don’t think there are any palm-treed islands nearer Ottawa than Florida.

There is one more point I wish to make that is not really relevant to the health-care issue. The writer uses the word “peasant” to describe the Canadians Williams would presumably have “bumped” to obtain preferred treatment. I find the use of that word to describe either Canadians, or Americans, seeking health care rather offensive. In no way can it describe either. I can’t imagine what the use of that word was intended to connote.

Guy Butterworth

Cranbury

http://www.centraljersey.com/articles/2010/03/10/cranbury_press/your_views/doc4b9030777efdf270118999.txt

[Letter Reader]

The letter title is a self fulfilling prophecy

[Guest]

That is hilarious.

Maybe he just needed a few more paragraphs to make his point?

[Guest]

My aren't we snarky. If you disagree, point out where the writer is mistaken.

[Guest]

The bottom line is that the Premier did choose to come to the US for the surgery. That should tell you all you need to know about his opinion of the Canadian system versus US health care. If the plan is to stop Canadians from coming here for health care I think the health care bill will probably do the trick.

[Guest]

[Guest]

Let's also remember that we often have a lot of doctors coming and training in the U.S. If we suddenly enforce stricter price controls, the drug companies who are businesses will determine if the investment is worth the return. For every successful drug there are many failures.

Further, the cost of malpractice insurance and medical schooling is insane. How many people will decide to still become doctors if they were to have more stringent controls. We do not mandate the cost of automobiles, homes (outside of COAH), etc... very few professions or products have state price controls.

Lastly, we are in a recession. Cutting insurance companies means cutting profits which means more layoffs. The public option will reduce many jobs in the insurance industry and related fields. No one is talking about this mass unemployment.

The safest option is to expand Medicaid to higher income individuals or to people who have lost their jobs after COBRA expires and who have not been able to secure new employment.

However, Mr. Butterworth as a retiree and someone on medicare these issues may be irrelevant to you.

[Guest]

I work for a Fortune 1000 company in NYC with typical corporate benefits. Despite that, I still have to pay about $3,000 annually (the company pays another $16,000 a year!) for my share of my medical benefits contributions (not even counting contributions to the dental or vision plans) for the privilege of being in an in-network providers only HMO that still requires me to pay 20% of all costs for visits, tests, etc. Recently our son had a slight abnormity in his heart beat and our pediatrician recommended seeing a specialist at CHOP for a consultation. He referred us to an in-network specialist. During our one hour appointment we briefly say a doctor and they did two tests using equipment right in the office, the more elaborate of which was an EKG. Our 20% share for this 1 hour visit using equipment available in their office was $690. When the EKG was done they had us wait for the doctor to explain the results. She never returned and eventually they came in and said she had to go cover an emergency elsewhere and told us to leave and she would call with the results. She never called and a few days later I proactively followed-up. She came on the phone and said “everything is fine.” That was pretty much the extent of the conversation, which we were only having because she left before our appt was over. When the billing came, in addition to the costs for the tests we were billed twice for the doctor’s visit – once for the appointment and a separate $400 (of which we owed 20%, the insurance company the rest) for a “phone consultation.”

Last year my mother was hospitalized for 5 days pending an out-patient heart procedure they wanted to do. For 5 days they pretty much did nothing but kept delaying the procedure because of the surgeon’s availability. After 4 days she complained and they initially said they would release her that day until they could schedule the procedure. But then one of attending said she should stay the fifth night so they could do one more test the next day. When the next day came the nurses prepped her for the test and were about the do it when her surgeon was consulted and said she had never needed that test and they released her without having it. So, in total she was hospitalized for five days supposedly because they had to monitor her medication before the procedure but then they ended up releasing her anyway a week before the procedure. And the final day was completely bogus and due to their error. Nonetheless they billed the insurance company almost $100,000 for this (before the typical insurance company-negotiated discounts) and expected us (me in the end) to pay about $1,500 out of pocket. When we complained about the billing for the last day due to their error it was the start of a 5 month process to appeal the billing.

I suspect almost everyone has stories like this. The system is broken, period. That’s not an endorsement or condemnation of the current health care reform bill, which predominately is trying to address the uninsured and not meaningfully deal with costs for the 85% of us who have some coverage. It is simply a statement of fact. Malpractice cases and insurance are out of control (I wish they’d through most of these class action lawyers in jail), the costs of medical equipment is out of control, billing for medical care is out of control, the cost of insurance is out of control, and the cost of drugs in this country – marked up often over 1000% what they cost in other countries – is out of control. And it only will get much, much, much worse. Combined with the fact that 41% of people in this country have absolutely no retirement savings and a majority of those that due have grossly inadequate savings, this will be a massive national crisis eventually. Already over 50% of all health care spending in this country is tied to government provided or subsidized insurance. So the government already is in this big time. And the burden on the public to make up the gap will only get worse, one way or another…

[Guest]

If we did not have the mark up here, then many of our drugs would not be available because of the cost of research. It would not be profitable to do this. In some other countries the drug prices are fixed so we're actually subsidizing the drugs in the other countries.

What you also fail to consider is that you did have the option to go and be seen right away with a specialist. While living in the UK I was lucky enough to have a private medical plan. When I first started I had the state plan only. Let me tell you the delay is horrible when compared to the U.S. I was expecting to call and see a doctor in a day or two. Not until I had a private medical plan with PPP did I get that option. People I know who were hospitalized under the state scheme not only got doctors who varied by day, but with one patient the doctor did not write down that they were medicated and the next doctor came in and gave an additional dose causing sever complications. In the U.S. we at least have the same doctor and at worst the same practice of doctors.

The biggest issue from what I saw above is the failure to shop your doctors. We tend to go to who we're referred to or to simply make appts. People often put more thought into their cars and the dealers they buy from then the doctors they use.


In terms of your HMO. I am surprised you're still in an HMO and have not opted for an HSA or PPO. Most companies did away with the HMO years ago.

[Guest]

I re-read my post and I want to make sure I am clear. I am not questioning you, in fact I agree with a lot of what you said it is broken. I am just highlighting your experience as one way we can take accountability ourselves to fix part of the system.

[Guest]

1) Technically it is labeled as a "PPO" but it is really an HMO-lite since there is token coverage for out of network use (we would have to pay 80%). And it is the only plan my compnay offers that would allow me to see doctors within 40 miles of Cranbury so we really have little choice.

2) Mark-up of drugs is fine, but when the mark up is often over 1000% the rates they offer them in other counrties it becomes excessive. Same with medical services and hospital billing. The system counts on most people being insured and therefore inflates prices knowing they will severely discount them by pre-negotiation for the insurance companies, but not for those who pay on their own.

[Guest]

And to be clear, I am not advocating a totally socialized system like Europe or Canada either.

[Guest]

If you have a PPO you don't need referrals. You can see any in network doctor at your discretion. Whereas an HMO requires the referral. Just in case this information is useful.

[Guest]

[Guest]