Another Horror Story

Just a warning, for those readers who are bored of hearing about desperately sick Americans who could be successfully treated with surgery but can’t get the surgery done because they don’t have health insurance, and so are probably going to die:

John is a sawmill worker from Yamhill County, Ore., where I grew up. He was a foreman at a mill, he felt strong and healthy, and he had very basic insurance coverage through his job. On April 18, he was married, at age 23, and life was looking up.

Ten days after the wedding, he was walking in his backyard carrying a neighbor’s dog — and he suddenly blacked out. That led, after rounds of CAT scans, M.R.I.’s and other tests, to the discovery that the left parietal lobe of his brain has a cavernous hemangioma. That’s an abnormal growth of blood vessels, and in John’s case it is chronically leaking blood into his brain.

John began to have trouble walking and would sometimes collapse. He developed spasms and restless leg syndrome, he began to use a cane, and his mind suffered.

[...]

Perhaps the worst is the pain — blinding, incapacitating headaches that have left him able to sleep only in short intervals. He vomits daily when the pain surges.

“The pain is constant,” John said. “It’s a 7 or 8 on a scale of 10, and then it hits the high peaks and makes me vomit.”

[...]

John says the principal obstacle to treatment appears to be simply his lack of insurance. In August, he qualified for an Oregon Medicaid program, but he hasn’t been able to find a doctor who will accept him as a patient for surgery, apparently because the reimbursements are so low. Doctors tell him that his condition is operable — but that they can’t accept him without conventional insurance. He is increasingly frustrated as he watches his family crushed by the burden of his illness.

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Author: KATHY KATTENBURG

  • VeratheGun

    I read the NYT column and something's not right about the story. There are definitely facts missing here. My hospital is a world renowned institution and we do brain surgeries on people without two pennies to rub together, if there's a need.

  • mnpokermvp

    VeratheGun, then you should look into this and then offer to do the surgery if this is a real story.

  • VeratheGun

    LOL. I just work there. I don't do the surgeries. But yes, I have taken care of people with this condition. I will pass this on to the neurosurgery service at my hospital.

  • JeffersonDavis

    This is a horror story from the Oregon Medicaid program.

    Can you imagine how much worse it will be when we're all on the United States Medicaid Program?

    Thanks for speaking for the opposition to government healthcare, Kathy.
    You're the best!

  • Marsh

    If anyone is interested in helping Mr. Brodniak, there's a way to do it today. (Kristof blog)
    Several readers have asked how they can help or if there is a fund to help John. There isn’t any such fund, but with John and Esther’s permission I’m posting their mailing address:
    John and Esther Brodniak,
    770 W Main St.
    Sheridan, OR 97378.

  • http://www.nonpartisanpundit.com/ Andy

    Kathy,

    As the article says, he has insurance (medicaid). So the problem is not lack of insurance, the problem is that doctors are refusing to admit him as a patient. If he dies, then is it the fault of insurance or is it the fault of his local doctors who don't want to reduce their incomes by accepting a reduced rate? What is the difference between Medicaid and other insurance? The surgery will be the same – the difference is that Medicaid pays doctors less than other insurance. Maybe the solution here isn't to spend a lot of money buying this man more expensive insurance. To do so is nothing but a subsidy to doctors. You'd be better off, I think, to simply tell doctors they cannot turn away patients with Medicare or Medicaid. You do that and this guy won't die.

  • http://sovereignmind.wordpress.com/ adelinesdad

    It is a horror story, Kathy. But in this case it happens to be a horror story regarding government-funded health care, so I'm not sure I see how you think this story is relevant to the current debate, assuming you support government-funded health-care. You've said before that you favor a strong public option, which implies lower re-reimbursement rates in order to reduce costs, which it appears is exactly the problem in this case.

    Andy: “Maybe the solution here isn't to spend a lot of money buying this man more expensive insurance. To do so is nothing but a subsidy to doctors. You'd be better off, I think, to simply tell doctors they cannot turn away patients with Medicare or Medicaid.”

    The assumption your making is that Medicaid cannot possibly be underpaying for health-care services. If we were to take your argument to its conclusion, we would conclude that we can solve all of our health care cost problems by just making every doctor accept Medicaid (expanded to include everyone), and then making Medicaid reimburse 1 cent per hour. Now, I know you're not saying that, but I've taken it to the extreme to make the point: you can't just force doctors (and nurses, and hospitals, etc) to accept lower payments without having an impact on supply.

    So, your argument is equivalent to this argument, which I hope we can all agree is obviously flawed: Do you want to lower the cost of health care? Just lower the price. Without addressing the reasons why the price is so high, such a strategy will inevitably lead to shortages and rationing.

  • DLS

    “Do you want to lower the cost of health care? Just lower the price.”

    Yes, or as was stated earlier,

    “simply tell doctors they cannot turn away patients with Medicare or Medicaid”

    Of course, forcing the doctors to accept less, to work for less, even for nothing if they could be forced to with some measure of reliability, is what some want, in order to have their dreams materialize magically.

    Never mind that, even if made legal in some form or another (converting to non-profit and paid according to federal direction, as under the best-known Medicare for All scheme), it amounts to a form of slavery (as well as theft, i.e., expropriation, in the case of Conyers — also not compensating for lost profits when converting medicine forcibly to non-profit status).

  • DLS

    “such a strategy will inevitably lead to shortages and rationing”

    Who will remain, or will emerge, to provide the care, is one of the next questions that come to mind.

  • kathykattenburg

    Can you imagine how much worse it will be when we're all on the United States Medicaid Program?

    That makes no sense at all, but considering the source it makes sense that it doesn't make sense.

    You're the best.

    I feel exactly the same way about you, JD.

  • kathykattenburg

    Thank you, Marsh.

  • kathykattenburg

    You've said before that you favor a strong public option, which implies lower re-reimbursement rates in order to reduce costs, which it appears is exactly the problem in this case.

    Actually, there are several problems. One is that he lost his insurance when he lost his job because of his illness. and it's not clear he would have been covered anyway, because Kristof says it was very basic insurance. Like many people who cannot afford the astronomical premiums associated with insurance policies that actually are good, comprehensive insurance policies, he gambled on his health remaining good, and lost.

    That is not a Medicaid problem.

    The next problem is that his wife, who also had insurance through her employer, could not add her husband to the plan because he had a pre-existing condition.

    And then she had to leave her job to take care of him.

    This, too, is not a Medicaid problem.

    Also, just thinking logically here, if Medicaid is the problem for John Brodniak because reimbursements are too low for the doctors in his area, then it's hard to see how rejecting the health care reform currently in Congress will help him, since it hasn't been passed yet. So why are we blaming health care reform when this is happening without health care reform?

    Finally, a wild and crazy idea: Maybe Medicaid reimbursement rates should be raised? Really out there, I know, but I like to think outside the box.

  • merkin

    There are many different reasons surgeons would refuse to do the surgery. I had an emergency colon loscopy. The surgeon who did it refused to do the required follow up operation because he didn't accept my private insurance. I asked why. He said it was because my insurance company always called and badgered him to discharge the patients from the hospital earlier than he thought was prudent.

    I think we don't have the full story and vote we withhold judgment for awhile.

  • JeffersonDavis

    “That makes no sense at all, but considering the source it makes sense that it doesn't make sense.”

    There you go, talking in circles again and avoiding the point.
    Yes, kathy, you know darned well it makes sense. It was not a complicated point.

    You presented an example of a poor fellow that could not get surgery because he was on Oregon's Medicaid Program. That's one of those government programs you USUALLY rave about, and want to install for all of us via public healthcare. Therefore, your dogging the medicaid acceptance problem totally backs up every argument that has been waged here on TMV against public healthcare.

    That is perfectly crystal clear. But I'm sure that, instead of admitting that, you'll come back and try to parse my words and go off on a tangent of some sort – it's what you always do. You're becoming extremely predictable and boring.

  • http://sovereignmind.wordpress.com/ adelinesdad

    You're right, Kathy. John's situation was a result of several misfortunes. But my point is that Medicaid, the government system that was put in place to help people who fall through the cracks, failed to help him because it tries to lower costs by lowering the price. And parts of the current reform efforts follow the same pattern as Medicaid: a government-run insurance plan by which the government wants to use its leverage to lower the price (not the cost of delivering health care).

    “Finally, a wild and crazy idea: Maybe Medicaid reimbursement rates should be raised?”

    It's not me who is arguing that government-run health insurance programs should use their leverage to drive down reimbursement rates. If we're going to have government funding of health insurance, then the government should pay the market rate or risk causing a shortage. Of course that would be expensive, which is why the reform should focus on containing cost, which in my opinion is does not do adequately.

  • http://www.nonpartisanpundit.com/ Andy

    adelinesdad,

    My main point was to illustrate that health care costs are the root problem, not insurance. People can't afford health insurance because health care is so expensive.

    Regardless, wages for providers makes up somewhere around 60% of total health care costs. You can't substantially reduce costs long-term and ignore that aspect. Doctor incomes have also risen substantially faster than other professions over the last several decades thanks to the fee-for-service system instituted by the creation of Medicare and now doctors have expectations about their income. It used to be that doctors made about the same amount of money as similiarly educated professionals – lawyers, PhD level engineers, etc. Not anymore. Medicare rates are not so low that doctors will be even close to getting food stamps. They would still make very good incomes, just not what they have grown accustomed to.

    But regardless, I'm not really advocating that, just making a point. As I have said before, more fundamental reform is needed – not more band-aids.

  • http://www.nonpartisanpundit.com/ Andy

    Finally, a wild and crazy idea: Maybe Medicaid reimbursement rates should be raised? Really out there, I know, but I like to think outside the box.

    Ok, where is the money going to come from when Medicaid costs are already increasing at 2-3 times the rate of inflation and GDP growth? The system is already unsustainable and already way too expensive so I don't see how making it more expensive does anything besides make the problem worse.

  • http://sovereignmind.wordpress.com/ adelinesdad

    Andy,

    Fair enough. I actually agree that labor costs are a major driver in the
    rise in health care costs. I'm actually doing a fair amount of research into
    this at the moment, and right now I'm wrestling with the question of how
    much of this increase is due to factors external to the health care system
    (ie. the increasing wealth gap in our society caused by lack of supply of
    high-skill labor, compounded by health care's dependence on high-skill
    labor), and how much it is due to problems within the health care system
    (ie. the incentive problems you pointed out, as well as potentionally
    limiting supply through over-regulation). But even regarding the aspect of
    the problem that is specific to the health-care system, it's questionable
    that the right way to address that would be to use the government' leverage
    to force providers to accept less. Even if providers are overpaid, forcing
    them to accept lower wages without correspondingly addressing the supply
    problems is still likely to result in less supply, because some people who
    are considering a medical career may be doing so in part *because* medical
    providers are overpaid.

    (As a side note, you mentioned somewhere around 60% of total health care
    costs is labor costs. I'm curious if you have any references for that. I'm
    not trying to challenge you on it, it's just that that is exactly the kind
    of thing I'm looking for to help me in my research. The number I've found
    for total wages for health care professionals is around 20%, but I do
    suspect that's an underestimation since it doesn't count the many indirect
    ways in which labor costs effect the total cost–ie. the labor cost of a
    medical device supplier. I suspect the number is closer to 60% than it is
    to 20%, but nontheless if you do have a reference, I'd be interested in
    seeing it).

  • http://www.nonpartisanpundit.com/ Andy

    adelinesdad,

    I'm trying to find my source, but am unable to atm. The 20% figure you cite (actually closer to 24%) is physician pay only. Once you add all the other health care professionals in, it's a lot. Not surprising since health-care is a very labor-intensive endeavor. I'll try to find my source a bit later and get back to you.

  • http://sovereignmind.wordpress.com/ adelinesdad

    Actually, I arrived at the 20% number by using the numbers from the bureau of labor statistics numbers for “Healthcare Practitioner and Technical Occupations” (http://www.bls.gov/oes/2008/may/oes_nat.htm#b29…), of which there are 7,076,800 with a mean salary of $67,890, which totals to $480 billion, which is about 22% of the total 2.2 trillion total health care costs (http://www.cms.hhs.gov/NationalHealthExpendData…). But again, I'm open to the possibility that my method underestimates the true number.

    For one thing, “salary” doesn't encompass all of labor costs.

  • http://www.nonpartisanpundit.com/ Andy

    Ok, I found what I was looking for – originally thought it was on the BEA site, but it's here:

    http://www.cms.hhs.gov/MedicareProgramRatesStat

    Each of the links provide a breakdown of costs for a variety of providers. Each one is above 60% labor costs and I just ballparked it down to 60% to provide a conservative figure and to acknowledge that not all spending occurs in those areas. Here's a quick overview of labor costs as a percentage of total costs:

    Hospitals: 62%
    Skilled Nursing: 62%
    Home Health Agencies: 77%
    Rehab, Phych and long-term care hospitals: 65%
    Private practice physicians: 71% (52% physician compensation, 19% non-physician compensation)

    Hope that helps.

  • kathykattenburg

    And parts of the current reform efforts follow the same pattern as Medicaid: a government-run insurance plan by which the government wants to use its leverage to lower the price (not the cost of delivering health care).

    Except that the cost of delivering health care in our non-competitive, private “free” market system is much higher than it needs to be, for lots of reasons that we've all discussed here before; e.g., millions of uninsured Americans using emergency rooms exclusively for their medical care, high private insurance administrative costs to cover an army of industrial lobbyists and gatekeepers whose only job is to find ways to deny coverage, etc.

    As I understand the health care reform legislation now in Congress, access to Medicaid is going to be expanded and funding for it is going to be increased. Also, you seem to gloss over my point about the system letting down the Oregon couple before they got to the point of needing Medicaid, but it seems to me this point is crucial Right now, Medicaid is a last-ditch resort for the poorest of the poor — people who have no source of income at all, like this couple in Oregon. It's underfunded and over-used (in the sense that there is more demand than it can meet because there are so few other options). You cannot get Medicaid unless you are completely indigent and have absolutely no other source of income.

    The point here is that when people are backed into a corner with no exit by the fact of losing their jobs and thus their employer-provided insurance, and then not being able to afford private insurance or being shut out of it by pre-existing conditions, and there is only one tiny, underfunded safety net program to save them, they get into very bad situations. Medicaid is not the answer to everything, it's not the be-all and end-all. The point is, with a sane and comprehensive national health care system, it doesn't have to be. THAT is the lesson here — that we *don't* have a federal health care program for everyone, not that the one itty bitty one we do have that only accepts you if you don't have two pennies to rub together isn't doing the job.

  • http://sovereignmind.wordpress.com/ adelinesdad

    Thanks for hunting that down. That link has a lot of numbers for me to dive into, so that should keep my busy for a while.

    (As a side note: why is it that I have to dive into raw numbers myself in order to get an understanding of health care cost issues? Isn't that the media's job?)

  • http://sovereignmind.wordpress.com/ adelinesdad

    “As I understand the health care reform legislation now in Congress, access to Medicaid is going to be expanded and funding for it is going to be increased. “

    Funding will need to be increased if access is expanded, but I'm not clear on whether that means reimbursement rates will be increased. The general argument I've heard from liberals is that reimbursement rates for the public option should be low in order to make it attractive to patients, thus “keeping the insurance companies honest”, and since the public option can be viewed as just a buy-in version of Medicaid or Medicare, it seems to me that the same logic would apply to Medicaid and Medicare. So I'd find it surprising if liberals were simultaneously arguing that Medicaid should raise reimbursement rates while arguing that the public option should keep them as low as possible. Maybe I'm missing some nuance there though.

    “Also, you seem to gloss over my point about the system letting down the Oregon couple before they got to the point of needing Medicaid,”

    I agree that the cracks that John slipped through are wide and need fixing. Since the part of the article you quoted did not mention anything about that, but instead mentioned the problem he had with doctors not accepting Medicaid, I interpreted that to mean that you felt that was the key part of the horror story. I felt that was ironic considering that's one of the problems that conservatives have been pointing to and liberals have been dismissing by arguing for more downward pressure on the price of health care, as opposed to the cost of providing health care.

    Now that you've clarified what really troubled you about the story, I agree that John is the victim of problems in our health care system that need fixing. With regards to how those problems should best be fixed (without trading one problem for another), that is another matter entirely which this story sheds little light on. For one thing, one of the problems was that he lost his job and therefore also lost his insurance. That seems to suggest that one problem we have is our employer-based insurance system, which the current reform would make even more prevalent by imposing penalties on employers that don't provide insurance.

    I admit defeat (for now) on one point though: we definately need to do something about covering people with pre-existing conditions. I think the way the current reform does it is not ideal because it requires an individual mandate which I'm opposed to as a matter of principle. But I also admit that I don't have a solid alternative. So, I have to give +1 to the liberal's column on that one until/unless I see something better. It's a question of principle vs. practicality that I am still wrestling with.

  • jasonatx

    Courtesy of Michelle Malkin
    “Well, OHSU confirmed for me two things:

    1) OHSU is a safety-net hospital not far from where Brodniak lives. The hospital accepts all Medicaid patients and would not turn Brodniak away.

    Okay, are you ready for Number 2?

    2) Brodniak is a patient at OHSU — and has been a patient there for the past three weeks.

    In other words, at the time Kristof’s article was published this past Sunday, Brodniak was already being treated and cared for by some of the best neurologists in the country!

    The spokesman told me that the Brodniaks were willing to confirm “reluctantly” for me that he has been a patient there for nearly a month, but they refuse to talk to me directly. The spokesman also told me that OHSU will not make its doctors available for further comment on the matter.”

    Might want to cancel any checks you have sent!!! Looks like a Merry Christmas for the Brodniaks.

  • Iwashereonetime

    tick, tick, tick…..