Critiquing The Invisible Elephant
Critiquing The Invisible Elephant
Navigating the invisible fence
Links, including to music, are at the end in the links lost & found.
Maundy Tax Tuesday. It seems that that the high altitude classes weren’t always up for washing the feet of the unwashed masses, so they handed out money instead. Here’s a dollar. Go wash your own feet.
Maundy Thursday falls pretty close to tax day. We should have a maundy tax, maybe 90% of every fortune greater than eight figures, earmarked for the feet of the poor and related items. Don’t make the baby jeebus weep, or spin his head around like a dreidel while you pray.
I was knowledgeable, even sympathetic, to the rationale behind insurance company policies
That’s from Carolyn Johnson, a Washington Post health care reporter whose young child acquired a rare and extremely painful debilitating disease.1 Two expensive and very effective drugs were available to treat it, but her insurance company refused to pay for either until she had tried dirt-cheap but ineffective remedies. They eventually approved the more expensive treatment of the two pricey treatments, which required a monthly infusion administered by a home care nurse.
In the four-month interval between her son’s initial days-long hospital stay and the eventual approval, she was able to get free doses of the less expensive effective treatment through the manufacturer’s short-term charity program. Prior to benefiting from that PR-inspired program, she simply had to watch the kid suffer while she and the doctors scrambled to fix it.
The policies for which she has sympathy are the ones denying appropriate care until a doctor or patient has tried less expensive potential remedies, in her case NSAIDs and/or steroids, neither of which were effective and both of which can be dangerous for kids. Insurers don’t want to pay $4,000/month or more when they could get by with $20. Understandable, she says, but frustrating.
Wolves dining on an unattended child is understandable too, but you wouldn’t necessarily want to institutionalize the practice.
Johnson has written about health care and insurance companies for years, including stories about the struggles people face trying to deal with the companies. She’s familiar with their policies, understands them well — and, as she says, even sympathizes with them to a degree — has access to insurance company executives, researchers, and pediatric specialists through her job, and still had to struggle getting the appropriate care for her kid. People who aren’t knowledgeable, and doctors with less persistence, experience and time than hers, are at the mercy of the companies to a much greater degree than Johnson was.
What’s most striking about the story is the near-total acceptance of our private insurance schemes and, to a lesser extent, the difficulty of getting appropriate care paid for by them under what could be conceived of as the best of circumstances; neither does she note how profitable they are, and how inclined toward fraud.2
And although Johnson acknowledges the excesses of pharmaceutical firms and the larcenous underpinning of the free medicine programs they sometimes offer, she suggests no remedies and offers no contrasts.
Yr. editor is knowledgeable about and even sympathizes with the journalistic constraints under which Johnson labors. This wasn’t a story about how to fix our fundamentally insane approach to health care delivery, but about the hazards of navigating it. Still and thusly, the context is a Kafkaesque situation which remains Kafkaesque, with the looming potential for tragedy, despite the protagonist knowing exactly what’s happening and why.
You understand where this is headed. The only moral and practical solution, and the most affordable one, is something like Medicare for All, which, you may recall, first appeared as a named concept in a New York Times story about legislation introduced by Republican senator Jacob Javits in 1970.3
That bill proposed a public-private system providing universal health care to be fully phased in within three years. Javits’ criticism of the system back then — the most money spent to the least effect — can be found more or less word-for-word 53 years on, but with the proposed solution a much more fringe idea now, congressionally speaking, than then, thanks to the acceleratingly steroidal rapacity of the opposed parties, with all that that entails.
So: Johnson cannot have been expected to deliver even a mild jeremiad against what is in favor of what should be, but the situation has been so dire for so long that failing to do so always seems at least a little bit like a little bit of journalistic malpractice.
Ah well. Maybe it’ll be more practical after a big die-off, whether in the general population or Congress. (Not proposing anything, mind you; only speculating.)
Music which fed this post
Sunny & Gabe, “Peace of Cake;”4 Grand Ole Party, "Humanimals;"5 Grave Flowers Bongo Band, "Strength of Spring;"6 Young Marble Giants, "Colossal Youth."7
I’ve always liked the spare instrumentation and vocals of Young Marble Giants, who were playing almost as long ago as Jacob Javits was proposing Medicare for All. I wish I could have seen them play. Everything else on the list is new to me and much more contemporary.
That, Comrades, is all there is.
Share what I do if you like it, and consider subscribing if you’ve not already—it’s free unless you want to pay, the latter of which I’d be pleased to see more.
But capitalism. . . freedom. . .
Hi Weldon:
I see my friend Jack has made it here already.
It has been a while since I have authored anything major on healthcare. Let state it in the beginning, healthcare should be available for all and not just the majority who can afford some version of it. I would not pick Fee-for-Service Medicare as the alternative. I would choose Single Payer.
Medicare does take care of me along with the Supplemental plan and Part D for pharma. But, that is the problem with FFS Medicare. It is incomplete and always has been. Congress has blocked it from supplying those additional benefits we now get with Part A and B.
I am stating this not so much for you as I am for others. I would guess you have Medicare (hopefully). I am not sure all people understand the dynamics which lead up to the situation you are describing in your example.
The competitor to FFS Medicare is Medicare Advantage, the commercial version run nu healthcare insurance companies and endorsed by AARP which sponsors MA as supplied by United Healthcare. With MA plans, you get everything all wrapped up neatly in one plan. Sounds great and just like traditional healthcare insurance most of us had in the past.
Amazing plans offering many freebies to attract oldsters into it. MA plans overcharged AMC to the tune 0f ~$12 billion in 2020 as reported by MedPac chapter 12. CMS has reported their overcharges since it became a major supplier of healthcare to oldsters. We or they love it until we or they start to get the same runaround you described for the child needing an advanced and better treatment.
FFS Medicare has its own issues with payment to healthcare doctors, pharma, and hospitals. FFS Medicare overpays commercial healthcare providers and it is complex. Try to follow how pharma gets to the drugstore from the manufacturer. It is complex and makes little sense. Everyone in between gets their cut of the pie. If you are fortunate, your drugs are a tier 1 or 2 and your deductible is lower. An old game is to set the deductible high and charge list price until it is satisfied. If you only have 1 or 2 drugs, you never hit the deductible even paying list as determined by the insurance plan.
That was the negative.
The positive is when I have to get 4 doses of Rituxan which lists for $28,000 per given dose. The last time I looked Medicare and whatever were paying $8000/dose. Even is a give way for an older drug. What happens is companies such as Roche will search for new uses of Rituxan. If the find one, they can up the price again. The ICER which studies drug pricing for legitimacy will approve or disapprove the new usage based upon the new info. It is not a mandatory approval needed to market. The companies do leap through many hoops to get the approval.
My point? FFS Medicare is better than commercial Healthcare Insurance or Medicare Commercial Advantage. Single Payer is far better than all of them as it does more with lowering the costs such as administration which is worth and ~15% cut in costs. Pretty heffy cut when you are talking about $2-3 trillion dollars a year, I would talk about more of the this except you may already know this. I do not want to bore you either. Good person to read is Kip Sullivan PNHP. I have sponsored his articles on single payer healthcare.
Sorry for the legth of this.
Bill