• Best in the world, my a** – ctd.

    Sometimes I lack the words. From the NYT:

    Two nights a year, Tennessee holds a health care lottery of sorts, giving the medically desperate a chance to get help.

    Yes, a lottery. That’s how the truly needy can hope to get care in the richest country in the world. More details:

    State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight — the line shuts down after 2,500 calls, typically within an hour — and the demand is so high that it is difficult to get through…

    “It’s like the Oklahoma land rush for an hour,” said Russell Overby, a lawyer with the Legal Aid Society in Nashville. “We encourage people to use multiple phones and to dial and dial and dial.”

    The phone line opened at 6 p.m. on Thursday for the first time in six months. At 5:58, Ida Gordon of Nashville picked up her cordless phone and started dialing. Ms. Gordon, 63, had qualified for TennCare until her grandson, who had been in her custody, graduated from high school last spring. Now she is uninsured, with crippling arthritis and a few recent trips to the emergency room haunting her.

    “I don’t ask for that much,” Ms. Gordon said as she got her first busy signal, hanging up and fruitlessly trying again, and then again. “I just want some insurance.”

    Sometimes I can get snarky when I talk about health care in the US. But I try – really hard – not to get emotional. This article made that difficult. Is this really a health care system which we can be proud of? Seriously?

    “At the end of the day, huge numbers of desperately ill people are being left out in the cold,” said Gordon Bonnyman, the executive director of the Tennessee Justice Center, an advocacy group for families in need that focuses on access to health care. “And that is a story in every state.”

    Kelly Gunderson, a TennCare spokeswoman, said that the spend-down program had enough money to cover 3,500 people, but that only about 1,000 were enrolled at any given time because the screening process was so complicated. The screeners, she said, must examine medical bills and records, among other duties.

    About 500 people are found to be eligible for the program each time the state opens the phone line. The line has opened six times since the program started in 2010.

    Technical glitches can thwart callers’ chances. According to the Tennessee Department of Human Services, which operates the phone line, callers did not start getting through until 6:38 p.m., and 2,500 calls, the maximum, had been received by 7:23. The department is investigating what caused the glitch, a spokeswoman said.

    It’s not enough that we force struggling people with significant health care needs to sit by a phone and push redial over and over like they’re trying to buy concert tickets. It’s not enough that they know most of them will fail. We can’t even make the phone lines work for them.

    In her small brick home on the city’s north side, Ms. Gordon also heard the recording that enrollment was closed. But she, too, persisted, never looking up from the phone in her hand. Dusk fell and the room grew dark; she was too focused to bother turning on a light.

    She had called about 50 times when, at 6:40, she got through. The woman on the other end of the line asked for Ms. Gordon’s name, birth date, Social Security number, telephone number and address. Ms. Gordon wrote down a confirmation number, thanked her and hung up. The application, she was told, should arrive in a few weeks.

    “I still don’t know if I’m getting in,” she warned her husband, Arthur. “If it’s meant to be, it’s meant to be.”

    If she is rejected for the spend-down program, Ms. Gordon said she would wait until next year, when President Obama’s health care law is supposed to make insurance more accessible to millions of low- and middle-income Americans.

    Keep your fingers crossed, Ms. Gordon. There are plenty of people who are trying to stop that from happening.

    Best in the world, my a**.


    • But someone from Canada once came to the US for hip surgery, so all that other stuff doesn’t count.

      [/depressed sarcasm]

    • “I just want some insurance.”

      How can we call health insurance “insurance”. Its not insurance. Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss (Wikipedia). But, we can all be very certain that we are going to get sick and one day die. Therefore there is no uncertainty and we shouldn’t call health insurance “insurance”.

      Instead, health insurance is a social contract between generations. Renaming health insurance as something more noble and patriotic could help change people’s perceptions, and just maybe we wont have to raffle off care like Tennessee.

    • There are cracks in every country that make all of us want to cry. We need to fix our cracks, but what we don’t need is to make those cracks into giant holes. We don’t need emotional outbursts as the centerpiece of healthcare reform.

      I like Canada and have no wish to condemn their system based upon their cracks. Here are some tear jerkers from Canada.

      “A short course in Brain surgery”

      If you think I or anyone else is being unfair to Canada I refer anyone to the Supreme Court of Canada in the case Chaoulli v. Quebec where the court found against Quebec in favor of the individual. The Supreme Court Justice said:

      “This virtual monopoly, on the evidence, results in delays in treatment that adversely affect the citizen’s security of the person. Where a law adversely affects life, liberty or security of the person, it must conform to the principles of fundamental justice. This law, in our view, fails to do so.”

      We can take every country and tear it apart. What we need to do is focus on the facts with open discussion.

      • The problem in getting delayed fro treatment is infinitely different than not getting treatment at all. The delay will never affect rich people; they can always pay for treatment anywhere they want (see Saudia Arabian monarchs coming to- gasp- Cleveland for heart treatment). For the rest of us, the question is will we get treatment at all? The richest country in the world shouldn’t have to even think about answering that question for its people. The answer is yes.

        • @Elboku: “The problem in getting delayed fro treatment is infinitely different than not getting treatment at all. The delay will never affect rich people”

          That statement would suggest that you would be happy if only the rich people were delayed like other people. Delaying the rich doesn’t solve the problem for those in need so why not make your argument based upon what would help those that need help?

          Remember, in both the most socialized western healthcare systems and the most despotic countries where there is minimal health care the rich always seem to be able to find the care they are looking for though they face the time delays of travel. The Canadian healthcare law didn’t significantly affect the rich (“a law adversely affects life, liberty or security of the person”) rather it adversely affected those that were most poor and had a lesser effect as one climbed the income ladder. That is one of the problems with your logic.

          Who says the poor don’t get treatment? We have safety nets and ERISA and people can spend their own funds on their own care. There is also charity. The problem is that 8 million Americans truly fall through the cracks. Maybe you think that number is greater and I’ll accept any reasonable number. I think that is the group that needs to be targeted. Remember two other things. Many of the uninsured don’t need healthcare that costs more than they are able to pay and many don’t need to be completely subsidized as a partial subsidy would do.

          • “Are there no prisons?”

            “Plenty of prisons…”

            “And the Union workhouses.” demanded Scrooge. “Are they still in operation?”

            “Both very busy, sir…””Those who are badly off must go there.”

            “Many can’t go there; and many would rather die.”

            “If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

          • And if the workhouse are full or the soup kitchens are empty, then those 8 million should just get on with dying, and decrease the surplus population.

            -Ebenezer Scrooge, libertarian extraordinare.

            • The above mimics the progressive line (not the libertarian or classical liberal line) of the early of the early 20th century.

    • Just a question–
      How much more of your income are you willing to give in taxes to make sure everyone is covered?
      And speaking of coverage, how much? What co-pays are fair?
      And after you think you know how much all US citizens need to pay in extra taxes, will it be enough?

    • So the point of this post is actually something that I think everyone who reads the blog agrees with. That said, I think the way it is presented is not at all constructive–i.e., as the commenter above said, this is yet another tearjerker anecdote.

      If proponents of reforms pull out these kinds of stories, then opponents will be justified in pulling out stories like that of hip surgery in Canada, the Liverpool protocol in the UK, etc. and frankly, the discussion becomes more like an Oprah episode rather than an evidence-based conversation.

      Overall, posts like the series on health care in America that Aaron did are much more effective and informative than this sort of tirade (justified or not).

      • I’ll disagree a bit. It’s a little more than an anecdote. It’s how the system works to try and get care for those who don’t have it in a state. It’s a description of how policy works in Tennessee.

        • Remember the lottery in Nova Scotia where those that won were provided a primary care doctor that they lacked. That I believe was another crack rather than a hole, but akin to the New York Times posting. Neither bits of information are appropriate for making health care policy.

          With regard to Tennessee, take a look at the history of TennCare.

          • Actually, I do remember. It was a “lottery” held to assign people primary care doctors in an area that was reported to have too few primary care physicians. Of course, all of those people could still get health care in EDs or urgent care centers because that’s what happens in Canada.

            Oh, and although people love to cite this anecdote as an example, they never follow up on the fact that when the lottery actually happened, there were less than 1500 applicants for – wait for it – 1500 slots. http://www.cbc.ca/news/canada/nova-scotia/story/2006/03/16/ns-lottery-doc20060316.html

            And now, that doctor shortage seems to have been fixed: http://thechronicleherald.ca/novascotia/94522-no-doctor-shortage-report-finds

            Sure, just like what’s going on in Tennessee.

            • That 1,500 left another 6,500 without a doctor. In 2007 it was reported that 1.5 million Ontarian’s (12% of Ontario’s population) couldn’t find family physicians [City Journal]. The Canadian Broadcasting Company can say whatever they wish. There are many in Canada that cannot find a family physician and that is the entry passage into the healthcare system. When they do find a physician some find the waits to be inhumane and so did the Canadian Supreme Court “This virtual monopoly, on the evidence, results in delays in treatment that adversely affect the citizen’s security of the person. Where a law adversely affects life, liberty or security of the person, it must conform to the principles of fundamental justice. This law, in our view, fails to do so.”.

              Your second citation that leads you to say “doctor shortage seems to have been fixed” does not leave Canadians with an adequate number of family physicians. The article states: “the province needs more family doctors in rural areas” and this is where “our ratio of doctors to population is among the highest in Canada”

              We can take every country and tear it apart. What we need to do is focus on the facts with open discussion”

              All of this is in answer to the tear jerking stories that are so frequently written to demonstrate how bad the US is and how good other countries are until one looks at the other countries with the same viewing glass. As I said before: “We can take every country and tear it apart. What we need to do is focus on the facts with open discussion.”

            • I have spent far too many hours arguing with facts and data in the “open discussion” you claim to crave, all of which you ignore, for this to continue. This is not a “tear jerker” anecdote. It’s the way Tennessee is operating at the moment.

              You claim there are far too few family physicians in Canada, except for the fact that there are fewer here. You claim that you can “tear any country apart”, and I’m sure you can, but it’s only by ignoring the fact that we perform worse in almost every area. You claim that it’s having a family physician that gets you into the health care system, but it’s in this country that people forego care because of cost.

              Oh, and fewer patients in the US actually ever develop a relationship with their physician, since in pretty much every other country, more people are able to keep a primary care physician for five years or more.

              But what’s the point? It’s no use arguing with you, and I’m done.

            • At any rate, the presence of a lottery is really only one objectionable issue with the TennCare situation, which,was also reported on here (http://www.timesfreepress.com/news/2012/sep/16/only-the-lucky-win-at-tenncare-lottery/) the last time the phone lines were open. The main issue, highlighted in both the NYT and Time Free Press articles, is the absolutely insane decision to limit applications to a one-hour hotline every 6 months. There really is just no reasonable way to justify this in an era when all manner of similar processes like tax returns, investment management, job applications, even insurance claims processing can be handled completely online or via downloaded form. Heck, in 5 minutes of googling, it appears you can even apply to the an equivalent OK medicaid program online (http://www.okhca.org/individuals.aspx?id=11698&menu=40&parts=7453x).

              I have no issue with open enrollment periods in general, but limiting access to even the application outside of the enrollment period is just crazy. It’s somewhat confusing since I can’t imagine TennCare is that different overall from other state medicaid waiver programs that manage to avoid absurd situations like this, but I honestly don’t know enough about the specifics of the various state programs to comment further on it.

              If Tenncare were simply holding a standard lottery that involved selecting names from a list that entered into the lottery by X date, a la NS, that may be eyebrow-raising and cause for complaint, but I could at least see that as defensible as opposed to the current system.

    • State residents who have high medical bills but would not normally qualify for Medicaid,

      Why are they not qualified for Medicaid?

      • Because in pretty much every state in the nation, if you don’t have children, you don’t qualify for Medicaid – no matter how poor you are.

    • I see a commentator above wringing his hands and asking in pleading tones, “But how will we pay for all these good intentions? Not more taxes!”

      Here’s a suggestion, my friend. Let’s begin with the fact that health care costs in the US are twice as much per capita than the average in other developed countries, yet all this spending produces no signifcantly better health outcomes. Until we face up to the fact that our fragmented, inefficient, profit-maximinzing, market based health care system is virtually designed to be too expensive and make the appropriate changes, we will be living in a world of crisis of our design.

      • Here’s $396 billion: Cancel the F-35 program.

        Here’s $30.2 billion: Cancel the Navy’s littoral combat ship program.

        Here’s $42 billion: Follow John McCain’s advice and cancel the Navy’s plan for a new class of aircraft carrier.

    • Reading through some of the comments… The style of the blog is perfect. We need very smart people to FIRST identify the problem on the ground and then bring their intelligence to bear on the problem.

      Still waiting for the person in dire circumstances trying to access healthcare to tell me how wonderful our system is, and we just have to “fix the cracks.” They ain’t cracks. They’re craters.

      On the other hand, I have seen some hardcore anti-Obamacare people jump ship. One family member went to the emergency room (not admitted!) and came out with a $14,000 bill, $7,000 of which is on him. His head is turned. The online marketplaces can’t come soon enough for him. Heard it with my own ears.

      No more waiting. Obamacare is a start.

    • Perhaps instead of playing oneupmanship and trying to defeat the arguments of other posters, we should consider reliable statistics. See http://www.californiahealthline.org/articles/2013/1/10/us-ranks-below-other-nations-for-many-health-indicators-report-finds.aspx for an example. If you don’t like this site…just google US standing among western countries and pick the one you like best..

      Since we currently spend more per capita on healthcare and rank 17th in the world on a variety of health care statistics…what would you suggest that we do?

    • The Wall Street Journal had an article on Tennessee’s healthcare system a good number of years ago and said that program nearly bankrupted the state so it had to be scaled down which is one of the causes of the problems seen above. That is precisely what many worry about with the PPACA. It too can bankrupt a nation with its lack of controls, preventative care, lack of sufficient deductibles, etc. Presently we are seeing countries in Europe on the verge of bankruptcy for not carefully managing their financial affairs. Alternatively, since we all know that the US will not go bankrupt, it could tighten up utilization review making survival for expensive chronic diseases less likely.