My friend’s surgery yesterday was elective. Like most other elective surgery, it was a long and winding path between first recognition that there’s a problem and a few minutes under the knife. If he had pushed harder, he’d been cut a month ago. If he dawdled a bit more, he might have been under anesthesia around Halloween. This is classic human behavior – very few of us run immediately to the office of a surgeon and demand him to cut at the first sign of an ailment.
Yet, to hear the Obamacare deniers tell it, if gramps can’t have his hip replacement the moment that he decides that the endpoint of a seventy year degenerative process has arrived, it’s like we’re shipping him to Auschwitz. I know a few people who’ve had major joint replacement, and it was an agonizing, long and unpleasant path to the operating table as they grew to accept that, yes, they will indeed need to be flayed open and have metal hammered into their bones. To expect that you’ll be booked into an OR as quickly as you could be booked into a hotel is a pretty crazy expectation, but that’s the reason the working poor should be denied insurance, according to Ted Cruz.
It’s hard to think of a major public benefit that hasn’t in the long run made this country stronger.
Wrong. The poor should be denied insurance because they are shiftless, lazy moochers who don’t pray enough. If they weren’t so lacking in morals, they wouldn’t be poor. Immoral takers don’t deserve insurance.
Anybody who thinks you can get immediate specialty care at the drop of a hat NOW needs to try to get an appointment with a neurosurgeon.
As things have been under our traditional health care policy, unless you’ve been brought to the er in an ambulance you are pretty much going to wait for surgery. Even in serious cases unless it looks like you will be dead tomorrow you will wait, in part because of the might be dead tomorrow cases that have to be inserted into the surgeons’ schedules. This should not surprise anyone. It should not surprise Mr. Cruz unless he’s never troubled to discover what the simple folk do.
I suspect that this is just one more iteration of “if other people can have what I have, how can I tell I’m rich”.
i have crappy insurance right now, for which I pay a fortune, for which I don’t want to use because I’m too scared that I’ll be dropped if I break a leg or something where I’ll really need it. Anyhow, we got a call from our insurance guy. I was going to post this on one of Richard Mayhew’s posts. The insurance guy was really pushing us to switch to another plan to “lock in” the rate before next year because he doesn’t know where the rates are going to go next year with the current plan. I mean being really really pushy. I didn’t tell him I had every intention of going o the exchange. I pretended to be a rube and he said you wouldn’t be able to get a tax credit if you didn’t go into the exchange which didn’t make sense to me. He also was doing his best not to make some out and out negative comments about Obamacare and I was holding my tongue because I really wanted to tell him that if they had tried to make things work, Obamacare wouldn’t have happened.
When I had a lump behind my ear that was, shall we say, suspicious, I was referred to a specialist for more tests. I had to wait two months before I could get in to see the otolaryngologist. Once the tests were done (fine needle aspiration, CT scan, etc.) and interpreted, the otolaryngologist determined that I needed surgery. I waited about another 3-4 weeks for that. I’m not complaining, and I got very good care, but it wasn’t like I got it all in the same week.
The most telling comment I saw, in the run up to Obamacare, was from a woman exclaiming in horror that, In Canada, everybody has to wait in the same line, no matter who they are!
I think that’s the core of it. I’m better than Those People, dammit! I should get better care!
I just had ear surgery and I scheduled it way back in March. I waited because my insurance deductible starts over Sept. 1. I am planning on doing every possible procedure/test I may ever need in the next twelve months because my surgery took up my whole deductible and now it is just co-pays for me. And I hate hate United Insurance.
Hey, another ear person! I just had cysts taken out of my left ear. Thankfully my doctor is excellent and I think he fixed everything in one shot.
My daughter is a surgical ICU nurse. She has a patient every single night, some of whom do not make it through the night. There are many immediately necessary surgeries and elective ones will always be delayed. She used to be a neuro ICU nurse and has mentioned how difficult it is to prioritize surgeries for victims of motorcyle accidents. Finding blocks of time for elective surgery (also think nose jobs as opposed to skin grafts for burn victims) is a lower priority for most surgeons. That is why certain Canadians with money come to the US for elective surgery.
And Gramps is under Medicare, not the ACA.
The time I got rapid scheduling, as in 10 days after diagnosis was confirmed, surgery? It wasn’t good. That only happens when the alternative is for your estate to have a case against your health plan, which was what happened to my dad.
The time I got same-day surgery was in the ER, and according to the pulse oxygen and BP machines they use to track vitals, I was technically dead when the residents started cutting.
Who ARE these morons who’ve apparently had no contact with health care as we know it, being fooled by the claim that bureaucrats are going to stop you from getting your surgery in time? Do they live on the prairie in a sod house?
Plus I don’t think it’s even true. I know it is not true for parts of Europe. Everybody is covered by government healthcare. But people also have the option of private health insurance with private doctors which has the effect of bypassing the lines. Heck, even the evil socialist Sweden has this.
The most idiotic thing about this debate about ACA is that tons of working folks are against it eventhough they are clueless of what it is. Don’t they realize that they could just be a layoff away from not having insurance at all? The stupidity is mind-boggling. It reminds me of the fact less debate of the wisdom of attacking Iraq in 2003.
@Patrick: no, it’s not true. We come closer than most. There used to be a phenomenon called “extra billing”, which basically let doctors charge a premium above OHIP to their patients, but it was ruled illegal.
Nevertheless, if the star centre forward of the Toronto maple Leafs has a booboo, he doesn’t exactly have to wait in line to see a doctor.
Davis X. Machina
It’s team spirit. You can get buried in this. Why would adherents of the GOP be different?
The right’s underlying argument about Obamacare is ideological, not factual; it’s about fundamental social values, not about objective analysis of affordability, availability, or cost-effectiveness. They regard their ideological assumptions as incontrovertible fundamental bedrock for evaluation of issues, and progressive counter-arguments of fact as merely seductively tempting constructs like perpetual motion machines that inescapably will prove unsound and unworkable.
That’s why the right is impenetrable to any amount of nonpartisan, objective Congressional Budget Office studies, or pointers to all the other western countries who have established, workable universal health care coverage, or any other kind of objective factual proof or argument for the feasibility of any true universal health care coverage reform. Facts contradicting their ideology are invalid, and straws which seem consistent are spun and treated as gold, even when it’s plain to anyone not in thrall of hard-core conservative ideolgoy that it’s merely bright yellow straw held together by nothing but pure shit.
They don’t even have to be laid off. Businesses are dropping health coverage right and left, and who can blame them? Health care should be seen as a public service like fire departments. I so wish that ACA had a public option, or better yet, was single payer, but it is a big step forward.
Davis X. Machina
@cmorenc: You can’t refute a theology.
Bill in Section 147
@dp: Ridiculous. Everyone who has a vote on whether or not to repeal ObamaCare can pretty much get surgery on demand. Even regular guys like the recently retired Dick Cheney can pretty much just call the doc and get a new heart when they need it.
Five years ago, my dad’s doctor found a mass on his kidney the size of an apple. It took 8 weeks for him to get surgery, they had to take the kidney. And this was a combination of Medicare & an Aetna supplement.
When people whine that the ACA will mean that they’ll have to wait for treatments, I just shake my head. They are so obviously not in touch with medical reality.
Editing to add: the mass found was fast-growing, dad has leukemia & regularly sees the doc for scans & tests; it hadn’t been there at all 3 months prior. And still, an 8 week wait.
Davis X. Machina
@cckids: How much of a difference would a public option have made, anyways?
The public option was nothing more, or less, than a requirement in the legislation that at least one of the insurance companies offering products on the exchange not be a traditional health-insurance corporation, but the state, or federal, government. (Depending on when in the sausage process you’re talking about.
There’s no guarantee it would have been cheaper, or better than the other products on offer, just the presumption — accurate in the analogous case of tuition loans — that they would be cheaper and/or better. But that would have depended on the regulations all the carriers making offerings ware under.
Buying into Medicare was the way the public option was made available in only one of the bills.
It wouldn’t have covered anyone already covered by employer-provided care, Medicare, TriCare, Medicaid or any of the existing large-scale systems of insurance and/or care provision.
By the time push came to shove in Congress, the public option was, mostly, a shibboleth.
Canada keeps waiting time statistics, but the US does not. Therefore, our waiting times must be less because FREEDOM!
A few years ago I felt crappy for 24 hours, then I developed a tiny pain in my right lower belly. I went to the ER, pointed at my appendix and told them that it hurt. I just had to wait for the surgeon to finish his previous case.
@Davis X. Machina: I guess I was thinking it would help the people who are in the donut hole at present – make too much for Medicaid (especially in the states with the moron govs), but buying insurance on the market will be tough for them. I was under the impression that the PO would help them out.
One of my favorite memes during the ACA debates was about wait times for hip surgery. The right loved the statistic showing that wait times in the US were much shorter than in the Uk or Canada. The advantages of our system, they claimed.
What they failed to point out is that almost all hip replacement surgery in the US is covered by Medicare. Government insurance.
No, he had to wait. Transplant lines are designed to be un-jumpable; this was a rare instance where Cheney could not get what he wanted.
I find hope in that.
To my knowledge, the public option was nothing more than an insurance company run by the government rather than a private entity. How good it would have been would have depended on what restrictions would have been placed on it in the legislation.
I am not sure if this was already covered but it looks like Cruz used a Rudgers University student’s experience to slam Obama, and it backfired on him big.
Ted Cruz’s anti-‘Obamacare’ poster child likes the health care law
@dr. luba: Yes, my aunt just got one last week; she waited until she qualified for Medicare, even though she has insurance.
The hospital screwed up her chart the night of surgery & gave her an overdose of morphine; her heart stopped for 3 minutes, they had to do chest compressions. So now, in addition to the hip, she has a cracked rib. And couldn’t have pain meds for 24 hours.
But we have the BEST health care in the world. F*ck yeah.
@Baud: Ah. So, it would have depended on your state govt.? Probably hit & miss, then.
One of the things that happens when people tell horror stories of long waits (not always applicable, but certainly sometimes) is that they don’t understand best medical practice. A little over a year ago when I went to my doctor for constipation, he prescribed a regimen of treatment. When that didn’t work after two weeks, he referred me to a gastroenterologist, and it took three weeks to get in to see him. When his course of treatment didn’t work after ten days, he sent me for a CAT scan, saw the results, immediately made an appointment with a gynecological oncologist who saw me five days later (a weekend in between) who scheduled surgery the next day. THAT is the proper progression. Not, OMG it’s cancer and my GP should have known that and I should have had surgery eight weeks prior. As long as they seem appropriate, you try the least invasive, simplest treatments first and only progress toward more radical treatments when those simpler steps fail. That isn’t “waiting”; that’s medicine.
Had the same arguments with a very wealthy and crazy friend who is all about lobbying for more money for mental health care (because she really is bipolar). She was dead against the ACA because “there won’t be enough doctors.” I pointed out this is a supply side issue which will be solved when increased demand enables more doctors to make a living in specialties like gp, primary care, and therapist. The market, in other words. No paying patients no increase in supply of doctors
But the argument was beyond stupid. It is easy to have shorter wait times when you intentionally have made the decision to not cover 80% of the population. Hell, if the UK had that luxury their wait times would be a hell of a lot shorter as well.
State or federal – depends on what’s in the law, if there were one. Also, even if federal, conservadems could insist on restrictions that make the PO less optimal than it could be.
Jim, Foolish Literalist
@Aimai: Doctors is Europe and the UK make less money than pre-school teachers and baguette bakers. True story.
Davis X. Machina
@cckids: It would give people in the donut hole — a co-creation of the Supreme Court and Republican state governments, by the way, and not the original legislation — a choice between a product from a private firm they can’t afford, and won’t be subsidized for, and a product provided for by the government that they can’t afford, and won’t be subsidized for.
Let’s not obscure where the real problem lies.
The Ancient Randonneur
Sounds to me like the only cure for this Obamacare malaise is vouchers. Look how well it works in education.
There is so much talk by economists, corporate providers and insurance and health providers about containing cost by controlling frivolous useage; what percentage of the population do these fucks think seek medical care for the fun of it ??
pseudonymous in nc
I’m pretty sure that sport has something to do with this: when nose tackle Calabash Bustlemunter gets the MRI results on his twisted knee before the end of the game and will have surgery tomorrow, the assumption is that You Too Can Have That In America for your achy elbow.
This kind of thing drives me completely around the bend. Is the concept of any change so frightening to this kind of person that they can’t conceive of it happening to ANYTHING else?
When the world has been utterly transformed by change in my own lifetime?
@Davis X. Machina:
Or, as a wise person once told me “You can’t use logic to persuade someone to abandon a position that logic didn’t lead them to in the first place.”
@Jim, Foolish Literalist: that’s a story, but it isn’t true. American GPs make 3.5 times the US average household income while German docs make a mere 3.2 times the average German household income. French and Japanese docs are quite a bit lower on the scale compared to their respective country ave. household income, but they get giant tax breaks compared to non-physicians. The Gini coefficient is much higher in the US too. The French, Canadian and British docs that I know do quite well. I compared salaries with a Welsh doc once. Both GPs, we made exactly the same income at the current exchange rate. It’s a nice myth, though, to explain away the discrepancy in costs. Dr. Uwe Reinhardt has explained it better.
pseudonymous in nc
Yeah, but that still has to deal with the stupid American resistance against seeing general practitioners, and the monetary incentives for becoming yet another bloody dermatologist.
A friend of a friend on Facebook, in responding to someone with a pre-existing genetic condition who couldn’t afford health insurance, neatly encapsulated the Tea Party attitude for me:
And of course got it wrong in all of his assumptions. But the overall position was clear: lazy moochers without sufficient foresight deserve to die miserable deaths.
Glad to hear it. In my case, I had a benign adenoma on the parotid gland, which extends to just behind the ear. No problems since it (the tumor) was removed.
My friend needed a hip replacement, and he had it scheduled, but his septic tank started leaking, so he spent the money on that instead. He saved up and got the hip replacement the next year. He could afford one or the other, and decided the pain was preferable to septic tank overflow.
How is a baby with a pre-existing supposed to get coverage when he/she is 18? Who before ACA can afford regular individual HI at 18 without employer subsidy? Does todays older white GOP voters, know that tea partiers like your friend want to abolish Medicare?
But to take the tea party logic at face value – if you want dumb wars against Iraq, work for it and fund it yourself you selfish b***ds.
Tea Party == Peasants For Feudalism, which the lords are happy to finance.
All excellent questions that are either ignored by Tea Partiers or never raised.
@Aimai: The “not enough doctors” thing drives me insane (as it has others, too.) Thirty Million People in Line to see My Doctor!
The young, healthy, and relatively poor people who will be getting coverage can’t even afford to take time off to see doctors anyhow, so what’s the problem? They aren’t going to be going unless they really need to, but now they can do so when it’s Important rather than an Emergency. Usually they won’t need to, but you can bet that someone wearing some store nametag is in line at a doctor’s office, they’re not happy to be shirking their fabulous job to get some “free” healthcare.
Obamacare: it won’t solve poverty, but it makes the lives of the poor better. That’s what drives some on the left crazier than some on the right. But it’s better than the old system.
@Hunter Gathers: That’s always been the strangest part of this debate: Republicans successfully selling the idea that Obamacare means delays in treatment – as opposed to the current state, where you’re either uninsured and can’t afford treatment at all, or your insurance company has the ability to delay treatment (or deny treatment completely) for various reasons (pre-existing condition, gatekeeper doctor doesn’t provide a specialist referral, etc.)
I remain flabbergasted that people who have ever needed health care (and weathered the resulting fights with their insurance provider) can’t see reality.
My sympathies if you’re having to talk with a neurosurgeon; I hope things turn out well. This has happened in my family: a craniotomy two days (if I remember correctly) after admittance in the ER.
In general, though, I don’t think access to immediate specialty care works as an idealized, best-case scenario. It often takes time to figure out what the problem is and how to address it. When immediate surgery is needed, that can mean that the patient is in a life-or-death situation and there’s little time for deliberation. Not a good time for anyone involved.
Does anyone have any facts to refute Michelle Malkin’s claim that she is losing her health insurance? Mark Steyn and Malkin have been going nuts over at NR telling how this “proves” Obama lied. I’d really like to see someone prove her wrong and stick up her worthless ass.
@Skippy-san: Since her private health insurer and private employer made a corporate decision to drop her coverage before Obamacare was enacted, I think the timing alone proves her to be a lying sack of crap.
Villago Delenda Est
It all boils down to a lack of empathy. The teahadists have a massive dearth of empathy, in spades.
“Yet, to hear the Obamacare deniers tell it, if gramps can’t have his hip replacement the moment that he decides that the endpoint of a seventy year degenerative process has arrived, it’s like we’re shipping him to Auschwitz.”
I use hip replacement waiting times as a test for ignorance; it’s major elective surgery, and so goes to the end of the line. I have gold-plated health coverage, and I waited seven months.
Yesterday somebody linked to a post by Digby, who received a similar letter but bothered to do a little investigation. She realized that, thanks to the exchanges, she will now be able to get a plan that has more coverage at (slightly) less cost. Needless to say, she’s very happy.
I suspect that part of the problem with people like Malkin is that they feel like they were able to play the system and get a deal, and now everyone’s going to be able to get the same (or a better) deal with a lot less effort and that’s not FAAAAAAIIIIIIRRRRRR!
@Davis X. Machina: The other thing about a public option is that it might work the way Medicaid does in my state. My daughter was covered by Medicaid through the SCHIP program for about a year. Only she was actually covered by another insurance company, because Medicaid in my state contracts out with four different insurers to actually provide the coverage. Medicaid just pays the bills.
Who are these republicans who can just waltz into their doctor’s offices? It has taken me four months to get into the gynecologist’s, and I have Blue Cross and Blue Shield. It was six months to get into the dermatologist’s. These people are liars.
@Lurking Canadian: I’m married to a Canadian. Though we live in the U.S. right now, we’ve watched several members of his family go through major health crises north of the border. We can’t see any significant way in which the care that they received was different than what husband and I have received here in the States, no matter how hard we squint. Except, of course, that payment for their care wasn’t tied to an employer’s generosity.
My in-laws encounter some good doctors and some mediocre ones. Sometimes they get right in for an appointment, sometimes they face delays. It all seems so astonishingly…normal. When I hear the Canadian system trotted out like the Osama bin Laden of health care – always evil all the time – I can’t take anything else the person says seriously. At all.
I’ve never known my in-laws to be denied care that they needed, by the way, even when they had to wait. I can’t say the same for myself – Blue Cross denied my doctor’s order for an MRI last year because “Fuck You and the trillion dollars your employer pays for this plan that you hardly ever use otherwise, that’s why.”
“Not enough doctors.” Another weird artifact of our allegedly efficient “free market” system of medicine: the number of medical school slots has increased at only about half the rate of the population since the ’70s.
I suffered advanced severe osteoarthrosis in my left hip which was percolating for a couple of years. However my private insurance company maintained that since I had had a history of back problems, though quite minor, this clearly classified as a pre-existing condition. Three months ago I made an appointment for the first day possible after my Medicare enrollment took effect on September 1st, with a surgeon 200 miles away who is highly recommended (I live in Montana) and at that appointment they asked if I could be ready for a total left hip replacement 9 days later. I burst into tears because by that time I was on opiates and using a cane and a walker to get around and the idea of potentially getting my life back and being pain free had been a mirage. I had the surgery on September 18th at a small surgical hospital in rural Idaho which specializes in elective procedures such as this and 11 days out am walking and planning to go back to work part time tomorrow. I do expect it will be another month or so before I will be back to anything close to normal, but if it were not for Medicare this would be a disaster for our family.
I was a Canadian citizen for 30 years and now that I am enrolled in Medicare with a very affordable supplemental policy, for the first time since I have lived in the United States I no longer worry about my future healthcare needs.
Frankly the Affordable Care Act should have been passed as Medicare for all – and I hope that as the years go by it will morph into something like Medicare. Years of being privately (and very expensively) insured taught me that the private insurance market is a total ripoff, and that both houses of Congress are bought and paid for by the insurance and pharmaceutical industries.
For now, I thank my lucky stars that Medicare was created when it was – with the current batch of morons in Congress we wouldn’t have a chance.