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The View From The Belly of The Beast: Part One

Wow, first post! Thanks to the other front-pagers for inviting me – I’m truly honored. I plan to do a three-part series on healthcare, with the first two parts detailing what is so wrong with the system, and the third part offering what I think are the solutions. I’ll be showing you what this looks like from the provider side, rather than the patient side.

42-15529728

The place I’d like  to start is identifying why I think the system is broken. Let me say at the outset that I am not a big-government person, nor am I a small-government person. I’m a constrained-and-watchdogged, effective and fiscally responsible government person.   I’m a liberal centrist, and mostly a pragmatist, and I could care less if a demonstrably good idea came from Dennis Kucinich or Newt freaking Gingrich. If it’s logical and it works, I do not care.  My approach to the whole question of healthcare reform is not rooted in ideology. At all.

Instead, it’s rooted in the years I have spent in the healthcare field. As a retired nurse, married to a Family Practice physician, I have spent many years observing how our system works from the inside. I was both nurse and office manager, billing/referral/pre-authorization clerk, phone person, lab tech, and chief cook and bottle washer for my husband’s solo private practice. I helped him set up that practice from scratch, with all the insurance contracts, credentialing, inspections, and everything else it entails.

So, now that I’ve established that I know (at least a little) what the hell I am talking about, let’s talk about insurance companies. Let’s talk about what goes on, on a daily basis, in a real live medical practice. We’ve all heard the horror stories from the patient end, the big denials. Those exist in abundance, but I’m not going to address that here, because we all know those stories, and we are familiar with them. Instead I’m going to try to show you, and hopefully help you understand and get a feel for, the sheer, crushing volume of all the other, “small” stuff. The dailyness of it all, that has become overwhelming.

It’s a chess game, played mostly blind, in which the rules and players on the board change constantly, at the will and whim of something much bigger than you are. It’s exhausting. It’s frustrating. It’s a real morale-killer. Oh, you thought I was talking about diagnosing and treating disease? No, I was talking about getting anything a)covered and b)paid for. You will see later that those two are not the same thing.

So – let’s check in at the office. What’s it really like, behind the scenes?

The first hurdle is getting things covered: Patient A has come into the office during the height of flu season. She has classic flu symptoms that began yesterday. Suspecting flu, the doctor orders a rapid flu screen test – a simple nasal swab, largely accurate (70 to 90%), and most importantly, the results are almost immediate. It’s positive for infuenza A. Great, so let’s write an RX for Tamiflu! That was easy. But before she leaves happily with her Tamiflu prescription, I tell hubby, “Can’t do it. You know she’s Cigna, right?” Uh Oh. Groan. You see, we’ve been having this argument with Cigna for weeks. Cigna refuses to pay for Tamiflu without a positive influenza culture, not a rapid swab. Yes, a culture is almost 100% accurate, with no false positives or negatives. It is also completely useless unless one is doing research, because it takes a minimum of 3 days to do it and get the results back. Tamiflu is only effective if started within 24-48 hours after onset of symptoms, so by the time you get the test back they’ve been sick for 4 to 5 days, and there’s NO POINT in prescribing the medication.

We have called. We have argued. We have railed at them to no avail that it’s a pointless policy. But  you see, its only pointless if your intention is to treat the patient. It makes perfect sense if your intent is to create a “plausible excuse” for not paying for an expensive medication like Tamiflu. Cigna would like you to know that they absolutely do not refuse needed medications, not at all. They’re just insisting on the most accurate test to make sure it’s needed, dontcha know. Wink wink.

The phone is ringing again. Patient B, who had horrible, horrible gastric and chest pain in the past, has been happy and stable for months on his acid reflux medication, but is having a problem. The pharmacy won’t fill his Aciphex – they say it needs pre-authorization. I pull his chart, and take a look. “What?” I say, “I got that authorized for 6 months, just 4 weeks ago!” Oh, wait, his employer has changed insurance plans again. This is a new company. We’ll have to do it all over again. So I call. I go through a phone tree, then get put on hold (3 times), and after about 30 minutes, finally get a person. They say he has to try the (cheap, totally different drug) Zantac first, for at least 6 weeks. I tell them that he already had a 6-week trial on Zantac, with no relief. The Aciphex is working. I’ll gladly fax them over the records, proof that he just HAD a trial on the cheaper drug a few months ago. No dice. He has to do the process all over again, with this new insurance.

I am hoping that he is not one, as many of our patients are, who has his insurance changed by his employer 2 or 3 or even 4 times in a year. Jeebus, we’ll never keep the man’s gut and esophagus stable if we have to keep going through the same process over and over. Maybe he’ll just give up and decide “Screw it, I’ll just pay for that pill out of pocket rather than keep going through this.” Ahhhh, now wouldn’t that be very conveeeenient for the insurance company if a lot of patients did that. But that’s not the reason they put nonsensical rules and illogical preconditions in place – of course not.

You can’t keep it straight, is the worst part. All the insurances are different, all have different coverage parameters, what is preferred, what is not. This one will pay for a lab test drawn in the office, but that one makes them go to an approved lab across town. This one will pay for a wart removal by freezing, that one only if you code it as an excision. They change the criteria, all the time, unilaterally, and you have no recourse. You can’t just treat the patient, not even in normal, everyday matters, because you are constantly having to check what their plan covers, what it doesn’t.   A medical practice may be contracted with 150 or more different  insurers, all of whom have different coverage, with different requirements, that shift again as fast as you can figure out what they will/won’t allow. One day you realize that as much time is spent getting (or trying and failing to get) treatment approved than you spend actually treating the patients.  It’s out of control. This isn’t working.

Take the above examples, multiply them by dozens and dozens of patients a day (phone-in plus office visits), five or six days a week, 52 weeks a year.   A lot slips through the cracks, because you just can’t keep up. You end up doing a procedure or test, and not finding out until after the fact that it needed a pre-certification, or isn’t covered. I’m sure the requirement was of course buried there in section 213, subsection 15, paragraph (h) of the latest amendment to the plan that was mailed to you along with the 2-foot stack of mail last Tuesday. Or maybe it wasn’t – who the hell knows? And is it worth hiring yet more staff to make sure?

Good luck figuring out which of your patients it applied to, and getting that noted on their file somewhere, and actually having time to check it before you treat them if you did. You’ve got people stacked up in the waiting room, and you simply cannot dig through the fine print of a 300 page coverage explanation on every patient, every single time they walk in the door. But you were (likely) “duly notified”, so you’re shit out of luck. Add in the frustration of not being able to provide any real continuity of care, because you can’t tailor your practice of medicine to what works for the patients, you have to tailor it to  dozens or even hundreds of different and constantly changing versions of what is allowed.

The insurance companies are not stupid. A lot of the sheer bureaucracy and nit-picky requirements and hoop-jumping is now designed for  exactly the effect it has. To exhaust the providers. To make them give up. To make them decide that it is just easier and cheaper to treat the patient, and eat the loss themselves if it’s not covered, than to spend the time, effort and man-hours necessary to figure it all out. They know damn well that most of what they are requiring a pre-approval for is, in fact, quite routine and WILL be approved if you spend that hour on the phone. They are banking on your inability to do that a lot of the time – it is a planned strategy.

This is important for you to understand, because it is NO ACCIDENT. It is deliberate. It is calculated. It did not used to be that way, but it is now. This is not your father’s Blue Cross Blue Shield. This is not “competition”, and this is not “free-market forces”. They are engaging in a predatory war of attrition, daily. It’s relentless. It’s exhausting. It’s confusing. It’s maddening.

And it is crippling and killing the practice of medicine in this country.

We’re not done yet, though. Now that I’ve said all that, realize that I have only touched on the first half of the problem: getting things covered. The second half of the perpetual adversarial chess game is getting things paid for. I want to introduce you all to some particular Big Insurance activities that are little known or discussed outside of the medical field. We’re going to talk about practices known as bundling, and  downcoding, and  black box downcoding. It’s nasty, nasty business.

What? You thought Goldman Sachs were the ONLY ones to have bright ideas about proprietary computer algorithms, that multiply fairly small price-shaves from billions of transactions into a tidy profit? Au contraire, my friends. Insurance companies have been doing it to doctors for years.  Stay tuned.


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81 Responses

  1. Welcome to the front page WMCB! Great first post!

    • WOW! It is so nice that people know that the system is broken, because they intended it to be…it is no accident. I am surprised the stacks of files aren’t bigger, with all the denials the insurance company do on a daily basis. I had to argue for over a year before getting a new medication approved, that is used in the UK regularly without pre-authorization. Go figure.

      Go wmcb Go!

      • WV, I plan to cover the intent in the next installment. I don’t believe that insurance companies are “evil” in the volitionally immoral sense. I just think it’s an inevitable function of the way the system is set-up and incentivized.

        • Our insurance company increased our rates in a recession and posted profits of over half a billion dollars?!? They may not be inherently evil, but when the profit margin is based on health…..gives one pause really.

          • Oh, and that was just one quarter profits… and they are still trying to empty out our pockets?

          • Palin responded to the criticism re: her death panel comments in a very clear way making this exact point. If end of life counseling, as it is in this bill, is closely associated with cost saving I centives, then there is ame opportunity for abuse & pressure on the elderly, infirm & disabled.

          • I am glad she is making an effort to do some ‘splaining’, but the operative word here is ‘IF’ and there is no tie in to profits or cost savings.

            A Living Will is just that, to make decisions while you are still living and in YOUR BEST INTEREST for your well being. See ya up thread with the new topic on the matter.

        • Great post, wmcb. I love reading your comments and I am delighted to see you posting. I agree with your statement that, “…it’s an inevitable function of the way the systme is set up and incentivized.” It’s obvious that the insurance companies are incented to deny claims. As well, the providers are incented to get the insurers to pay whether or not the policy actually covers a service and naturally, consumers are incented to go along with the providers. I know that most providers are just trying to get through the massive amounts of paperwork and get paid for their services but, how many times have people heard from their providers, “…Don’t worry, we know how to get your insurance to pay for this…”

          I know I’ve heard it many times even after I’ve told the providers that I worked for the insurance company and I know a particular service is not covered.

          If you put a huge amount of money into a pool, the incentive is to get as much as you can as fast as you can. That, to me, is what health insurance has become.

          • Some people think that doctors who cross the line into fudging diagnoses, etc. are just outright insurance fraudsters, ordering completely unnecessary stuff just to make a buck. And probably a few are, I won’t lie.

            But many are just docs who are trying to do the right thing for the patient, and DID think that test or procedure was truthfully medically necessary. They get frustrated with the effort to get paid for what they did, though, and cross over from just “massaging” the facts into bending them pretty far, if not lying.

            I’m not saying that’s right – not at all. I’m saying it is a product of the fucked-up system.

        • Thanks for your pov. Now I get it. It’s a feature, not a flaw.

          For a long time I’ve been wondering how it is that I go into almost any store or restaurant, or to any atm, swipe my bank card or credit card, and somehow within a matter of a few seconds a reply comes back to either approve a withdrawal or tell me that I’m broke. I haven’t been out of the country in awhile but I am told the same feat can be done in other countries with the added computation of the exchange rates.

          But in my dr’s office, I give them my paper insurance card which has to be copied by an office worker plus copy machine and most if not all transactions between my doc and the insurer has to be negotiated and approved over the phone (who even uses landlines much anymore), I just don’t believe for a moment that the whole process could not be digitalized with some clever software and a database but that would require some investment and coordination on the part of the health insurers, no? Not part of their profit model. And of course they are all competing with each other so why should they coordinate?

          Just one more thing about the non-system that makes me angry. Thanks for your post.

    • Congratulations, WMCB great first front page! I’m so glad you’ve decided to become a front pager – you always have such wonderful information to share!
      Thanx – 🙂

  2. WMCB,

    It’s great to have you as our newest writer! I have long thought you’d make a terrific front-pager.

    Welcome!

  3. Looking forward to future posts. Congratulations on your first post. It was a good one.

  4. Aww, thanks, guys. I had to work hard to cut this down some, because I could write pages and pages of specific examples. It’s very difficult to describe how mountainous and confusing it feels behind the scenes, dealing with these hundreds and hundreds of plans.

    • I was really surprised that each year one of the courses my daughter had to take in med school was basically on how to deal with insurance companies and all that paper work and how to get them to not interfere with providing patient care. She’s a complete supporter of single payer. (Most of you know she’s a first year resident in ob/gyn).

      • There is an entire industry now built around coding, and how to get paid, and what the latest tricks and loopholes of the insurance industry are. Week-long seminars galore, just to teach you how to stay a little ahead of their tricks and actually get paid for your work.

        It’s freaking insane.

    • I’m very happy that you have agreed to be become a front pager at TC.

      Can I still disagree with you? Because you know our next argument is around the corner.

      • Absolutely! You’re one of my favorite sparring partners! 🙂 I’m also not a person of cast-in-stone opinion, so maybe you’ll convince me (or at least modify me) on some stuff.

    • Excellent first post! Thanks for the new perspective on this.

  5. When I rub the belly of the beast he starts lawnmowering whichever of his rear legs is topmost.

    Auspicious start. 😉

  6. Great post. Keep ’em coming. Can’t wait for part 3.

  7. Wow, this is a great post wmcb. Now even I am beginning to understand how effed up the US health system is. Thanks!
    (I knew it was, just not how !)

    Looking forward to the sequels! 🙂

    • Btw Pips, my German colleagues here tell me that the Healthcare system in Denmark is better that what they have here, can you confirm that?

      I’m so fond of the German system because so far, I can afford far more that I could back home and my co-payments are ridiculous.

      • You know, I feel so spoiled by the Danish Healthcare system, that I’m ashamed to even mention it here, knowing how bad it is for so many Americans. We are more or less pampered from cradle to grave – but pay through our pretty steep taxes.

        And there are so many factors to take into consideration putting up a “ranking”, that I don’t really think you can point out which system is better overall. From what I’ve seen, comparing HC in all EU countries, to my surprise we/DK are far from at the top of any ranking!

        So I’m pretty sure getting the benefit of the German system, you have nothing to be envious of. 😉
        (Not saying that you implied that, lol!)

  8. Nice to see an “insider” confirming my worst thoughts about how difficult the Big Insurance Parasites (BIPs) are to deal with from the health CARE PROVIDERS’
    side.

    It matches exactly what happened to me in an ER situation. Many calls by highly trained, highly needed physicians trying to get permission to treat the patient as they saw clearly was necessary, but the BIP wanted to save money. Time was of the essence, as in the Tamiflu example, and the BIP rep was trained to deny, deny, deny until the procedure could no longer be done effectively.

    And multiply our problems with one BIP to cover the time and personnel needed to deal with all the various permutations between BIPS and, indeed, within the same BIP.

    I usually call my BIP with any “prescription” for a test written by my docs, to make sure a ‘script can cover it, that a referral is not needed. I got several different answers at the rep level. (I usually call at least twice to get different reps to make sure they’re on the same page giving the same answer. I should have a telephone recording device to use in necessary.)

    I escalated, and, over two days, finally got someone who knew what was really in the BIP’s regulations and gotcha rules: In northern NJ a prescription was accepted for my test; in southern NJ –ame BIP, same plan– a referral was required. Go figure.

    Of course, the providers’ office people have to “go figure” over and over and over and over. At tremendous cost to the health care system.

    Single payer would remove this paperwork, telephone tag burden.

    Medicare for All…with a robust private option.

    Call Rep. Weiner to praise him for getting HR676, Medicare for All on the floor for a House vote. Call your representative to vote YES on it.

  9. Great post! WCMB, Daily Howler has a great series this week on health care I think would interest you.

  10. Thank you for this!

    My mom is a psychiatrist with her own practice, and she tells me stories like this all the time. And she does it all without an assistant, so she is up until all hours of the night filling out paperwork, and spending hours during the day calling and fighting it out with the for-profit insurance companies. I honestly don’t know how she does it.

    She’s a big fan of single payer, by the way, as am I.

  11. Thank you WCMB. Please hurry and post the next one so I can get a better understanding of this mess. I am looking forward to your opinion on how to fix the system.

    • Thank you! The hardest part is deciding what to leave out, because I could practically write a book on this crap.

      • Maybe you should. It’d be timely at the very least, and your writing style is wonderfully clear and articulate. I’d buy a book like that.

      • Add some of the left out examples in comments–

  12. Just adding my applause here, wmcb. I know a young doctor who finally gave up trying to keep his private practice because he couldn’t afford the admin. costs of the paperwork. He joined one of those groups that allow you to work with a set number of patients for a guaranteed fee per patient per year. He felt miserable having to tell some of his long-term patients that unless they could afford the annual fee he wouldn’t be able to treat them anymore.

    Years ago I worked for a large bank–10,000 employees worldwide. We had one woman in HR whose job it was to review every insurance claim (routinely for surgery, by request for lesser procedures) to make sure that the employee was being reimbursed appropriately. I remember receiving a call from her one day saying that she’d reviewed the recent $1000 surgery I’d had (this was light years ago) and had determined, based on the doctor’s coding, that the insurance company was obligated to cough up $400, since part of the procedure was covered under our policy. IMO, all large companies should be doing this for their employees until, if ever, we get UHC.

  13. Congratulations on your front page post!

    For a while locally we had a program where our doctors all got together and decided to offer services to cash paying customers for half price. If you paid your bill at the time of service with no insurance billing required, they cut it in half. They discovered that without having to bill insurance companies and pay a whole staff to deal with the paperwork, it only cost them half price to provide the service.

    It was fabulous for many of us, you could see a doctor for 35 bucks instead of 70. Unfortunately our hospital, some local insurance providers, and our local politicians didn’t like it, so they pressured the doctors to stop this practice.

    • Insurance companies are fighting that sort of “direct practice” model negotiated directly with the patient like mad in many states. They don’t like it one bit.

    • Yes, and if you can’t negotiate like that, the only way you can have a cut rate for care is to have insurance.

      I had surgery one year, and the difference between the amount the hospital charged and the insurance co negotiated reduced rate for treatment actually more than covered my premiums that year (and I’m an individual insuree).

      It’s a trap. I carry “catastrophic insurance” now, simply to get the insurance negotiated price for care.

      A really good reform would be to require that providers not charge the uninsured more than they charge the insured — including that insurance companies can’t severely underpay providers and eat terribly into provider profits.

  14. And Obama’s plan just continues the madness, but on a bigger scale. Perhaps that’s why people are so upset about Obamacare. But just look at who his big donors are—he propped up his big Wall Street friends with billiions and now is planing to do the same for his big pharma-insurance company donors. Frank Rich did finally wise up–we are being punked as Obama is for corporations not for citizens and it shows in his policies and focus. What a disaster in the making.

  15. Fault Lines – Healthcare special -Al Jazeera’s Fault Lines interviews Wendell Potter, a former Cigna Executive. 6 Aug 09 – Interview 3

    • Fault Lines – Healthcare reform -Fault Lines looks at the US healthcare system, exposes its cracks, and uncovers the forces that are spending millions of dollars every day to influence the debate over the US healthcare reform. 6 August 09 – Part 1

  16. Healthcare reform – 6 August 09 – Part 2 Fault Lines looks at the US healthcare system, exposes its cracks, and uncovers the forces that are spending millions of dollars every day to influence the debate over the US healthcare reform.

  17. What a wonderful first post. You made a clear case of the problems of doctors,and patients against insurance companies.
    Most people do not know and wrongly blame the doctor.
    Keep up the good work. You have made us understand the problems. Thank You

    WOMEN WITH INTELLIGENCE AND EXPERIENCE,MEN WHO SUPPORT THEM AND COUNTRY BEFORE PARTY ALWAYS

    PUMAS,BUBBAS,EQUALISTS ,WMCB, AND THOSE PEOPLE RULE

  18. http://chicagoboyz.net/archives/8627.html

    this is a different take on backtrack’s health care plan

    WOMEN WITH INTELLIGENCE AND EXPERIENCE,MEN WHO SUPPORT THEM AND COUNTRY BEFORE PARTY ALWAYS

    PUMAS,BUBBAS,EQUALISTS AND THOSE PEOPLE RULE

  19. From a different perspective…

    When single payer was implemented in Canada, the plan covered 90 percent of any doctor’s bill. Until then, doctors averaged 53% return on billings, so they immediately were guaranteed 90%. Fifteen years later, extra-billing was outlawed and the government moved to 100% coverage. The province provides a schedule of covered services. (Excluded are things like cosmetic nose jobs, tummy tucks, breast implants and the like.)

    All medically necessary procedures, as determined by you and your medical practitioner, are automatically covered, no special approval required. If you want or need to go out of country for a procedure (very rare), coverage must be pre-negotiated and pre-approved; if you are being looked after in-province, there is no question.

    Aside from receiving a guaranteed 100%, the other huge benefit to doctors is that their paperwork (billing) takes an average of 45 MINUTES PER WEEK!

    Once one achieves the venerable age of 65, drug benefits kick in as well. The province provides a schedule of all covered medications. There is a $100. PER YEAR deductible for each patient. You can go into any pharmacy in Ontario and the pharmacist will call up your account on his computer and instantly know what to charge. (The dispensing fee is not covered, so after the $100 deductible, most prescriptions cost the $6-$11 dispensing fee, depending on the pharmacy you choose).

    I see in the NYT this a.m. that the hospital industry has stated it will refuse to cooperate if they don’t get a deal they like. I find this confusing, to say the least. If the government decides to go to single-payer, exactly who will the hospitals have as customers if they refuse to cooperate? It seems to me like a very big tail madly wagging a toothless dog!

  20. Obama Is Taking an Active Role in Talks on Health Care Plan
    8/13 – NYT
    WASHINGTON — In pursuing his proposed overhaul of the health care system, President Obama has consistently presented himself as aloof from the legislative fray, merely offering broad principles. Prominent among them is the creation of a strong, government-run insurance plan to compete with private insurers and press for lower costs.

    Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.

    http://www.nytimes.com/2009/08/13/health/policy/13health.html?_r=1&hp

    • cold-eyed realism? Translation: cutting deals and giving away the farm to put a legislative feather in his cap, in secret talks that do not consider US at all.

      We the People have yet to be considered a “stakeholder”.

  21. WMCB: Great article! I feel your pain. As an RN in an out-patient clinic, I have had to jump through the many hoops to obtain pre-authorization for a medication that the pt. has been on for YEARS, But, alas, their drug carrier has changed, so the process begins once again. Some companies are faster than others, but I had an experience about 3 weeks ago, where they kept changing WHAT FRIGGIN form was required. It took me 3 WEEKS of faxing a form, not hearing anything, nor did they send me the required form, despite the pt being involved and a 3-way phone call. I saved the faxes and the confirmation that they had gone through, so when they sent us a 3rd form, I sent copies of previous faxes, in addition, to the new form. This was for a generic medication, bupropion, that the pt had been on for 7 freakin YEARS! This problem is becoming greater and I only see it getting worse. It is totally designed to make providers jump through many hoops and give up. Luckily, my docs have RNs to do this. UGH!

    I work for a large HMO in Northern CA that has treatement and disease protoccols, so our docs aren’t faced with as much paperwork as private providers, but they still have to deal with red tape. No wonder so many MDs want to work for this company. Less hassle than private practice; at least in some areas. They are totally overbooked and overworked. 😦

    Congratulations on being a front pager!

    • Ugh. Seriously? They have RNs doing that? Because I’m sure that’s why so many people go into nursing- to do the paperwork rather than engage in direct patient care. Grr…

      • Yep, we do it, so they don’t have to do it. After doing a few, they are less time consuming. One carrier was even simpler, check the box, if the pt has been on the medication before. That one was a piece of cake.

        As far as the MDs, it is amazing how many disability and other forms that they have to fill out. For some reason the psychiatrists are left to do their own, whereas the other medical specialities have the business office to complete the forms. It is totally crazy making.

    • Oh, yeah, you know what it’s like. I’ve played that multi-day “We never got the request.” “But I faxed it four times already!” game a lot.

      I also just love it when the patient calls them all irate, and they try to dump it back on the provider. “We asked for more info in order to approve this, but your doctor never sent it.”

      • I hear you. I get so tired of hearing “we did not receive it.” Luckily, this doesn’t happen everyday, but it is occuring more often.

        When the pt is irate, I ask them to call and tell the insurance carrier that it has been faxed 3 times already. GRRR! And then, I have to send a DIFFERENT form.

    • I train students in medical office administration. Mainly they are women who are trying to leave retail, waitressing, and welfare for more stable jobs with better hours. But I get heartsick because I know what they are in for when they get out in the field. It is a convoluted mess.

  22. “Translation: cutting deals and giving away the farm to put a legislative feather in his cap, in secret talks that do not consider US at all.”

    That’s pretty much what Max Baucus told the head of the CA Nurses Assoc. when she went to his office to discuss single payer. According to her, Baucus said: “Obama needs a win.” She was appalled that Baucus et al didn’t much seem to care what people really needed so long as it was viewed as a political victory for Obama.

    • Well, if that doesn’t make her jaded and pessimistic, I don’t know what would. That’s awful!

      • I’d love to see some people at these townhalls with signs that have a big arrow pointing down, and simply have one word:

        —-> STAKEHOLDER

    • Rose De Moro, head of CNA (California Nurses Association) recently penned an article about the health care plan and even though she gave Obama praise on many fronts, she said that he lacked the “political courage” needed for the promotion of a single payer system.

      Obama wants a win, even if the plan stinks and is a giveaway to the insurance and drug companies.

      • Political Courage (Come on Obama, you can do it, there are no excuses left!)

        • Good clip. It says it all, but no one in congress and the POTUS has the political courage to stand up and say “No more” the insurance and drug companies.

          We need term limits and campaign finance reform. Yeah, like that is going to ever happen, but it would certainly help to weed out a lot of the corruption and back room deals. Where is the transparency that Obama promised? His motto should be : Believe what I say, not what I do. Sleazbag.

          • A good example is Joe Biden 26 + years in the Senate and HE IS GOING TO WORK ON HEALTH CARE??? Yea, WHAT TOOK HIM SOOOOOOOOOOOOOOOOOOOOOOOOOO Long!

  23. Woo hoo WMCB is in the house!! You must be aware that I am a Big Fan of your ever-insightful & uncompromising comments, so I am thrilled that you will be posting here. TC just gets better & better–so many great minds at work.

    My father has been an internist for 56 YEARS!?! My mother, like you, is a retired R.N. Many of his colleagues have retired from bureaucratic frustration due to what you outline above. He is truly devoted & still practicing, though he works 7 days a week & still worries about being paid a decent wage after taxes. That is another myth: people think all doctors are rich. Not primary care physicians or internists ( or some others I’m sure), & it depends on the populations you treAT. Most of dad’s patients are low-income and/or Medicare folks. Small hospitals struggling to survive is another good topic. I am going to pass this on to him–he’ll love it, & I look forward to more of your insider p.o.v. posts.

  24. WMCB, great post. After reading this, I’m beginning to trhink that it may be simpler to work in an inner city hospital where noone is going to pay you, so there’s no worries about forms.

  25. Great post wmcb, and very well written-it made everything clear to me.

  26. You are a very talented writer. Thank you.

  27. Congratulations on your first post, wmcb!!

    An excellent job. 🙂

  28. Oh, how I love getting the “inside” scoop. Great post.What took ya so long!!!

  29. Article at Huffington Post: “Internal Memo Confirms Big Giveaways in White House Deal with Big Pharma”

    Things that make you go Hmmmmmmmm

  30. WMCB: I have been waiting for your debut. You are great and have a gift for making things understandable. Sharing your knowledge with us is a real bravo.

  31. I am so happy you are writing as a front-pager, WMCB!!

  32. WMCB, I just saw this post! terrific! Thank you for writing it!

  33. WMCB, I have followed and greatly enjoyed your informative and entertaining comments since the days of TM, and could not be more pleased that you’ve become a front-pager here.

    Congrats on your first post, and I look forward to many, many more!!

  34. WMCB,

    I didn’t have time to comment yesterday, but wanted to come back this morning to tell you how much I appreciated and enjoyed your post. I always look forward to reading your comments, and am thrilled to see you posting.

    Based on personal experience, it now seems more difficult to get anything covered by insurance. In the middle of an unbelievable conversation with a customer service representative over why certain tests and procedures hadn’t been covered, I decided to be blunt and tell her that although I had worked in the insurance industry for over 10 years and had a professional designation in employee benefits, I couldn’t understand what she was telling me. In the end, after numerous conversations with the doctor’s office, the insurance company and a patient advocate, the insurance company ended up covering more.

    After that experience, I believe that at least some insurers are trying to take advantage of those who won’t bother to go any further after hearing that the coded procedure isn’t covered (never mind that perhaps all that needs to be done is change the code). The insurance representative I spoke with wasn’t truly helpful until she got a sense that the issue was going to pushed further.

    Insurance reform is necessary, but I fear the current proposal could prove to be disaster in the making. The implementation stage tends to be the failing of most reforms, and by rushing this thing through, I fear we’re setting ourselves up for a number of unintended negative consequences. They haven’t even taken the time to read it, never mind putting it up for the type of debate and feedback that’s necessary for such a large overhaul.

    • Sam, I don’t trust the govt a lot more than I trust the insurance companies, and I sure as heck don’t want them in bed together, screwing us over in unison – which is what Obama wants to do.

      I’m working on parts 2 and 3 to this, and plan to address what course IMO will give US, the people, the most leverage in controlling our healthcare.

      • At times it seems that rather than regulating business to protect the people (and ensure a fair and efficient market), the government is now helping the corporate world steal us blind.

  35. Wmcb, you need to circulate this post–to anyone willing to listen. You and your husband are on the front lines with knowledge that most don’t know or appreciate, certainly our politicians, who are glib at best and liars at worst.

    Just from the peanut gallery, my husband as Type II diabetes. I was absolutely appalled by Obama’s comments about frivilous surgical expenditures. Cut me a frigging break! My husband is on medication, tries to keep his diet in check but knows his condition could lead to serious complications. The idea that his doctor or a accompanying surgeon is waiting with baited breath to amputate his leg is beyond the pale.

    Btw, I had my tonsils removed as a kid because of chronic strep throat. Once those tonsils were removed, the strep magically disappeared.

    Hello?

    This need to find a boogie man is completely insane and makes me very suspect. Are there bad doctors out there? I’m sure there are. Fortunately, I haven’t run across any. And like any profession, I think they [the truly bad doctors] are the exception, not the norm.

    So, please. Run this article on other sites. Because we need reports from the front lines, not the nonsense and peculiar anecdotes that’s posing as the “be all.”

    I am so sick of the misdirection and finger-pointing.

    Give us the story. The good, the bad and the depressingly ugly. Give it to anyone willing to read and think.

    You’ll be doing a great service.

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