Glibbertysmidgeon

A recent New Yorker Article reveals that insurance companies find excuses to reject 30% of all claims.

In my sister’s case, that number is more like 40%.
Donna is a clinical massage therapist, treating people injured on the job, in car accidents, or in mishaps in their daily lives. As an independent businesswoman, Donna doesn’t have the bargaining power of a major hospital. If the insurance company decides she should only get half her normal wage for their clients, then half is what she gets. If they decide not to pay, she has about a 50/50 chance of getting anything at all, no matter how hard she fights the paperwork battle.

I admit that I’ve advised her many times to go private. Donna sometimes works one or two days a week at a local spa doing relaxation massage, which is paid by cash, instead of insurance. These cash clients always pay, and they never try to force her to work for half her normal rate. On most weeks, she makes more money in her one or two spa days than she does working a 30 hour week treating injured patients at the clinic.

As it turns out, more and more medical professionals are going private. One surgeon, who phoned in on the Brian Lehrer radio talk show today, claims he has given up taking insurance patients altogether. This surgeon charges $8,500 for a gall bladder removal surgery, while a typical insurance company pays only $700 for the same procedure.

While I’m not feeling sorry for a man who gets $8,500 for two or three hours’ work, I am sensitive to the fact that he has invested years of his life and hundreds of thousands of dollars into his education and training. I know that if you want someone good, you’ve got to pay them enought to make their investment worthwhile. I also know that his job is extremely risky. Every surgery could end in the death of his patient, and a nasty lawsuit for him.

It makes me wonder what kind of a surgeon can you get for 700 bucks.

One psychiatrist claims that, by not accepting insurance, he saves thousands on the staff he does not have to hire to process the mountains of paperwork insurance companies require. He claims that that he can lower his rates to a level that could, for a long term patient, work out to be less expensive than using insurance in the first place. But even his lower rate of $125 per hour is out of reach for most people.

That is just one of the ways these insurance policies manage to harm doctors and patients both.

I have health insurance, but I can’t go running anymore.

Three years ago, the pain in my hips was sporadic. It would flare up if I wore high heels, or after sitting in my chair with my legs tucked up under me for too long. When I went to the orthopedic doctor, he told me it’s probably bursitis. Then he sent me home with a prescription for physical therapy, a list of physical therapists, and the following instructions:

“Call these, and find one that takes your insurance.”

Two years later, my hips hurt every day, and the pain is enough to make me limp. I am thinking of taking up the list again. Maybe someone has joined my preferred provider plan since last I checked. I wonder where that prescription has gotten to? If I can’t find my two year old prescription, will my insurance pay for another visit to the orthopedist to get a new one?

How does my health insurance help me if I can’t find a doctor who is “in network”?

Looking at all this from the insurance company’s point of view, it makes perfect, if ominous, sense. These are for profit organizations. Their goal is to make money. How does a business make money? By increasing revenue, and by cutting costs.

So they bring in lots of revenue by raising rates, and they cut costs:

• Make it their policy to avoid paying on claims
• Work hard to limit the things they will pay for

It seems to be working. My former employer, AIG insurance, is the 12th richest company in the country. Or was, when I was there.

It feels good to tell ourselves that our health care system is the best in the world. I believe it’s true that we have great doctors, great technology, and great hospitals. But if our system encourages our best and brightest to stop taking health insurance as payment, then these great doctors are really only there for the rich who can afford to pay them in cash.

Right now, my sister is balancing her desire to help injured people with her need to pay her student loans by working two jobs. Speaking for myself, I’m not sure how long I’d be willing to to work that hard for so little.

When we leave a for profit corporation in charge of deciding how much to pay for our medical service, as well as which services it should pay for, isn’t it a bit like leaving the fox in charge of the henhouse?

Kris’ godson, Sammy, was in the newspaper recently, because his school is being shut down. Sammy attended an extended day program that specialized in helping autistic children.

We were surprised when we heard of Sammy’s diagnosis, but not for the reasons you might expect.

“What are the odds,” we asked ourselves, “that we’d have a godson AND a nephew who have autism?”

As it turns out the odds are quite good.

The current incidence of autism is 60 for every 10,000 children. That’s one child out of every 166 born. I was astonished. If autism is so prevalent, why didn’t I know any autistic kids when I was in school? Turns out there weren’t as many then. In 1988, 6 out of every 10,000 children had autism. That’s one out of every 1660. In just seventeen years, the number of intances of the disorder has increased tenfold.

What could have caused this alarming increase? Some suspect it was something environmental:

In 1988, the Centers for Disease Control (CDC) recommended important new additions to the nation’s infant immunization program, including three Hepatitis B immunizations (one injected at birth), and three Haemophilis B shots—all delivered by six months of age. Drug companies responded with vaccinations supplied in multiple dose containers preserved with the mercury-based antibacterial Thimerosal. Neither the CDC, nor the Food and Drug Administration (FDA), which monitors the safety of vaccinations, expressed concerns at that time about the relatively high doses of mercury that newborn babies and infants would be exposed to through these shots.
A dramatic nationwide increase in autism followed directly on the heels of the abrupt rise in thimerosal exposure (Blaxill 2001).

Environmental Working Group Report

I’d never heard of Thimerosal until I read recently about a leaked memo, which revealed drug company Merck’s big mercury coverup. Written by Dr. Maurice R. Hilleman, a former SVP of Merck, to the (then) head of Merck’s vaccine division, Dr. Gordon Douglas, the memo says:

… infants who receive their vaccines on schedule would be dosed with as much as 87 times more mercury than is accepted as safe in daily consumption. “When viewed in this way, the mercury load appears rather large,” wrote Hilleman.

News Standard

(Public health officials did not find out about the high levels of mercury in vaccinations unti 1999- eight years after Hillman wrote this memo. )

Dr. Jill James is a former FDA senior research scientist who now works for the University of Arkansas for Medical Sciences. Dr James has recently published a new study that could explain why some kids who recieved immunizations containing the poison have autism, while some do not.

The new study shows that autistic children have a severe deficit in a chemical called glutathione. Our bodies use glutathione to remove poisons from the body.

When compared to normal health children, autistic children showed a significant impairment in every one of five measurements of the body’s ability to maintain a healthy glutathione defense. These findings are strong evidence that if these children were exposed to a potentially toxic dose of mercury or other compound they would be much less able to mount an effective defense.

Environmental Working Group Report

Drug companies continue to say there is no hard evidence that the immunizations containing Thimerosal were unsafe.

When I was a little girl, I broke a thermometer on the floor at Grandma’s house. When I attempted to clean up I discovered a grand new game. Aunt Barbara found me half an hour later, on my hands and knees, chasing little silver globes of liquid around the chipped legs of the clawfoot tub.

“DON’T TOUCH THAT!” she shrieked, sweeping me up and away from the mess. Even in the early 70’s, Every mother knew that mercury was poison.

Common sense tells me that you don’t inject poison into babies, ever.

When corporate behavior flies in the face of common sense and the common good, their excuse needs to be better than, “There is no hard evidence it was unsafe .”

FDA Statement on thimerosal

Update: A new book has been published on this topic called “Evidence of Harm“.