Number of years ago had brain surgery and had my claim turned down twice. Doctor just told staff to resubmit as they always refused at least twice. He look at the refusals as a cost of doing business.
The story behind above: He was my kind of doctor always looking after people. He was taking a three week vacation when I came in with constant headaches (fall 1998) and therefore told me a staff doctor would be looking at the results of testing. Six months later when I begged him to find something, anything he was shocked and asked me what I was told. I said the letter I received (I had a copy of in a folder I could show him) said everything was normal. He looked at my record and asked me to take a walk with him. We walked into a wide area where a number of hallways intersected, he called out for all staff, including doctors. He put his arm over my shoulder and told his staff, look at this man, we just murdered him⌠those were his words, words Iâll never forget. He then explained that six months before I came for help and the doctors and staff allowed my case to slip through the cracks by not reviewing and double checking as policy required. He then told the staff the office was closed, to call the state to report their failure and to immediate start calling hospitals and doctors to get me admitted that day. Result was of course I did not die, I had surgery within a couple of days (3x3x5 cm golf ball sized tumor removed), the doctor who was to review the test results was found to have been abusing drugs and lost his license as well as served time.
The ACA was originally a GOP health care policy, that was tweaked to include the Gingrich mandate. Of course, Hillary can get them all to the table, just let her meet with the GOP leadership and remind them of the fact that this is their plan and she merely co-opted it back '93. Capitulate and let the Koch Bros. have their subsidies back, the merger for Aetna/Humana, and she will get them to back off and the other tweaks will go through quickly enough. See - easy-peasy!
Of course, what is needed is universal Medicare for all, and guess what the premiums drop for everyone from retirees and the disabled to the smallest child. Everyone has healthcare and we actually would save money in the process on Main Street. Of course, under neither Clinton nor Trump will that ever happen, and sadly, even my grandchildren will never live to see it as long as corporate insurance money helps fund political campaigns.
Obama had one chance to actually make universal health care a reality - and when he sold out to the Clinton Cartel and appointed Seblius as HHS secretary, he threw that away because he had to support her comment about single payer being off the table. He should have vetoed ACA - told Pelosi and Reid to put through universal healthcare via Medicare (they had the votes because they then controlled both houses) - and then made real history by signing the best major legislation in history since the New Deal. He blew it - and now the rest of us will suffer, both health wise and financially. The repeated votes by the GOP hit squad called the House of Representatives has cost this nation millions of dollars. They have created an atmosphere so poisonous that getting cooperation from states and insurance companies is nearly impossible. At what point to Americans say Enough? I wonder if I will live long enough to see that moment, because at 63 I no longer hold out much hope.
You need a major congressional shakeup if thatâs even going to be a consideration on the table. Without that you donât have the votes to do anything.
Which means, GOTV. In a big BIG way for both the top AND down ticket races.
Aetna may also be pissed about this article Obama penned in the JAMA in July regarding the public option:
â[M]ore can and should be done to enhance competition in the Marketplaces,â Obama wrote. âFor most Americans in most places, the Marketplaces are working. The ACA supports competition and has encouraged the entry of hospital-based plans, Medicaid managed care plans, and other plans into new areas. As a result, the majority of the country has benefited from competition in the Marketplaces, with 88 percent of enrollees living in counties with at least 3 issuers in 2016, which helps keep costs in these areas low.
However, he noted, that leaves 12 percent of the population â millions of people â living in an area served by only one or two insurers. Among the conclusions Obama reaches in his JAMA article is that the idea of a public option â part of the original Obamacare proposal â ought to be revived.
They NEVER had the votes for universal/single payer. THAT along with the inability to sell it to insurers is why it was off the table. People have very short memories about exactly who composed that very brief 60 vote supermajorityâŚand just how many Blue Dogs in shaky districts had to basically be pistol whipped into supporting this, and you still needed two Independents for it to pass (two Independents I might add who threatened to scuttle the whole thing themselves more than once).
The Dems had a supermajority for approximately two months in total in 2009/2010. From the time that Al Franken was finally sworn in late July, until November when Scott Brown took the special to fill the late Sen. Kennedyâs seat and was sworn in February. During that time, Congress was out of session more days than they were in.
Do you have even the slightest hint of how universal health care works in countries that have fought to implement it? Do you understand that the United States balks at even the smallest tax increase, to the point of violent rhetoric and borderline armed rebellion? Do you know what funds universal health care in most countries where itâs implemented? You guessed right - TAXES. Do you have an idea of just what kind of increases would be required - up front - to fund an immediate 180 of your health system to implement the equivalent of Medicare for All? Do you understand what kind of budget numbers would be required to staff it, administer it, and have it run smoothly? You canât even get people to agree to properly fund Medicare FFS but you expect them to implement something like this for 300+million people overnight?
Nobody âblew itâ. You got the best possible solution at the time that was available with the votes that you had. It was a starting point, and a starting point only. The BIGGER issue is the crybabies who went away moaning and whining about not getting their gotdamn unicorn, so they sat at home in 2010 and then 2014 and then gave the President no functional Congress to adapt, change or improve the ACA. Thus, 6 solid years of joke repeal votes and millions in wasted taxpayer dollars, instead of having a Congress work on improving the system to the stage where you could implement something resembling a universal health care system.
If youâre going to complain about this system, I really wish you emoprogs would get the fucking facts right at least. This horse is not only dead because youâve beat it for so long, itâs risen and is now being beaten again. Itâs a zombie.
My husband was hit by a car and as a result lost a leg, shattered the bones in the other leg and in one wrist/arm, as well as many other injuries. His âdeath and dismembermentâ insurance was with Aetna. The policy was supposed to pay him 75% of his former salary until he died or was able to go back to work in a similar job with similar pay. His former job was as a merchandiser for Coke.
Right before the ACA, he was dropped by Aetna with a letter stating they had found him a job as a party planner II on the other side of the country.
Before the loss of income had really sunk in, he got another letter from them the next day stating that we owed them money. They said they overpaid him because he could have found a job as easily as they found one for him. Needless to say, theyâre still waiting to be paid.
Forgive the snarkâŚI see you were educated in Florida so is that why the âless optionsââŚgoogle âless/fewerâ and find out what we old timers learnedâŚgeesh
Excellent column. The government is not helpless. If you donât participate to a certain level in the ACA, you donât get to participate in Medicaid expansion. Aetna is disorganized and doesnât want to do the hard work of creating a functional ACA program. Also, I and others detect a whiff of revenge for federal opposition to the Aetna/Humana merger, which should have been mentioned in the TPM article.
Aetna Inc. Chief Executive Mark T. Bertoliniâs compensation was valued at $17.3 million last year, up from $15.1 million in 2014, reflecting higher stock and option awards. Mr. Bertolini received a base salary of about $1 million and a bonus of $1.84 million. Apr 8, 2016
HARTFORD â Aetna
Chairman and CEO Mark Bertolini received $27.9 million in compensation last year (2015), according to a filing Friday with the Securities and Exchange Commission.
Try not to let the door hit your ass on the way out you crooks. Weâd hate to sully our door.
One small point - Democrats never had a supermajority - Lieberman was elected by the âLieberman for Connecticutâ party and not as a Democrat. Always making the perfect the blood enemy of the good, these Naderites.
Thanks for that update. This of course leads me again to the point that so many have missed since 2009, that the President wasnât exactly working from a position of complete strength. The fact he was able to negotiate and get what he did is still, to quote VP Biden, a big f-ing deal.
Now the task is to actually continue the work; to elect Clinton to the WH and give her a Dem Congress to be able to actually accomplish a few things rather than continuing the hyper partisan gridlock thatâs handcuffed this President for 6 years.
(mind you, when someone posts that this was the fault of Obama and âthe Clinton Cartelâ, from that point onwards Iâm taking their viewpoints with a very large grain of salt)
âGeorge W Bush lied America into a disastrous unnecessary war.â Donald Trump in a GOP debate.
I think the problem is far deeper than just gerrymandering. That is what this article says to me is that to lead the party of Lincoln back to sanity and away from a platform reminding historians of the Spanish Inquisition the first thing that must be done is slay Paul Ryan, Mitch McConnell and the GOP establishment.
I mean if you think George W Bush is anything but a war criminal you cannot vote for Donald Trump. Most Trump voters did and if he was the GOP nominee in 2016 would vote again for George W Bush. However, if you watched the GOP convention for 5 seconds this paradox is easily explained.
What was obvious from the GOP convention is that the only requirement to be a Republican in 2016 is an irrational hatred of all Democrats. That is there is no policy the GOP is unified around other than shafting democrats because they are nothing short of pure biblical evil. Because the GOP has lead its base, or in some cases been lead by its base, to where any compromise with Obama, Clinton or any Democrat is a deal with the devil, any GOP politician who agrees with a Democrat on anything is seen as a heretic deserving of crucifixion.
This capital crime of compromising with Democrats, in fact this capital crime of agreeing with Democrats on even issues the GOP itself by doctrine supports like Romneycare which was originally Bob Doleâs health care policy, has forced the party into opposing science, health care, trade and even child immunization. In short this irrational hatred that the establishment GOP has lead its base so as to advance economic policies that steal from that very base has turned the party of Lincoln into the party of the Spanish Inquisition.
It will take a leader within the GOP to save it from itself and lead the party back to sanity. The problem is any such leader will need to back away from the current Paul Ryan doctrine of what is good for billionaires is good for all or he will lose the base as they turn from hatred and screwing the other guy to what is good for me. Which means the first thing any leader wishing to reform the GOP and lead it back to sanity is destroy Paul Ryan and the GOP establishment.
And whatever else you want to say about Donald Trump, he has gone a good way to slaying the GOP establishment.
Jesus, what a story. Thankfully your doctor did what he did. Those kinds of ethics should never be overridden by money. Doesnât exactly jibe with the whole Hippocratic oath does it?
(Iâll just note here though for those who think universal health care solves those kinds of problemsâŚit doesnât. Itâs still up to the med schools and other more senior practitioners to actually TEACH and EDUCATE so that this kind of situation happens less and less. Just as many unethicals in universal health care countries as there are in the US, people shouldnât assume itâs an immediate quick fix)
I worked for an insurance company briefly in the 1980s. They didnât toss claims, they did sit on claims that were expected to be large, looking for ways to lower their cost. At a later job I worked with personnel issues; I always told people that if their claim was denied they should question it. Every time I questioned an insurance denial it turned out that someone had âmis-codedâ it or otherwise worked it to the companyâs advantage. Advice still stands - always question anything that doesnât pay off as you understood it would.
How many people are enrolled in Obamacare now, over 20 million right with all sorts of ancillary benefits.
This train isnât turning around despite the intentional road blocks and influences geared only towards profits.
We the peeps want a working, affordable, quality health care system and have already fought past the obstruction to get where we are at.
If certain insurers want it to be about them and their goals as opposed to what itâs really all about, then those insurers need to service the obstruction crowd and leave affordable health care to the rest of us.
They can have their own private insurance agency, Known as the UCA, U standing for unaffordable and that should satisfy the snakes of the industry as well as the obstructers.
Obstructing Obamacare at this point is like defusing a bomb after it has gone off. Itâs too late. Itâs get on board and enjoy the ride or be left on the sidelines time, these are the choices.
So, if insurers canât make a go of the ACA gift that Congress gave them the solution is roll healthcare admin. into single-payer, Medicare-for-all. Insurers have their chance, they need to make it work or the best interests of the American people is get them out of the middle, not give them everything like they had in he old days of Lifetime Limits, and Pre-Existing Conditions. That should be the deal on the table with recalcitrant Republicans. Make it work, or else.
