Blog For Iowa

As I wrote last week we have been deeply involved in the health care system as an elderly relative seems to be entering the latter stages of life. 

What a goddamned mess. It is so hard to believe that Americans have gone through such a totally discombobulated system without near riots. We were at that point during the 2008 presidential campaign when the combination of outrageous costs, pre-existing conditions, disjointed care, bankruptcies caused by health care bills led to the health care system being one of the top issues.

Ten years later and hundreds of thousands of hours of media blitz against Obamacare, attacks in courts and nibbling away at state levels we are almost back in the same situation once again. Now that our Dear Leader has a candidate for the SCOTUS who is known to be totally opposed to government involvement in healthcare, crashing not just Obamacare but other areas of healthcare as well. Think of chipping away at Medicare and Medicaid through the courts.

Add into that the “progress” the right has made over the years in chipping away at a woman’s right to choose since the 1973 decision of Roe v. Wade. Iowa now has the most restrictive abortion restrictions in the country on the books and going through the court system. There is a very good chance that Iowa’s bill may end up as the test case to overturn Roe.

Then just to add insult, the current administration announced last Saturday evening – the Saturday of a holiday weekend – that they would be cutting billions paid to insurers from other insurers to even out the risk costs. This is not “government” money. The Hill does a great job of explaining how this will scare insurers and probably drastically raise premiums:

The flurry of activity is the result of a surprise announcement Saturday by the administration that it had suspended $10.4 billion in funding that is supposed to be paid to insurers to help them provide coverage to particularly sick and costly enrollees.

Insurers denounced the move.

“This action will significantly increase 2019 premiums for millions of individuals and small-business owners and could result in far fewer health plan choices,” Scott Serota, CEO of the Blue Cross Blue Shield Association, said in a statement. “It will undermine Americans’ access to affordable coverage, particularly those who need medical care the most.”

With that as background we continue to try to do what is right for our elderly relative. This has involved 4 or 5 trips to the ER that are certainly costly not to mention hard on a body. It has also involved a change of nursing homes. Some of the care here has been, shall we say kindly, not up to snuff causing discomfort for the patient and some confrontational moments.

And at every stop along the path there is a little cop of sorts that hops out and screams “payment first!” Well that is hyperbole, but it feels like it. “How will you pay? How will you pay? Over and over.

We have the presentation of the insurance papers – one of those “privatized” Medicare policies that seems to put a scare into every one that sees it. Then after the various treatments have been administered here comes the insurance specter once again to hover over the process. The specter acts like a presence that constantly nags “get her out of the hospital. Don’t pay one penny extra! Coverage ends today at noon!” 

Once we went to visit in the hospital and found her just being loaded into a van for a trip back to the nursing home without any notification to us. Just this week we arrange a discharge plan for the next day only to be called on our way home to be told that insurance would not cover her after noon so she had already been transferred back to the nursing home. 

The patient has seemingly been tossed back and forth like a bag of beans. Then we got a call from the nursing home informing us that her status had been changed. This resulted in some additional charges and they needed some money up front – today.

Just think – our patient had done some planning and had insurances and plans. I shudder to think what a person who had one of the new crap policies that Iowa is selling now would do. Medicaid has changed drastically in this state. Branstad and Reynold’s privatization has dried up much of those funds and put it into the hands of businesses instead of providing patient care.

Along with having fewer funds available for Medicaid patients, the privatized Medicaid organizations have not been paying bills on time, paying at lower rates or denying claims after services have been rendered. Thus hospitals across the state have had to eat millions of dollars in costs that have not been reimbursed. All they can do is cut back on personnel and services. This can make a hospital stay traumatic at times.

In a previous life I helped design a flow chart of our business. The object of this exercise was to identify stopping points in our system that added costs and decreased service to the customer. Certainly the ideal flow would be from the manufacturing line to the customer with no stops except the loading and unloading of the transport truck. No warehousing, no moving it around between warehouses or inside warehouses or any other handling or processing that would add costs without adding benefits.

Applying this in our situation, the ideal would be to get the patient in a care system where the patients needs are the focal point of the system. When there is need to move the patient for extra care, all costs are covered and a plan is made and executed with input from the family. The patient’s health is always top concern. Thus moves, change of medications, health care personnel are all planned as best as is possible. The system should be set up so that money concerns are eliminated. There is simply a continuous alignment toward a good health end.

I am told this is how many countries have their single payer systems aligned. I understand this is the concept behind the team concept at the Mayo Clinic.

Instead our current system is similar to the Middle Ages where castles with moats and drawbridges are erected. Every time a patient must go to a different castle their must be a tribute paid. At the end of the visit, communications between castles may or may not happen. 

America has lots of very smart and talented people yet we let this non-system that seems to be set up for the benefit of the insurance companies just clunk along. The people who are in charge of making these changes seem to be captives of the insurance companies. 

Health care needs to be a top priority this election. If it isn’t it may be even more dismantled by 2020. Do you want to bet your life on it? Because that is already what is being done!

And if all that isn’t enough, Monday HHS is planning on deleting 20 years of critical medical guidelines. Don’t believe it? Read it and weep here. If we leave Republicans in charge expect bleeding as a medical procedure to make a comeback.