Health Care That Isn't

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I just returned from a trip to Lakewood Colo. to visit a niece who is seriously ill.

She has Kaiser Permanente health ins.....and no primary care doctor. It seems they dont have enough Dr.'s to provide Dr.'s for their patients. She sometimes is lucky enough to get a telephone call returned by one. That is her doctor's "visit".

Her medical care since having Kaiser through her employer has primarily been through ER visits. One ER referred her to a Kaiser Ear/Nose/Throat specialist months ago where she was given a wrong diagnosis. Her condition continued to worsen....and no dr.'s were available at Kaiser to follow or observe the worsening condition.

Finally, after nearly 6 months, an ER physician had her seen by a neurologist. An MRI was taken showing severe compression of nerves...the cause of her daily falls, weight loss, pain, and spreading numbness in all of her limbs..The Kaiser ENT specialist and records continue to maintain it's an unidentified ear infection that should have gone away on its own...many months ago.

MRI results were sent to Kaiser neurosurgeons....with no replies.

After losing her job, she lost her insurance. I commend her employer for keeping her on the payroll for months...and paying the ins. premiums. They no longer can do that. It's a small business. Her insurance will now expire before she can get the proper diagnosis addressed. Months of delays because no Dr.'s were available in the Kaiser system. to follow the worsening results of treatment.

She'll be in a wheel, chair, finally qualify for Medicaid after getting Soc. Security Disability, and be treated. Some damage will remain.

My advice. If you live in Lakewood Colo., don't sign up for Kaiser. After your intake physical...you're on your own even if you send them your monthly premiums

The supposedly best health care system in the world...STINKS and Kaiser sells what it can't provide.

Not much different than another health care system I'm familiar with who pays their Dr.s bonuses not to test. A friend died of FIVE treatable diseases that were never uncovered until it was too late. They were uncovered when he was placed in a state-run health care system...MediCal in Calif.

ObamaCare is a sham that doesn't really address any of the core problems, isn't it?.

As for Kaiser, I'd like to see their corporate charter shredded and the firm disolved. Just like the rest of our health care system, it's a sham and a scam. A scam that can not only take your money, but also your life..

If you have medicare, and have Kaiser....you can switch to another provider (who may not be much better) in November.

Retired Monk - "Ideology is a disease"

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polycarp2
Joined:
Jul. 31, 2007 4:01 pm

Comments

Our 'system' has engulfed the corporatization of health care wholeheartedly--and Obamacare is just endorsing that for more corporate profit-taking and, maybe, a little more government 'penalty taxes' for itself as the corporate colluding partner--but, that's on top of America already paying around twice as much per capita for its health care than most organized, civilized, socialized, systems in the rest of the world.

And, as polycarp notes, corporatization plays into the rather Orwellian distortion that all coporations seem to capitalize on when colluding with government in the 'free market'. As some laws (like EMTALA) imply, universal access is there. But, now, due to the profit-taking of the corporatization of health care, not 'universal care' (it's hard to 'profit-take' a 'universally accessible product' that's actually 'universal'--while the sheeple can be misled by the distortions, when it is universally accessible and universally applied, they usually catch onto the deceptive practices of profit-taking--like the military commodes costing hundreds and hundreds of dollars, etc.). A responsibly managed universally accessible health care system that is universally applied would have someone minding the store--and that would be a single payer. But, the colluders don't want that--that's not capable of as much profit-taking (for each of them in their respective roles in 'the collusion' to 'capitalize on'). So, in typical Orwellian fashion (that we have been conditioned to see as if it were 'the real world'), it's 'there' ('guaranteed' by law by government)--but, it's 'not there' ('constrained' for profit-takiing by corporations)--and that's called our health care system's rendition of 'the free market'.....and 'care for everyone'....

And, the corporatization of health care does something else--as polycarp is describing. It's more a 'customer-driven assembly line system' than it is the more time-honored 'patient managing continuity of care'. And, polycarp's example shows the problem--NO ONE follows up on each patient. That makes a big difference in how the patient gets managed. Since health care is really the practice of medicine, a more reasonable way to practically apply it would be sequentially through each patient and their primary care provider--very much like what Canada has with its 'gatekeeper model'. When treatments are tried (and all health care systems despite whatever else they do, and whoever is doing it, 'try treatments'), and one doesn't work, a patient-managing system would have the provider go to the next sequence of options. But, that's not what a customer-driven assembly line does because, as polycarp's example shows, since no one is responsible for following up on any one person's care, they oftentimes get 'stuck in a revolving door' where the ER may 'rule out a life or limb threatening illness at that time', but, then, once that has been ruled out, they may have little option for anything else to be done that could be directed by a health care worker following their care (maybe 'trying a treatment' to see if it works--but, then, there's no one there to even follow that up). And such 'ruling out' procedures can be quite expensive. People can have recurrent chest pain and abdominal pain issues that, in most cases, are not life or limb threatening illnesses at the time--but it does take a fairly extensive--and expensive--work-up to make sure of that. And, they may get that same extensive and expensive work-up everytime they come in. But, since no one provider is following each course, they oftentimes don't get directed to the 'next step'.

Why not sue to recoup costs and pay for suffering? That was a more likely, and a more successful, option when there wasn't as much corporatization--and assembly-line managing--of medical care. It is easier to sue one physician than it is to sue several--especially since none of them are actually 'responsible for that one patient'. So, when a diagnosis is missed and several physicians (none of which are responsible for 'putting it all together') see the patient, who do the malpractice lawyers go after? In the manner in which malpractice litigation works (right in line with how most people think when they feel like something is wrong and they need to accuse someone to 'get rid of it'--as much scapegoating as it is 'resolving the problem' in many cases...), it's much easier to pin the blame upon one than it is to try to extend the blame to all--and corporations (and lawyers--and doctors, for that matter) know this very well. While, in some issues, you can successfully sue the corporation, in medicine's case, that isn't as likely. While corporate managers love to tell physicians what to do, they are too smart to take legal responsibility for what they 'impose as policy' upon them (and, if a physician knowing that 'bucks the system too much over it', the corporation just gets rid of them)--and, since no one physician is responsible for that patient, a 'group of physicians' is hard to attack with malpractice litigation--after all, each physician can be each other's own 'expert witness' against the plaintiff's one 'expert witness' (as in nature, packs offer a better defense against 'the one'). Plus, as I've said before about Texas medical malpractice, the laws have changed so much (just in time for the completion of the corporatization of health care) that it is much more difficult to bring up a medical malpractice lawsuit, anyway....

Will all this make medicine better? I sincerely doubt it. It will make it more costly. But, since corporations do control the media and the legislators, it will 'look better' in court and on paper....but, issues like polycarp describes above will keep 'falling through the cracks'.....but, what's 'one case', right--when statistics can be manipulated to show anything....? As if an Orwellian 'fact'....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm

Your input on the matter is appreciated kerry. I appreciate the view of a physician.

I'm still of the mind that Kaiser Permanente should have its corporate charter shredded and be put out of business. Their handbook clearly states each patient will have an access to a primary care physician who will remain their physician until the patient sees fit to select another. When they can't provide physicians...that isn't the case, is it?

She hasn't had a primary physician from the day her co. enrolled her in Kaiser...nearly a year ago. Most of her "physician visits" are though a several minute phone call...and seldom with the same Dr..

Kaiser Permanente sells what it can't and doesn't provide for all of its policyholders. At the least, I'd consider that fraud. Fraud that can lead to unnecessary suffering and death.

No one oversaw her worsening condition over a period of many months which should have been a clue that the diagnosis was wrong. The proper diagnosis came from an ER...not from Kaiser who couldn't/wouldn't even provide a primary care physician to see her. Next stop...a wheel chair. or worse.

Our corporate health care system has to go. Start with Kaiser and work on down. If the Federal Government can't insitute universal care, at the least the states could revoke health insurance corporate charters and put them out of business...forcing national change to a well-functioning system at moderate cost.

My own preference is the Japanese model. There are others.

Retired Monk - "Ideology is a disease"

polycarp2
Joined:
Jul. 31, 2007 4:01 pm
Quote polycarp:

I'm still of the mind that Kaiser Permanente should have its corporate charter shredded and be put out of business. Their handbook clearly states each patient will have an access to a primary care physician who will remain their physician until the patient sees fit to select another. When they can't provide physicians...that isn't the case, is it?

Well, if my rendition of the litigatability of any one case without a responsible primary care provider has any merit, then you could see that corporations don't want a single physician (that they hire as an employee--instead of, say, an independent contractor) to be responsible for you, It better confuses the malpractice issue.....

As far as them being responsible for what they say? These are corporations, after all--and they have the special attribute in business of being 'limitedly liable'--and, of course, whatever open promises they make can be 'handled' in the fine print of any policy or contract.....and, don't forget that the 'freedom of speech' includes the 'freedom to lie' (unless under oath).....as any advertising firm realizes....now, they can't blatantly lie--but, they can offer issues in a 'bait and switch' and 'look the other way' manner that is lying--but it isn't lying.....and, as they obtain less and less regulatory requirements over anything that they say, they, then, can blatantly lie....(after all, how do you put a corporation 'under oath'?).....

Quote polycarp:

No one oversaw her worsening condition over a period of many months which should have been a clue that the diagnosis was wrong. Next stop...a wheel chair. or worse.

And, that is a perfect example of what is wrong with the corporatization of medical care--and 'customer-driven assembly line medicine' instead of the 'patient-managing continuity of care' type.

But, this is just like what the Republicans said wouldn't happen as long as 'we' didn't go to 'socialized medicine'--ie. you wouldn't have the choice of your own doctor if we socialized (therefore, you should be able to keep the choice of your own doctor if we don't socialize). But, in typical Orwellian fashion, it happened anyway that 'your choice of doctor' was removed--and the Republicans aren't saying a thing.....but, then, neither are the Democrats. And, the 'solution' offered is Obamacare? Turning more money over to the colluders to continue misdistributing 'universal' care for profit-taking..... What a farce....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm

I was under the impression that at least some states and some health care plans (some of which fall under U.S. Department of Labor regulations and guidelines) have some kind of appeals or at least complaint procedure.

If a person has a complicated medical condition that is difficult to diagnosis, it may be essential that the person go to either one or possibly more specialists. As Kerry would no doubt agree, there are some conditions for which there is no known effective treatment. I recently had a low vibrating sound in one of my ears. My family doctor cleaned some wax out, and the vibrating sound went away, but sometimes, I get a less serious version of it in my other ear. I went to see an ear, nose, and throat specialist. There is an ear condition which has the word "tympani" in the name of it which is a low thumping or beating sound in the ear. He said that there is no known cause or cure for this condition, and that many people suffer from different noises they hear generated within the ear itself.

I had a bill from an anesthesiologist which I paid in full with several payments. The billing company for the doctor never credited my account for one of the payments I made. I even sent them a copy of the cancelled check provided by the bank, but they still sent me an incorrect bill. I can't go to an office to discuss this as all they provide is a phone number and a post office box. I even called the hospital where the doctor works and where I had my operation, but no one has called me back to say that the matter has been resolved. Now I can see why medical billilng fraud is another troubling component to the whole greedy picture.

A relative of mine had prostrate symptoms. The doctor had to rule out cancer. They took some kind of bone X-ray or scan and found something which they thought may have been the spreading of possible prostrate cancer to the bone. As it turned out, they found that he did not have cancer but had a long-term infection which had to go away on its own. Apparently, there isn't any antibotic that is effective for this type of infection. The spot on the bone turned out to be damage from arthritis. He was referred to both a urologist and I think a neurologist. They couldn't come up with a correct diagnosis until pondering his conditoin and ordering various tests, and at one point, he thought about making an appointment to be seen at a well-known medical school.

Lawyers in conjunction with politicians have made lawsuits so expensive and difficult to carry out that many people have no legal recourse. If customer does not receive the service one is supposed to receive under an insurance policy, you should either be able to file a complaint or sue the company.

We don't have Kaiser Permanente in my area of the country as I think they are only out west. It would have been helpful to clarify whether the doctors are employed directly by Kaiser, or if the patients see physicians in private practice who are participating members of the health plan. My understanding is that Kaiser is an HMO rather than a health insurance company. HMOs at one timewere touted as the solution to the rising health of health care, because you would have a "gatekeeper" to refer you to specialists only when needed. The doctors all work for the HMO company and are on salary, which supposedly would hold down costs, although I think it is common for them to get bonsuses if they meet a quota for the number of patients they see or if the amount of tests they order is below a certain amount.

Medicare has its problems also due to the corruption and financial mismangement of the federal government and because of the number of people who are retiring or disabled.

Robindell's picture
Robindell
Joined:
Jul. 31, 2007 4:01 pm

I thought kiaser prementie was a non profit organization. So what you are.discribing will be hoe everything is under single payer type system.

workingman's picture
workingman
Joined:
Mar. 20, 2012 8:13 am

I know 4 people who have been treated by Kaiser. One is happy. One will spend the rest of his life in a wheelchair because Kaiser blurred an x-ray and said they'd "found nothing" instead of retaking it. (there was a calcium deposit in his neck that was pinching the nerve) One is dead because of a prescription conflict. And the last is dead from a combination of infections he got from an unsterile operating room.

Kaiser is one of the primary supporters of Obamacare - they believe that they will get almost all of the uninsured in the west because their premiums are the lowest.

doh1304's picture
doh1304
Joined:
Dec. 6, 2010 10:49 am
Quote workingman:I thought kiaser prementie was a non profit organization. So what you are.discribing will be hoe everything is under single payer type system.

And their profits over the past two years were only a billion or so.They weren't disbursed to profit-seeking shareholders. Big deal.

My own preference is the Japanese system. Government takes in the low premiums and pays the medical bills to private hospitals and private doctors. Everyone is covered. It's among the least expensive health care systems in the world.

The Japanese, unlike Americans, aren't nit wits. Americans celebrate being #37. http://www.youtube.com/watch?v=yVgOl3cETb4

Retired Monk - "Ideology is a disease"

polycarp2
Joined:
Jul. 31, 2007 4:01 pm

Here in Orange County CA, there seems to be a Kaiser building on every corner. Lots of construction for the past 10 years.

DynoDon
Joined:
Jun. 29, 2012 10:24 am
Quote DynoDon:

Here in Orange County CA, there seems to be a Kaiser building on every corner. Lots of construction for the past 10 years.

That "non-profit" company isn't paying for them with M & M's.

My sister's Dr. lost his office space. The Medical Building received a cut of his billing. His patients didn't return often enough to please them.

Keep patients returning...retain the space. Keep patients well....get evicted. It's called by some the best system in the world.

Retired Monk - "Ideology is a disease"

polycarp2
Joined:
Jul. 31, 2007 4:01 pm
Quote Robindell:

If a person has a complicated medical condition that is difficult to diagnosis, it may be essential that the person go to either one or possibly more specialists. As Kerry would no doubt agree, there are some conditions for which there is no known effective treatment. I recently had a low vibrating sound in one of my ears. My family doctor cleaned some wax out, and the vibrating sound went away, but sometimes, I get a less serious version of it in my other ear. I went to see an ear, nose, and throat specialist. There is an ear condition which has the word "tympani" in the name of it which is a low thumping or beating sound in the ear. He said that there is no known cause or cure for this condition, and that many people suffer from different noises they hear generated within the ear itself.

Well, there are lots of treatments--and few cures--in medicine. That's true. And, you went to the specialist to be told there was no cure, didn't you? How did that solve your issue?

I'm not saying 'don't go to specialists'--I am saying that a specialty-centered application of medical care will be more expensive and less comprehensive than one that has one physician coordinating your condition to the care available. All physicians have a basic concept as to what is available in any field in medicine--general practitioners make it their job to know--and specialists don't get paid to coordinate it (after all, there is more money in medicine with procedures than advice). And, if no physician is coordinating your care, you are more in line with the 'customer driven assembly line medicine' than the more time honored 'patient managing continuity of care'--and I don't agree with 'customer driven assembly line medicine'--the lack of coordination tends to have people get 'stuck in a revolving door' when no one follows their treatment in line with their progress and, then, directs the intervention--today, people seem to think that 'the intervention' is 'the treatment' when, as you even point out, nothing is 'cured'.....

Quote Robindell:

I had a bill from an anesthesiologist which I paid in full with several payments. The billing company for the doctor never credited my account for one of the payments I made. I even sent them a copy of the cancelled check provided by the bank, but they still sent me an incorrect bill. I can't go to an office to discuss this as all they provide is a phone number and a post office box. I even called the hospital where the doctor works and where I had my operation, but no one has called me back to say that the matter has been resolved. Now I can see why medical billilng fraud is another troubling component to the whole greedy picture.

And, you had no one to turn to, didn't you? Did you even know that anesthesiologist? Did you ever see that anethesiologist again? And, it's hard to blame anyone when you can't finger out someone, isn't it? And, that's how corporations like it....and lawyers know that works, also....

Quote Robindell:

A relative of mine had prostrate symptoms. The doctor had to rule out cancer. They took some kind of bone X-ray or scan and found something which they thought may have been the spreading of possible prostrate cancer to the bone. As it turned out, they found that he did not have cancer but had a long-term infection which had to go away on its own. Apparently, there isn't any antibotic that is effective for this type of infection. The spot on the bone turned out to be damage from arthritis. He was referred to both a urologist and I think a neurologist. They couldn't come up with a correct diagnosis until pondering his conditoin and ordering various tests, and at one point, he thought about making an appointment to be seen at a well-known medical school.

Well, if it were a bone infection, those are, indeed, hard to treat with antibiotics--but, that is because bone has such poor circulation in some regions of it that any antibiotic given would have to be in higher doses than what is usually tolerated orally (although Cipro holds a claim that it can treat bone infections orally--but, that, of course, is only to susceptible organisms)--and IV drug treatment over weeks and weeks is quite expensive (by the way, that's the same problem with trying to treat bone metastasis with chemotherapy--IV or oral). Arthritis is a different issue. And, no matter how many experts your relative goes to, there is no cure for that. Someone may be able to get you a more effective treatment--but, I think that is better managed by someone that knows what treatment you have tried.....and what specialists you have already seen.....

Quote Robindell:

Lawyers in conjunction with politicians have made lawsuits so expensive and difficult to carry out that many people have no legal recourse. If customer does not receive the service one is supposed to receive under an insurance policy, you should either be able to file a complaint or sue the company.

Particular mainly to medical malpractice--and primarily only to private solo practitioners--lawsuits were quite common not too long ago--and those lawsuits didn't sue companies, they sued individual practitioners. In fact, as I am trying to point out, those lawsuits were best suited to sue individual practitioners. 'Groups of doctors' are hard to 'finger out the blame' to--and each one in that group can serve as an expert witness for the other (lawyers can point that out in court--but, that doesn't matter--it matters who the jury believes as the expert witness--and most juries believe more doctors than just one 'expert witness' that, say, the plaintiff might bring in--they could bring in more expert witnesses but expert witnesses cost a lot of money and, at some point, that will be taking away the plaintiff's lawyer's cut in bringing out the lawsuit). In the same manner--and especially with the corporate limited liability advantage (that solo private practitioners don't have)--while successful company lawsuits actually may make the plaintiff more money, it actually never gets down to making any one in that company personally responsible for its mishaps or misjudgments (in other words, thanks to the corporate limited liability advantage, no one in the corporation ever has their own personal property or wealth at stake--that's always the case in principle in suing a solo private practitioner for medical malpractice--which is the reason most of them had medical malpractice insurance--that and the fact that most hospitals that they may associate with required it from them).

Quote Robindell:

We don't have Kaiser Permanente in my area of the country as I think they are only out west. It would have been helpful to clarify whether the doctors are employed directly by Kaiser, or if the patients see physicians in private practice who are participating members of the health plan. My understanding is that Kaiser is an HMO rather than a health insurance company. HMOs at one timewere touted as the solution to the rising health of health care, because you would have a "gatekeeper" to refer you to specialists only when needed. The doctors all work for the HMO company and are on salary, which supposedly would hold down costs, although I think it is common for them to get bonsuses if they meet a quota for the number of patients they see or if the amount of tests they order is below a certain amount.

Not all doctors that work for a salary are bad doctors--or, at least, when they are in a setting where they determine the method of treatment instead of the money-managers, they have a better chance of not being so bad. I was trained in a facility (Scott and White) that operates just like the Mayo Clinic who had all their staff on salaries. Then, all those doctors could do what they were trained to--take care of the patient--without so much worry over how to bill it out and how to cover the costs--and they were quite good at what they did (and very efficient in the management since the care was coordinated by a general practitioner). But, that was then (over 30 years ago)--and this is now. Now, as I've said, the money-managers through the corporations are more involved in directing medical care through policy-applications affecting every one else's position in medicine--and every one else's method of judging (and applying) any particular person's care.....it's a totally different ball of wax now....

Also, as I've pointed out, many states have changed their medical malpractices litigation laws in a manner that makes it more difficult to bring them up in court. Texas' laws have changed so much that lawyers don't even advertize for medical malpractice lawsuits, anymore--just in time for the corporatization of medical care....now claiming 'they do better care because there are less lawsuits filed'--without once explaining how that 'change' actually came about--similar to how the Reagan admnistration changed how unemployment was counted--and, then, using the 'new statistics' to show how much 'less' unemployment the trickle downers had....

Quote Robindell:

Medicare has its problems also due to the corruption and financial mismangement of the federal government and because of the number of people who are retiring or disabled.

I don't see that as the only problem with Medicare. Like private insurance companies (who, oftentimes, follow the exact same protocols as Medicare in what is, and how it's, paid), many are paying solo private practitioners less (what few are left doing solo private practice) as they gear up to pay corporate entities more. I don't think that this is by accident. I think it's more in line with the corporatization of medical care--and just in time for Obamacare.....

At any rate, I see a distinction between 'customer driven assembly line medicine' and 'patient managing continuity of care'--and I still think that we are driving medicine over the cliff by having it as 'customer driven assembly lined'....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm
Quote polycarp:

Keep patients returning...retain the space. Keep patients well....get evicted. It's called by some the best system in the world.

I think there's a lot of truth to that, polycarp. 'Assembly line medicine' loves 'the revolving door'--and, remember, medicine has many treatments--and few cures.....

Kerry's picture
Kerry
Joined:
Jul. 31, 2007 4:01 pm

The Affordable Care Act affords some measure of health insurance regulation. Will this regulation be sufficient to correct the poor service from an insurer that brought about the original post of polycarp2? Probably not, but perhaps, by some miracle, the regulatory process will be strengthened as time progresses.

My relative who I mentioned above did not have a bone infection. He was treated by a urologist and is recovering from what I understanding, but slowly. At one point, he thought that the medicine he was prescribed was making him worse and so he stopped taking it, at least for a while, I don't know enough about his conditon to know if this was actually the case.

Yes, both Medicare and Medicaid don't pay enough to doctors so that many from what I have read have stopped taking Medicaid, and some probably don't take Medicare patients.

In Japan, there is a list of what the government insurance program will pay doctors for specfic medical procedures. In Germany, there have been some complaints from some doctors about inadequate income from reimbursements, but the health insurance system there is working. Switzerland and Germany have non-profit health insurance plans and companies. Non-profit organizations in the U.S. are often no different from commercial companies from the standpoint of the paying customer.

Robindell's picture
Robindell
Joined:
Jul. 31, 2007 4:01 pm

Oh, by the way, all Kaiser plans have a mandatory arbitration clause. You cannot sue them.

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doh1304
Joined:
Dec. 6, 2010 10:49 am

I will tell you three ways that ACA has effected health care for me.

- I have a health saving account. In the past my HSA could be used to buy whatever medical items I needed with my pre-tax money. I could use it to buy asprin, pepto, bandaids, as well as use it for co-pays and other authorized medical expenses. Now with the ACA, I cannot use my HSA to buy any over the counter meds without a prescription! How does that save costs? Why attack the HSA?

- My insurance costs have gone up about 30% and Dr visit copays also went up. I have not confirmed but one of the nurses said that because of caps on insurance reimbursement of the ACA they have to charge the patient more to offset the costs and additional paperwork.

- My doctor of 10 years is leaving public practice and standing up a private health practice because he cannot afford to lose money on Medicaire/Medicaid. As a result my insurance doesnt cover private health practices so if I want to keep my doctor I have to pay out of pocket.

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