Guaranteed Healthcare

"One pill makes you larger, and one pill makes you small," so begins the verse from Jefferson Starship's classic song, White Rabbit.  "And the one that AHIP's selling, won't do anything at all."

O.K., so that's not the way the verse really goes, but my subject, healthcare reform and the placebo politics that surround it is enough to make me mad as a hatter. Actually, it's made a lot of us angry, and we're getting organized for the fight of our lives. Our success and our ability to achieve true healthcare reform has everything to do with perception, placebos, and a good dose of myth-busting reality. 

When it comes to health care reform, any politician that welcomes insurers to the table as invited guests and expects them to behave like polite company, will be sadly, even tragically disappointed. Like the oysters in Lewis Caroll's classic, The Walrus and the Carpenter, we must be especially wary when the insurance industry repackages and markets itself as a solution to the health care crisis. "Now if you're ready, oysters dear, we can begin to feed."    

America's Health Insurance Plans (AHIP), are doing just that; they're gluttonously greedy and they're pandering for an invitation to 'fix' the crisis they created. Skyrocketing costs; marginal, reduced, detrimental-to-our-health 'benefits'; recissions, denials, exclusions, and huge profiteering by insurers has eroded and eaten away at our collective health like a cancer.  There can be no doubt about it. In medicine we have a term for that, pathognomic: distinctively characteristic of a particular disease or condition.  For example, lesions in the brain which are pathognomic of a cancerous glioma.

"So, what is that tumor or neoplasm thing in my head, nurse?" Senator Edward Kennedy might have asked that question of his trusted nurse, after his venerable doctors left the room. The short answer might have included a definition and an analogy to aid in the patient's understanding. "A neoplasm is best described as a new, uncontrolled growth of tissue that's serving no useful physiologic function.  It's crowding out healthy tissue and it's very greedy.  It doesn't share or play fair with the oxygen, nutrients, and the blood vessels that supply them.  That's why you're sick."  Like for-profit health insurers who serve no useful function in health care, they're shortening our lives and we're dying because of them.

The two major party candidates for President of the United States have extended that "invitation" anyway. It's party-convention time, and we the people are seated at the table. It's time to shed our naivete.  AHIP is not unlike the fabled Walrus and Carpenter; they're waltzing in with their buckets of campaign cash, profits they took at our expense. They're hoping we won't recognize them for who they are and they're hoping to control the party's platform. They're hoping to keep control of a system that works for them, and they're hoping that Harry, Louise, and the rest of us believe their  love affair with our premium dollars will be enough to sustain a long term relationship that's been in their best interest, not ours.  "It seems a shame, the walrus said, to play them such a trick." In reality, AHIP has no shame.  A bandaid for your cancer, Senator? Salmonella on your salad, anyone?

As a nurse with over 34 years of experience, I look at what the insurers are bringing to the table; a fantastical sugar pill of false hope. Insurance instead of health care?  It comes with a high price. How many deaths will it take before we can get our government pull their defective "products" off the market, and ban the sale of them outright?

With apologies to Lewis Carroll, the AHIP placebo has all the potential of 'ORANGE MARMALADE' when it comes to being the restorative pill that they assert will heal our broken health care system.  Remember, "The one that AHIP gives you, won't do anything at all.  Go ask Alice, I think she'll know." 

"Either the well was very deep, or she fell very slowly, for she had plenty of time as she went down to look about her and to wonder what was going to happen next….then she looked at the sides of the well, and noticed that they were filled with cupboards and book-shelves; here and there she saw maps and pictures hung upon pegs. She took down a jar from one of the shelves as she passed; it was labelled ‘ORANGE MARMALADE’, but to her great disappointment it was empty."

It's time for Harry and Louise, and the rest of us to wake up and leave our disappointments behind. Placebos are unethical and ineffective; we've tried them time and time again, "but answer, came there none."

I know a nurse who works for a major insurer, and she offers a revealing look from the inside. For some insight and for privacy, I'll refer to her as, Alice.

Alice: "I work for a large insurance company. I am a nurse reviewer who approves or denies claims for members. We have to go by each insurance contract that each company has. Believe me, the public has no clue what and how much infrastructure goes into the insurance industry. I have no trouble believing that if we cut out the middleman, that there WILL BE MORE THAN ENOUGH MONEY FOR UNIVERSAL HEALTHCARE! Profit has no place in healthcare."

Our response: "Thanks for speaking up about this practice. This is important information and it occurs to me that nurses have to be especially careful about having their "fingerprints" on the process of insurance company denials. You may remember hearing about a patient in Valencia, CA; a high school student named Nick Columbo, who suffers from Ewing's Sarcoma. His family's insurer, PacifiCare/United Health initially denied CyberKnife treatment, calling it unnecessary and experimental.

During a massive grassroots protest in front of PC/UHC's headquarters that was organized by the California Nurses Association, a spokesman for PC/UHC named Tyler Mason, in announcing the company's reversal of their decision to deny approval for the treatment, tried to lay the blame for the initial denial on a nurse. It was pointed out to him that RNs are not licensed to prescribe or deny medical treatment. The insurers are slick and devious; they will spread lies and attack the credibility of nurses, and sully the public's respect and trust of nurses, as a smoke screen to try to hide their greediness."

Alice: "The nurses don't actually deny the claims. We review the policy, and then send it to the physician reviewers with a recommendation to deny. The actual denial is the physician's responsibility. His ID number and name goes on the denial. If I recommend denial, it is still their decision to deny. He can approve the claim even if a nurse recommends denial. I can't speak for Pacificare, and how they run their company. But ultimately we have to go by policy. If I approve something that is against the policy I will get in hot water."

Our response: A single-payer, national health care plan, HR 676 would be the ultimate, transparent solution in terms of equitably securing an accessible health care delivery system for people based on medical need. It would be publicly accountable; a responsible public health policy, as opposed to a proprietary, bureaucratic for-profit private wealth policy."

It's unconscionable and almost unimaginable that good and well-meaning people have to worry about balancing "making a living" and "getting in to hot water" when they find themselves working for a company that profits by denying care to people based on policy. Dr. Linda Peeno used to be a claims reviewer for Humana and I was so moved by her testimony and her appearance in the movie, SiCKO.
http://www.youtube.com/watch?v=TqSshZZMHGA

The point being that most of us who think we have insurance that will provide for our health care if we need it, and prevent us from financial ruin in the event of illness or injury may be sadly and tragically deceived. In fact the evidence is overwhelming that we are; nearly 80% of people who are bankrupted by illness had insurance at the onset. Having insurance is not the same as being able to get needed care!

It's a shame that we live in the wealthiest nation in the world in terms of material goods, but we're morally bankrupt among all the other industrialized nations of the world because we don't have a national health plan that provides medically necessary care for our most precious resource, the people who live here. It's a shame that 101,000 people die of PREVENTABLE illness in this country every year; not the "best healthcare in the world" at all!

I'd invite you to start some conversations of your own. Now is the time. We the people, are finally getting mad enough to organize against this injustice, and in support of HR 676. Where we lead, our politicians must follow, or face being voted out of the way. HR 676 now has 91 Congressional co-sponsors, true leaders and they deserve our support. It's politically feasible, fiscally responsible, and morally just.  Senator Obama is on record as saying that he will sign the legislation if it gets to his desk as President.  We have the audacity to hope that the Dems will put that plank in their platform and run with it, all the way to the White House.